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					Workshop 1

Title:                 Using Code-A-Text to Analyse Psychotherapy Texts

Authors:               Alan Cartwright

Address for Correspondence:

                       Dr Alan Cartwright
                       Senior Lecturer in Psychotherapy, Kent Institute of Medicine and Health
                       Sciences
                       University of Kent, Canterbury, Kent CT2 7PD UK.
                       Telephone 01227 823691 Fax 01227 823224
                       Email A.K.Cartwright@ukc.ac.uk

                                           ABSTRACT

     Code-A-Text was developed to help investigators analyse psychotherapy discourses,
whether for training or research. It can be applied to any form of document i.e. transcriptions,
process notes sound or video recordings. Its real power becomes apparent when working with
sound and transcriptions together. The workshop will cover the new Code-A-Text interface
which offers the investigator four methods of coding texts [based upon content analysis
(including standardised dictionaries), scales, interpretative methods and vocal analyse (volume,
pitch and speech rate)].

      The system was designed to be interactive, allowing the user the opportunity to ask
―questions‖ of a text or group of texts and receive quick responses from the programme which
are immediately intelligible. Thus, the investigator might request that ―the programme identify
all the sections within a group of texts in which the patient rejected the therapeutic alliance (a
scale code) and the therapist responded within a give number of interventions (segment code)
with an interpretation (scale code) making sexual references (content code based on words in
text)‖. The programme would display all the sections of the texts which fitted this criteria and
play the relevant recordings if available. At the other extreme a sound file might be searched for
all sections where there is a rapid change in vocal quality e.g. volume increases and pitch profiles
change. Other outputs are more analytical displaying associations between codes and presenting
graphical displays of sequences of codes.

    This workshop will introduce the participants to Code-A-Text taking them step by step
through the process of developing and analysing a project. The stages covered will be

· Recording, transcribing and linking text and sound.
· Creating archives for content analysis and using standardised dictionaries
· Creating a Coding Frame for scales analysis. Using assimilation as a method.
· Segmenting, annotating and coding text.
· Automatic creation of complex codes.
· Identifying relationships and displaying graphs and outputting data to statistical programmes.
Workshop 2



                                                1
   Title:                  How to Find FRAMES

Participants:           Hartvig Dahl, Mark Sammons and Paul Siegel

Address for Correspondence:

                Hartvig Dahl
                SLrNY Health Science Center
                450 Clarkson Avenue/Bx 88
                Brooklyn, NY 11203
                USA
                                         ABSTRACT

Hoelzer & Dahl (1996) wrote:
  A psychotherapeutic "talking cure" relies essentially on a patient's storytelling. Thus, the
     principle of free association as the "basic rule" of psychoanalysis is to sample stories that are
     characteristic or typical of a person's emotional experiences. FRAMES as defined and
     described by Dahl and Teller (1994) are Fundamental Repetitive And Maladaptive Emotion
     Structures that capture the plots of these stories. These plots reoccur again and again with
     different people in different situations under different circumstances. And it is the repetition of
     these plots in and out of the therapeutic situation that makes possible inferences about what
     clinicians call a patient's basic psychodynamics. Their maladaptive character lies mainly in
     their invariance. Their tendency to recur over and over makes for a typically inflexible,
     neurotic patient.

   We claim that FRAMES fulfill Strupp et al's (1988) principle of using PTO
   (Problem-Treatment-Outcome) congruent measures in psychotherapy research and demonstrate
   its importance. Our goal is to introduce participants to the three crucial steps in finding
   FRAMES in the transcripts of psychoanalytic and psychodynamic therapeutic sessions: (1)
   Classify the expressions of emotions, (2) make Object Maps, and (3) find Prototype FRAMES
   and their Instantiations (repetitions) in each selected session. Participants should E-mail their
   names and addresses to dahl@hscbklyn.edu so that Dahl can mail them: (1) summaries of the
   underlying theory of emotions, (2) an example of a transcript of a psychoanalytic session with
   the emotions all classified according to the theory, (3) the Hoelzer & Dahl paper on How to Find
   FRAMES, which includes a description of how to make Object Maps, and (4) a reprint of the
   story of the discovery of FRAMES (Dahl 1998). Reading these before the Workshop will make
   it much easier for participants to profit from this beginning instruction. Each participant will be
   given a transcript of a session and again instructed on how to classify the emotions. The graduate
   students, Mark Sammons and Paul Siegel, both expert FRAMES finders, will assist in
   monitoring these classifications, answer questions, and offer other help. They will also help
   oversee the map construction and supervise the finding of sample FRAMES. Participants will
   be expected to ask questions--and perhaps most importantly--will be offered the chance to
   communicate with Dahl in the future for ongoing help by E-mail.




                                                    2
Workshop 3

Title:                  Research on Child Group Psychotherapy: What Do We Know And What
                        Do We Need to Learn?

Author:                 Zipora Shechtman

Address for Correspondence:

                        Zipora Shechtman
                        Faculty of Education
                        The University of Haifa
                        Haifa, Israel

                                           ABSTRACT

     The purpose of this workshop is to highlight the importance of research in child group
counseling and psychotherapy. Research on child group psychotherapy lags largely behind adult
group psychotherapy. As a result our knowledge on children‘s groups is either applied from
research on adult groups or drawn from clinical experience. The limited research available is
mostly outcome research. Yet, many process questions are still open for inquiry regarding the
therapeutic factors, leader‘s role, difficult patients and situation, among others. These issues bear
important implications for training and supervision of therapists in children groups. Pioneering
research in child group processes will be illustrated and goals for future investigation discussed.




                                                  3
Panel Session 1 - Overall Summary

Title:                 Group Therapy Research: State-of-the-Field Review

Participants:          Mark Aveline, Gary Burlingame, Bernhard Strauss, Denise Wilfley

Moderator:             Roy MacKenzie

Address for Correspondence:

                       Roy MacKenzie
                       201 - 1600 Howe Street
                       Vancouver, BC V6Z 2L9
                       Canada
                       Fax: (604) 669-7783
                       E-mail: rmack@interchg.ubc.ca

                                          ABSTRACT

     The state of the field of group therapy research will be considered. During the first hour,
panelists will address key questions posed by the moderator. During the final half hour,
members of the audience will be invited to respond with questions and comments. The format is
intended to stimulate an examination of issues related to the past performance, current status, and
future direction of group therapy research.




                                                4
Panel Session 2 - Overall Summary

Title:                  An Examination of Therapist Use of Silence

Participants:           Barbara J. Thompson, Clara E. Hill, Nicholas Ladany, Karen O'Brien

Moderator:              Nicholas Ladany

Discussant:             Horst Kaechele

Address for Correspondence:

                        Nicholas Ladany, Ph.D.
                        111 Research Dr.
                        Counseling Psychology Program
                        Lehigh University
                        Bethlehem, Pennsylvania, 18015, USA
                        Phone: 610-758-3253
                        Fax: 610-758-3227
                        Email: nil3@lehigh.edu

                                            ABSTRACT

       The purpose of this panel session is to present an overview of a qualitative study that
examined therapist intentional use of silence. The first presentation will report on the theoretical
and empirical literature on therapist use of silence and our resulting research questions. The
presenter will also include an overview of the qualitative methodology we employed, that is,
consensual qualitative research (Hill, Thompson, & Williams, 1997). She will demonstrate how
interpretations of the data were made across cases, and how the methodology controls for
researcher bias, as well as accounts for the validity and reliability of the data.
    The second presentation will report on the results of the thematic qualitative analysis as it
pertains to therapist reasons and contraindications for using silence in therapy. The reasons
identified in our analyses for using silence included (a) to convey empathy or respect, (b) to
encourage or challenge client's to reflect on their experiences, (c) to assess how clients react to
silence, (d) to slow the pace of therapy, (e) for clients to take responsibility for therapy, (f) to
create productive anxiety, (g) because the therapist doesn't know what to say, and (h) because the
therapist was preoccupied. We will also review a number of indications for, and
contraindications against, using silence in therapy that were identified relating to client variables,
session variables, and the therapeutic alliance.
    The third presentation will report on the results of the thematic qualitative analysis as it
pertains to personal and training variables influencing therapist use of silence. Specifically, this
presentation will address therapists' personal variables such as the way silence was used in their
family of origin, the use of silence in their current relationships, therapist personality, and
therapist's own therapy experiences. Furthermore, therapist training related to using silence and
their changes in their use of silence with experience will be discussed.
    A discussant who has expertise in the fields of qualitative research and psychotherapy
research will respond to the aforementioned presentations.

                                                 5
Paper in Panel - Panel Session 2

Title:             Applying Consensual Qualitative Research to Understanding Therapist Use of
                      Silence

Author:                Barbara J. Thompson

Address for Correspondence:

                       Barbara J. Thompson, Ph.D.
                       609 Allegheny Ave.
                       Towson, Maryland 21204, USA
                       Phone: 410-296-8680
                       Fax: 410-296-8681
                       Email: drbarb@home.com

                                           ABSTRACT

        Although addressed somewhat in the theoretical psychotherapy literature (e.g., Basch,
1980; Greenson, 1967), therapist use of silence has been examined empirically in a limited
fashion (Hill et al., 1988). Alternatively, silence as a therapeutic intervention is likely used by
most psychotherapists. In order to understand the multiple factors associated with therapist use of
silence, an in-depth qualitative investigation seemed relevant. Qualitative research seemed
ideally suited for many of the questions that we had about therapist use of silence for several
reasons: (a) it allowed us to examine the inner experiences of participants, (b) it allowed us to
looks at sequences of events that are not orderly and predictable, and (c) it allowed us to explore
domains about which we do not have enough information to make hypotheses. Based on a review
of the literature, we created a series of research questions aimed at exploring and understanding
the multiple factors related to therapist use of silence (e.g., the reasons therapists use silence).
This paper will report on the theoretical and empirical literature on therapist use of silence
resulting in the research questions.

       This presentation will also describe the specific qualitative methodology used to study
therapist use of silence, that is, consensual qualitative research (Hill, Thompson, & Williams,
1997). The discussion pertaining to consensual qualitative research will describe how we used
consensual qualitative research to examine therapist use of silence of 12 experienced therapists.
Essentially, following the methodology guidelines, we collected all the data using a standard
semi-structured interview, coded data initially into rationally-derived domains (i.e., categories)
which were modified based on the emerging data, used a primary team of three judges and a
method of consensus to arrive at all decisions about domains and core ideas, used an auditor to
check the work of the primary team, and compared data across cases to determine consistency of
findings within the sample. Additional details and examples pertaining to the methodology will
be discussed along with how the modifications provided standard data across cases, reduced the
amount of bias, and increased the validity and reliability of the data.




                                                6
Paper in Panel - Panel Session 2

Title:                  Silence in Therapy: Reasons and Contraindications

Author:                 Clara E. Hill

Address for Correspondence:

                        Clara E. Hill, Ph.D.
                        Department of Psychology
                        University of Maryland
                        College Park, Maryland 20742, USA
                        Phone: 301-405-5791
                        Fax: 410-314-9202
                        Email: hill@bss3.umd.edu

                                              ABSTRACT
    The purpose of this presentation is to review the themes relevant to therapist reasons and
contraindications for using silence along with examples from the data. The participants in this
study were 12 experienced therapists practising in the eastern region of the United States. Based
on the qualitative analysis, a variety of reasons for therapist use of silence emerged. The reasons
identified for using silence included (a) to convey empathy or respect, (b) to encourage or
challenge client's to reflect on their experiences, (c) to assess how clients react to silence, (d) to
slow the pace of therapy, (e) for clients to take responsibility for therapy, (f) to create productive
anxiety, (g) because the therapist doesn't know what to say, and (h) because the therapist was
preoccupied. We found a number of indications and contraindications for different clients,
session variables, and the therapeutic alliance. For example, an indication for using silence was
with "a client who presents with a need for direction" and a contraindication against using silence
was with "a client who has extremely high levels of anxiety." Regarding session variables, an
indication for using silence is "in the first sessions of long term psychotherapy" and a
contraindication against the use of silence was "in brief psychotherapy." Pertaining to the
therapeutic alliance, an indication for using silence was when "the therapeutic alliance was
strong" and a contraindication against using silence was when "the therapeutic relationship was
just forming." Additional examples from the data, and their relative frequency within each of the
themes will be presented. Findings will be discussed in light of the limitations to research design
and implications of the findings for psychotherapy theory, research, and practice will be
addressed.




                                                 7
Paper in Panel - Panel Session 2

Title:                  Silence in Therapy: Therapist Personal and Training Variables

Authors:                Nicholas Ladany & Karen O'Brien

Address for Correspondence:

                        Nicholas Ladany, Ph.D.
                        111 Research Dr.
                        Counseling Psychology Program
                        Lehigh University
                        Bethlehem, Pennsylvania, 18015, USA
                        Phone: 610-758-3253
                        Fax: 610-758-3227
                        Email: nil3@lehigh.edu

                                            ABSTRACT
    Following the identification and discussion of reasons and contraindications for therapist use
of silence, this presentation will examine factors influencing therapist use of silence related to
their personal and professional development. Although there is some literature indicating when
and why therapists use silence, there is virtually no theoretical or empirical literature examining
personal and professional development factors that influence therapists' use of silence. To this
end, the purpose of this presentation is to report on the results relevant to personal and
professional development factors that influence therapist use of silence.

    Results from the qualitative analyses indicated that aspects of therapist personal development
was related to their use of silence. Factors across participants that emerged from the data
included the therapist personality (e.g., therapist is introverted), the use of silence in family of
origin (e.g., was used as a weapon), the use of silence in current relationships (e.g., friends find it
uncomfortable), and the use of silence in the therapist's own therapy (e.g., I model my use of
silence based on how my own therapist used it). In terms of professional development, therapists
identified training experiences in using silence (e.g., trained to be analytic and not answer clients
questions) and therapists identified changes in their use of silence with experience (e.g., uses
silence more frequently now than earlier in career because she is more comfortable with her own
abilities). Additional examples from the data, and their relative frequency within each of the
factors will be presented. The empirical findings will be discussed in light of the limitations to
research design. Implications of these results for psychotherapy training will be also addressed.




                                                  8
Panel Session 3 - Overall Summary

Title:                    From Individual Stories to Relational Themes: Tracking Narrative
                          Change in Individual and Group Therapy Sessions

Participants:             Lynne Angus, Yifaht Korman, Jacqueline Brunshaw, Jukka Vapaavuori

Moderator:                Lynne Angus

Discussant:               Oscar Gonçalves

Address for Correspondence:

                           Lynne Angus, Ph.D.
                           Department of Psychology
                           York University
                           4700 Keele Street, Toronto
                           Ontario, Canada M3J 1P3
                           E-mail: langus@yorku.ca

                                               ABSTRACT

         The construal of the psychotherapy session as a unique form of narrative expression holds special
promise for therapy practitioners and researchers alike. The Narrative Processes model and Coding
System (Angus, Levitt & Hardtke, 1996) are focused on the strategies and processes by which a client and
therapist - irrespective of therapeutic approach - transform the events of everyday life into a meaningful
story that both organizes and represents the client's sense of self and others in the world. All three papers
in this panel will demonstrate how the Topic Identification procedures of the Narrative Processes Coding
System (NPCS) can be utilized to generate macronarrative relational themes in order to track change at
the level of individual stories (micronarratives) and across session relational themes (macronarrative).

        In the first paper,Yifaht Korman will present findings from an intensive structural
analysis of micronarratives - identified in NPCS derived self and relational themes - drawn from one
good-outcome, brief client-centred psychotherapy dyad (York I Depression Study). In particular the
degree to which stories told in therapy sessions conform to canonical story structures or schemas and/or
change in structure over time will be assessed and the findings presented.

         In the second paper, Jacqueline Brunshaw will describe a theme identification procedure in which
a) topic shifts in therapy sessions are identified using the NPCS and then b) a qualitative research strategy
is employed to inductively derive core categories relating to client issues represented in topic segments.
Comparing six poor and six good outcome brief experiential psychotherapies drawn from the York I
Depression Study, the pattern of relational focus and core theme change over sessions will be addressed
and implications for therapy practice will be discussed.

        And finally, Jukka Vapaavouri will present findings from an intensive analysis of relational
themes - integrating NPCS strategies for topic segment and relational theme identification with Grounded
Theory analysis strategies - in the analysis of work-related group consultation sessions. The
development of process maps using this procedure and the utility of this approach for identifying change
episodes in sessions will be discussed.
Paper in Panel - Panel Session 3



                                                     9
Title:                 Story Structure and Narrative Coherence in Brief Client-Centered
                       Psychotherapy

Authors:               Yifaht Korman & Lynne Angus

Address for Correspondence:

                        Department of Psychology
                        York University
                        4700 Keele Street, Toronto
                        Ontario, Canada M3J 1P3
                        E-mail: ykorman@yorku.ca

                                          ABSTRACT

         The present study investigated coherence in the micro narratives (individual stories) told
in one good-outcome client-centered dyad. Since narrative structure is believed to contribute to
narrative coherence (Mandler, 1984), the present investigation focussed on the structures of
micro narratives in psychotherapy. Intensive study by story grammar theorists (such as
Mandler, 1984) on the structure of written narratives such as myths, children stories and folktales
revealed that these stories have the same underlying structure despite gross differences in the
stories' contents. Moreover, researchers who have examined the structure of oral interactions
(such as interviews) obtained similar findings (Labov & Waletzky, 1967). Based on these
findings, researchers have argued that people have a story schema, a heuristic way of storing,
retrieving and processing information. Further, stories which manifest the story schema
structures are perceived as more coherent than stories where one of the story schema constituents
is missing.

        The present investigation explored the structure of micro narratives told in sequential
psychotherapy sessions and compared them to the canonical story structures proposed by the
above story schema researchers. The study also examined the frequency of story schema
constituents across the therapy dyad. The results of the study indicated that the majority of
micro narratives told in psychotherapy did not exhibit the canonical story schema structure
proposed by the above theorists. Nonetheless, as therapy progressed, the micro narratives did
become more 'complete' and showed more story schema constituents compared to the micro
narratives told in earlier sessions.




                                               10
Paper in Panel - Panel Session 3

Title:                 Examining Self Change in Brief-Experiential Psychotherapy: A
                       Relational Theme Analysis Using the Narrative Process Coding System

Authors:               Jacqueline Brunshaw, Lynne Angus & Les Greenberg

Address for Correspondence:

                       Jacqueline M. Brunshaw
                       Department of Psychology
                       York University
                       4700 Keele Street, Toronto
                       Ontario, Canada M3J 1P3
                       Fax: 416/736-5814 / E-mail: jbrunsh@yorku.ca

                                          ABSTRACT

         This study developed a method of content theme analysis to examine the narrative
process by which clients re-structure and re-transform the meaning of their self-theory over the
course of therapy. Content theme analysis is gaining attention in the process research field as
clinicians increasingly recognize that people give meaning to their lives through their "identity
stories". These stories are composed of numerous "micro"-narratives or discrete life events
that are thematically woven together by the therapist and client over the therapeutic discourse to
form a comprehensive whole or "macro"-narrative. Contained within the client's
macro-narrative is an inherent set of beliefs, attitudes, and values that have evolved out of past
personal and relational experiences. The macro-narrative therefore serves to not only guide the
client's thought processes and behaviours, but also provides a means by which new information is
processed and assimilated into the client's pre-existing self-schema. In essence, the
macro-narrative becomes the framework of the client's theory about themselves, or their
"self-theory". Further analysis of these themes can then examine different characteristics of the
pattern of change in the themes that clients engage in towards re-structuring and acquiring new
meaning of their self-theory.

        In this study, the Narrative Process Coding System was found to be a reliable method by
which to extract and derive self and relational themes from sequential therapy sessions. The
sample consisted of complete session transcripts from 12 clients who presented with major
depression. Half were treated with client-centered therapy, half with Process-Experiential.
Half were rated as successful outcome, the other half as unsuccessful. Differences and
similarities in the pattern of content theme change between the two outcomes and two therapeutic
modalities will be discussed, as well as clinical implications of this type of process research.




                                              11
Paper in Panel - Panel Session 3

Title:                 Conflict Between Two Persons in a Staff Group: How the Narrative
                       Themes of the Joined Conversations Changed During a Consultative
                       Group Intervention

Authors:               Jukka Vapaavuori

Address for Correspondence:

                       Department of Psychology
                       University of Joensuu
                       Psychiatric Clinic, University of Kuopia
                       Jokirannantie 28, FIN-77600
                       Suonenjoki, Finland

                                           ABSTRACT

        The aim of this qualitative case study was to find out, how construals of a social services
staff group, suffering from a persistent conflict between two members, change during a seven
months' successful group intervention. The consultant, using a therapy-like dynamic approach,
met the group in five joint sessions. Two follow-up interviews were arranged, in which it was
established that the group members had experienced significant relief in relation to feeling stuck
as a group. The present study undertakes multiple methods of analysing the consultation
sessions including a qualitative analysis of the group discussion transcripts. The aim is to find
out and describe the essential changes in the flow of the group discussion themes. The
forthcoming presentation aims to illuminate the application of The Narrative Processes Coding
System (NPCS) and a Grounded Theory procedure, serving as the first phase of the narrative
analysis of the conflict themes throughout the intervention process. The special features of
using theses methods in a group context are going to be discussed. The results of the first phase
of analysis will be presented as 'process maps' describing the ongoing flow and changes in the
session conversations. The value and usefulness of these maps as the base for further fine
grained narrative analysis will also be discussed.




                                               12
Panel Session 4 - Overall Summary

Title:                  Therapeutic Change as a Developmental Process

Participants:           Eva Bänninger-Huber, Verena Müller, Christine Widmer, Barbara
                        Dahinden

Moderator:              Eva Bänninger-Huber

Discussant:             Barbara Juen

Address for Correspondence:

                         Eva Bänninger-Huber
                         Department of Psychology, University of Innsbruck
                         Innrain 52
                         A-6020 Innsbruck, Austria
                         e-mail: eva.baenninger-huber@uibk.ac.at

                                            ABSTRACT

        Positive change of affective disturbances can only occur in interpersonal relationships. If
the internalization of affective regulation during childhood fails, a client will delegate parts of his
or her affective self-regulation to other individuals even during his or her later life. In such cases,
a specific form of psychotherapeutic interaction is required to allow positive change. It is the task
of the therapist not to fully take over the client´s affective regulation. This means that the
conflictive tension has to be maintained in a way that the working alliance remains secure
without relieving the client from his affective conflicts precipitately. Such delegations of a
client´s self-regulation can be observed as specific role-offers to the therapist. We conceptualize
these role-offers as traps and prototypical affective microsequences (PAMS).

        The studies presented in this panel pursue a microanalytic approach, investigating the
verbal and nonverbal aspects (mainly facial expression) of therapist-client interactions. Christine
Widmer analyzes several productive sequences of videotaped therapy sessions with a depressive
client and shows how therapeutic interaction has to be structured in order to allow positive
change. In the contribution of Verena Müller & Barbara Dahinden, the role of PAMS for the
establishment of the therapeutic working alliance will be shown by analyzing a series of
diagnostic interviews with an anorectic client. In addition to this, the significance of PAMs for
positive change will demonstrated by comparing a productive and a non-productive therapy
session with a neurotic client. In the last contribution, Eva Bänninger-Huber will present various
types of traps in different therapeutic settings which occur in the context of clients´guilt feelings.
Finally, Barbara Juen will discuss the studies presented from a developmental psychologist‘s
point of view.




Paper in Panel - Panel Session 4

Title:                  Interactive Processes, Emotion Regulation and Psychotherapeutic Change

                                                 13
Authors:               Eva Bänninger-Huber and Christine Widmer

Address for Correspondence:

                       Eva Bänninger-Huber
                       Department of Psychology, University of Innsbruck
                       Innrain 52
                       A-6020 Innsbruck, Austria
                       e-mail: eva.baenninger-huber@uibk.ac.at

                                           ABSTRACT

        According to clinical models, psychotherapeutic relationships are characterized by
repetitive interactive relationship patterns which should change in the course of a successful
psychotherapy. These interactive relationship patterns are understood as the observable
components of the affective relationship regulation and are typical for the two partners involved.
So far, such interactive role offers enacted by the client with the therapist have been
conceptualized as traps. In several single case studies traps in the context of guilt feelings and
shame have been identified and investigated with a microanalytic approach. Successful and
unsuccessful traps were differentiated with regard to their verbal and nonverbal elements
(especially facial expression) and their significance for psychotherapeutic change was analyzed.

        This contribution concentrates on our recent attempt to test the validity of our concepts
and results by the investigation of a larger sample. Particularly, we were interested in the
following questions: Can traps regularly be identified in the interaction of different therapeutic
dyads? Are they exclusively found in the context of the clients guilt feelings or do they also
occur as a means of affective regulation of other emotions? Are traps enacted in psychoanalytic
therapies only? And finally: Does the investigation of a larger number of therapies confirm our
findings on the significance of successful and unsuccessful traps for therapeutic change?




                                               14
Paper in Panel - Panel Session 4

Title:                 Interactive Relationship Patterns and Psychotherapeutic Change

Authors:               Christine Widmer and Eva Bänninger-Huber

Address for Correspondence:

                        Christine Widmer
                        Psychological Institute, University of Zurich
                        Zürichbergstr. 43
                        CH-8044 Zurich, Switzerland

                                           ABSTRACT

        According to the theory of psychoanalytic treatment, it is the task of the therapist to
maintain a balance between two requirements: On the one side, he or she has to provide a reliable
working alliance to give the client a basic sense of security. On the other side, the maintenance of
a certain level of conflictive tension is a prerequisite for recognizing and working on the client‘s
problems and conflictive topics.

        In the course of our research, we have identified and described two types of repetitively
occurring interactive relationship patterns, which are of importance for the above mentioned
balance: Prototypical affective microsequences (PAMS) are fundamental for the sustenance of a
reliable working alliance. They are mainly expressed nonverbally and are characterized by
frequent smiling and laughing of both, client and therapist. So-called traps are interactively
enacted role offers which can reduce conflictive tension by provoking a specific reaction of the
therapist (e.g. a verbal confirmation or a legitimizing comment).

        The observation of these interactive patterns and therapists‘ reactions to them allow an
empirical evaluation of therapists‘ professional behavior and of its effect on therapeutic change.
The investigation of several productive sequences of videotaped therapy sessions with specific
microanalytic methods shows the following results: While the therapist usually stays „abstinent―
to the role offers made in traps, her reactions to PAMS show a broader variety. Thereby,
conflictive tension remains on a relatively high level, while the therapist‘s occasionally
responding reactions to PAMS contribute to a trustworthy and relatively relaxed working
alliance.




                                               15
Paper in Panel - Panel Session 4

Title:                 Prototypical Affective Microsequences (PAMS), Working Alliance and
                       Productive Therapeutic Work

Authors:               Verena Müller and Barbara Dahinden

Address for Correspondence:

                       Verena Müller
                       Addiction Research Institute
                       Konradstr. 32
                       CH-8005 Zurich, Switzerland
                       e-mail: isfvemu@isf.unizh.ch

                                          ABSTRACT

        PAMS are short sequences of affective relationship regulation and serve the function to
balance out perturbations in a client‘s affective regulation. They last some seconds. PAMS are
mainly expressed nonverbally and are characterized by frequent smiling and laughing of both,
client and therapist (Bänninger-Huber, 1992, 1996). PAMS can be observed in the context of
several negative emotions. According to the reaction of the therapists, successful and
unsuccessful PAMs as well as so-called participation PAMS may be differentiated
(Bänninger-Huber & Widmer, 1997).

        The aim of our research is to gain a better understanding of the functions such PAMS
serve in the establishment and maintenance of the therapeutic working alliance and of their
significance for productive therapeutic work. For this purpose, a series of five diagnostic
interviews with an anorectic client was investigated, applying Bänninger-Huber´s microanalytic
approach. In addition, a psychoanalytic therapy with a neurotic patient has been studied,
comparing a productive with a non-productive therapy session. Our hitherto existing analyses
show that all three types of PAMS occur in both therapeutic dyads. In our contribution, „typical―
examples of the three types of PAMS will be presented and their function in the affective
regulation of each therapeutic dyad will be described. Furthermore, the significance of the
different types of PAMS for the establishment and maintenance of the therapeutic working
alliance and for productive therapeutic work will be discussed.




                                              16
Panel Session 5 - Overall Summary

Title:                  Comparing Change Processes in CBT, IPT, and Dynamic Therapy

Authors:                Sarah Chisholm-Stockard, Kristin L. Schneider, Gregory G. Kolden

Moderator:              Gregory G. Kolden

Address for Correspondence:

                        Gregory G. Kolden, Ph.D.
                        Department of Psychiatry
                        University of Wisconsin
                        6001 Research Park Blvd.
                        Madison, WI 53719 USA
                        ggkolden@facstaff.wisc.edu

                                           ABSTRACT

        Change process research involves the study of the condition of patients (outcomes) in
relation to parameters of the treatment delivered (processes). That is, change process research
pertains to how therapy works, rather than whether it works. Change process research has
important implications for the evolution of clinical theory, effective practice,
training/supervision, and efficient service delivery. The generic model of psychotherapy is
presented as a transtheoretical model of universal session-level change processes.
        In this panel we will examine the importance of universal and specific change processes
in three theoretically distinct approaches to psychotherapy: cognitive behavioral therapy (CBT),
interpersonal therapy (IPT), and dynamic therapy (DT). Session-level change processes are
examined via statistical modeling techniques in two naturalistic studies of psychotherapy
delivered in outpatient settings offering clinical training. Our findings highlight the consistency
of early session-level universal change processes across the three approaches to therapy as well
as theoretically meaningful differences among the treatment modalities. Discussion outlines a
transtheoretical model of change in early sessions of psychotherapy and underscores the
usefulness of the generic model for change process research.
        The participants in this panel will present recent work examining universal and specific
change processes in CBT, IPT, and DT. Dr. Chisholm-Stockard will present work examining
universal and specific change processes in IPT as well as discuss the application of statistical
modeling techniques to change process research. Ms. Schneider will present work examining
universal and specific change processes in CBT. Dr. Kolden will present work examining
universal and specific change processes in DT. He will also summarize the similarities and
differences across the three types of therapy and will discuss the implications of these findings
for understanding the common and unique efficacious elements of these therapies.




                                                17
Paper in Panel - Panel Session 5

Title:                 Change Processes in IPT

Authors:               Sarah Chisholm-Stockard, Gregory G. Kolden, and Timothy J. Strauman

Address for Correspondence:

                       Department of Psychiatry
                       University of Wisconsin
                       6001 Research Park Blvd.
                       Madison, WI 53719 USA


                                         ABSTRACT

        The generic model of psychotherapy is presented as a transtheoretical model of universal
session-level change processes in Interpersonal Psychotherapy (IPT). Work examining
propositions of the generic model in IPT is presented. Early session-level change processes
(session 3) were examined via structural equation modeling methods in a naturalistic study of
IPT delivered in a psychotherapy training clinic. Our findings highlight both universal and
specific change processes in early sessions of IPT. Discussion underscores the usefulness of the
generic model for change process research examining similarities and differences between
diverse therapies.




                                              18
Paper in Panel - Panel Session 5

Title:                 Change Processes in CBT

Authors:               Kristin L. Schneider, Timothy J. Strauman, Sarah Chisholm-Stockard,
                       & Gregory G. Kolden

Address for Correspondence:

                       Department of Psychiatry
                       University of Wisconsin
                       6001 Research Park Blvd.
                       Madison, WI 53719 USA
                       tjstraum@facstaff.wisc.edu

                                          ABSTRACT

        The generic model of psychotherapy is presented as a transtheoretical model of universal
session-level change processes in Cognitive Behavioral Therapy (CBT). Early session-level
change processes (session 3) were examined via structural equation modeling methods in a
naturalistic study of CBT delivered in a psychotherapy training clinic. Our findings highlight
both universal and specific change processes in early sessions of CBT. Discussion underscores
the usefulness of the generic model for change process research examining similarities and
differences between diverse therapies. The author will also discuss how structural equation
modeling was used to compare path models for the impact of universal change processes across
three types of psychotherapy.




                                              19
Paper in Panel - Panel Session 5

Title:                Change Processes in Dynamic Therapy

Authors:              Gregory G. Kolden, Timothy J. Strauman, Sarah Chisholm-Stockard,
                      & Kristin L. Schneider

Address for Correspondence:

                       Department of Psychiatry
                       University of Wisconsin
                       6001 Research Park Blvd.
                       Madison, WI 53719 USA
                       ggkolden@facstaff.wisc.edu



                                         ABSTRACT

       The generic model of psychotherapy is presented as a transtheoretical model of universal
session-level change processes in Dynamic Therapy (DT). Work examining propositions of the
generic model in DT is presented. Early session-level change processes (session 3) were
examined via structural equation modeling methods in a naturalistic study of DT delivered in a
psychotherapy training clinic. Our findings highlight the multiple functions of the Therapeutic
Bond as well as the contribution of specific interventions to change in early sessions of DT.
Discussion underscores the usefulness of the generic model for change process research. The
author will also summarize similarities and differences in change processes among DT, CBT, and
IPT as well as discuss the implications of these findings for understanding common and unique
elements of diverse psychotherapies.




Panel Session 6 - Overall Summary

Title:                A Comparison of FRAMES and SASB as Measures of Pathology and
                      Psychotherapy Treatment Process

                                             20
Participants:          Hartvig Dahl, Paul Siegel, Mark Sammons, William Henry and Kenneth
                       Critchfeld

Discussant:            John F. Clarkin

Moderator:             Hartvig Dahl

Address for Correspondence:

                       Hartvig Dahl, MD
                       SLrNY Health Science Center
                       450 Clarkson Avenue / Bx 88
                       Brooklyn, NY 11203, USA
                       dahl@hscbklyn.edu

                                          ABSTRACT

       In 1988 Strupp, Schacht and Henry offered three criteria for selecting psychotherapy
research measures when they wrote:

        The principle of P-T-O Congruence proposes that the intelligibility of psychotherapy
research is a function of the similarity, isomorphism, or congruence among how we
conceptualize and measure the clinical problem (P), the process of therapeutic change (T), and
the clinical outcome (O) (p. 7).

         In this panel we shall limit ourselves to a comparison of FRAMES (Fundamental
Repetitive And Maladaptive Emotion Structures) with SASB (Structural Analysis of Social
Behavior) as measures of "P" and "T", i.e., measures of (1) the patient's pathology (P) and (2) a
point of change (T) in the course of the tape~recorded psychoanalysis of Mrs C. The data include
the first five sessions of the treatment plus sessions 726-728, which occurred during the height of
a transference neurosis as documented by Jones and Windholz (1990). In addition we will focus
on the strikingly different uses FRAMES and SASB have made of the essentially similar three
independent dimensions on which each measure is based.




                                               21
Paper in Panel - Panel Session 6

Title:                 FRAMES as Measures of Pathology and Change; and a Comparison of
                       the Contrasting Use of Three Basic Dimensions to Classify Emotions and
                       Construct SASB's.

Authors:               Hartvig Dahl, Paul Siegel and Mark Sammons

Address for Correspondence:

                       Hartvig Dahl, MD
                       SUNY Health Science Center 450 Clarkson Avenue /
                       Bx 88 Brooklyn, NY 1203, USA
                       dahl@hscbklyn. edu

                                           ABSTRACT

        FRAMES (Fundamental Repetitive And Maladaptive Emotion Structures) and SASB
(Structural Analysis of Social Behavior) are both based on essentially similar three dimensional
classification systems. In FRAMES the system is used to classify emotions and is an adaptation
of the n-dimensional scheme that de Rivera (1962) used in his "decision" theory of emotions. The
three polarities are the same as those that Freud (1915) claimed are basic to all mental life:
Subject-Object, Pleasure-Unpleasure, and Active-Passive. In classifying emotions the following
terms are used: Orientation (IT-ME), Valence
(ATTRACTION/REPULSION-POSITIVE/NEGATIVE), and Control (ACTIVE/PASSIVE).
Benjamin (1986) used Focus (Subject-Object), Affiliation (Friendly-Unfriendly), and
Interdependence (Controlling-Emancipating) and proposed using the resulting structures to
examine the sequence of associations in therapy transcripts. She stressed the Focus dimension as
crucial and missing from most earlier studies of relevant theories.

        FRAMES are a reliable and demonstrably useful method for representing the plots of the
stories that patients in psychotherapy or psychoanalysis inevitably tell. These stories reflect the
"same dumb things" that they do and, seemingly inevitably, as Freud stressed, are reenacted with
the therapist. The events in these plots are now represented by expressions of emotions - not just
the labeled emotions, e.g., angry, surprised, afraid, anxious, sad. etc., but even more often in
enacted expressions, e.g., I told him off; I ran away; I kissed her on the cheek, etc.

        I will illustrate samples of FRAMES from early sessions of Ms. C. and then focus on a
significant change in a frequently repeated FRAME Structure that we have labeled Provocation,
which occurred in hours 726-728 during the height of an independently identified transference
neurosis (Jones & Windholtz, 1990). The procedure also allows us to ask questions about how
the therapist's interventions contributed, if at all, to the change.




                                               22
Paper in Panel - Panel Session 6

Title:                  Interpersonal Case Formulation (ICF) and Subsequent Therapeutic
                        Process and Change: A Comparison of SASB Based Methodology to
                        Dahl‘s FRAMES Model

Authors:                William P. Henry and Kenneth Critchfield

Address for Correspondence:

                        William P. Henry, Ph.D.
                        Dept. of Psychology
                        University of Utah
                        Salt Lake City, UT 84102 USA
                        henry@psych.utah.edu

                                           ABSTRACT

        Interpersonal Case Formulation (ICF: Henry, 1997) is a method for organizing
interpersonal narratives, expectancies, wishes and fears into a serf-sustaining system
operationalized in SASB language (Structural Analysis of Social Behavior: Benjamin, 1974). An
ICF links a patient's early history to their adult intrapsychic structure, behavior, and internalized
object representations via three "copy processes" - identification, internalization and introjection
(Henry, 1994; Benjamin, 1993). The ICF model provides a detailed methodology and a specific
template for organizing SASB-coded patient material into interpersonal problem cycles based on
early social learning. It also shows graphically how these patterns are maintained in
contemporary relationships via interpersonal complementarity and introjection of ongoing
process. It permits a reliable, replicable method of operationalized case-formulation that does not
sacrifice the richness of underlying dynamics.

        ICF and SASB are similar to Dahl's FRAMES model in that both systems provide
reliable, psychodynamically based methods for representing and categorizing a patient's "stories"
and explaining their repetitive nature. In this paper an Interpersonal Case Formulation in SASB
language will be constructed for the case of Ms. C., and following the principle of P-T-O
congruence, sessions 726-728 will be SASB coded for interpersonal process and content. This
procedure will allow for the first direct comparison of the FRAMES and SASB/ICF models. The
similarities and contrasts should prove interesting in that both models utilize a similar three
dimensional structure, but SASB/lCF is centered on the description of behavior (toward serf and
others), while FRAMES focuses on emotion structures. These two methods will allow a direct
comparison of the similar, complementary, and distinct types of knowledge each system adds to
the understanding of a specific episode of therapeutic change.




                                                23
Panel Session 7 - Overall Summary

Title:                 Broadening the Scope of Psychoanalytic Treatment to Diverse
                       Populations and Problems

Participants:          Christopher Christian, Wilma Bucci, Mechthild Weber, Friedemann
                       Pfäfflin, Erhard Mergenthaler, Sverre Varvin

Moderator:             Erhard Mergenthaler

Address for Correspondence:

                        Erhard Mergenthaler
                        Sektion Informatik in der Psychotherapie
                        Universität Ulm - Medizinische Fakultät
                        Am Hochsträß 8
                        89081 Ulm, Gernamy
                        Fax: (0049) 731 502 5662
                        merg@sip.medizin.uni-ulm.de

                                          ABSTRACT

        This panel focuses on a special population of patients. In all three papers violence is in
the center: Violence-prone adolescents, a torture victim, and a sex offender. Furthermore all of
these papers share the same methodological background: The Computerized Referential Activity
and Emotion-Abstraction patterns as measured in verbatim transcripts.

        The first paper by Christopher Christian and Wilma Bucci reports on a new approach to
individual therapy with violence prone youth, and presents the application of this approach in
two treatments. The individual therapy is part of a multi-therapeutic program of treatment and
research at a front-line urban community clinic. The program includes the parent or caretaker as
well as the child, and provides systematic parent training and family therapy along with
individual treatment.

        The second paper by Sverre Varvin reports about psychotherapy with a severely
traumatized refugee. Patients as such often suffer from a difficulty in organizing memory and
experience. A central task of psychotherapy is to facilitate the symbolization and contex-
tualisation of such dissociated and warded off experiences. A central aspect of this process of
integration or assimilation is the ongoing referencing of verbal and other symbols with non- or
sub-symbolic schemas.

       The third paper by Mechthild Weber presents a single case study with a patient who was
sentenced of sexual child abuse and treated under court order. It will be shown that text analytic
methods as they have been used for clinical (as opposed to forensic) patients so far, successfully
can applied in investigating this patient, with specific restrictions however.




                                               24
Paper in Panel - Panel Session 7

Title:                 Symbolization in the Violent Act: An Application of the Multiple Code
                       Theory to the Treatment of Violence-Prone Adolescents

Authors:               Christopher Christian and Wilma Bucci

Address of Correspondence:

                        Christopher Christian, Ph.D.
                        Glass Institute for Basic Psychoanalytic Research
                        75 Varick Street
                        N.Y., N.Y. 10013
                        USA

                                          ABSTRACT


        This paper reports on a new approach to individual therapy with violence prone youth,
and presents the application of this approach in two treatments. The individual therapy is part of
a multi-therapeutic program of treatment and research at a front-line urban community clinic.
The program includes the parent or caretaker as well as the child, and provides systematic parent
training and family therapy along with individual treatment.

        Traditional psychodynamic approaches have not been effective with this population; new
treatment approaches are required. The aspect of the psychodynamic approach that is applicable
– and, we claim, necessary - for this population is a focus on inner experience leading to
self-awareness and self-direction of behavior, rather than emphasizing behavioral change
directly.
 A basic premise of the individual treatment design, based on principles derived from Bucci‗s
multiple code theory (1997), is that violent acts represent difficulties in the process of
symbolization. The person who frequently acts out violently has difficulties in processing
symbolically the visceral and motoric sensations associated with anger, threat, and fear. The
communication proceeds in the subsymbolic domain from sensory experience to action without
the intervention of the symbolizing process. Therapy initially must make use of whatever
symbolizing processes are available to the person; for many of these adolescents their
experience may initially be dominated by representations of somatic experience, which constitute
incipient nonverbal symbols. Progressively, treatment seeks to bring these representations into
the domain of reflection, to facilitate the creation or the emergence of other symbolic entities
with connections to other people.

        Individual therapies are recorded and transcribed, and are assessed using computerized
procedures developed by Mergenthaler and Bucci (In press), including the Computerized
Referential Activity (CRA) and Emotion-Abstraction patterns. The computerized analyses are
used on-line in training and supervision, as we will show here, and in further development of
the new treatment protocol. In later phases of the study , the computerized analyses will also be
used to monitor adherence to the treatment protocol and to evaluate effectiveness of the
treatment.
 Paper in Panel - Panel Session 7

                                               25
Title:                 CRA and Therapeutic Process with a Torture Victim

Authors:               Sverre Varvin

Address of Correspondence:

                        Sverre Varvin
                        Norwegian Psychoanalytic Institute
                        Industri gt 46
                        0357 Oslo, Norway.
                        Fax +47 22468422
                        e-mail: sverrev@ulrik.uio.no

                                           ABSTRACT

        Clinical evidence and research findings point to "dissociation" as central both as adaption
and defense during and after extreme experiences. Dissociation is conceptualized as the isolation
or warding off of mental representations (thoughts, emotions, memories, object-relations) from
their experiential context .

       Severely traumatized persons often suffer from a difficulty in organizing memory and
experience. It is assumed that a lack of connections between frightful memories (represented in
the body, in behavior, in imagery etc), and the organizing ego (symbolizing function) which may
create meaning (semiosis), is at the center of pathology. The symbolizing process, which may
connect experience and feelings to mediating symbols (primarily verbal language), is disturbed
and the process of giving affective experience a voice, is hampered.

       A central task of psychotherapy is to facilitate the symbolization and contextualisation of
such dissociated and warded off experiences. A central aspect of this process of integration or
assimilation is the ongoing referencing of verbal and other symbols with non- or sub-symbolic
schemas (referential activity, Bucci 1977).

        A psychotherapy with a severely traumatized refugee will be analyzed, using the
computerized referential activity measure (CRA, Mergenthaler & Bucci, in press) and a
qualitative approach to selected segments.




Paper in Panel - Panel Session 7

Title:                 Process Research in Forensic Psychotherapy: A Single Case Study

Authors:               Mechthild Weber, Erhard Mergenthaler, Friedemann Pfäfflin

                                               26
Address for Correspondence:

                        Mechthild Weber
                        Section of Forensic Psychotherapy
                        Ulm University - Faculty of Medicine
                        89081 Ulm, Germany
                        Tel: +49 731 5025693, Fax: +49 731 5025662
                        e-mail: weber@sip.medizin.uni-ulm.de

                                           ABSTRACT

        In this paper we will present a single case study with a forensic patient who was
sentenced of sexual child abuse and treated under court order in a high security hospital. The
therapy is still ongoing and we will use a sample covering transcripts from the first 60 sessions of
the analytically oriented psychotherapy.

        The goal of this exploratory study is to find specific aspects of the psychotherapeutic
process within this patient. Our methodological approach is based on the Therapeutic Cycle
Model (Mergenthaler 1996). This includes computer assisted language measures for patterns of
Emotion Tone and Abstraction. Recent extensions of the model also differentiate positive and
negative emotion tone as well as the use of narrative style as measured by the Computer
Referential Activity (CRA) (Mergenthaler & Bucci, in print). Further emphasis will be put on the
differentiation of self- and object-related emotion tone.

       First results confirmed the expectation that key moments - the temporal coincidence of
emotion tone and abstraction - graphically could be identified both, in the micro-analytic and in
the macro-analytic process.

        All findings will be parallelled to clinical evaluations such as the rating of defense
mechanisms, therapeutic alliance, the patient‗s self reflective capacity, and the patient‗s openness
for therapeutic interventions.




                                               27
Panel Session 8 - Overall Summary

Title:                 The Challenge of Investigating Follow-up Change in Psychotherapy
                       Outcome: Traditional and Alternative Methods of Analysis

Participants:          William E. Piper, John S. Ogrodniczuk

Moderator:             William E. Piper

Discussant:            M. Tracie Shea

Address of Correspondence:

                       William E. Piper, Ph.D.
                       Department of Psychiatry
                       University of British Columbia
                       2255 Wesbrook Mall
                       Vancouver, BC V6T 2A1
                       Canada

                                          ABSTRACT

         An important question regarding the effectiveness of psychotherapy is whether it brings
about lasting change. Follow-up studies of short-term treatments address important issues for
psychotherapy outcome research, such as whether patients change after therapy, what types of
change occur, and what types of patients change. A number of confounding factors make it
difficult to arrive at valid answers to these questions. This panel considers follow-up findings
from a randomized clinical trial that investigated the efficacy of interpretive and supportive
forms of short-term individual psychotherapy and the impact of patient personality variables.
First, a traditional method of analysis using averaged patient scores is considered. Then, an
alternative method of analysis using hierarchical linear modeling is considered. Merits and
limitations associated with each approach are considered, as well as common limitations
associated with follow-up research.




                                              28
Paper in Panel - Panel Session 8

Title:                  Follow-up Findings for Interpretive and Supportive Forms of
                        Psychotherapy and Patient Personality Variables

Author:                 William E. Piper

Address of Correspondence:

                        William E. Piper, Ph.D.
                        Department. of Psychiatry
                        University of British Columbia
                        2255 Wesbrook Mall
                        Vancouver, BC V6T 2A1
                        Canada

                                           ABSTRACT

         Follow-up assessment of treatment outcome is generally regarded as an important aspect
of psychotherapy investigations. Clinicians and researchers wish to know whether treatment
effects last or whether they change. Unfortunately, there are a number of confounding factors
that make the collection, interpretation, and understanding of follow-up data difficult. This
presentation considers some of these factors and their potential impact. It also presents
follow-up findings 6 and 12 months after the completion of treatment for a comparative clinical
trial that investigated the efficacy of interpretive and supportive forms of time-limited individual
psychotherapy and the interaction of each form with the patient‘s quality of object relations
(QOR) and psychological mindedness (PM). Patients in both forms of therapy maintained their
post-therapy improvements at 6- and 12-month follow-up assessments according to criteria of
statistical significance, clinical significance, and reliable change. They did not, however,
significantly differ from each other. At each assessment, there was evidence for a direct relation
between QOR and favourable outcome. At 12 months, there was also evidence for an
interaction effect, which indicated a direct relation between QOR and favourable outcome for
interpretive therapy and almost no relation for supportive therapy. Thus, QOR continued to be
an important predictor of outcome throughout the follow-up period. In contrast, no follow-up
effects were found for PM. Explanations and limitations of the findings are considered.




                                               29
Paper in Panel - Panel Session 8

Title:                 Investigation of Follow-up Findings of Psychotherapy Outcome Using
                       Hierarchical Linear Modeling

Author:                John S. Ogrodniczuk

Address of Correspondence:

                        John S. Ogrodniczuk, Ph.D.
                        Department of Psychiatry
                        University of British Columbia
                        2250 Wesbrook Mall
                        Vancouver, BC V6T 1W6
                        Canada

                                          ABSTRACT

        Assessment of change plays a central role in many areas of clinical research. Research
on change, however, is complicated by a number of problems. This presentation considers
some of these problems. It also examines how recent advances in the statistical theory of
hierarchical linear models (HLM) should enable important breakthroughs in the study of
psychological change. To illustrate the application of HLM and its potential uses, we present
findings from our investigation of change in psychotherapy outcome over a 12-month follow-up
period, and examine correlates of this change. Our findings revealed that a patient‘s pattern of
improvement (or deterioration) following treatment completion is influenced by his or her level
of quality of object relations. Possible explanations and potential implications will be discussed.




                                               30
Panel Session 9 - Overall Summary

Title:                Research on Psychotherapists in Spain and Portugal: Iberian
                      Contributions to the International Study of the Development of
                      Psychotherapists

Participants:               Montserrat Alonso Alvarez, Alejandro Avila-Espada, Antonio
                      Branco Vasco, Isabel Caro, Amparo Coscollá, Antonio Garcia de la Hoz

Moderator:            Alejandro Avila-Espada

Discussant:           David Orlinsky

Address for Correspondence:

                       Montserrat Alonso Alvarez
                       Facultad de Psicología, Universidad de Salamanca
                       Dpto. Personalidad, Evaluación y Tratamiento Psicológicos.
                       Avda. de la Merced, 109-131.
                       37.005 Salamanca. España.
                       Email: <montse@gugu.usal.es>

                                         ABSTRACT

      The SPR Collaborative Research Network‘s international study of the development of
psychotherapists was initiated in 1989 and has since been joined by research teams in many
countries in Europe, Asia, and North and South America. The main concepts, questions, and
methods of the study have been described by Orlinsky, Ambuehl, Ronnestad et al. (1999). Using
Spanish and Portuguese translations of the Development of Psychotherapists Common Core
Questionnaire (DPCCQ), the Spanish team coordinated by Prof. Avila Espada (Salamanca) and
Prof. Isabel Caro (Valencia), and the Portuguese team coordinated by Prof. Branco Vasco
(Lisbon), have each collected data on approximately 200 therapists. This panel presents initial
findings by the Spanish and Portuguese teams on psychotherapists of several professions,
theoretical orientations, and career levels in their respective countries.




Paper in Panel - Panel Session 9

Title:                Personal and Professional Development of the Psychotherapist in Spain



                                             31
Authors:                Montserrat Alonso Alvarez, Alejandro Avila-Espada, Isabel Caro,
                        Amparo Coscollá and Antonio García de la Hoz

Address for Correspondence:

                        Montserrat Alonso Alvarez
                        Facultad de Psicología, Universidad de Salamanca
                        Dpto. Personalidad, Evaluación y Tratamiento Psicológicos.
                        Avda. de la Merced, 109-131.
                        37.005 Salamanca. España.
                        Email: <montse@gugu.usal.es>

                                           ABSTRACT

        This study reports data on the nature, correlates, and determinants of development
collected from a sample of psychotherapists in several Spanish communities using a Spanish
translation of the Development of Psychotherapists Common Core Questionnaire (DPCCQ). The
subjects were trained in different professions and theoretical orientations, and included all career
levels from complete beginners to the very experienced. Psychotherapeutic development is
examined from varying perspectives, beginning with therapists‘ retrospective reports of their
overall career development and their contemporaneous reports of currently experienced
development. To this will be added cross-sectional analyses of therapist cohorts at various levels
of experience and training, as well as longitudinal analyses of therapists who have been assessed
at intervals over a longer period of time. This presentation will focus on the personal and
professional development of psychotherapists in Spain today, with the eventual aim of making
coordinated comparative analyses with other samples that have been contributed to the
international data base of the SPR Collaborative Research Network.




                                                32
Paper in Panel - Panel Session 9

Title:                  Changes in Theoretical Orientations of Spanish Psychotherapists: The
                        Tendency Toward Eclecticism and Integration

Authors:                Amparo Coscollá, Isabel Caro Gabalda Alejandro Avila-Espada and
                        Montserrat Alonso Alvarez

Address for Correspondence:

                        Isabel Caro Gabalda
                        Avda. Blasco Ibanez, nº 21
                        Facultad de Psicología
                        46007 Valencia, España
                        Email: Isabel.caro@uv.es

                                            ABSTRACT

        This study investigates the changing patterns in the theoretical orientation in the
development of Spanish psychotherapists. For this purpose, we dispose the data from
approximately 190 therapists, who answered the Development of Psychotherapists Common
Core Questionnaire (CCQ). This instrument was elaborated by the Society for Psychotherapy
Research (SPR) members of the Collaborative Research Network (CRN) coordinated by
Orlinsky, to collect an extensive amount of information related to therapists‘ backgrounds,
training, education, clinical practices, work context, etc,... The CCQ also contains two sections
that ask directly about the theoretical framework that guided the therapists‘ clinical work, using a
scale (0 to 5) to assess the degree to which psychotherapists trust on general models of
psychotherapy (analytic/psychodynamic, behavioral, humanistic, cognitive, systems theory,
other) in two different phases of their professional career: at the beginning of their practice and at
the present.

        Previous researches have confirmed the evidence of the progress towards integration and
the rapproachment between models. (For instance, Garfield y Kurtz 1976, Kelly, Goldgerg, Fiske
y Kilkowski, 1978; Bergin y Greaves, 1990; Mahoney, 1995' Ambuhl y Orlinky, 1995).

        Our aim is to identify the process of development of the Spanish therapist‘s theoretical
framework and to confirm previous findings, for example, if more experienced therapists use an
increasingly wide array of theoretical orientation and become more eclectic (Ambuehl &
Orlinsky, 1995) or integrative.




                                                33
Paper in Panel - Panel Session 9

Title:                       Characterizing Portuguese Psychotherapists: The ‗80s and the ‗90s

Author:                António Branco Vasco

Address for Correspondence:

                       António Branco Vasco
                       Faculdade de Psicologia e de Ciências da Educação
                       da Universidade de Lisboa
                       Alameda da Universidade
                       1600 Lisboa, Portugal
                       Email: <brancov@mail.telepac.pt>

                                         ABSTRACT

       The present study was conducted with data that integrate a larger international research
project on the development of psychotherapists across various countries. Data were collected via
mail using a Portuguese translation of the Development of Psychotherapists‘ Common Core
Questionnaire. Subjects were members of several Portuguese psychotherapeutic associations and
societies (N = 186). In the present paper, and with the aim of characterizing the Portuguese
psychotherapeutic community, the authors report data on several variables: (1) demographics; (2)
training and professional experience; (3) therapeutic difficulties and coping strategies; (4)
theoretical orientation; and (5) personal and professional development. Comparisons are made
regarding experience, development and theoretical orientation. With the aim of tapping possible
changes within the community, further comparisons are also made taking into consideration data
from a previous study conducted in the 80s.




                                              34
Panel Session 10 - Overall Summary

Title:                 Change in Three Dynamic Measures in a Naturalistic Sample of
                       Treatment-Resistant Adults After Three Years: The Austen Riggs
                       Follow-Along Study

Participants:          Stephen Beck, Rachel LeFebvre, Martin Drapeau

Moderator:             Christopher Perry

Address for Correspondence:

                       The Erikson Institute of the Austen Riggs Center
                       (& Harvard Medical School)
                       25 Main St.
                       Stockbridge, Massachusetts 01262-0962 (U.S.A.)
                       [& Institute of Community & Family Psychiatry, McGill University,
                       Montreal Quebec, Canada)

                                           ABSTRACT

        While case formulations are useful for guiding the therapist in focusing treatment,
quantitative assessments are necessary for most research purposes. This panel examines three
instruments designed for dynamic formulation that also yield quantitative ratings. These include
a measure of defenses, the Defense Mechanism Rating Scales (DMRS), and two measures of
dynamic patterns: the Core Conflictual Relationship Theme (CCRT) and the Wish and Fear List.
As quantitative measures, they can address fundamental questions about psychopathology and
treatment response.

       In 1992, the Austen Riggs Center, a residential psychodynamically oriented facility for
treatment-resistant patients, began a naturalistic follow-along study of adults entering treatment.
This panel examines the first 25 to 35 subjects who have completed three to four years of
follow-along after beginning treatment there. Treatments varied from one to 24 months, although
most subjects continued some form of treatment after discharge. After entry, all subjects received
repeated assessments every 6 to 12 months, including dynamic interviews, Relationship
Anecdote Paradigm (RAP) interviews, and separate interviews to assess symptoms and
functioning.

       The presenters will compare the dynamic measures in three contexts. The first will
compare the three assessments both to one another and to other measures of psychopathology.
The second will examine change in each measure over the course of treatment. The third will
compare dynamic change on the three methods with change in other measures of symptoms and
functioning. This naturalistic data should help us understand the dynamic and descriptive
changes that treatment-resistant adults make, and how the different measures capture this.
Paper in Panel - Panel Session 10

Title:                 Defenses, The CCRT, and Wishes & Fears: A Baseline Comparison to
                       Psychopathology and Functioning Among Treatment-Resistant Adults in

                                               35
                       the Austen Riggs Follow-Along Study

Authors:               Stephen Beck, J. Christopher Perry, Rachel LeFebvre, Martin Drapeau,
                       Ann Greif, Eric Plakun, Barbara Zheutlin, and Lueen Lapitsky

Address for Correspondence:

                       The Erikson Institute of the Austen Riggs Center
                       25 Main St.
                       Stockbridge, Massachusetts 01262-0962 (U.S.A.)
                       [& Institute of Community & Family Psychiatry, McGill University,
                       Montreal Quebec, Canada)

                                          ABSTRACT

        Dynamic therapies focus on dynamic mechanisms as an avenue to producing
improvement in symptoms and functioning. Understanding how dynamic measures compare with
one another is an important methodological need, while elucidating their relationship to
psychopathology is a fundamental need. This presentation will examine both of these on a
sample of individuals with treatment-resistant disorders referred to an intensive
dynamically-oriented residential treatment facility.
        Participating subjects were given independent diagnostic interviews (Guided Clinical
Interview), dynamic interviews, and Relationship Anecdote Paradigm (RAP) interviews upon
entry into the study. The latter two interviews were then scored for Defenses (DMRS), the
CCRT, and Wishes & Fears. Each measure has several unique quantitative scores which we
compared. The DMRS measures 28 individual defenses, 7 hierarchically arranged defense levels,
and Overall Defensive Functioning (ODF), a weighted average of all the defenses identified. The
CCRT, scored quantitatively, can assess Wishes, Response of the Other (RO) and Response of
Self (RS) in each of 8 clusters, as well as the proportion of negative RO and RS components. The
Wish and Fear list assesses 40 Wishes and 40 Fears hierarchically arranged by Erikson's 8
developmental stages. This allows quantitative assessment of individual motives, of the
proportion in any stage, or an overall mean stage for Wishes or Fears. It also reports the
percentage of Wishes that are Disappointed or of Fears that are Unrealized.
        The inter-correlations of the above dynamic measures will be presented. Correlations will
also be presented between these and descriptive measures, including number of lifetime Axis I
disorders, Axis II disorders, GAF (current and usual), SCL-90-R, and any specific disorders of
high prevalence in the sample (e.g. Borderline PD). Regression analyses will help determine
whether the individual dynamic methods each predict unique variance in the psychopathology
and functioning or whether they are redundant.

Paper in Panel - Panel Session 10

Title:                 Changes in Defenses, CCRT and Wishes and Fears After 3 to 4 years
                       Among Treatment-Resistant Adults in the Austen Riggs Follow-Along
                       Study

Authors:               Rachel LeFebvre, J. Christopher Perry, Stephen Beck, Martin Drapeau,
                       Valerie Lepine, Marta Valenzuela, Judy Kolmeir, Suzanne Marcote

                                              36
Address for Correspondence:

                        The Erikson Institute of the Austen Riggs Center
                        25 Main St.
                        Stockbridge, Massachusetts 01262-0962 (U.S.A.)
                        [& Institute of Community & Family Psychiatry, McGill University,
                        Montreal Quebec, Canada)

                                           ABSTRACT

         Psychodynamic treatments aim at improving the individual's psychodynamic functioning.
It is therefore important to assess the amount and course of change over treatment using
psychodynamic measures. Futhermore, campring changes on one measure with another may
elucidate those aspects of dynamic change that are more or less resistant to change. Finally, if the
measures have a built in developmental framework, or some cut-off points for healthy
functioning, it may be possible to estimate at any point in treatment how far the subject has
progressed toward healthy dynamic functioning, or how much farther he or she has to improve.
Those are the aims of this presentation.

        Participating subjects from the Austen Riggs Follow-along Study were re-interviewed
every 6-12 months after entry for up to four years. This presentation will focus on ratings made
from dynamic interviews and Relationship Anecdote Paradigm (RAP) interviews. Each RAP
interview was scored for the CCRT (quantitative methods), while both the RAP and dynamic
interviews were scored for defenses (DMRS) and motives (Wish & Fear List). All ratings were
done independently and blindly to one another. We examined change on each of the quantitative
scores for each method. For defenses we examined improvement in Overall Defensive
Functioning (ODF), as well as decreases in the lowest defense levels (action, major
image-distorting, disavowal and minor image-distorting), and increase in the high adaptive
(mature) level defenses. For the CCRT we examined the proportion of Wishes in each of the 8
clusters as well as decreases in the proportion of negative RO and RS components. For motives,
we examined improvement in the mean Eriksonian stages of Wishes and Fears, as well as
decreases in the lowest stages (I and II), and changes in the proportion of Disappointed Wishes
and Unrealized Fears. These measures were then correlated and compared as to overall effect
size.


Paper in Panel - Panel Session 10

Title:                  How Do Changes in Dynamic and Descriptive Measures Compare After 3
                        - 4 Years Among Treatment-Resistant Adults in the Austen Riggs
                        Follow-Along Study?

Authors:                Martin Drapeau, J. Christopher Perry, Rachel Lefebvre, Stephen Beck,
                        Barbara Zheutlin, and Leueen Lapitsky

Address for Correspondence:



                                               37
                       The Erikson Institute of the Austen Riggs Center
                       (& Harvard Medical School)
                       25 Main St.
                       Stockbridge, Massachusetts 01262-0962 (U.S.A.)
                       & Institute of Community & Family Psychiatry, McGill University,
                       Montreal Quebec, Canada)

                                          ABSTRACT

        Improvement in psychodynamic functioning should be associated with improvement in
other measures of descriptive psychopathology and functioning. Examining the pattern and
magnitude of the changes may reveal whether dynamic and descriptive measures change in
unrelated or related ways. This presentation examines improvement in a sub-sample of 25-35
adults from the Austen Riggs Follow-along Study who were followed for up to four years. We
will correlate the changes (within-condition effect sizes) for the quantitative measures of
defenses, the CCRT, and Wishes & Fears along with descriptive measures including GAF,
SCL-90-R, and proportion of time ill with Axis I disorders.

        The developmental framework for ordering motives has the heuristic possibility of
guiding the clinician to focus on issues at the appropriate developmental stage and helping track
dynamic progress. Therapy appears to help individuals move to developmentally higher fears
prior to improving the developmental level of Wishes that concern them.




                                               38
Panel Session 11 - Overall Summary

Title:                 The Development and Implementation of a Continuous Quality
                       Management Program into Clinical Practice

Participants:          David Smart, Arthur E. Finch, Michael J. Lambert, David A. Vermeersch

Moderator:             Michael J. Lambert

Discussant:            Hans Kordy

Address for Correspondence:

                       Michael J. Lambert
                       Department of Psychology,
                       Brigham Young University
                       284 TLRB
                       Provo, Utah 84602, USA

                                          ABSTRACT

        The proposed panel summarizes four years of research aimed at monitoring and
improving the clinical services in a university counseling center. The first presentation focuses
on the development, logistics, and politics of implementing a quality control program into
clinical practice, introducing the salient issues that must be addressed by administrators when
monitoring service and how these issues were handled in our program. The second presentation
summarizes the first three years of research and the use of these results to develop decision rules
for quality management to improve clinical services. The third presentation describes the results
from a controlled experiment utilizing the previously developed decision rules with an
experimental group providing feedback to therapists about the progress of their clients. The
outcome of the clients in the experimental group was compared with the outcome of clients in a
control group whose therapists were not provided with feedback. Finally, the fourth
presentation gives an overview of the reactions of clinicians involved in the quality
management program. Particularly, this presentation focuses on how therapists utilize the
information that was received through quality management feedback, and how this impacted
clinical practice and client outcome. Hans Kordy, an internationally recognized expert on
Quality Management, will be offering critical commentary on the proposed panel.




                                               39
Paper in Panel - Panel Session 11

Title:                  Strategies for Implementing and Administrating a Quality Management
                        Program in Clinical Practice

Authors:                David Smart and Stevan L. Neilsen

Address for Correspondence:

                        Michael J. Lambert
                        Department of Psychology,
                        Brigham Young University
                        284 TLRB
                        Provo, Utah 84602, USA

                                           ABSTRACT

        This presentation aims at outlining essential features that need to be addressed in
designing and implementing a quality control program into clinical practice. From an
administrative perspective, there are many issues and competing needs that have to be weighed
and balanced to successfully impact treatment delivery without affecting the morale of the clinic.
The needs of therapists, staff, and clients, as well as possible third party payers, must be balanced
along with issues of cost, time, and material resources. There are several key elements that will
be covered in this presentation, including: (1) defining outcome and selecting measurement tools;
 (2) addressing therapists‘ fear of being monitored; (3) evaluating the quality of service and
looking for areas for improvement; (4) maintaining therapist confidentiality; (5) identifying what
equipment and staff are required; (6) weighing costs and benefits; (7) gaining and maintaining
staff support; (8) providing feedback to therapists; and (9) providing opportunities for scholarly
contributions. As each of these issues is addressed, the solution utilized in our program will be
discussed, as well as the successes and failures we have experienced in implementing these
strategies.




Paper in Panel - Panel Session 11

Title:                  Developing Decision Rules for Monitoring Outcome and Informing
                        Clinical Practice

                                                40
Authors:               Arthur E. Finch and Michael J. Lambert

Address for Correspondence:

                       Michael J. Lambert
                       Department of Psychology,
                       Brigham Young University
                       284 TLRB
                       Provo, Utah 84602, USA

                                          ABSTRACT

        This presentation comes as a response to the need for research to be integrated into
feedback delivery systems for therapists regarding the progress of individual clients in
psychotherapy. There is little question that patient outcomes need to be measured and evaluated
to assure the quality of treatment that is provided. In order to inform therapists about client
progress, two goals need to be met: (1) clients need to be grouped into meaningful categories that
are predictive of outcome (prior to and early in treatment) and (2) normative recovery curves
need to be established for these categories. Outcome data from three years of clinical work at a
university counseling center from 1654 subjects who have completed repeated administrations of
the Outcome Questionnaire (OQ) were analyzed using cluster analysis to form meaningful client
groupings. These groups were then subjected to a Hierarchical Linear Modeling analysis to
identify differential growth curves. The results were then used to create tables of expected
recovery rates for the various client groupings. This provided the foundation for the
development of parameters for an early warning system to identify clients who are not
benefitting from psychotherapy as expected. The merits of this type of therapy monitoring for
informing clinical practice will be discussed.




Paper in Panel - Panel Session 11

Title:                 The Implementation of a Quality Management System into Clinical
                       Practice: A Controlled Experiment

Authors:               Michael J. Lambert, David A. Vermeersch, and Nathan B. Hansen

Address for Correspondence:

                                              41
                       Michael J. Lambert
                       Department of Psychology,
                       Brigham Young University
                       284 TLRB
                       Provo, Utah 84602, USA

                                          ABSTRACT

        This study examines the effects of providing clinicians with psychotherapy outcome data
at specified times throughout the course of treatment. Six hundred individuals who received
treatment at a college counseling center and who completed the Outcome Questionnaire (OQ) (a
widely used instrument designed to track patient progress throughout the course of treatment)
prior to each therapy session were included in the study. Expected levels of patient progress
were determined by prior research which utilized the OQ to establish normative rates of change
for counseling center patients. Prior to receiving services, patients were randomized to either
the ―feedback‖ (experimental) or the ―non-feedback‖ (control) group. Therapists of patients in
the experimental group were provided feedback regarding patient progress following sessions 3,
5, and 9, whereas therapists of patients in the control group received no feedback regarding
patient progress. Therapists receiving feedback were given one of four messages based on the
client‘s initial OQ score and the OQ score change from intake. Each of the four messages were
designed to: (1) inform therapists regarding a specific patient‘s progress relative to expected
change at that point in time; and (2) provide therapists with suggestions for altering their
treatment plan. Results were analyzed through the use of Hierarchical Linear Modeling to see if
the provision of feedback enhanced outcomes for patients who were expected to have a poor
outcome. Implications of the current study and suggestions for further research designed to
improve the quality of clinical services through the utilization of psychotherapy outcome data are
discussed.




Paper in Panel - Panel Session 11

Title:                 Quality Management and Outcome Monitoring: The Therapist's
                       Perspective

Authors:               David A. Vermeersch and Nathan B. Hansen

Address for Correspondence:

                       Michael J. Lambert
                       Department of Psychology,

                                              42
                       Brigham Young University
                       284 TLRB
                       Provo, Utah 84602, USA

                                          ABSTRACT

         This presentation focuses on the experience of therapists who participated in a continuous
quality management study that included providing feedback to clinicians on client progress in
treatment. A structured interview format was used to address the following questions: (1) Did
therapists use the feedback information; (2) How did therapists use the feedback information; (3)
Did this result in treatment plan change; (4) Did changing the treatment plan impact client
change; (5) Was there agreement between feedback information and therapist perception of client
status and needs; (6) What are the overall perceptions of having and using feedback; (7)
Compare treating clients with and without feedback; and (8) What would therapists change about
the feedback system? Also, a sample of individual cases will be selected for discussion where
feedback was found to be particularly helpful or unhelpful. It is felt that obtaining feedback
from the individual treatment providers in the quality management program is an important
aspect of continuous quality management. The implications of therapist reactions are discussed
in relation to modifying both the process and product of the patient progress feedback system.




                                               43
Panel Session 12 - Overall Summary

Title:                  Self-Criticism: Understanding and Tracking the Self-Critical Process

Participants:           Heidi Levitt, Nele Stinckens, William J. Whelton

Moderator:              Leslie Greenberg

Address for Correspondence:

                        William J. Whelton
                        Department of Psychology, York University
                        4700 Keele St.
                        Toronto, Ontario, Canada M3J-1P3
                        wwhelton@yorku.ca

                                           ABSTRACT

         Self-criticism has long been recognized as an important factor in psychological
dysfunction, of particular significance in disorders such as depression and anxiety(Blatt and
Zuroff, 1992).At least as far back as Freud it has been observed that in certain psychological
states, such as morbid grief, some part of the self can turn on the self, mercilessly tormenting and
berating it for its ostensible deficiencies. Self-criticism is both a cause and a consequence of pain
and distress, becoming ever more severe as dysphoric mood worsens. It is also a feature of a
number of dysfunctional interpersonal cycles, taking a toll on marriages and other significant
relationships(Mongrain & Vettese, 1998).This panel proposes to address the theme of
self-criticism. The papers explore the cognitive-affective roots of self-criticism and present
research that describes a number of dimensions of the self-critical process as it is manifested
experientially in a variety of situations. Each of the studies will, in different ways, attempt to
describe and explain some of the psychological processes and characteristics which make up
self-criticism. As well, the panel will look at the impact of self-criticism on the process of
therapy and at therapeutic techniques for promoting change in self-criticism(Greenberg & Paivio,
1997).




Paper in Panel - Panel Session 12

Title:                  Clients‘ Experiences of Silent Resistance: Re-framing Psychoanalytic and

                                                44
                        Object-Relations Theories

Author:                 Heidi Levitt

Address for Correspondence:

                        Heidi Levitt
                        Department of Psychology
                        University of Florida
                        114C Psychology Building
                        Gainesville, FL 3261
                        USA

                                           ABSTRACT

        This paper reviews the psychoanalytic and object relational perspectives on silences in
psychotherapy in conjunction with clients‘ reports of Disengaged Pauses within their therapy
sessions. This type of pauses were identified in a qualitative analysis of clients‘ descriptions of
in-session pausing experiences gathered using interpersonal process recall interviews (e.g.,
Kagan, 1975). This study was informed by a method of analysis based on the grounded theory
approach (Glaser & Strauss, 1967; Glaser, 1992) in which the Pausing Inventory Categorization
System was formed (Levitt, 1998). Within the description of Disengaged Pauses, clients
described processes of avoiding their emotion, of trying to recompose themselves after
experiencing emotion, and of trying to redirect their therapist away from threatening issues.
Techniques are suggested which can be useful in dealing with these moments in therapy,
including the identification of Disengaged Pauses and the examination of self-critical and
self-interruptive processes (e.g., Greenberg, Rice & Elliott, 1996).




                                                45
Paper in Panel - Panel Session 12

Title:                  The Inner Critic in Client-Centered/Experiential Psychotherapy:
                        Empirical Illustration of a Micromodel

Author:                 Nele Stinckens

Address for Correspondence:

                        Nele Stinckens
                        Counseling Centrum
                        Blijde Inkomststraat 13
                        3000 Leuven
                        Belgium
                        E-mail: Nele Stinckens@psy.kuleuven.ac.be

                                           ABSTRACT

         The term 'inner critic' describes the strong inner normative voice with which people block
themselves. In experiential theory this voice is considered as a process disturbance that
interferes with the organismic experiencing of the client. In the existing experiential literature,
however, there has been little systematic research into the manner in which the inner critic
appears
 in the concrete therapy situation. An encompassing micromodel will be introduced in which
diverse therapeutic and diagnostic insights are synthesized. With this model we illuminate the
 intrapersonal and interpersonal characteristics of the inner critic, the repertoire of facilitating
therapist interventions and the progress or possible stagnations of the therapy process. The
micromodel will be illustrated with an 'in depth analysis' of an episode from a short term
experiential therapy. By using a battery of qualitative and quantitative measuring instruments we
show which process characteristics of the inner critic are manifested in this client, in what ways
the therapist responds and what the impact is on the client process. Besides existing scales, like
the SASB Introject, the Levels of Client Perceptual Processing and the Hill Counselor Verbal
Response Category System, some new scales will be used to grasp the various process aspects.
Finally, the limitations of our model will be indicated and suggestions and implications for future
research and clinical application will be addressed.




                                               46
Paper in Panel - Panel Session 12

Title:                  Affective Processes of Self-Contempt in the Self-Criticism of Persons
                        Vulnerable to Depression

Authors:            William J. Whelton and Leslie S. GreenbergAuthors William J.
                    Whelton and Leslie S. Greenberg
Address for Correspondence:

                        William J. Whelton
                        Department of Psychology, York University
                        4700 Keele St.
                        Toronto, Ontario, Canada M3J-1P3
                        wwhelton@yorku.ca

                                          ABSTRACT

        The aim of this project was to understand the affective components of self-criticism in
persons vulnerable to depression. The study involved either a one or two hour research session
with each of 60 participants. All had been previously selected using the Depressive Experiences
Questionnaire (Blatt, D., Afflitti, & Quinlan, 1976). Thirty were high self-critics, fifteen high
dependents and fifteen controls. After a mood induction exercise each participant was
videotaped naturalistically criticizing him or herself for five minutes and responding to this
criticism for five minutes. The thirty high self-critics then received a one-hour analogue of
therapy focussed on their self-criticism. Fifteen were randomly assigned to receive cognitive
therapy focussed on their automatic thoughts and fifteen to receive two-chair therapy focussed on
both cognition and affect in an experiential framework. Before and after the session the
participants filled out measures of depression, mood, self-empathy, and state self-esteem.

         Two independent coders coded the videotapes for verbal and non-verbal expressions of
affect using a modified version of the Specific Affect Coding System(Gottman,1996). The thirty
self-critics were compared with the thirty non self-critics for expressions of contempt toward the
self and for assertion and confidence in their response to the critic. The effects of the two
therapeutic modalities in mitigating self-criticism were compared. The discussion considers the
importance of hostility and contempt for the self in the genesis of depressive mood and of
self-resiliency as a buffer to these hostile affects. The place of these emotion schemes in the
self-organizations of those self-critically vulnerable to depression will be considered.




Panel Session 13 - Overall Summary

               Title:                 CCRTs in Clinical Studies



                                               47
Participants:           Nikolaus Freymann, Hermann Staats, Michael Stasch, Manfred Cierpka,
                        Alexander Wilczek, Robert M. Weinryb, Jacques P. Barber, J. Petter
                        Gustavsson, Marie Åsberg, Hermann Staats, Claudia Hoevelmann, and
                        Ulrich Seidler

Moderator:              Hermann Staats

Discussant:             Larry Beutler

Address for Correspondence:

                        Hermann Staats
                        Psychosomatics and Psychotherapy, University of Goettingen
                               Nikolausberger Weg 17
                        D - 37073 Goettingen
                        Tel.: ++/551/394595,
                        Fax: ++/551/394596,
                        E-mail: hstaats@gwdg.de

                                              ABSTRACT

        The Core Conflictual Relationship Theme (CCRT) and the
Relationship-Episode-Paradigm (RAP) Interview have become widely used tools for studying
relational patterns, transference and transference dispositions in clinical and non clinical samples.

        In this panel we report on clinical studies involving patients from different diagnostic
groups and of different psychopathology and on a study on gender differences, adding a new
aspect to the CCRT method, which may become useful for testing clinical hypotheses.
Limitations of the method are dealt with, especially, if narratives are recorded outside a
therapeutic relationship; and special opportunities opened up by this approach are considered.

        The contributions show, that one of the key concepts of the CCRT method, the
―pervasiveness‖ of a theme, is not simply a sign of psychopathology but - depending on the
context of the study and the diagnosis of the patient - may also be considered as an indicator of
interpersonal resources.




                                                48
Paper in Panel - Panel Session 13

Title:                 Pervasiveness of the CCRT – Does it Have Different a Clinical Meaning
                       for Different Diagnostic Groups?

Authors:               Nikolaus Freymann, Hermann Staats, Michael Stasch, and Manfred
                       Cierpka

Address for Correspondence:

                       Nikolaus Freymann
                       Psychosomatics and Psychotherapy, University of Goettingen
                       Nikolausberger Weg 17
                       D - 37073 Goettingen
                       Tel..: ++/551/394595,
                       Fax: ++/551/394596,
                       E-mail: hstaats@gwdg.de

                                           ABSTRACT

        In this study we examined correlations between the pervasiveness of the CCRT and the
severity of disturbance in a group of young female patients. Severity of disturbance was assessed
with regard to symptoms (SCL-90-R) and the quality of interpersonal relationships (Global
Assessment of Relational Functioning Scale GARF). RAP Interviews with 29 patients were
evaluated.

      For the sample as a whole we found little evidence for a correlation between pervasiveness
of the CCRT and severity of disturbance. However, results in diagnostic subgroups - ICD 10:
depressed patients (n=7) and patients with eating disorders (n=20) - were different:

        In the depressed patients we found a positive correlation with the severity of disturbance
both for symptoms and relationship functioning. Contrary to expectations we found an inverse
correlation in the subsample of patients with eating disorders. Here, rigidity of transference
disposition correlated with a low symptom index and better functioning in relationships.

       Opposing effects found in two different diagnostic groups obscured the relation between
the rigidity of transference disposition and the severity of disturbance. In patients with eating
disorders and possibly in other diagnostic groups, pervasiveness of a CCRT may be an indicator
of a functional capability.




                                               49
Paper in Panel - Panel Session 13

Title:                 The Core Conflictual Relationship Theme (CCRT) and Psychopathology
                       in Patients Selected for Dynamic Psychotherapy

Authors:               Alexander Wilczek, Robert M. Weinryb, Jacques P. Barber, J. Petter
                       Gustavsson, and Marie Åsberg

Address for Correspondence:

                       Alexander Wilczek, MD.,
                       Bastugatan 19
                       S-118 25 Stockholm
                       Sweden
                       Telephone: +46 8 6585305
                       Fax: +46 8 196508
                       E-mail: alexander.wilczek@pi.ki.se

                                         ABSTRACT

       The present study examined the relation between core interpersonal patterns measured by
the Core Conflictual Relationship Theme (CCRT) method and psychopathology.

       Psychopathology was assessed by the presence of diagnostic categories, the self-report of
symptoms and the character pathology. Fifty-five patients selected for a long-term dynamic
psychotherapy participated in this naturalistic study.

        Patients with different general kinds of DSM-III-R diagnoses did not differ in their
CCRTs abstracted from the Relationship Anecdote Paradigm interview. Furthermore the degree
of inflexibility ('pervasiveness') in the use of different CCRT components was not associated
with psychiatric symptoms. In regard to the relation between character pathology and CCRT,
only very few correlation's were found significant. Namely, patients with impaired character
organization and patients with an impaired capacity to form stable relationships had more
negative responses. Limitations of the CCRT method and the sample used are discussed.




                                              50
         Paper in Panel - Panel Session 13

Title:                  Relationship Themes and the People Involved. Object Specific
                        Relationship Patterns in RAP-Interviews with Men and Women

Authors:                Hermann Staats, Claudia Hoevelmann, Ulrich Seidler

Address for Correspondence:

                        Hermann Staats
                        Psychosomatics and Psychotherapy, University of Goettingen
                        Nikolausberger Weg 17
                        D - 37073 Goettingen
                        Tel.: ++/551/394595,
                        Fax: ++/551/394596,
                        E-mail: hstaats@gwdg.de

                                           ABSTRACT

        Objects of narratives and the age of the narrator at the time of a relationship episode are
not included in the standard evaluation of a CCRT. These factors may be indicators of
transference triggers and influence the expression of a CCRT. They are probably more
influential, when narratives outside a clinical setting are evaluated, e.g transference dispositions
in RAP interviews.

        In an exploratory study we recorded CCRTs, the objects in the narratives and the life
period, the narratives came from, in 39 RAP-interviews from a not clinically defined sample (18
men and 21 women). Objects could be described by using the 7 categories ―partner‖. ―mother‖,
―father‖, ―friends‖, ―family‖, authorities‖ and ―strangers‖. Correlating CCRT parameters and
object categories lead to different relational patterns in the men and in the women and to
different patterns for the life periods examined. Results found seem meaningful and are in line
with developmental theories for the genders.

       Evaluating the objects referred to in the narratives may be a useful addition to the
CCRT-method and add to our knowledge about pervasive relationship patterns in clinically
defined groups of patients.




                                                51
Panel Session 14 - Overall Summary

Title:                 Qualitative Approaches in Psychotherapy Process Research

Participants:          Brigitte Boothe, Michael B. Buchholz, Ulrich Streeck, Wolfgang
                       Tschacher, Agnes von Wyl

Moderator:             Wolfgang Tschacher

Address for Correspondence:

                       Agnes von Wyl
                       Psychological Institut of the University of Zurich
                       Departement of Clinical Psychology
                       Schmelzbergstrasse 40
                       CH-8044 Zurich
                       Tel.: 0041 1 634 30 86
                       e-mail: vonwyl@klipsy.unizh.ch

                                          ABSTRACT

        Four qualitative approaches in psychotherapy process research are presented. The first
three approaches work with therapeutical transcripts. They focus on language: metaphors,
narratives or conversation. The last project present multivariate time series analyses based on
patients‗ as well as therapists‘ therapy session reports.




                                               52
Paper in Panel - Panel Session 14

Title:                 The Change of Patient‘s Metaphors During Psychotherapy

Author:                Michael B. Buchholz

Address for Correspondence:

                       Michael B. Bucholz
                       Friedländer Weg 11
                       D-37085 Goettingen
                       Germany
                       phone: ++49 551 5005 278
                       phone: ++49 171 2689 613
                       e-mail: buchholz.mbb@t-online.de


                                          ABSTRACT

         Metaphors are a powerful tool in psychotherapeutic dialogue. Therapists and patients are
using them while interacting with each other. The change of metaphors for such central domains
as self, interaction, and therapy can be seen as an indicator for therapeutic change. A 30-hour
therapy is evaluated along these guidelines by qualitative analysis. The theoretical rationale is
cognitive linguistics as outlined by Lakoff and Johnson which gives a useful and comprehensive
understanding of what metaphor is and how it works.




                                              53
Paper in Panel - Panel Session 14

Title:                 Narratives as Dynamic Self-Presentations in Psychotherapeutic Dialogue

Author:                Brigitte Boothe

Address for Correspondence:

                       Brigitte Boothe
                       Psychological Institut of the University of Zurich
                       Departement of Clinical Psychology
                       Schmelzbergstrasse 40
                       CH-8044 Zurich
                       phone: 0041 1 634 30 86
                       e-mail: boothe@klipsy.unizh.ch

                                         ABSTRACT

       A systematic sequential case study of a psychotherapeutic process is presented which is
organized around patient‘s narratives. By narrative analysis, we study the articulated
organization of psychodynamic conflict and its modification during psychotherapy.




                                              54
Paper in Panel - Panel Session 14

Title:                 Narrative Analysis of Relationships in Patients‗ Stories

Author:                Agnes von Wyl

Address for Correspondence:

                       Agnes von Wyl
                       Psychological Institut of the University of Zurich
                       Departement Clinical Psychology
                       Schmelzbergstrasse 40
                       CH-8044 Zurich
                       phone: 0041 1 634 30 86
                       e-mail: vonwyl@klipsy.unizh.ch

                                          ABSTRACT

        Analyzing 30 patients stories told in the course of therapy two different main patterns of
interaction between the figure of the narrator and other figures are found. One pattern,
―searching for relationship‖, shows one or two other actors beside the narrator himself. The
other pattern, ―support and dependency‖, shows mostly one ore no other actor. These patterns are
compared with other results of the narrative analysis and with the diagnose of the patients.




                                              55
Paper in Panel - Panel Session 14

Title:                  The Interative Production of Transference Resistance

Author:                 Ulrich Streeck

Address for Correspondence

                        Ulrich Streeck
                        Herzberger Landstr. 53
                        D-37085 Goettingen
                        Germany
                        phone: 0049 551 5005 210
                        fax: 0049 551 5005 301
                        e-mail: ustreeck@t-online.de

                                           ABSTRACT

        The first version of the concept of resistance as a force of the patient against which Freud
had to summon psychic work already names an interactive process. The examination of a
therapeutic dialogue by means of conversation analysis may show how transference resistance is
not just embedded in the interpersonal relationship but is a co-production of patient and
psychotherapist created by verbal and gestural means with which both participants handle their
interaction. What is called transference resistance of the patient reveals – in a certain sense – an
elaborated interative competence.

       Ways and means of interactive production are described with a micro analysis of
sequences from an psychodynamic psychotherapy of a patient with the diagnosis of compulsive
personality disorder.




                                                56
Paper in Panel - Panel Session 14

Title:                  The Sequential Flow of Psychotherapy: A Time Series Approach to Study
                        Therapy Process

Authors:                Wolfgang Tschacher and Klaus Grawe

Address for Correspondence:

                        Wolfgang Tschacher, PD Ph.D.
                        University of Bern Psychiatric Services
                        Laupenstrasse 49
                        CH-3010 Bern
                        tschacher@spk.unibe.ch
                        fax +41 31 382 9020

                                           ABSTRACT

        In an ongoing project we examine the sequential flow of psychotherapy. In this present
study, multivariate time series analyses based on patients' as well as therapists' therapy session
reports were implemented. Drawing on the extensive data set of the Bern psychotherapy study,
the courses of N=91 psychotherapies were analyzed in this way.

        The sample consists of various therapy modalities, namely cognitive behavior therapy,
client-centered and heuristic psychotherapy, and schema-oriented psychotherapy which
combined insight and mastery-oriented procedures. The therapies included were selected
exclusively on the basis of the number of sessions (the criterium was a minimum of 20 sessions
per therapy; the mean duration of therapies in this sample was approx. 40 sessions).

         We first applied principal component analysis to condense the session report items into a
set of factors which then served as the basis for further analysis. Four factors were found:
'Coping capacity', 'commitment of patient', 'therapeutic bond' and 'therapist competence'. The
time series analyses were then conducted using the state space approach; the analyses yielded a
dynamical model for the time-lagged interrelations of these factors in each of the 91 therapy
courses.

        Results show that coping capacity was the core factor in the sequential flow of the
therapies investigated here. Changes of coping capacity at any session t significantly preceded
changes in all the other factors at session t+1. This time-lagged association may be cautiously
interpreted as a causal link.

       In a further step, the relationship of this dynamics with therapy outcome was investigated.
This addresses questions such as, "Which sequential model is found in therapies with the best
outcome?" and "Do different therapy modalities have different models?" were investigated.




                                                57
Paper Session 1

Title:                  Systematic Treatment Selection for Long-Term Psychodynamic
                        Psychotherapy. Results from a Prospective Longitudinal Study in 25
                        Psychotherapists in Private Practice

Authors:                Carl E. Scheidt, Karin Seidenglanz, and Michael Wirsching

Address for Correspondence:

                        Carl E. Scheidt
                        Department of Psychosomatics and Psychotherapeutic Medicine
                        University Hospital of Freiburg
                        Hauptstr. 8
                        79104 Freiburg, Germany
                        Phone: 49-761/270-6512
                        Fax: 49-761/270-6885
                        e-mail ces@pss1.ukl.uni-freiburg.de

                                           ABSTRACT

        Treatment selection for long-term psychodynamic psychotherapy is a complex and often
idiosyncratic decision, which is influenced by a variety of patient and therapist variables (Beutler
and Clarkin 1990). In a prospective longitudinal study we investigated treatment selection for
long-term psychodynamic psychotherapy in 25 psychotherapists in private practice. Treatment
selection processes were studied on three levels: 1) Acceptance for psychotherapy or referral to
other therapists or therapeutic institutions after the initial assessment. 2) Acceptance for
long-term (50 sessions or more) or for short-term psychotherapy (25 sessions or less)? 3)
Termination or continuation of psychotherapy after 25 sessions.

        215 patients in 25 private psychotherapeutic practices participated in the study. 79 of
these were seen only for initial assessment. 68 patients were accepted for long-term
psychotherapy immediately. Additional 68 patients were taken into short-term psychodynamic
psychotherapy. Based on a comparison of these groups patient characteristics and features of
the therapists assessment are described which predict the decision for treatment selection.

        After termination of short-term psychotherapy a substantial proportion of the patients
continued in long-term psychotherapy (with the same therapist). Which therapies were finished
after 25 sessions and in which therapies the treatment plan was changed and the therapy
continued? Based on these data the issue of an adaptive approach to treatment selection will be
discussed. Empirical evidence on the issue of treatment selection is of crucial importance in order
to convince health care insurance companies that the available therapeutic resources are used
rationally.




                                               58
Paper Session 1

Title:                  Therapist Factors as Predictors of Intervention Profiles in General
                        Hospital Mental Health Care

Authors:                Barbara Stein, Thomas Herzog & the European Consultation Liaison
                        Workgroup

Address for Correspondence:
                    Dept. of Psychosomatics and Psychotherapeutic Medicine,
                    University Hospital, Hauptstr. 8, D-79104 Freiburg, Germany
                    e-mail:stein@pss1.ukl.uni-freiburg.de

                                             ABSTRACT
        The generic model of psychotherapy emphasizes the influence of input factors on the
process and outcome of psychotherapy. Beside patient and therapist variables external factors
like the therapeutic setting or the service delivery system are relevant context conditions. In a
naturalistic field study of mental health care delivery in the general hospital by psychiatric and
psychosomatic consultation liaison services (CL) we studied the impact of therapist, patient and
contextual input factors on therapeutic intervention patterns. Although mental health care in the
general hospital is highly structured by the limitating factors of the hospital´s setting, there is an
enormous variety in diagnostic and therapeutic action for patients with similar clinical problems.
The CL therapists, mostly psychiatrists with intensive psychotherapy training, see the referred
patients only for 1 to 3 sessions focusing on patient, her/his relatives, and consultees for
diagnostic and treatment aspects.
        CL therapists filled in a comprehensive questionnaire (sociodemographic data,
professional training and activities, CL practice, therapeutic goals, theoretical orientation, etc.).
During a one-year period, consecutive CL patient episodes were reliably documented. Each
patient was described by sociodemographic, anamnestic and administrative data, diagnoses, Cl
interventions and health status. We focused on a subsample of patients with neurotic, stress
related or somatoform disorders (ICD-10 F4, F54), who had comparable level of psychosocial
disturbances (Global Assessment of Functioning Scale (GAF) > 30). Based on central patient,
therapist and referral characteristics, a logistic regression was performed to identify factors
predicting therapist intervention.
        92 CL therapists of 48 CL services in 11 European countries provided 2.137 consultation
episodes. The therapists differed widely in professional experience, psychotherapeutic and CL
specific training, profiles of professional activities, perception of the CL practice and theoretical
orientations. Exclusively psychosocial interventions for patients with neurotic, stress related or
somatoform disorders could be more explained by therapist variables (professional experience
and activities) than patient variables (age, GAF) or referral characteristics (urgency of referral,
time for episode). All together, however, they explained 10 % of the variance. The results
underline the role of professional experience in adapting interventions to the needs of patients.
Furthermore, the large amount of variance remaining unexplained points to the impact of the
service delivery system and local practice on intervention patterns. Further research is needed to
explore relevant background factors for therapeutic processes.
Paper Session 1

Title:                  Attitude to Psychotherapy by General Practitioners and its Impact on


                                                59
                        Willingness and Ability to Identify Neurotic Disorders. An Empirical
                        Study in Two Stages

Authors:                Brigitte Montau, Dan Pokorny, and Wolfram Ehlers

Address for Correspondence:

                        Brigitte Montau (c/o Dan Pokorny)
                        Dept. of Psychotherapy and Psychosom. Medicine, Univ. of Ulm
                        Am Hochstraess 8, D-89081 Ulm, Germany
                        email Brigitte Montau c/o:pokorny@sip.medizin.uni-ulm.de

                                            ABSTRACT

         The study investigates the association between the attitude of general practitioners to the
field of psychotherapy on the one hand and on the other hand their willingness to identify
neurotic disorders as well as ability to identify them correctly.
         In the first stage of the study, all male general practitioners in one German city not having
a special additional psychotherapeutic training were asked to fill out the questionnaire
concerning attitude to psychotherapy. The psychometric analysis of 57 questionnaires allowed
the global scale of general attitude to be constructed. We chose 4 practitioners with extremely
high scores on the scale who are considered (additionally to their somatic training) open to
psychotherapy. We call them ÑP-practitioners. On the other extreme of the scale we chose 4
practitioners with extremely low scores who we considered to be concentrated solely on somatic
questions. We call them ÑS-practitioners.
         In the second stage of the study these 4+4 practitioners completed a short questionnaire
about their judgment of total 409 patients who visited the surgery on selected days: Were there
conspicuous psychotherapeutic disorders and was the treatment being recommended? It was
found that all P-practitioners diagnosed disorders and recommended treatment more frequently
than all S-practitioners. This was interpreted as an association between attitude and willingness.
         Additionally, each patient was independently investigated by the researcher with the
screening questionnaire for neurotic disorders BFB. The ability was operationalized as an
agreement between results of the screening instrument and the practitioners judgment. The
agreement was measured by the kappa coefficient and we have proposed a procedure for the
statistical comparison of kappa coefficients for this purpose. P-practitioners generally reached a
significantly better agreement then S-practitioners. Hence, we have found the association
between attitude and ability, too. However, we will demonstrate that the Psychotherapy friendly
attitude itself does not lead to the high ability automatically.
         Studies such as the present raise questions on the communication between general
practitioners and psychotherapists, application of screening instruments in general surgery,
quality control and psychotherapeutic educational practices in the medicine.

Paper Session 1

Title:                  Provision of Psychotherapy and Other Mental Health Services by Primary
                        Care Physicians

Authors:                Michael Scherer, Kenneth Howard and John Lyons


                                                60
Address for Correspondence:

                       Michael Scherer
                       Dept. of Psychiatry, University of California
                       400 Parnassus, ACC846
                       San Francisco, CA 94143-0348, U.S.A.

                                          ABSTRACT

       Training for primary care physicians increasingly emphasizes the administration of
"behavioral" or mental health care. Relatively little is known, however, about the actual
provision of mental health services and, more specifically, psychotherapy services by primary
care physicians (PCPs). This paper uses the health plan database of a large corporation to
examine the types of mental health care provided by primary care practitioners and the
characteristics of those who receive these services.

        Between 1990 and 1994, 4% of all individuals who sought any type of mental health care,
and 7% of individuals who sought psychotherapy services, received such care exclusively from
their PCP. Findings related to the mental health care provided to these individuals are
compared with the practices and patient population characteristics of psychologists and
psychiatrists. Comparisons are also made for individuals receiving services from more than one
of these providers.

        We examined the frequency of different types of mental health services provided, rates
for various doses of psychotherapy administered, differences in the medical and psychiatric
composition of respective patient populations, and patient characteristics between the different
provider types.

        Findings suggest that significant differences exist in the health, medical expenses and
ages of individuals who seek mental health care exclusively through PCPs. Differences also
exist across provider types in the comorbid medical conditions of the patients they treat and in
the diagnostic compositions of the respective patient populations. For individuals receiving
psychotherapy services, PCPs tend to vary least in their administration of psychotherapy services
when compared with psychiatrists. PCPs administer fewer sessions on average than
psychologists, however. PCPs see a greater percentage of their patients for one session only
compared to both psychiatrists and psychologists. Psychologists retain significantly more
patients for moderate treatment doses than PCPs. As therapy dose increases beyond 8 sessions,
however, percentages of patients retained become more similar across provider types.
Paper Session 2

Title:                 Evidence of Structural Change in Long-Term Psychodynamic
                       Psychotherapy

Authors:               Jeremy W. Bloomfield, Zoran Martinovich, and Kenneth I. Howard

Address for Correspondence:



                                               61
                       Jeremy W Bloomfield, MA
                       Chicago School of Professional Psychology
                       806 South Plymouth Court
                       Chicago, IL 60605
                       USA

                                           ABSTRACT


        This study examined presenting therapeutic assets and their patterns of change in
time-unlimited psychodynamic psychotherapy using Daskovsky‘s Therapeutic Assets
Questionnaire (TAQ, 1988). This questionnaire is composed of five therapist-rated scales
measuring (1) capacity to delay gratification, (2) psychological mindedness, (3) level of object
relations, (4) willingness to engage in treatment, and (5) degree of distress. The scales themselves
were derived from research on qualities associated with engagement and effective outcomes in
psychoanalytically-oriented therapies. The first three scales represent structural qualities not
traditionally thought of as amenable to change in short-term treatments.

        As part of the Northwestern-Chicago Psychotherapy Research Program, a naturalistic
study of psychotherapy outcomes and processes, therapists were asked to complete the TAQ at
an intake assessment, on a fixed schedule of session numbers during treatment, and at
termination. Patterns of change in the TAQ scales were examined for short-term cases (between
8 and 20 sessions), medium-term cases (between 20 and 40 sessions), and long-term cases (more
than 40 sessions). Repeated measures analyses within each of the treatment duration groups
suggested that psychological mindedness and level of object relations do not show short-term
change, but do show improvement in the latter phases of treatment for the long-term cases. The
TAQ scales at intake did not predict treatment response as measured by a multi-item symptom
inventory. However, the pattern of change suggests that these scales may be meaningful
measures of long-term outcomes in traditional psychodynamically-oriented therapies.




                                               62
Paper Session 2

Title:                 Patterns of Change in Coping Style in Time-Unlimited Psychodynamic
                       Psychotherapy

Authors:               Renanah Kaufman, Zoran Martinovich, and Joanna S. Burg

Address for Correspondence:

               Renanah Kaufman
                      Department of Psychiatry & Behavioral Sciences
                      Division of Psychology
                      Northwestern University
                      303 E. Chicago Avenue, Suite 9-217
                      Chicago, IL USA 60611

                                          ABSTRACT

       This study examined presenting coping styles and their patterns of change in
time-unlimited psychodynamic psychotherapy using Tobin‘s Coping Strategies Inventory (CSI,
1985). This inventory asks persons to rate coping strategies for a personally stressful event.
The items load on eight primary scales: Problem solving, cognitive restructuring, express
emotions, social contact, problem avoidance, wishful thinking, self-criticism, and social
withdrawal. The CSI includes secondary scales assessing whether coping styles are problem vs.
emotion focused and engaging vs. disengaging.

       As part of the Northwestern-Chicago Psychotherapy Research Program, patients were
asked to complete the CSI before, during, and at the termination of treatment. Based on a
sample of 492 cases, prior to a first session, patients were more likely to use the emotion-focused
disengagement strategies (social withdrawal and self-criticism) than the problem-focused
engagement strategies (problem solving and cognitive restructuring). The two problem-focused
disengagement strategies (wishful thinking and problem avoidance) were used at different rates.
Wishful thinking showed reliably higher rates than all but one other primary scale and problem
avoidance showed lower rates than all the other primary scales.

        Problem solving and cognitive restructuring showed the greatest increase during
treatment for both moderate and long-term cases, but did not show any signs of increased use
among patients who terminated within the first 10 sessions. With respect to problem avoidance
and wishful thinking, both long-term and short-term cases showed a reliable decrease. For the
long-term cases, however, this decrease was only noted after at least one year of weekly therapy.
The emotion-focused coping strategies did not show reliable change. Implications of coping
style assessment for the evaluation of psychotherapy outcomes are discussed.




                                               63
Paper Session 2

Title:                 Patterns of Outcome Change During Interpretive Versus Supportive
                       Forms of Brief Individual Psychotherapy

Authors:              Anthony S. Joyce, John Ogrodniczuk, William E. Piper, and Mary
                      McCallum

Address for Correspondence:

                      Anthony S. Joyce
                      Department of Psychiatry
                      University of Alberta
                      8440 112 Street
                      Edmonton, Alberta
                      CANADA T6G 2B7


                                          ABSTRACT


         We recently completed a comparative trial of two forms (interpretive, supportive) of
short-term, time-limited individual (STI) psychotherapy. Seventy-two outpatients completed
each form of STI treatment; the comparative trial thus involved a total of 144 therapy completers.
The trial also assessed the influence of two patient personality variables, quality of object
relations and psychological mindedness, on the process of change. On five occasions during
their 20-session treatment (at sessions 4, 8, 12, 16, and 20), patients were asked to complete the
Compass outcome measure. The Compass instrument assesses three dimensions (well-being,
symptoms, life functioning) that reflect different phases of the psychotherapy change process
(i.e., remoralization, remediation, and rehabilitation, respectively). We were interested in
whether the patterns of change across the five assessments on these dimensions could be
differentiated by patient personality, form of therapy, or the interaction between patient
personality and form of therapy. The Compass data were analyzed using a hierarchical linear
modeling approach. The results of the analysis are expected to illuminate differences in the
change process associated with differences in patient personality and the interpretive versus
supportive approaches to STI therapy.




                                              64
Paper Session 2

Title:                 The Trondheim Psychotherapy Study: The Long-Term Effects of
                       Short-Term Dynamic and Cognitive Psychotherapies for Cluster C
                       Personality Disorders

Authors:               Martin Svartberg, Tore C. Stiles, and Michael H. Seltzer

Address for Correspondence:

                       Martin Svartberg
                       Department of Psychiatry and Behavioural Medicine
                       Norwegian University of Science and Technology
                       P.O. Box 3008, Lade
                       N-7002 Trondheim
                       Norway
                       E-mail: martin.svartberg@medisin.ntnu.no

                                          ABSTRACT

       This presentation reports on the long-term effects of short-term anxiety-regulating
therapy (START; McCullough-Vaillant, 1997) and cognitive therapy (CT; Beck, Freeman, &
associates, 1990; Young, 1990) in the treatment of Cluster C personality disorders.

        Fifty patients meeting the DSM-III-R criteria for any of the Cluster C personality
disorders were randomized to one of the two treatment conditions. Most patients also met criteria
for an Axis I disorder, typically depression or anxiety. All treatments were 40 sessions long, were
conducted in ordinary outpatient settings, and therapists in both conditions were experienced
psychiatrists and psychologists receiving weekly manual-guided supervision.

        To assess outcome a variety of measures were employed, including the Symptom
Checklist-90 (SCL-90; Derogatis, 1977) and the Inventory of Interpersonal Problems (IIP;
Horowitz et al., 1988). Measures were administered pretherapy, midtherapy, and at termination
as well as 6, 12, and 24 months posttreatment. Growth curve analyses (i.e., Hierarchical Linear
Models, HLM) were performed to examine (1) rates of improvement during and after treatment,
(2) differential treatment effects, and (3) correlates of improvement.

       Results for the SCL-90 and the lIP pertaining to the follow up period, in particular, will
be presented. The clinical significance of the findings will be emphasized.




                                               65
Paper Session 3

Title:                  CCRT‘s Measure of ―Wishes‖: An Analysis of the W Categories Through
                        Linguistic Organization of Meanings

Authors:                Nino Dazzi, Alessandra De Coro, and Silvia Andreassi

Address for Correspondence:

                        Nino Dazzi
                        Università degli Studi di Roma ―La Sapienza‖, Facoltà di Psicologia
                        Via dei Marsi, 78 - 00185
                        Roma (Italia)

                                           ABSTRACT

        CCRT, as a guided measure of transference, captures a ―central relationship pattern‖
(Luborsky, Luborsky, 1995). Such pattern, originating from primary relationships and not
sufficiently integrated in the mental organization of an adult, is likely to constitute the basic
theme of narratives and dreams in psychotherapy until it gradually changes in the course of the
therapeutic process.

        From this point of view, the W component (defined by the Authors as ―wishes, needs and
intentions‖) acquires a certain emphasis, as it should represent the ―opening movement‖ of such
interactional anticipation which act as a guide to emotional and behaviour regulation in
interpersonal interactions.

       Empirical research, however, has shown that the W component undergoes fewer, if any,
change through psychotherapy process. This appears to be contrasting with current
psychodynamic clinical assumptions: through successful psychotherapies, patients are supposed
to become able to differentiate wishes and intentions in different relational contexts, and to
organize more flexible relational patterns on the basis of their modified expectations.
Luborsky and Crits-Christoph (1990) have already pointed out that the ―wish‖ component
requires a higher level of inference for the attribution of standard categories. In a previous study
we argued that a more detailed analysis of transformations from tailor-made to standard
categories should be required in order to operationalize clinical inference in the definition of W
categories (Dazzi et al., 1997).

        In this presentation, we propose that different linguistic formulations correspond to
different cognitive-emotional organizations of the same affective interactional meaning (as it is
―condensed‖ by a single standard category). We have studied tailor-made and standard categories
in a sample of 53 sessions from the initial phase of 20 psychotherapies in Italian language; we
will show the results of this study, giving some tentative suggestions for new standard categories.




                                                66
Paper Session 3

Title:                 Subject Object Affective Connections: A Linguistic Scale for Assessing
                       Internal Working Models of Self With Other

Authors:               Andrea Seganti, Giorgio Carnevale, Roberto Mucelli, and Luigi Solano

Address for correspondence:

                       Andrea Seganti
                       Italian Psychoanalytic Society
                       via Francesco Denza 21
                       00197 Roma, Italy
                       e-mail: a.seganti@iol.it

                                          ABSTRACT

        Verbs carry with them four types of sensuous images of self with other. To "hate" as to
"delude", for example, evoke a negative image of both self and other (S-/O-). To"love" as to
"like" evoke a shared positive image (S+/0+). To "hit" as to"soothe" evoke positive images of
the self and a negative or needing image of the other (S+/O-). To "loose" as to "undergo" evoke
negative images of the self in respect of positive images of the other (S-/O+). In the last two
cases opposite images of self with other are experienced by the speaking subject, depending
whether these verbs appear in 1st person or in 2nd/3rd person phrases.

        A computerized Scale for word to word assessment of Subject Object Affective
Connections was created (Seganti et al, 1998) for assessing dominant images of self with other
within patients' discourse. The Scale assesses the intensity and the direction of each
subject/object connection within each single phrase containing a verb. The output of the Scale is
expressed by the percentage (independently from the length of the text) of each type of
subject/object connection along the text.

        The Scale was applied to the assessment of written "worst and best"episodes of more than
100 subjects. Two separate experiments demonstrated a significant statistical power of the Scale
in discriminating among different attachment groups as assessed with Hazan & Shaver's self
report and with Bartolemew's and Horowitz's recently modified version. Stable and unstable
correlation of images of self with other at one week and four month of distance were examined in
a sample of 100 students and compared with the results from a sample of 100 psychosomatic
patients (anorexia, amenorrea, lupus, and alopecia).




                                              67
Paper Session 3

Title:                  Assessing Patient-Therapist Interactions and Their Change: A
                        Time-Series Approach

Authors:                Shuki Cohen and Enrico E. Jones

Address for Correspondence:

                        Shuki Cohen
                        360 Minor Hall
                        UC Berkeley
                        Berkeley, CA 94720-2020 USA
                        Email: shuki@pinoko.berkeley.edu

                                           ABSTRACT

        The role of the interpersonal interaction between therapist and patient has been the focus
of recent theories about the nature of therapeutic action and patient change. Jones‘s (1997)
Repetitive Interaction Structure construct, which refers to repeated, mutually influencing
interactions between therapist and patient, attempts to bridge therapeutic action by insight and by
relationship. RISs provide a way of formulation and empirically operationalizing those aspects of
the analytic process that have come the be termed intersubjectivity,
transference-countertransference enactments and role responsiveness. In this view of therapeutic
action, insight and relationship are inseparable, as the one can not take place without the other.
        Computerized text analysis was used to establish the presence of interaction structure in
the verbal behavior of therapist and patient in three longer-term psychodynamic therapies. The
study‘s method was based on principles derived from linguistics and from time series analysis.
Time series analysis is a quantitative technique that can assess changes in measured parameters
over time. Following established procedures in linguistic research, the verbal utterance, which
includes everything the person said in his/her turn, was used as the basic unit for analysis. The
individual treatment session was used as a natural time frame for computational purposes. First,
verbatim transcripts of therapy hours were ―read‖ by a set of computer programs that tally up the
occurrence of linguistic markers within the speech of each interlocutor. Linguistic markers are
specific speech characteristics that capture key aspects of the speaker‘s meaning. These markers
were extracted from the linguistics literature of colloquial English, and included the number of
words uttered by each person, verb tenses, time phrases, length of pauses and silences, and
specific content markers pertinent to the case at hand (mother, guilt etc.).
        The resulting series of markers level were tracked over treatment sessions, and reflected
the fluctuations of these particular linguistic markers across time. A correlation-based time series
analysis was then carried out to detect any significant co-occurrence of linguistic markers. We
uncovered several repetitive verbal interaction patterns in a number of case transcripts. Some of
those patterns were identified as verbal correlates of RISs revealed independently using the
Psychotherapy Process Q-sort (Jones, 1991; Jones & Price, 1998). This new content-analytic
framework, however, enabled us to trace these patterns throughout the sessions in a
moment-by-moment time resolution. This improved sensitivity was used to estimate the
frequency and intensity of these client-therapist repetitive interaction structures, and the increase


                                                68
and decrease in the RIS level was then related to the patient‘s progress in treatment.
Paper Session 3

Title:                  Research Foundations of a Narrative Approach to Psychotherapy

Authors:                Oscar F. Goncalves and Paulo P. P. Machado

Address for Correspondence:

                        Oscar F. Goncalves
                        Universidade do Minho
                        Departamento de Psicologia
                        Campus Gualtar
                        4700 BRAGA
                        PORTUGAL
                        Tel# +351-53-604241
                        fax4# +351-53-678987
                        e-mail: goncalves@iep.uminho.pt

                                           ABSTRACT

        Since its early formulations psychotherapy has been conceived as a discursive
phenomena. The notion of ‗talking cure' has been present in Freud's early work and since then
has generalized to all the psychotherapeutic approaches. Roger‘s formulation of the necessary
conditions for personality change constituted the first impetus for studying psychotherapy as a
language phenomena. Not differently, more behavioral oriented researchers have dedicated an
extended research program on the contingent use of verbal modes across the therapeutic process.
More recently research and theoretical formulations of the therapeutic process suggested that we
must move from the microscopic study of verbal modes to a macroscopic approach in which
these modes are organized into narratives. Narratives are conceived, in this perspective, as the
basic instruments for meaning making. In this article the research on narrative processes in
psychotherapy is reviewed and discussed in terms of its implications for the theory and practice
of cognitive narrative psychotherapy. Additionally some of the main data coming from research
projects on cognitive narrative psychotherapy are presented.




                                               69
Paper Session 4

Title:                 Reliability of Therapist Formulation Choice in Interpersonal
                       Psychotherapy

Authors:               John C. Markowitz and Andrew Leon

Address for Correspondence:

                       Cornell University Medical College
                       445 East 68th Street, Suite 3N
                       New York, NY 10021 USA
                       fax: 212 746-8529
                       e-mail: jcmarko@mail.med.cornell.edu

                                          ABSTRACT

         Research on IPT, unlike most psychotherapies, has focused almost entirely on outcome
rather than process. This work has demonstrated the efficacy of IPT for major depression,
bulimia, and other diagnoses. Less is known about how IPT works. This study addresses a basic
process of IPT by examining for the first time whether therapists agree in formulating a treatment
focus based on audiotaped initial interviews. Given that there are only four IPT problem areas
(grief, role dispute, role transition, interpersonal deficits), we hypothesized high levels of
therapist agreement. Methods: Three trained IPT therapists blindly rated audiotapes (n=20) of
initial anamnestic sessions with depressed patients. Using the Interpersonal Problem Area Rating
Scale (IPARS), they rated the presence or absence of each of the four IPT problem areas as well
as the salient area for a treatment focus. Interrater agreement was assessed using kappa. Results:
Full results will be presented at the Braga conference. Interim analyses on the first 9 tapes found
a mean kappa for agreement on problem areas of .829 (s.d.= .237), median kappa 1.000. For
agreement on a treatment focus, = 1.000. Conclusions: As anticipated, trained IPT
psychotherapists had high agreement in recognizing interpersonal problem areas and choosing a
potential treatment focus.




                                               70
Paper Session 4

Title:                 Interpersonal Problems in Psychiatric Outpatients With and Without
                       Personality Disorders

Authors:               Bo E. Vinnars, Kristina Norén, Barbro Thormählen, Carol Foltz, Jacques
                       P. Barber, Robert M. Weinryb

Address for Correspondence:

                       Bo Vinnars
                       Department of Psychiatry, M56
                       Huddinge University Hospital
                       S-141 86 Huddinge, Sweden
                       Email: Bo.Vinnars@psyk.svso.sll.se

                                          ABSTRACT

        An alternative diagnostic approach to the DSM approach to personality disorders is the
interpersonal circumplex model. With the development of the Inventory of Interpersonal
Problems (IIP) research in this area has acquired an instrument with excellent circumplex
properties. In order to estimate the interpersonal distinctiveness of the different personality
disorders Gurtman and Balakrishnan (1998) has proposed using a structural summary, which
identifies the important structural parameters of an individual‘s interpersonal profile.

        The purpose of the study was to investigate how much of the interpersonal complexity of
the personality disorders that could be explained by the structural summary in the IIP. A Swedish
sample consisting of 356 psychiatric outpatients was used. The patients in the sample have
received a DSM IV diagnosis through a SCID interview and have filled out the IIP-C. Half the
patients had at least one diagnosis of personality disorder. Of the personality disordered patients
half had a comorbidity of at least two personality disorders.

        The calculations of the IIP material were made in three steps. First the structural summary
containing the elevation, amplitude and angular displacement for the standardized scores of each
subscale was estimated. The clinical significance of the profiles for the different personality
disorders will be described. Second the goodness-of-fit, i.e. how well a given profile can be
modeled by its structural summary, was estimated. This is a way of describing the interpersonal
interpretability of a given profile. Third, a simple test of proportion was performed to show how
many of each of the DSM IV personality disorders were situated in each angle location of the
circumplex.




                                               71
Paper Session 4

Title:                  Interpersonal Case Formulation in First Episode Psychosis

Author:                 Susanne Harder

Address for Correspondence:

                        Susanne Harder
                        Department of Psychology, University of Copenhagen
                        Njalsgade 90
                        DK-2300 S
                        Copenhagen, Denmark
                        E-mail Address: Harder@axp.psl.ku.dk

                                           ABSTRACT

        This study was designed to test the reliability of Interpersonal Case Formulation (ICF,
Henry 1996) and to examine the content validity of the method as a measure of relationship
patterns and as a tool for guiding psychodynamic psychotherapy within a population of first
episode psychotic persons (schizophrenic spectrum). The reliability and validity study was based
on case formulations of an unselected 20 month cohort of 6 patients coming from a small
catchment area in Denmark. The ratings from the group of judges fell within the
acceptable-to-good range of reliability. The meaningfulness and usefulness of the Interpersonal
Case Formulation was discussed in relation to interpersonal and object relation theories about
psychosis.

       The study is part of The Danish National Schizophrenia Project - a collaboratory
research project between 12 hospitals in Denmark, financially supported by the Danish
Government. The patients are offered an integrated treatment program consisting of
psychotherapy, family intervention, milieu therapy and medical treatment and are followed for a
period of 5 years.

        During the last 10-15 years there has been a growing research interest in the initial phases
of the development of schizophrenia. One possible background for this is a growing body of
evidence that early treatment may have a substantial influence on the course of the illness in
slowing down or even in some cases stopping the deterioration process and the deepening of the
symptoms of the illness. An integrated treatment program combining biological, psychological
and social interventions is regarded as the optimal treatment. In the Nordic countries
psychotherapy is an important element in integrated treatment programs for persons with
psychosis within the schizophrenic spectrum.




                                               72
Paper Session 4

Title:                 A Survival Analysis of Clinically Significant Change in Outpatient
                       Psychotherapy

Authors:               Edward M. Anderson and Michael J. Lambert

Address for Correspondence:

                       Michael J. Lambert
                       Clinical Psychology Department
                       Brigham Young University
                       272 Taylor Building
                       PO BOX 28626
                       Provo, UT 84602-8626
                       USA

                                         ABSTRACT

        Seventy-five clients attending outpatient therapy at a university-affiliated clinic were
tracked on a weekly basis using the Outcome Questionnaire (Lambert et at., 1996) in order to
determine the number of sessions required to attain clinically significant change (CS). Survival
analysis indicated that the median time required to attain CS was 11 sessions. When current data
were combined with those from an earlier investigation (Kadera, Lambert, and Andrews, 1996),
it was found that clients with higher levels of distress took 8 more sessions to reach a 50% CS
recovery level than clients entering with lower levels of distress. At six-month follow-up, CS
gains appeared to have been maintained. Other indices of change were also examined (reliable
change, average change per session). The implications of these results for allocating mental
health benefits, such as the number of sessions provided through insurance, are discussed.




                                              73
Paper Session 5

Title:                 The Attachment Interview Works by Highlighting the Actual State of the
                       Mind of the Interviewee: Diagnostic and Therapeutic Value of
                       Idealization in Eating Disorder Patients

Authors:               Antonio Ciocca and Carla Candelori

Address for Correspondence:

                       Antonio Ciocca
                       Department of Psychiatry and Psychology
                       University Hospital ―A. Gemelli‖
                       Largo Agostino Gemelli, 8
                       00197 Roma
                       Italy

                                          ABSTRACT

       36 ED patients were interviewed using the IAL form ( Candelori et al,1992) of the AAI
(Adult Attachment Interview : George, Kaplan, and Main,1985). In order to highlight differences
between groups, 12 patients were AN restricting type, 12 AN binge/purging type, and 12 BN.

         We found a high frequency of insecure a. (30 = 83%) in comparison to that of secure a. (6
= 17%). Furthermore, we have noticed that dismissing a. (Ds) is specifically present in An
restricting type, while in BN and AN binge/purging type the preoccupied form (E) prevails.

        Idealization, one of the main scales that characterizes the dismissing stance, shows the
way the subject thinks and judges, which is based on a general idea (semantic level) instead of on
experiences and personal memories (episodic level). We can say that is an index of the capacity
of the mind to set his whole function in an independent way not any longer based on experience
and reality. We discuss the implications of such results in psychopathological and
psychotherapeutic approach to these disorders.




                                              74
Paper Session 5

Title:                 Efficacy of Focused and Time Limited Psychoanalytic Group Therapy for
                       Eating Disorders.

Authors:               Maria Riccio, G. Faragalli, C. La Rosa, and A. Ciocca

Address for Correspondence:

                       Antonio Ciocca
                       Department of Psychiatry and Psychology
                       University Hospital ―A. Gemelli‖
                       Largo Agostino Gemelli, 8
                       00197 Roma Italy

                                          ABSTRACT

       At the ED Unit in the University Hospital ―A. Gemelli‖ in Rome an example of focused
and time-limited psychoanalytic group therapy has been adopted.

       The groups are made up homogeneously by sex, age and symptom; they last a year
(though eventually renewable) and take place once a week for an hour and half. On average the
groups consist of eight people that remain the same during the entire year. The groups are
conducted by one therapist and an observer by means of psychoanalytic method such as
empathetic listening, free associations and interpretive interventions by the therapist.

        The effectiveness of the therapy was controlled and tested not only on the various
symptoms but also on the patient‘s personality and her integration within family or society. The
following tests were respectively used at the beginning and at the end of the treatment: SCID I
and II, Structured Clinical Interview for DSM III R (Spitzer et al,1990); EDI 2, Eating Disorders
Inventory (Garner,1991); DES II, Dissociative Experience Scale (Carlson and Putnam,1993);
BAT, Body Attitude Test (Vandereycken,1995); SCL-90-R, Symptom Check List (Derogatis et
al,1983); FKS, Familien Klima Skalen; FPI-R, Freiburger Personlichkeits Inventar- Revidierte
Fassung (Farhenberg et al,1989).




                                              75
Paper Session 5

Title:                 Perception and Differentiation of Internal States During Severe Starvation
                       and Weight Gain in Anorexia Nervosa - A Pilot Study

Authors:               Almut Zeeck, Thomas Herzog, Armin Hartmann

Address for Correspondence:

                       Dr. med. Almut Zeeck
                       Department for Psychosomatic and Psychotherapeutic Medicine
                       University of Freiburg
                       Hauptstrasse 8
                       D - 79104 Freiburg, Germany
                       E-mail: zeeck@pss1.ukl.uni-freiburg.de
                       FAX: 0761/270-6885

                                           ABSTRACT

        In our specialized treatment setting for eating disorders (1) Anorexia Nervosa patients
with increasing weight gain regulary experience the recurrence of more complex feelings and
access to internal conflicts. For a phase specific treatment planning, it is necessary to describe
this stage more precisely. We used the Toronto Alexithymia Scale (2), which measures
difficulties in discriminating and describing internal states. Patients with Anorexia Nervosa were
shown to have severe difficulties in discriminating and describing internal states compared to
patients with other mental disorders or normal controls (3) and are seen as alexithymic. Most of
the studies suggest alexithymia to be a personality trait rather than a state, induced for example
by starvation or defence, but we found no study measuring alexithymia over several time points
during weight gain and treatment process.

       In this pilot study we addressed the following questions: Are alexithymic features related
to weight of patients (body mass index)? Are there changes in alexithymic features over the
course of weight gain and treatment process?

       At the time of submission of the abstract we had examined n=24 anorexic patients (DSM
IV), which were treated on a specialized inpatient unit for eating disorders (1), using the
TAS-scale (Toronto-Alexithymia Scale, German version, (2)), the SCL-90 and the EDI (Eating
Disorder Inventory), being administered every 4 weeks. Up to this point 14 patients were
followed over the course of treatment and had between three and ten time points of measurement.

        Findings will be discussed compared to other studies, in terms of clinical implications and
the alexithymia construct.




                                               76
Paper Session 5

Title:                 Modeling Individual Change: Growth Curve Modeling and Clinical
                       Significance: Results from The Freiburg Psychotherapy Process Outcome
                       Study

Authors:               Armin Hartmann and Thomas Herzog

Address for Correspondence:

                       Armin Hartmann
                       Abt. für Psychosomatik und Psychotherapeutische Medizin
                       Hauptstrasse. 8, 79108 Freiburg
                       Germany
                       e-mail: ah@pss1.ukl.uni-freiburg.de,
                       FAX: 0049-761-270-6885,
                       Tel: 0049-761-270-6872

                                           ABSTRACT

        Objective: Growth curve analysis (Bryk et al., 1992; Bryk et al., 1994) is slowly
becoming a standard statistical tool in psychotherapy research. It promises to overcome some
methodological problems of standard analysis procedures like ANOVA and may provide
another, probably more informative perspective on data. A commonly underestimated problem of
growth curve analysis is the choice of the so called level-1 model. Depending on the chosen
model, some individual data may be severely misfit. We know that patients do follow different
outcome trajectories and therefore the analysis must account for that fact. We will present
suggestions for the solution of this methodological problem. Also the interpretation of curve
parameters in terms of individual outcome is sometimes unclear. We suggest, that the results of
growth curve analysis should be interpreted in the light of clinical significance.
        Method: From the Freiburg Psychotherapy Process Outcome Study (Herzog et al.,
submitted) (N=64 patients, all female, all DSM-IV 307.51 ―Bulimia Nervosa‖, treated with 25
sessions of manualized (Herzog et al., 1997) outpt. indiv. psychotherapy, combined symptom-
and conflict oriented treatment) 55 trajectories of the outcome measure ‖Bulimia‖ (Eating
Disorders Inventory, Scale 2) were analyzed in varying growth curve analyses. The results of
growth curve analyses are combined with the methods of clinical significance.
        Results: There are distinct sub-samples of patients following different outcome
trajectories. We identified linear, delayed linear, logarithmic and inversely u-shaped trajectories.
Outcome trajectories were closely linked to overall outcome determined by methods of clinical
significance. Patients following linear and logarithmic outcome trajectories had the greatest
chance to end therapy successfully.
        Conclusions: Growth curves should not be fitted for individual cases, where the
differences between time points lie within the range of unreliable change. The decision rules for
individual curve shape identification should be linked to measures of clinically significant
change. Choosing a level-1 model for a whole (study) population is not a trivial task.
Sometimes it may be reasonable to fit different level-1 models for sub-samples of patients. There
are solutions for the problem of the integration of growth curve parameters stemming form
different models.
                                               77
Paper Session 6

Title:                 Cocaine Abusers and Their Families: A Study on Identification Processes
                       in 143 Triads

Authors:               Ricardo T. Pinheiro, Manuela Fleming, Paulo L. R. Sousa, and Ricardo
                       A. Silva.

Address for Correspondence:

                       Ricardo T. Pinheiro
                       NUPPLAC – Research Center on Psychoanalysis and its Applications,
                       School of Psychology / Medicine, Universidade Católica de Pelotas, Rua
                       Barão de Butuí, 281/901 CEP 96010 – 330, Pelotas – RS – Brazil

                                          ABSTRACT

         The mental functioning of cocaine abusers and its association with their family group is
a real field of investigation that needs new and elucidating empirical studies with better data
about this problem from an interrelationship point of view. The objective of the study is to verify
the existence of a model of identification in the familial mental processes in cocaine abusers.
With a sample of 402 individuals, we have 134 triads (father, mother and son) divided in two
groups: 67 triads with a male son that is a cocaine abuser who consulted in a specialized
institution and 67 triads, as a control group, chosen from the community and properly gauged.
Rorschach Test modified by Lerner‘s Defence Scale, Personal Authority in the Family System
and Self Report Measure of Family Functioning are the three investigation tools we used.
Quantitative findings were very consistent with strong identification processes, specially among
father and the son addicted to cocaine, stressing the importance of the paternal function in this
problem. In the crossed studies among fathers the Odds Ratio to projective identification was
8.66 to 1 which points to a strong correlation between cocaine abuse and mental split and
primitive functioning of parents. We also used two systemic instruments, the findings of which
were mainly fusion, triangulation and emmeshment, pointing to a trend in primitive models of an
interpersonal relationship, such as inversion of functions, rupture of limits, stressing the
possibility of organizing the perverse triangle of Haley, which are observed in the triads with
cocaine abuse in the son. Our conclusion using empirical methods was able to corroborate the
data that have been found from clinical studies using isolated cases. We find that identification
phenomena and its dysfunction in the familial structure are the main mechanism in the mental
organization of cocaine dependence.




                                               78
Paper Session 6

Title:                  Termination from Mental Health Services with Adolescents

Author:                 Diane Mirabito

Address for Correspondence:

                        Diane Mirabito
                        Adolescent Health Center, Mount Sinai Medical Center
                        312 East 94th Street
                        New York, New York 10128, USA

                                            ABSTRACT

       This study examined the termination process from mental health services with
adolescents at an urban, comprehensive Health/Mental Health Center. The research design
combined quantitative and qualitative methods to explore the phenomenon of both planned
(acknowledged) and unplanned (unacknowledged) terminations. The study explores the
following questions:

1.       How does termination occur? Is termination planned or unplanned      (acknowledged or
         unacknowledged)?
2.       What are the reasons for planned and unplanned terminations?
3.       What variables are associated with planned and unplanned terminations?
4.       How do adolescents experience the ending process in planned and unplanned
         terminations?

        The integration of quantitative and qualitative findings derived from this study provides
an expanded and updated conceptualization of termination that can be used to enhance clinical
practice and more effectively plan and deliver mental health services to inner-city adolescents.

        Quantitative data was collected, with an instrument developed by the researcher, from
100 closed agency records of individual, family, and group psychotherapy. Descriptive data is
provided pertaining to the dependent variables: type of termination (planned or unplanned) and
case outcome (improved or unimproved), and the independent variables: demographic and
referral characteristics; psychosocial risk factors; characteristics of treatment (length, modality);
and characteristics of the termination of treatment (circumstances and reasons for termination).
Findings regarding the relationships between these variables are also provided.

       Qualitative data was obtained from in-depth interviews with a sample of 14 adolescents
who experienced both planned and unplanned terminations from mental health services. Data
from the interviews provides an in-depth understanding, from the adolescents' perspective, about
how and why they terminated services as well as their experiences, perceptions, and
understanding of the termination process.




                                                 79
Paper Session 6

Title:                  The Difficulties in Therapeutic Practice and the Representation of the
                        Difficult Patient, as Perceived by the Therapist. How are They Related to
                        Treatment Failure?

Author:                 Elena Scherb

Address for Correspondence:

                        Elena Scherb
                        Research Department
                        AIGLE Foundation
                        Virrey Olaguer y Feliú 2679 C.P. 1426 CAP.FED.
                        ARGENTINA

                                           ABSTRACT

        This study explores the therapists´ representations of the difficult patient, the difficulties
in therapeutic practice and its relationships with therapeutic failure. Although we are standing in
a social-cognitive perspective, the issue of treatment failure is common to every kind of therapy.
Whereas the percentage of treatment failures reported in efficacy studies tends to be much lower
than not, it is nevertheless intriguing. What do we, as clinicians, attribute treatment failure to?
We know already that difficulties can be found at any point of the particular relationship between
patient, therapist, delivery system and the beliefs system of the community. Moreover, the
specificity of the therapeutic relationship and the therapeutic alliance, studied at large as
determinant of outcome, can no longer be understood independently of the interaction with
patient´s characteristics, type of therapy, situation and therapists´ characteristics (Beutler, 1994).
Also it is important to differentiate treatment failure from drop-out (Sledge et al., 1990).

        We will utilize data collected from the CCQ from the International Study of the
Development of Psychotherapists (directed by David Orlinsky) in Argentina, to explore the
difficulties in therapeutic practice, comparing different orientations, expertise, gender, and some
other variables. Then we will utilize data collected from the Follow-up questionnaire for
Therapists (Fernández-Alvarez & García, 1997) to explore the therapists´ representations of the
difficult patient and the factors to which to attribute failure in treatment.

        These data will be utilized to propose different perspectives for the understanding of
difficult patients, difficulties in therapeutic practice and treatment failures. Taking into
consideration the socio-cultural determination of the practice of psychotherapy, these conclusions
will be applicable, in principle, to the population of Buenos Aires, Argentina.




                                                80
Paper Session 6

Title:                 Using Qualitative Data to Obtain Multiple Perspectives in Domestic
                       Violence Focused Couples Treatment

Authors:                Karen H. Rosen, Sandra M. Stith, Eric E. McCollum

Address for Correspondence:

                        Karen Rosen,
                        Department of Human Development,
                        Virginia Tech, 7054 Haycock Road,
                        Falls Church, VA USA 22043

                                           ABSTRACT

       In this paper, we illustrate how qualitative research methods can be used to refine a
treatment manual and assess the effectiveness of a solution-oriented conjoint domestic violence
focused treatment model. To date, little research has been conducted on conjoint domestic
violence treatment models. What studies have been conducted have been primarily quantitative
with methodological shortcomings and have often resulted in inconclusive findings (Edelson &
Toleman, 1992). While quantitative research designs are useful in measuring treatment
outcomes, they are limited in their ability to provide useful information for refining treatment
models or for understanding which aspects of a model are useful and which are not (Hezel,
1995).

                Qualitative research has been recognized as a useful tool for gaining
understanding of a treatment program including specific interventions that participants find
helpful and those they do not find helpful (Hezel, 1995; Llewelyn, 1988; Sprenkle & Bischoff,
1995). In a qualitative study, the researcher can ask for clarification and elaboration, making
possible an in-depth understanding of how participants experience the therapy process. To date
there has been no published research examining conjoint domestic violence focused treatment
using qualitative methods of inquiry, a gap that our project attempts to fill. As part of our
NIMH funded project to develop and pilot test a domestic violence focused couples treatment
approach, we conducted in-depth interviews throughout treatment with selected client-therapist
units and asked all clients and therapists to answer a brief series of questions after each session,
to discover which aspects of treatment were helpful and which were not, and how treatment
effected clients.

                In this paper, we present strategies for using qualitative methods in outcome
research as well as preliminary findings from our in-depth interviews and the short answer
questions and discuss how this data has been useful in assisting us to refine our treatment manual
and target our treatment to appropriate clients. Based on our findings, for example, we have
made modifications of our treatment manual including modifying the teaching of "time out" (a
violence prevention procedure) to make it more interactional, and widening the definition of
solution-focused therapy to include female clients' discussion of their pain and hurt about the
abuse.




                                               81
Paper Session 7

Title:                 The INTREX and the Lost Relationship in Pathological Bereavement

Authors:               Mary McCallum, Anthony S. Joyce, and William E. Piper

Address for Correspondence:

                       Mary McCallum
                       Department of Psychiatry, University of Alberta
                       8440 - 112 Street
                       Edmonton, Alberta,
                       T6G 2B7
                       Canada

                                          ABSTRACT

        The INTREX, a questionnaire measure based on Benjamin's SASB, was used in a study
of Pathological Bereavement. The study involved a comparison of interpretive versus
supportive forms of short-term group therapy. We investigated whether the patients' perception
of the relationship with the lost person changed as a result of treatment. Of particular interest,
was whether there were differential effects contingent on the two different technical approaches
to therapy. Relationships between changes on the INTREX and therapy outcome - particularly
symptoms of pathological bereavement - were also examined. Results based on the first ten
groups of the project will be presented.




                                               82
Paper Session 7

Title:                 Outpatient Integrated Psychodynamic Psychotherapy for Psychosomatic
                       Diseased Mothers with Preschool Children - First Empirical Data of 61
                       Patients

Authors:               Anette Kersting, Michael Reutemann, Klaus Schonauer, Patricia
                       Ohrmann

Address for Correspondence:

                       Anette Kersting
                       Department of Psychiatry
                       Westfälische Wilhelms-University
                       Albert-Schweitzer-Str. 11
                       D 48149 Münster, Germany

                                         ABSTRACT

        Due to family reasons necessary treatment for psychosomatically diseased mothers with
preschool children is frequently delayed or does not take place at all. These circumstances among
others contribute to the chronification of psychosomatic diseases in this particular group of
women.

        A model for the integrative psychodynamically based treatment of mothers who suffer
from eating disorders, depressive symptoms, anxiety and somatic disorders (according to ICD
10) is presented. The efficacy of this outpatient psychodynamic treatment is examined in a
pretest-posttest design.

       Results: The outpatient psychodynamic group therapy of 61 patients leads to a significant
and important reduction of the symptoms ( bodily complaint by Zerssen, ADS, STAI).




                                              83
Paper Session 7

Title:                 An Expressive-Supportive Group Therapy Intervention for Women at
                       Risk for Breast Cancer: Results of a Phase I Trial

Authors:               Mary Jane Esplen, Brenda B. Toner, Jonathan J. Hunter, Gordon
                       Glendon, Steven A. Narod, Alexander Liede, Kate J. Butler, Barbara
                       Field, and Noreen Stuckless

Address for Correspondence:

                       Mary Jane Esplen
                       Department of Psychiatry
                       Mount Sinai Hospital
                       600 University Avenue
                       Toronto, Ontario M5G 1X5
                       Canada

                                         ABSTRACT

                Women with a family history of breast cancer (BC) tend to experience high levels
of perceived risk for developing cancer and experience psychological distress that may impede
adherence to recommended screening. Perceived risk and psychological distress are minimally
influenced by interventions that communicate risk information without addressing associated
psychological factors. The purposes of this trial were to develop, describe and standardize a
group therapeutic intervention that addresses the emotional impact of familial BC and to examine
its effect on personal risk assessment, psychosocial adjustment, BC risk knowledge and
screening adherence. The study consisted of a one arm pre post design involving measures of
perceived risk, psychosocial functioning and BC knowledge. The intervention consisted of 8
weekly and 4 monthly booster sessions. Thirty-one women with a first degree relative with breast
cancer were recruited from genetic clinics at Mount Sinai & Women's College Hospitals & had a
mean age of 43.3 (S.D.=9.9), 77% were married and >50% had university education. Results
demonstrated a significant decrease in perceived risk (p<0.001). There was a significant decrease
on the Intrusion subscale on the IES (p=0.014) and for Avoidance (p=0.015), a significant
decrease for trait & state anxiety (p<0.05), on the BSI subscale for depression (P<0.05) and for
the STAXI measure of anger (p<0.05). There was also a decrease in present feelings associated
with prior loss as measured by the Texas Revised Inventory For Grief. In addition, the group
intervention significantly improved knowledge level of genetic/risk information and enhanced
screening adherence. The study demonstrated feasibility of conducting a group program for
women at risk of BC and demonstrated improvement on perceived risk, psychological
functioning and knowledge, lending support for a multi-site randomized trial.




                                              84
Paper Session 7

Title:                  A Comparison of Therapeutic Factors in Two Group Treatment
                        Modalities: Verbal and Art Therapy

Authors:                Ofra Pearl-Dekel and Zipora Shechtman

Address for Correspondence:

                        Zipora Shechtman
                        Faculty of Education
                        The University of Haifa
                        Haifa, Israel

                                            ABSTRACT

     Therapeutic factors in verbal group psychotherapy have been extensively researched,
producing a set of factors that have received both theoretical and empirical support; A consensus
has been pretty well established regarding the most meaningful factors and the least meaningful
ones (Yalom, 1995). However, in art group therapy, although long practised, the therapeutic
process has rarely been investigated (Gladding, 1995).

      This study was designed to compare factors in verbal and visual art group psychotherapy, to
learn whether the ―core‖ of group psychotherapy is indeed universal, regardless of the unique
―front‖ of each group (Yalom, 1995). Participants were 27 psychiatric patients in a day-treatment
clinic. They were arranged in groups of 10 to 12 patients, in an open-ended type of group, with a
turnover of 2-3 patients per month. Clients participated each week in both group modalities on
two successive days. Their perceptions of therapeutic factors were generated by two instruments:
a questionnaire based on the Q-sort, and Critical Incidents. Information was collected in 5 points
of time during the twelve sessions, from both the therapists and clients. Three therapists led the
groups, one was constant for both types of groups and the other two varied. Under the conditions
in which the clinic operates it was impossible to distinguish outcome differences as clients
received a battery of treatment; therefore we measured satisfaction only. We hypothesized that (a)
no difference would be found in the therapeutic factors in respect of their frequencies and rank
order; (b) differences would be found between therapists‘ and clients‘ perceptions of the
frequencies and rank order of factors. Results showed that all factors were mentioned in both
therapies and by the two sources of information, and their rank order was consistent with previous
research. A MANOVA repeated measures followed by paired t-tests indicated that the major
differences were in therapists‘ and clients‘ perceptions rather than in the modalities of treatment,
yet, therapists were better able to differentiate the therapies than the clients. In addition, a set of
factors unique to art therapy were revealed, which could not be classified in the given factors.
Results also suggested that clients were equally satisfied with the two therapies, yet, therapists
attributed to clients more satisfaction in art therapy. Further research is recommended to develop a
theory of change for art therapy, yet, the results pretty well supported the universal core of factors
suggested by Yalom.




                                                  85
Poster Session A

Title:                  A Comparison of Several Procedures to Formulate the Central
                        Relationship Patterns for a Group of People with the CCRT Method

Authors:                A. Körner, C. Albani, K. Blumstengel, M. Geyer

Address for Correspondence:

                        A. Körner
                        Universität Leipzig, Klinik für Psychotherapie und Psychosomatische
                        Medizin
                        Karl-Tauchnitz-Str. 25, 04107 Leipzig, Germany
                        phone +49 341 97 188-84 (-50) / fax +49 341 2 13 12 57
                        koea@medizin.uni-leipzig.de

                                            ABSTRACT

      In several published studies different methods are used to formulate the Core Conflictual
Relationship Theme (CCRT) of a group of persons. A common way is to calculate first the
relative frequencies of the CCRT categories occurring in the course of an interview, therapy
session, etc. of each single personas the basis of the group CCRT. Other considerations determine
the CCRT by summation of the absolute frequencies of the rated categories of all members of the
group to create a ―metaperson‖. Yet, a further approach to analyze the relationship episodes
reported by patients is to combine absolute frequencies and the pervasiveness score which is
defined by Crits-Christoph and Luborsky (1997) as a measure for the pervasiveness of conflicts
across relationship episodes. Besides it is possible to use a rank statistical procedure to get a group
typical result.

      However, to compare the results of different studies in literature ones should keep in mind
the influence of the data analysing procedure onto the related outcome. Thus, we apply the above
mentioned methods exemplarily to the CCRT data of 34 inpatients with eating disorders to
examine the respective methodical influence onto the group result.

      These effects we investigate on the basis of standard categories, original clusters (Barber et
al., 1997) and, additionally a new developed, alternate set of CCRT clusters (Körner et al., 1998).
The results we interpret and compare in a methodical background what should contribute to the
question of choosing an adequate data analysing procedure to formulate the CCRT of a group of
persons.




                                                 86
Poster Session A

Title:                 A Methodological Study of Luborsky‘s CCRT: The Level of
                       Generalization of the Relationship Episodes

Authors:               N. Dazzi, A. De Coro, F. Ortu, S. Andreassi, F. Falcioni, V. Ostuni, A.
                       Tagini

Address for Correspondence:

               Prof. Nino Dazzi
                      Università degli Studi di Roma ―La Sapienza‖
                      Facoltà di Psicologia
                      Via dei Marsi, 78 - 00185 Roma (Italia)


                                          ABSTRACT

      Luborsky‘s CCRT method provides to answer to the question about how the therapist
usually infers the transference from the sessions. In a presentation of CCRT as a measure of
transference, in 1995, Lester and Ellen Luborsky defined it as ―the oldest reliably guided system
for deriving a central relationship pattern from psychotherapy sessions‖. As L. Luborsky writes, a
―core conflictual theme‖, originating from primary relationship and not integrated in the following
development of adult personality, is ―repeated through narratives and dreams in psychotherapy,
until it gradually changes under the influence of therapeutic relationship, through interpretation
and insight. As Kernberg writes, the work of Luborsky on CCRT provides a ―well-tested
instrument‖ for empirical evaluation of dominant transferences during therapeutic treatment.

     The aim of our study is to compare - on an Italian sample of 20 psychotherapies - the CCRT
extracted from Relational Episodes of a high level of generalization and low level of completeness
with CCRT from RE of level of completeness of at least 3.0.




                                               87
Poster Session A

Title:                 Analysis of the Variations of the States of Mind in a Borderline Patient
                       Using the ―Grid of Problematic States‖

Authors:               Antonino Carcione, Giancarlo Dimaggio, Maurizio Falcone, Giuseppe
                       Nicolò, Michele Procacci, Antonio Semerari

Address for Correspondence

                       Antonio Semerari
                       III Centro di Psicoterapia Cognitiva
                       Via Ravenna 9/c      00161 Roma, Italy
                       e-mail: terzocentro@iol.it
                       Tel/Fax 06/44233878

                                           ABSTRACT

      We analyzed the transcripts of a whole tape-recorded cognitive psychotherapy with a
borderline patients. Then we applied the ―Grid of problematic states‖ to discover main clusters of
subjective experience, made of thought themes, emotions and bodily sensations. Our aim was to
discover the main pattern of experience of the patient and know whether it had changed or not
during the psychotherapy. Findings was that the problematic state was made of thought themes of
injustice suffered, being refused and cast out associated with the switching emotions of anger and
compassion. This cluster didn‘t substantially change during the psychotherapy, except for a
decrease in the intensity of the negative emotions. However, the patient improved, so we had to
hypothesize that this was due not to a change in the states of mind but in an increasing of her
metacognitive functioning. Data are shown and the hypotheses are discussed.




                                               88
Poster Session A

Title:                 Anxiety Disorders in Children: An Intervention With Parent

Authors:               Miguel Goncalves and Helena Pinto

Address for Correspondence:

                       Miguel Goncalves
                       Department of Psychology
                       University of Minho
                       4700 Braga
                       Portugal

                                          ABSTRACT

      In this article we describe a group intervention program with parents of anxious children
attending individual therapy. We present the intervention programs structure along with goals
and strategies devised. Afterwards, we present a qualitative analysis of the program, taking into
account two aspects: (1) emergent themes in the sessions and (2) the group outcome results from
the parent‘s perspective. We conclude highlighting the importance of developing similar
interventions, as well as the value of the qualitative methods in this kind of research.




                                               89
Poster Session A

Title:                 Assessment of Attachment and Physiological Measures Based on a
                       Multimedia System

Authors:               Joao Paulo Cunha, Isabel Soares, Li Zhan Jian, Armando Pinho, Lucia
                       Neves and Carla Martins

Address for Correspondence:

                       Joao Paulo Cunha
                       Departamento de Engenharia Electronica/INESC Aveiro
                       Universidade de Aveiro
                       Campus Universitario de Santiago
                       3810 Aveiro, Portugal
                       Fax: 351-34-370545
                       Email: jcunha@inesca.pt

                                          ABSTRACT

      Recent development of multimedia technology has enabled the application of digital
procedures to psycho-physiological assessment. In this paper, we present a multimedia system a
full digital solution, named BioDReAMS (Bio-Dual channel and Representation of Attachment
Multimedia System) for assessment attachment strategies and physiological measures during the
Adult Attachment Interview (AAI). Attachment patterns assessed through the Adult Attachment
Interview (AAI) have been conceived as different strategies to regulate the access to relevant
attachment information and to process distress-related information. The psycho-physiological
activation led by emotional processing of attachment experiences during the AAI procedure may
be a critical factor in order to understand the subject‘s attachment strategies. Bio Dreams
integrates bio-signals, video/audio information of the AAI and the rater‘s coding procedure all
together and runs in the MS Windows 95 environment on a PC. Using this system, we can acquire
ECG signal, skin conductance signal and capture video/audio in a synchronous way. It also
enables the raters to analyse and to evaluate psychological and physiological events and to explore
possible relations. BioDReAMS provides a user-friendly interface to support the clinical
procedure workflow, from interview analysis to rating codes, which simplifies greatly the
research‘s work. Our poster will show how BioDReAMS works in a real situation.




                                               90
Poster Session A

Title:                 Assessment of Health Consumption by Patients in Focal Psychoanalytic
                       Psychotherapy

Authors:               Jose A. Castillo, Enrique de la Lama, and Manel Salamero.

Address for Correspondence:

                       Jose A. Castillo
                       Facultat de Psicologia i Ciencies de l'Educacio Blanquerna
                       Universitat Ramon Llull
                       Cister, 34
                       08022 Barcelona, Spain

                                           ABSTRACT

      We present an empirical study in which results obtained by 35 patients, who carried out a
Focal Psychoanalytic Psychotherapy for a year, are assessed. Patients were assessed in a
longitudinal manner (beginning, halfway and end of psychotherapy, follow-up after a year and
two years), being studied possible changes in the anxious and depressive symptomatology, in their
vulnerability to suffer from a new psychopathological disorder, in the basic dimensions of
personality and in the psychodynamic profile. Results show that there is clinically and
statistically significant decrease in anxiety, depression and vulnerability of patients (with Effect
Sizes -ES- 0.81, 0.97, and 0.76, respectively), as well as in the dimension Neuroticism (ES = 0.67)
and in different aspects of the psychoanalytical profile of their personality. These changes tend to
be maintained throughout the follow-up carried out after a year and two years of ending
psychotherapy.

      Health consumption by patients (medical visits, diagnostic tests, medication, and so forth)
was also assessed. Results show that medical visits and diagnostic tests tend to increase during
psychotherapy, and they decrease after its end. No difference reaches statistic significance.
Medication consumption is stable if we compare data from the beginning and end of therapy,
tending to decrease in the later follow-up (statistic significance is not reached, either).
Psychopharmacological consumption does decrease significantly when we compare assessment
carried out at the beginning of and halfway through psychotherapy (ES = 0.48), being stable at the
end of treatment and disappearing in follow-up.

      We consider that the study shows empirical evidence on the efficacy of Focal and Brief
Psychoanalytical Psychotherapy for a year. Results on health consumption are discussed in
relation to treatment cost-effectiveness and to the influence of psychotherapeutic treatments on the
patients' general health.




                                                91
Poster Session A

Title:                 Assessment of Obsessions and Compulsions: A Self Report Measure

Authors:               Ana Galhardo and José Pinto Gouveia

Address for Correspondence:

                       Ana Galhardo
                       Núcleo de Estudos e Intervenção Cognitivo-Comportamental
                       Faculdade de Psicologia e de Ciências da Educação da Universidade de
                       Coimbra
                       Rua do Colégio Novo
                       3000 Coimbra, Portugal

                                          ABSTRACT

     Once considered rare, obsessive-compulsive disorder is now recognised as one of the most
common psychiatric disorders (Jenike, 1989 in Taylor, 1995). Recent epidemiological data
indicate a prevalence between 1% and 3% in general population (Salkovskis, 1997). This led to a
greater interest in identifying its clinical characteristics, assessment, conceptual models and
treatment.

     There is a variety of self-report measures which aim the assessment of
Obsessive-Compulsive Disorder. The Leyton Obsessional Inventory (LOI; Cooper, 1970), the
Maudsley Obsessive Compulsive Inventory (MOCI; Hodgson & Rachman, 1977), the
Compulsive Activity Checklist (CAC; Freund, Steketee & Foa, 1987), the Padua Inventory (PI;
Sanavio, 1988) and the Yale-Brown Obsessive Compulsive Scale ( YBOCS; Goodman et al.,
1989 a, b) are the most widely used. However, they do not include items related to the excessive
sense of responsibility that these patients exhibit. According to recent models, obsessions would
be associated with a dysfunctional cognitive schema involving responsibility that would lead
patients to evaluate their thoughts in terms of the harm they could do to themselves or others
(Salkovskis, 1985).

     This poster presents a new self-report instrument developed to address diagnostic and
severity issues as well as the inflated responsibility postulated by the cognitive model.




                                               92
Poster Session A

Title: Client Concerns in Counseling: A Concept Map

Authors:       Robin Everall, Barbara Paulson, and Derek Truscott

Address Correspondence:

                        Robin Everall
                        Department of Educational Psychology, University of Alberta
                        6-102 Education North
                        Edmonton, Alberta, Canada
                        T6G 2G5

                                            ABSTRACT

          Despite a considerable amount of research in the area of client change processes, relatively
little attention has been devoted to the substance of counseling from the clients‘ perspective; the
concerns that they deal with. Given that clients' perceptions of the counseling process often differ
from their counselors' perceptions, categories of client concerns derived from clients‘ experiences
of counseling promise great utility. The purpose of the present study was to develop a preliminary
taxonomy of client concerns from their perspective without imposing preconceived notions about
findings. The development of a system of categorizing client concerns could form the basis for
studying client change processes in counseling based on the assumption that different processes
are involved for different clients.

        The concept mapping method was utilized to gather and analyze clients' perceptions of
concerns that they dealt with in counseling. Concept mapping is a relatively new methodology
that combines qualitative and quantitative research strategies and actively involves research
participants in generating items and gathering data. Participants were adult clients aged 18 and
older who sought individual counseling services. The total sample was comprised of 35
participants: 9 male and 26 female. Of the sample 15 were single, 10 were married or cohabiting,
and 10 were divorced or separated. Participants‘ mean age was 34.14 years, with a range of 18-56
years. Participants‘ mean number of sessions was 11.14, with a range of 1-23. In the first stage,
participants responded to the open-ended probe, ―What concerns did you deal with during
counseling?‖. In the second stage, 19 participants returned to sort each of 57 statements according
to "how they seem to go together".

         Concept mapping resulted in nine categories of client concerns: Childhood Abuse,
Parent-Child Relationships, Adult Relationships, Personal Validation, Life Obstacles, Depression
and Suicide, Emotionality, Career, and Life Skills. These categories fell along a continuum from
personal, life-oriented issues to interpersonal, relationship-oriented issues. A second intersecting
continuum ranged from victimhood issues to active coping techniques. The findings demonstrate
that client concerns often lie outside diagnostic categories and tend to be goal specific.




                                                 93
Poster Session A

Title:                 Cognitive Behavior Therapy With Depressed Elderly

Author:                Martin Hautzinger

Address for Correspondence:

                        Martin Hautzinger
                        Department of Psychology, Eberhard-Karls-University
                        Reutlinger Str. 12
                        D - 72072 Tuebingen
                        Germany

                                           ABSTRACT

      This presentation will describe the construction, the experiences, and the outcome of several
pilot studies of a structured, course-like intervention program developed especially for older
depressed patients. Using the well-known CBT-approach to depression, treatment material was
adapted for depressed people 65 and older (up to 85 years) being treated as out-patients or
in-patients. Another focus of our research was the comparison of only behavioral with only
cognitive interventions in the older patient sample. The results show that CBT with depressed
elderly works, both with in- and out-patients, that a six-week intervention is a promising treatment
component in a geriatric setting. With depressed out-patients being treated only with CBT, a
six-week program is too short to produce lasting changes.




                                                94
Poster Session A

Title:                 Cognitive Narrative Therapy--A Supportive/Self-Directed Variation of the
                       Model

Authors:               Lynette D. Glasman, Robert E. Romanelli, and Larry E. Beutler

Address for Correspondence:

                        Lynette D. Glasman, Ph.D.
                        Psychotherapy Research Program
                        Graduate School of Education
                        University of California, Santa Barbara
                        Santa Barbara, California 93106-9490
                        U.S.A.

                                           ABSTRACT

      This paper describes how the Cognitive Narrative Therapy (CNT) model developed by
Oscar Goncalves has been modified for use with clients from a population of chemical substance
abusers with co-morbid depression (age 18--65). Using Goncalves' five-step procedure as the
basis for the therapeutic work, this model has been adapted to fit into a supportive/self-directed
framework, one where clients may choose if and how they will approach each of the model's five
stages.

      In addition to the clients constructing narratives based on their own lives, a number of books
(including poetry) and videotapes of movies are made available for them to use at home, if they
wish. Follow-up then involves the clients developing their own five-stage narratives based on the
books/films which they have selected to explore.

      Currently there are six clients being seen in treatment by carefully selected therapists who
are highly trained in the model. By June, 1999 there should be approximately a dozen clients on
whose progress this paper will report. A large number of assessment instruments are being used in
this study and all therapy sessions are being videotaped for future analyses (as well as for use in
on-going therapist supervision).




                                                95
Poster Session A

Title:                 Cognitive vs. Psychodynamic Psychotherapy Effects: A Comparative
                       Study

Authors:               Jerzy W. Aleksandrowicz and Jerzy A. Sobañski

Address for Correspondence:

               Department of Psychotherapy
               Jagiellonian University Medical College
                        ul. Lenartowicza 14
               31-138 Cracow, Poland
               fax: (+48 12) 633 40 67
               e-mail: psych@kom-red-wyd-ptp.com.pl

                                          ABSTRACT

        Paper presents research design, methodology and preliminary findings concerning the
results of psychodynamically oriented psychotherapy and those of cognitive oriented one. This
study compares the effects of both approaches in treatment of two neurotic disorders diagnosed
with the Research Diagnostic “Field” Criteria (in terms of ICD-10 and DSM-IV) as Generalized
Anxiety Disorder and as Somatisation Disorder.

        Four equally experienced female psychotherapists treat in individual or group short term
(30 hours) psychotherapy outpatients suffering GAD or Somatization. Patients allocation to
approach, modality as well as psychotherapist is randomized. Therapy effects are conceptualised
as: symptom relief – measured with Global Severity Index derivative SCL-―O‖ and personality
changes measured with Neurotic Disintegration Index derivative 16 PF Cattell personality test.
Therapy results are also compared to the effects of the complex, intensive, eclectic psychotherapy
of patients with GAD or Somatisation diagnoses in a day-hospital settings (150 hours of both
group and individual therapy in 10-16 weeks) treated as a frame of reference.

      The pilot study concerns the results of compared approaches and modalities in the first
subgroup of patients.




                                               96
Poster Session A

Title:                  Construct Validity and Interrater Reliability of the Personality
                        Organization Diagnostic Form (PODF).

Authors:                Étienne Hébert and Louis Diguer

Address for Correspondence:

                        Etienne Hébert
                        Laboratoire de Recherches sur la Personnalité et la Psychopathologie
                        École de Psychologie, Pavillon Félix-Antoine Savard, local 1434
                        Université Laval
                        Québec, Canada
                        G1K 7P4
                        e-mail : labold@darwin.psy.ulaval.ca

                                             ABSTRACT

        The Personality Organization Diagnostic Form (PODF; Diguer et Normandin, 1996) is an
instrument that operationalize the psychoanalytic model of personality developed by Otto F.
Kernberg (1975, 1996). This instrument allows us to assess the four dimensions of Kernberg's
model : Identity Diffusion, Primitive Defense Mechanisms, Lack of Reality Testing and the
Quality of Object Relations. Each dimension is evaluated by the rating of a set of items. The
PODF allows us to make a diagnosis in terms of Neurotic, Borderline (low, medium and high
levels) and Psychotic Personality Organizations.

        This instrument is essentially based on clinical judgement. It was devised to be flexible
and usable with different kinds of material. In this study, two kinds of clinical material were
available : 1. Material excerpt from interviews of evaluation (SCID-I and II, demographic data
and narratives from Relationship Anecdotes Paradigm (RAP; Luborsky, 1998)) and 2. Videotapes
of Structural Interviews (Kernberg, 1984).

        The present study provides the very first empirical support to the PODF. It is divided in
three parts. First, interrater reliability scores were calculated for the two types of clinical material
from a 30-subject sample. The reliability between the two types of clinical material was also
calculated. Finally, confirmatory analysis was carried out on 160 subjects in order to examine the
construct validity of the PODF.




                                                  97
Poster Session A

Title:                 Development of Psychotherapists in Korea: Quantitative and Qualitative
                       Analyses of Therapeutic Relationship

Author:                Eunsun Joo

Address for Correspondence:

                       Eunsun Joo
                       Department of Psychology
                       Duksung Women's University
                       419 Ssangrnun-Dong
                       Tobong-Gu, Seoul
                       Korea

                                          ABSTRACT

        This study combines quantitative and qualitative approaches to explore the development of
psychotherapists in Korea. The study is a part of the "International Study of the Development of
Psychotherapists" which is a large scale multinational, collaborative research effort designed to
study the professional development of psychotherapists (Orlinsky et al, in press). The researcher
conducts quantitative analyses of 500 Korean psychotherapists (psychiatrists, clinical
psychologists, and counselors) concerning the various aspects of their practices such as
professional training, theoretical orientation, working environment, difficulties and coping
strategies. Specifically, the study focuses on the therapists' perception of "therapeutic
relationship". In order to overcome the limitation of translation and cross-cultural differences of
the Development of Psychotherapists Common Core Questionnaire (CCQ), the researcher
conducts qualitative analyses of in-depth interview with 100 Korean psychotherapists. The
findings of the qualitative analyses supplements the meaning of Korean psychotherapists' unique
experience of "therapeutic relationship" (Joo, 1996). Furthermore, the study provides an
opportunity to understand how Western psychotherapy applies in a non-Western society.




                                               98
Poster Session A

Title:                 Development of the CORE (Clinical Outcomes in Routine Evaluation)
                       System for Auditing Psychotherapy Outcomes

Authors:               John Mellor-Clark, Janice Connell, Michael Barkham, Kerry Audin, Chris
                       Evans, Graeme McGrath & Frank Margison

Address for Correspondence:

                       Frank Margison, Gaskell Psychotherapy Centre; Manchester Royal
                       Infirmary; Swinton Grove; Manchester M13 0EU; UK
                       Telephone: +44 161 273 2762      Email: frmargison@aol.com

                                           ABSTRACT

       Aims: The CORE System is now widely used as a research and audit tool in the UK. It
was developed with support of SPR(UK) members and other professionals across multiple sites.
This poster provides a review of progress.

        Methods: The CORE measure is a 34 item measure covering well-being, symptoms,
personal functioning and risk items. There are two parallel 18-item short form versions for
repeated administration. The CORE measure is complemented by instruments profiling the
assessment and end of therapy stages. The CORE measure shows good internal reliability, and is
responsive to clinical change. The measure can be hand-scored, entered directly, or scanned
directly using specialist data scanning methods developed by Formic. Data are now available
across several ethnic minority groups and from different types of service organisation and
summary data and norms will be presented up to Spring 1999.

       Progress to date will be presented on the measure being used to test the phase model of
change, as a repeat measure to track progress, and for clinical audit within units which have not
previously been part of the research community. Cross referential data against the BDI, BAI,
SCL-90(R) and IIP are now available for comparison.

        Conclusions: CORE is now established as a clinician-friendly system for auditing
psychotherapy outcomes which helps to bridge the therapist-researcher gap. The measure is also
promising as a research outcome measure and preliminary data will be presented from studies
using the CORE measure to assess outcome.




                                                99
Poster Session A

Title:                 Difficulties in Doing Empirical Research from a Jungian Perspective: The
                       Thorny Paradigms in Analytical Psychology

Authors:               Grazia M. Cerbo, Leonella Magagnini, and Luisa Zoppi

Address for Correspondence:

                       Dott.ssa Grazia M. Cerbo
                       AIPA Via G. Pisanelli 1
                       00100 Rome
                       Italy
                       email :MD 754 @mclink.it

                                           ABSTRACT


        Looking at the field of empirical research in psychotherapy, we can easily note there is
a great amount of work from many (and sometimes very different) theoretical perspectives and, at
the same time as psychotherapists and researchers, we are struck by the lack of contributions
deriving from a Jungian framework.

       Although some Jungian analysts (W. Keller, G. Mattanza, G. Rudolf) have recently started
to work in order to achieve an empirical validation of analytical therapy, Jungians generally do
not seem to be interested in this kind of research.

        The authors try to highlight those paradigms that can be considered thorny in analytical
psychology: they are the ones which can make the application of a scientific procedure to the
investigation of change more difficult than usual.

        So, starting from the‖ labelling ― of non -systematic method, the Authors point out some
of the central topic analytical psychology such as the transpersonal components of the transfer, the
interaction between the Ego and the archetypical images and the mechanism of autoregulation of
the psyche.

      The Authors wish to offer an opportunity to broaden the debate particularly in order to
improve empirical research in the specific Jungian field.




                                               100
Poster Session A

Title:                  Effectiveness of Emotional Activation in Treatment of Depression:
                        Training Therapists in Manualized Treatments

Authors:                Ginger Goodrich and Benny Martin

Address for Correspondence:

                       Ginger Goodrich
                       Graduate School of Education,
               C.C.S.P. Program University of California
                       Santa Barbara, CA 93106
                       USA

                                            ABSTRACT

        While the value of manualized treatments in research has been acknowledged, some raise
the question of whether manualized training emphasizes techniques at the expense of the
therapeutic relationship. This exploratory, N-of-one study examined the impact of a I O-week
training for therapists in a manualized experiential technique intended to increase clients' affective
arousal. Therapists who participated in the training were asked to implement the technique with
depressed clients during two sessions within a 1 O-week period. Therapist adherence to the
experiential model and the general process of therapy were rated for two sessions per therapist:
one session in which the experiential technique was used, and one session of "therapy as usual."

        The effectiveness of the training was evaluated through the compliance ratings, which
rated the degree of adherence to the experiential model following the training. The process ratings
were analyzed to identify meaningful differences in general process between "therapy as usual"
and sessions using the experiential technique on a variety of categories: directiveness, therapist
skill, emotional arousal, and therapeutic alliance.

        Findings regarding compliance to the experiential model were in the expected direction;
however, the compliance ratings for those sessions did not differ from the grand mean to a degree
great enough to be clinically meaningful. Furthermore, clinically significant differences were
observed between sessions of "therapy as usual" and experiential sessions in terms of therapeutic
alliance. These findings suggest that although the training had some effect on therapist behavior in
session, that effect was not very great, and the perception of therapeutic alliance went down In the
experiential sessions. These findings could have Implications for the training of therapists in
manualized treatments.




                                                101
Poster Session A

Title:                 Experience Effects in the Medical Profession: They Have the Same
                       Problems We Do.

Authors:               Scott Leon and Kenneth Howard


Address for Correspondence:

               Scott Leon
                       303 E. Chicago Ave
                       Ward 9-217
                       Chicago, IL. 60611
               USA

                                          ABSTRACT

        Research on the effects of training and experience on psychotherapy outcomes has lead
many to conclude that these variables have little to do with therapeutic benefit. Meta-analyses
over the past 20 years have all shown that experience- typically defined as the number of years
practicing since achieving a degree- and training- typically defined as the presence or absence of
formal training- have little relationship with outcomes. The notion that psychotherapy is a
sophisticated service that requires an extended training period plus several years of experience in
order to be successfully mastered has been called into question by these findings. The variables
and measures used to assess training and experience have been criticized, however. Comparisons
between how our profession has examined training and experience variables and how others have
examined them have not been made.

        This paper analyzes the relationship between outcomes and experience and training
variables for the medical profession. The medical outcomes literature has consistently failed to
find a relationship between years of experience as a physician and measures of outcome (e.g.
mortality rates). Medical outcomes research has also failed to find a relationship between board
certification and outcome. One experience variable that has shown to influence outcome is the
volume of specific types of patients a physician has seen. Physicians who have specialized in a
certain procedure by virtue of volume of patients tend to have better outcomes for that procedure.
This is a variable that has not been examined in the psychotherapy literature.

        By showing the similar difficulties the medical profession has had demonstrating an
experience effect, we suggest that the challenge finding an effect for training and experience may
be widespread. The consistent findings in the literature demonstrating the effect of volume of
treating certain medical problems on the outcomes for those problems suggests that the difficulty
finding an experience effect may have to do with the quality of the research that has been
conducted. A more sophisticated refinement of our experience variables may be indicated.




                                              102
Poster Session A

Title:                 Figurative Discourse and the Assimilation Model: A Promising Way
                       Ahead

Author:                Sophia Balamoutsou

Address for Correspondence:

                       Sophia Balamoutsou
                       Psychology Department
                       University of Wolverhampton
                       Wulfruna Street, Wolverhampton WV1 1DG, England
                       e-mail: in5915@wlv.ac.uk

                                          ABSTRACT

        The Assimilation Model (Stiles, xxxx) has offered a meaningful way of understanding the
counselling process. However, there still remains a fundamental question: how do clients move
through the sequence of stages described as warded off, unwanted thoughts, vague awareness,
problem statement clarification, understanding/insight, application/working through, problem
solution, mastery.

        An intensive analysis of a single case of experiential person-centred psychotherapy
revealed that there were a number of facilitative processes that took place during psychotherapy
that seemed to be important factors enabling the development from one stage to the next.
1) The use of foretellers: the client gave the therapist a number of hints long before the
occurrence of a problem statement clarification.
2) The figurative use of stories: the client offered a series of stories, both through the therapy
session and across the sessions, that could be seen as metaphors for a core theme later presented.
3) Empowering of silenced voices: The therapist empowered 'silenced' voices in the client by
responding more to them rather than to the 'louder' voices that were contributing to the
stuckness of the client.

        The existence of these narrative phenomena suggest a social, rather than
psychological     explanation for the assimilation process. Results can not be conclusive by any
means. There remains a need to examine these concepts across a series of case studies.
Limitations of the Assimilation Model are discussed.




                                              103
Poster Session A

Title:                  Focusing Skills of Unsuccessful Clients in Client-Centered Experiential
                        Psychotherapy

Author:                 Mia Leijssen

Address for Correspondence:

                        Mia Leijssen
                        Dep. Psychology, Leuven University
                        Blijde Inkomststraat 13
                        3000 Leuven
                        Belgium
                        Email: mia.leijssen@psy.kuleuven.ac.be


                                            ABSTRACT

        In this study we selected four clients with a history of therapy failure. Their already
lengthy therapy was interrupted and they received focusing training sessions from a second
therapist, after which they returned to their former therapist for regular therapy.

        We measured these clients' experiencing levels before, during, and after the training
sessions, by means of the Experiencing Scale. Therapist interventions were analysed by means of
a Therapist Interventions Category System. For each of the four clients six transcripts were
studied, totalling 24 transcripts. Quantitative analysis of the data, analysis of the individual
patterns, client's Post-session comments, qualitative content analyses and outcome results show to
what degree the focusing skill is a determining factor in therapy success.

       Besides evaluating the focusing skill, we tried to look more closely at the specific process
blocks of each client and tried to find out which therapists interventions had positive effect on
them.




                                                104
Poster Session A

Title:                 French-Canadian Validation and Development of a Self-Report Form of
                       the HSRS

Authors:               Jean-Philippe Daoust, Martin Drapeau, Louis Diguer and Lester Luborsky

Address for Correspondence:

                       Jean-Philippe Daoust
                       Laboratoire de Recherches sur la Personnalité et la Psychopathologie
                       École de psychologie, Pavillon Félix-Antoine Savard, local 1434
                       Université Laval
                       Québec, Canada
                       G1K 7P4
                       e-mail : labold@darwin.psy.ulaval.ca

                                           ABSTRACT

        The HSRS is an instrument that permits an empirical evaluation of mental health on a
scale ranging from 0 to 100, by relying on the assessment of seven major concepts largely
accepted as representative of mental health (Luborsky, 1975) : (a) the patient's need to be
protected and/or supported by the therapist or hospital versus the patient's ability to function
autonomously, (b) the seriousness of the patient's symptoms, (c) the degree of the patient's
subjective discomfort and distress, (d) the patient's effect on his environment, (e) the degree to
which the patient can utilize his abilities, especially in work, (f) the quality of the patient's
interpersonal relationships, (g) the breadth and depth of the patient's interests. Many studies
(Luborsky and Bachrach, 1974) have demonstrated the HSRS‘s excellent psychometric properties
and an international validation has confirmed its relevance in European as well as American
populations (ICC of 0.96; Armelius, Gerin, Luborsky and Alexander, 1991). Although these
results did include a validation with a sample of French professionals, there are too many
differences between French and Quebec cultures to systematically use an original translation of
the HSRS done by a group of French researchers (Peyras, Gerin, Sali and Tissot, 1984); a second
translation and a validation of the instrument was therefore necessary with a sample of Quebec
health professionals. Our new French version of the HSRS was validated by 29 Quebec mental
professionals. The agreement inside the group was very good (ICC = 0.77). The agreement
between this sample and the Luborsky's original was very good (ICC = 0.97). The same level of
agreement was observed with the other international samples (French, Sweden, American) : ICC
= 0.98.

         Secondary we also wished to develop a self-report version of the HSRS in order to
facilitate the use of this measure in research and clinical settings. This self-report questionnaire
relies on the same principles as the original clinician version HSRS. To validate this new version,
the scores on the self-report form are compared with those obtained by clinicians who evaluated
the same subjects. Preliminary results on 16 subjects show a strong correlation between the two
measures (ICC of 0.73) as well as excellent reliability with co-raters (ICC of 0.81). These
preliminary results therefore support the validation of a self-report version of the HSRS.
Poster Session A

Title:                 Functions of Mutual Smiles Between Therapist and Patient and Early

                                               105
                        Alliance Building

Authors:                Yves de Roten

Address for Correspondence:

                        Yves de Roten
                        Centre d'Etude des Psychotherapies Psychanalytiques
                        University of Lausanne
                        Rue du Tunnel 1
                        CH- 1005 Lausanne (Switzerland)
                        E-mail Yves.deroten@inst.hospvd.ch

                                            ABSTRACT

        Studies on emotional micro-processes during therapy have demonstrated the importance of
mutual smiles as a key indicator of the affective regulation process between patient and therapist.
This study sought to document the relation between mutual smiles and early alliance building,
which seems to depend much on a mutual emotional involvement process.

        Based on the work of Vanger & Czogalik (1994), we have developed a method to study
episodes of mutual smile from a functional point of view. Different types of episodes have been
identified and classified according to two basic interpersonal dimensions:

12.   Mode of affiliation. Patient and therapist are sometimes in agreement, and sometimes in
      conflict. When they agree, a mutual smile establishes an affective resonance; when they
      disagree or are in conflict, a mutual smile functions more as a "damage control strategy".
13.   Level of coordination. Mutual smiles function to regulate, at least, two different levels of
      affective exchanges: (a) the first one regulates social interactions; it coordinates the
      partners' readiness to interact, to attend and to express, by means of synchronization and
      harmonization of their affect signals; (b) the second one regulates intersubjective sharing; it
      coordinates the partners' feelings.

        We will present the method and results from a pilot study made on 20 patients, videotaped
during the first four therapy sessions. Alliance, measured by HAq after each session, shows three
profiles: (I) high and stable, (II) low and stable, (III) from low to high.

         Results show that mutual smiles in alliance profile II indicate a very different mode of
affiliation and level of coordination. This constitutes an affective regulation context that could
explain differences in the efficacy of therapeutic interventions.




                                                106
Poster Session A

Title:                 Gender Composition in Groups and its Influence on Verbal Participation
                       Percentage and Turn-Taking Percentage: A Study on 11 Groups

Authors:               Wally Festini and Davide Liccione

Address for Correspondence:

                       Wally Festini
                       Dept. Of General Psychology
                       Via Venezia 8
                       35131 Padova
                       Italy

                                          ABSTRACT

        This study examined the relationship between gender composition in 11 role-plays, with
different gender compositions, and the verbal participation of males and females.

        Each role-play session lasted an hour, was acted by psychology students and the
composition included differences between 5 M - 3 F down to 1 M - 9 F. The role-plays were
tape-recorded and transcribed in order to do quantitative measures and also qualitative
observations.

       To measure the quantity of speech for both genders, we used the Verbal Participation
Percentage (N of lines of transcript over 100) and the Turn-Taking Percentage (N of turn-takings
over 100).

       The aim of the study was to outline the most favorable gender composition in order to get
balanced verbal participation for both genders in clinical groups. Results gave a few interesting
and unexpected answers: male dominate both when they are in the majority and when they are in
the minority.




                                              107
Poster Session A

Title:                 How Do Professional Groups Prioritize Patients to Psychotherapy?

Authors:               Gunilla Fredelius, Cecilia Lindquist and Rolf Sandell

Address for Correspondence:

                       Gunilla Fredelius
                       Stockholm County Council Institute of Psychotherapy
                       Björngårdsgatan 25
                       S-118 52 Stockholm
                       e-mail: gunilla.fredelius@psti.csso.sll.se
                       fax: +46 8 615 97 06

                                           ABSTRACT

         Prioritizing patients for subsidized psychotherapy is necessary when resources are
scarce—and they are. To find principles acceptable to the general public as well as clinicians and
politicians, this project is a series of studies of the actual selection of patients. Our first study
included 30 judges from three different groups, clinicians, health care officials and laymen,
individually given the task to select patients for subsidized psychotherapy from a pool of 15 cases,
presented through vignettes. Think-aloud-protocols collected during the task were analysed with
statistical and qualitative methods. A principal conclusion was that prioritizing basically is a
conflict between the urgency of the case and its suitability for treatment. The clinicians put most
weight on issues of suitability whereas health care officials and laymen rather focus on issues of
urgency. Our second, ongoing, study is a naturalistic investigation of decision-making in
psychiatry-personnel groups specifically organized for the task of prioritizing patients for
psychotherapy. The tape-recorded regular discussions in these groups are taken as group
equivalents to the individual think-aloud-protocols in the first study, and we use the same
qualitative methods to analyze them. The analyses focus both on the group interaction and its
individual members. The aim of the study is to test the generalizability of the results of the first
study as well as to develop a ―decision-makers´ aide‖ in real-life prioritizing.




                                               108
Poster Session A

Title:                 Identification of Cognitive Conflicts Using the Repertory Grid Technique

Authors:               Luis Angel Saúl-Gutiérrez, Guillem Feixa, and Vicente
                       Sánchez-Rodríguez

Address for Correspondence:

                       Luis Ángel Saúl-Gutiérrez
                       Avenida de la Merced, 109-131
                       37005-Salamanca, Spain
                       Telephone (9)23-294400 ext. 3327 / 3301
                       Fax (9)23-294607
                       e-mail: lasaul@gugu.usal.es

                                           ABSTRACT

        The aim of this poster is to introduce the manner of proceeding in the detection of possible
cognitive conflicts in the patient through the use of the repertory grid technique and their
subsequent analysis using the computer program RECORD v. 2.0. (Feixas, G., y Cornejo, J.M.).
This method of assessment allows us to measure very precisely any change in the client during
their psychotherapy. This level of precision is necessarily specific to each client, given that each
cognitive conflict is particular to that individual. The method is illustrated with the aid of a
clinical case study.




                                               109
Poster Session A

Title:                  Information Processing in Social Phobia: The Modified Stroop Test

Authors:                Maria do Céu Salvador and José Pinto Gouveia

Address for Correspondence:

                        Maria do Céu Salvador
                        Núcleo de Estudos e Intervenção Cognitivo-Comportamental
                        Faculdade de Psicologia e de Ciências da Educação da Universidade de
                        Coimbra
                        Rua do Colégio Novo
                        3000 Coimbra, Portugal

                                            ABSTRACT

        According to a cognitive view of emotional disorders, anxiety states arise from the activity
of cognitive structures concerned with the processing of information related to personal danger
("danger schemata") which guide the intake and organization of current information, selectively
favoring the encoding of schema consistent information. Furthermore, it is hypothesized that this
pattern of selectivity occurs quite automatically in the sense that it does not reflect an intentional
strategy mediated by conscious awareness.

        For social phobics (SPs), the danger-schemata become active in social situations. Beck
(1985) states that their self-schema define them as defective or lacking the resources to meet
social demands and that vulnerability to negative evaluation is the primary construct of their
cognitive representation of themselves in social situations. Therefore, SPs process social
information differently from non-phobics, selecting and interpreting information consistently with
their negative self-views.

        In this poster, the authors present an investigation in social phobia that makes use of an
introspection-free methodology which is not limited to conscious cognitions — the modified
Stroop test. In this methodology, the colour naming latencies for affectively valenced words
appear to provide a reliable measure of attencional bias, sensitive to specific anxiety-linked
processing bias. SPs have been compared with individuals with other anxiety disorders (OADs)
and with non-clinical subjects. Results confirm that SPs process social threat information
differently from normal subjects (although this was not the case with OADs), showing a
significant increase of latencies in social threat words. This suggests an attentional bias to this
type of information as it is postulated by cognitive paradigms.




                                                110
Poster Session A

Title:                 Information Technology in Psychotherapy - Friend or Foe

Authors:               Sarah Baldry and Stephen Goss

Address for Correspondence:

                       Stephen Goss
                       Student Services
                       Napier University
                       219 Colinton Road
                       Edinburgh
                       EH14 1DJ
                       Scotland


                                           ABSTRACT

        This poster summarises the results from a Masters research project entitled ‗The Use of
Information Technology in Counselling and Psychotherapy‘ which assimilated a wide range of
existing papers relating to the topic and identified issues to be addressed by the mental health
industry in an increasingly Information Technology (I.T.) literate age.

       The conventional domain of I.T. has been in the ‗number crunching‘ arenas of business
and physical science, but the increasing communications capabilities introduced by modern
technology are having an impact on all walks of life and psychotherapy is no exception.

        As a human orientated activity psychotherapy has had an involvement with IT stretching
back over thirty years to the development of ELIZA emulating Rogerian therapy. Recently I.T.
has diversified away from bespoke software providing direct therapy for specific conditions, to
offering a means of communication employing the technologies of telephone, video conferencing,
email, and the Internet. These are enabling therapeutic activities to transcend the limitations of
geography and time, but also strike at the heart of traditional face to face therapeutic relationship
building techniques.

        I.T. is a driver for potentially awe-inspiring changes in mental health practices, both by
the technologies available and by the demands made by an increasingly I.T. literate client base.
This poster highlights the identified effects on both providers and clients of employing a range of
I.T. facilities in mental health provision, and draws attention to the issues that result.




                                               111
Poster Session A

Title:                  JAKOB: The Development of a Tool for Analysing Narratives

Author:                 Alexandra Fleischmann

Address for Correspondence:

                        Dr. Alexandra Fleischmann
                        Psychological Institute of the University of Zurich
                        Department of Clinical Psychology
                        Schmelzbergstrasse 40
                        CH-8044 Zurich, Switzerland
                        Phone: (+41)-1-634 30 85
                        Fax: (+41)-1-634 49 30
                        E-Mail: alexf@klipsy.unizh.ch

                                            ABSTRACT

        In research on psychotherapy and on process of psychotherapy the importance of
narratives has been increasing over the past few years. Why narratives? What is special about
them? Why are they valuable?

        If someone wants to express personal experience and seeks the listener‘s emotional
participation he or she will choose the narrative. By narrating stories which are evoked by
emotionally destabilizing or significant events one creates a room or a ‗stage‘ respectively for
sharing one‘s subjective view and intrapsychic world. How this stage is arranged, the placement
of persons and figures, and the dramaturgical organisation play crucial roles in the analysis.

        On this basis we regard narratives or more specifically ‗everyday stories‘ as the key to
psychodiagnostic and psychotherapeutic relevant data. The method JAKOB enables us to obtain
information about functions of the narrative and about the narrator‘s wishes, fears, defense,
resistance, compromises, and conflicts. JAKOB allows to describe and interpret the material
systematically.

        I will present in detail the various steps of the psychoanalytical based narrative analysis
JAKOB (Boothe 1992-1998; Boothe, von Wyl, Wepfer, 1998) from the step of extracting
narratives, the application of coding rules to identification of conflicts. Furthermore I would like
to discuss in which ways JAKOB is further developed, changed, and automated by using a
computer programme.




                                                112
Poster Session A

Title:                 Morita Therapy in the Light of a Generic Model of Psychotherapy -
                       Discussion in Ulm

Authors:               Mihoko Kusano, Kei Nakamura, and Horst Kachele

Address for Correspondence:

                       Mihoko Kusano
                       (1) Dept. of Psychotherapy and Psychosomatic
                       Medicine, University of Ulm, Am Hochstraess 8,
                       89081 Ulm, Germany
                       (2) Dept. of Psychiatry, Jikei Univ., 4-11-1 Izumi-
                       Honcho Komae-shi, 201-8601 Tokyo, Japan


                                          ABSTRACT

       Morita Therapy is a psychotherapy for neurosis initiated in the 1920s by Prof. Masatake
Morita in Japan. In the face of the many diverse forms of psychotherapy, it is not surprising that
Morita Therapy has stirred up controversial discussions either from Western and Eastern aspects.

         In 1987, Orlinsky & Howard published the "Generic Model of Psychotherapy" which tries
to clarify an universal framework of psychotherapy. We shall try to grasp Morita Therapy in the
light of this generic model. We shall report on German clinicians' way of understanding Morita
Therapy presented in the Generic Model language in Ulm. The features of this reception will be
the focus of this presentation. We hope to contribute to a better understanding of Morita Therapy's
future potential in the West.




                                              113
Poster Session A

Title:                 Multi-Centre Research Ethics Committees: Issues in Gaining Health
                       Service Access for Psychotherapy Research in the UK.

Author:                Bernadette Bartlam

Address for Correspondence:

                       Bernadette Bartlam
                       Department of Applied Social Studies,
                       Keele University, Staffordshire, ST5 5BG, England.
                       Fax: +44 (0)1782 584 069
                       email: spa14@appsoc.keele.ac.uk

                                          ABSTRACT

        Multi-centre research ethics committees (MRECs) have been established in the UK since
1997 to process research applications intending to use National Health Service (NHS) sites falling
under the remit of more than three Local Research Ethics Committees (LRECs). The intention is
one of facilitating and streamlining multi-site studies, of standardising requirements and avoiding
unnecessary bureaucracy.

        This paper arose as a result of submitting a study examining Counselling in Reproductive
Medicine to an MREC. This three year study is being funded by West Midlands Regional
Health Authority as a New Blood Research Fellowship, a national initiative to develop and
encourage non-medical neophyte researchers in the NHS. The paper explores the issues raised
by the MREC, including concern over asking patients 'negative' questions, such as those
contained in the Beck Depression Inventory (Short Form) and Counselling Outcomes in Routine
Evaluation. The paper moves on to examine issues around gate keeping and control in research,
and ends with a discussion of the possible implications for psychotherapy research in medical
settings in the UK.




                                              114
Poster Session A

Title:                 Objectivity and Reliability of the PMAP: Translation into German and the
                       Determination of its Qualities on a German Sample

Authors:               Birger Arnhold, Elke Horn, Sybille Hower, Volker Tschuschke, Jurgen
                       Ott, and Luciano Alberti

Address for Correspondence:

                       Elke Horn
                       Klin. Institut fur Psychosomat. Medizin und Psychotherapie
                       HH - University Dusseldorf
                       Moorenstr. 5
                       D-40225 Dusseldorf
                       Germany
                       Fax: 0049-211-8116250
                       Email: horne.uni-duesseldorf.de

                                         ABSTRACT

       The PMAP- manual of Piper & McCallum (1987) has been translated into German
(Tschuschke 1996) and revised for a German population (Arnhold & Horn, 1998).

       Psychological Mindedness is believed to be very important for working with all kinds of
psychodynamic therapy. Recent studies showed evidence, that psychological mindedness is an
important measure of therapy outcome, especially for dynamic group psychotherapy.

        The PMAP works with a scale, that differentiates nine levels of psychological mindedness.
The criteria for each level reflect basic assumptions of psychodynamic theory (McCallum, Piper,
1987).

         A mixed group of ninety subjects has been examined for the Duesseldorf-PMAP-Study
(Arnhold, Horn, Hower, 1998). Fifty-five medical students and thirty-five patients of the
psychosomatic outpatient clinic of the University of Dusseldorf were examined. All patients were
examined with a clinical interview and questionnaires (SCL-90, IIP). The objectivity and the
reliability scores of the PMAP were obtained using the re-test reliability method.




                                             115
Poster Session A

Title:                 On The Relevance of Personal Therapy for Cognitive-Behavioral
                       Therapists in German-Speaking Countries

Authors:               Hansruedi Ambühl and Ulrike Willutzki

Address for Correspondence:

               Dr. Hansruedi Ambahl
                      Psychotherapeutische Praxisstelle der Universitaet Bern
                      Mittelstrasse 42, 3012 Bern, Switzerland
                      Email: Ambuehl@ptpunibe.ch

                                          ABSTRACT

       This paper is based on data of an international Study on the Development of
Psychotherapists (ISDP) which was started on 1989 by a group of clinicians and therapy
researchers who work together in the SPR Collaborative Research Network (CRN). The ISDP
examines the nature, correlates, and perceived determinants of development among professional
psychotherapists. This paper focuses on the question of the relevance of personal therapy for the
development of psychotherapists with a cognitive-behavioral theoretical background.

        Based on data of 140 German-speaking therapists with a salient cognitive-behavioral
orientation, the following four questions were examined: (1) Does personal therapy have an
impact on the professional self-conception? (2) Does the amount of personal therapy correlate
positively with the amount of therapeutic skills? (3) Does personal therapy prevent or reduce
signs of burnout among psychotherapists? (4) Does personal therapy influence the amount of
professional development reported by therapists? The findings do not support the idea that
personal therapy is necessary as a component of professional training.




                                              116
Poster Session A

Title:                  Outcome and Process Psychotherapy Evaluation: Some Methodological
                        and Statistical Problems and a Research Project

Author:                 Santo F. DiNuovo

Address for Correspondence:

               Santo F. Di Nuovo
               Faculty of Education
               University of Catania, Italy
               Via Ofelia, 2 - 95124 Catania, Italy
               Fax ++39 095 316792
               E-mail: s.dinuovo@mail.fmag.unict.it


                                            ABSTRACT

       The author will discuss a project of psychotherapy evaluation research carried out in Italy
with the participation of therapists following different theoretical approaches: psychoanalytical,
body-oriented, cognitive-behavioral, group and family therapy.

        The project was focused on the relationships between ‗outcome‘ (pre-post-follow up
measurement) and ‗process‘ (longitudinal analysis of therapist‘s session reports and client‘s
self-report).

         The participants to the research project agreed on the use of a pool of instruments, useful
for the assessment of client‘s and client/therapist relation in the different phases of the treatment:
i.e., grids and psychometric tests as ―Cognitive Behavioral Assessment‖ and Thematic
Apperception Test.

        Some time-series statistics useful for the analysis of the psychotherapy process have been
selected for the evaluation of the effect of single case or small group studies. A meta-analytical
approach was planned to cumulate and integrate findings of these single-case studies, using as
moderators some variables related to patients (e.g., sex, age, type and level of pathology),
therapists (theoretical approach, age, experience) and context (institutional vs. private practice,
individual vs. family or group setting, frequence of sessions, drugs use, etc.)

        Some preliminary results obtained in the first year of research will be presented and
discussed, with reference to theoretical and methodological aspects of the psychotherapy
effectiveness evaluation.




                                                117
Poster Session A

Title:                 Prototype Narratives and Cognitive Organization in Depression

Authors:               Angela Costa Maia and Oscar F. Goncalves

Address for Correspondence:

                       Angela Costa Maia
                       Departamento de Psicolgia
                       Campus de Gualtar Universidade do Minho
                       Braga, Portugal
                       Email: Angelam@iep.uminho.pt

                                           ABSTRACT

       This poster will present a study on the knowledge organization in depression. Working
from a narrative framework on the question of the nature of the central aspects of the knowledge
organization in this pathology, our first work was the identification of a prototype narrative in
depression. In a second moment we worked on the validation of this narrative with depressives
and psychotherapists.

        The prototype narrative of depression and the results of three separate validation studies
will be presented and discussed.




                                               118
Poster Session A

Title:                  Psychodynamic Psychotherapy of Panic Disorder

Authors:                Carlos Edson Duarte, Cloyra Almeida, Marlene Dias da Silva, Sergio
                        Zusmann, Veronica Portella Nunes, Maria Angelica Arcoverde, Daniele
                        Ramalho de Assis, Isabela M.M.M. Vieira, and Adelmo Pontes Aragão

Address for Correspondence:

                        Carlos Edson Duarte
                        Department of Psychiatry
                        Federal University of Rio de Janeiro (UFRJ)
                        Praia do Flamengo, 66 – Bloco B – Sala 817
                        CEP 22 210-030 – Rio de Janeiro – BRAZIL
                        Telephone: +55 21 285-5952
                        Email: cedson@ax.apc.org

                                            ABSTRACT

       The Authors intend to show some preliminary findings with the use of the Manual of
Panic-Focused Psychodynamic Psychotherapy, by MILROD, B.; BUSCH, F.; COOPER, A.; and
SHAPIRO, T., on training new therapists to psychotherapeutic work addressed to Panic Disorder.

        The project will be carried out in the Psychiatric Institute of Federal University of Rio de
Janeiro (IPUB) from January 1999 to December 2000. Five post-graduation students (medical
doctors and psychologists) will be selected as therapists. After a 3 month pre-training period,
they will be allowed to start a maximum of two brief psychotherapies each one applied to 10
patients previously selected. The therapists will be evaluated by themselves and the
investigators; the therapies will be evaluated on the basis of the supervision, the interviews and
the clinical evolution assessed by CCRT and SCL-90, the supervisors will evaluate the progress
obtained by therapists, on a scale from 0 (none) to 5 (maximum).

        The patients will be selected among those who demand the IPUB Outpatient Clinic by
reason of Panic Disorder (DSM-IV). All patients will be submitted to a Diagnostic Interview and
a Relationship Anecdote Paradigm Interview (RAP) before starting the therapy, not conducted
both by the assigned therapist; they will be also asked to fill a Hopkins Symptom Checklist
(SCL-90) during the pre-treatment period. These procedures will be repeated at termination and
at follow-up period (3,6 and 9 month post-therapy), being the interviews conducted by the
therapists themselves. When necessary, and according to the Manual prescriptions and other
relevant information, the patients may be medicated at the IPUB Outpatient Clinic.




                                                119
Poster Session A

Title:                 Psychological Problems of University Students: A Comparison of
                       Counseling Center Clients and Nonpatient University Students

Authors:               Tina Dorn, Ulrich Soeder & Rainer Holm-Hadulla

Address for Correspondence:

               Rainer Holm-Hadulla, M.D.
               Psychotherapeutische Beratungsstelle des Studentenwerks
               Neue Schloßstr.42
               D-69117 Heidelberg
               Germany
               e-mail: rainer.holm-hadulla@urz.uni-heidelberg.de

                                           ABSTRACT

        The present study reports data on the symptomatic distress experienced by the clients of a
university-based counseling service in Heidelberg, Germany. For the assessment of symptomatic
distress, the students completed the Symptom Checklist-90 (SCL-90-R) at the time of initial
contact. A total of 130 clients (96 females and 34 males, mean age=25,53, sd=5,38) was included
in the study.

       The scores of the client sample were compared to the scores of 346 nonpatient students
from the same university, consisting of 221 females and 115 males (mean age=24,3, sd=1,9).
Adult norms and the scores of psychotherapy patients provided further information on the
evaluation of the clients‘ psychological status. An external validation of the self-reported distress
was provided by diagnostic information according to DSM-IV.

        The counseling center clients were similar to adult psychotherapy patients on the
SCL-90-R. When compared with norms based on community samples, nonpatient students were
more symptomatic than adults. Also, nonpatient students were significantly less symptomatic than
counseling center clients. Compared with the scores of a large U.S. client sample, German clients
appear more symptomatic. In general, the results of this study are consistent with the findings of
Northern American publications. The data‘s implication for the professional status of counseling
centers and further multicenter research are discussed.




                                               120
Poster Session A

Title:                  Psychotherapy Process Research on Dialogical Narrative Transformation:
                        A Computer-Assisted Method for the Qualitative Coding and Analysis of
                        Self-Narratives

Author:                 Luis Botella & Meritxell Pacheco

Address for Correspondence:

                        Luis Botella.
                        Department of Psychology, Ramon Llull University.
                        Cister 24-34.
                        08022-Barcelona. Spain.
                        Fax: 34-93-253 30 31.
                        E-mail: lluisBG@blanquerna.url.es

                                            ABSTRACT

        Psychotherapy can be considered as a process of social influence through language, a form
of human relationship in which client‘s self-narrative transformation is fostered. This paper will
present a process research concerning the nature of narrative reconstruction that takes place
during the psychotherapeutic dialogue.

        A computer-assisted method for the qualitative analysis of narrative texts through a set of
categories relevant to the study of the psychotherapeutic process will be discussed. Our aim is to
describe changes in the client‘s self narratives during the psychotherapeutic process and how the
therapist interventions contribute to the dialogical reconstruction of these self-narratives.
Consequently, we will discuss the usefulness of the narrative as a unit of analysis in order to
understand the psychotherapeutic process.

        A single case study will be presented in order to demonstrate how we implement our
method for the qualitative analysis of self-narratives as well as to describe changes in the client‘s
self narratives during the psychotherapeutic process.




                                                121
Poster Session A

Title:              Psychotherapeutic Outpatients and Patients from a
                    Consultation-Liaison-Service: How Do They Differ in Symptoms and
                    Interpersonal Problems?

Authors:            S. Buse, R. Karig, N. Hartkamp, and N. Schmitz

Address for Correspondence:

              Stephan Buse
              Christophstrasse 23
              40225 Duesseldorf
              Germany
              Fax: +49-211-9348338
              E-mail: buse@uni-duesseldorf.de


                                        ABSTRACT

       The present poster investigates symptoms and interpersonal problems of patients from the
psychosomatic consultation-liaison-service of the HHU-Duesseldorf. The data on the n=442 (283
female, 159 male) subjects were collected over a period of nearly two years.

       Symptomatic distress was measured using the SCL-90-R, interpersonal problems were
measured using the IIP (64 items version). Additional instruments were the Impairment-Score
(BSS) and questionnaires on sociodemographic variables.

        Our results show that among the consultation-liaison-patients anxiety and depressive
symptoms are about as important as in a population of psychotherapeutic outpatients that was
used for comparison. The latter group shows a different pattern of somatization symptoms as
compared to the consultation-liaison-patients. With regard to interpersonal problems the
psychotherapeutic outpatients show a markedly higher IIP-sum score, and these patients also
score higher on each of the IIP-subscales.

       Our findings are consistent with the assumption, that patients from a medical hospital
show more somatization as compared to psychotherapeutic patients who perceive their problems
more in an interpersonal realm.




                                            122
Poster Session A

Title:                  Representations of The Therapeutic Relationship, Therapeutic Alliance,
                        and Therapist Introject

Authors:                Conrad Lecomte and Claire Lebourgeois

Address for Correspondence:

                       Conrad Lecomte
               Full Professor
               University of Montreal
                       Department of Psychology
               C.P. 6128, succursale Centre-Ville
               Montreal, QC H3C 3J7
                       Fax: 514-343-2184
               Email: conrad.lecomte@umontreal.ca

                                               Abstract

        This study examined the influence of therapist introject on the therapist's representations
of the therapeutic relationship and on therapeutic alliance during the formation phase of the
alliance. Eighteen novices therapists participated in this study. Therapist Introject and therapist's
representations of the relationship was measured by Intrex Questionnaire (Benjamin, 1988).
Results showed that therapists with friendly introject perceived themselves more accepting than
therapists who reported hostile introject. Findings also indicated that therapists with friendly
introject associated therapeutic alliance with their accepting attitude and with their perception of
the friendly attitude of their clients. These findings highlighted the interest to study the therapist's
representations of the relationship.




                                                123
Poster Session A

Title:                 Role Patterns In Group Supervision

Authors:               Siv BoaIt Boethius and Marie-Louise 0gren

Address for Correspondence:

                       Siv BoaIt Boethius
                       Ericastiftelsen, Odengatan 9
                       114 24 Stockholm, Sweden
                       tel 08-402 17 60
                       fax 08-10 96 91


                                          ABSTRACT

        An analysis of 22 supervision groups in two training programs in psychotherapy was
performed. The questions concerned role patterns and changes over time. SYMLOG ratings of
Actual and Wish in the beginning, middle and end of each program was used. The results showed
no significant differences between the two categories of supervisees, whereas the differences
between the supervisors and the supervisees, independent of program level, were highly
significant. The results indicate that it is just as difficult to find one's voice and role in a
supervision group on advanced as on basic level. For the supervisors the result was interpreted in
terms of their role in relation to the supervisees and the goal of the supervision.




                                              124
Poster Session A

Title:                  Self and Observer Ratings on the Central Relationship Questionnaire:
                        Issues of Self-observer Agreement and Assumed Similarity

Authors:                Carol Foltz and Jacques Barber

Address for Correspondence:

                        Jacques Barber, Ph.D.
                        Center for Psychotherapy Research
                        University of Pennsylvania
                        3600 Market Street, Room 704
                        Philadelphia, PA 19104-2648, USA

                                           ABSTRACT

        The present study investigates self-observer agreement on a measure of central
relationship patterns in order to determine whether the substantial degree of agreement found
between self and observer reports of personality among couples generalizes to more subjective
aspects of personality. A second goal of the study is to examine the degree of assumed similarity
in observer ratings of central relationship patterns. Assumed similarity refers to observers' use of
(or projection of) their own personality as a point of reference when rating the target person.
Both partners of 97 young adult couples rated themselves and their partners on the Central
Relationship Questionnaire (CRQ, Barber et al., 1998), a measure of individuals' Wishes or
desires in their close relationships, their perceptions of others' responses to them (ROs), and their
own responses to both of these (RSs). Results for specific CRQ subscales demonstrated that
couples generally evidenced moderate agreement in characterizing the central relationship
patterns of each target person in terms of ROs and RSs, while self-partner agreement for wishes
was small. For the profile of Wishes, ROs, and RSs, couples evidenced significant self-partner
agreement on all CRQ components. Regarding the second issue of assumed similarity, observers
assumed a significant amount of similarity between themselves and their partners. The extent of
this assumed similarity differed markedly from the actual similarity between partners, as reflected
in weak correlations between the two partners' self ratings. Despite the significant degree of
assumed similarity in observers' ratings, results of multiple regressions indicated that the
observer's rating of the target person was a significant predictor of the target person's self
description, over and above observers' own self-description (assumed similarity), although
subsequent regression analyses controlling for multicollinearity showed that this result was not
always significant. Finally, contrary to predictions, the degree of assumed similarity between
self and partner was related to better psychological adjustment and relationship satisfaction,
suggesting that assumed similarity is a normal perceptual bias at least in the present sample.




                                               125
Poster Session A

Title:                 Self, Complexity, and Psychopathology

Authors:               Miguel Goncalves and Joao Salgado

Address for Correspondence:

                       Miguel Goncalves
                       Department of Psychology
                       University of Minho
                       4700 Braga
                       Portugal

                                          ABSTRACT

        In this study we analyze the impact of the complexity of the self on the psychopathological
complaints of college students. In a partial replication of the research made by Linville(1987) on
self-complexity, we add two more variables of complexity - ambiguity tolerance and behavior
imprevisibility. The results obtained by Linville (1987) suggested a buffering effect of
self-complexity. Our results didn‘t show this pattern for any of the complexity variables. The
best predictor of the present dysfunctionality is the previous level of the dysfunctionality. The
results of a principal components analysis suggest that the variables of complexity are
independent from the variables of dysfunctionality. These results are discussed in regard of two
different positions in psychology - one more tradition in which the complexity is associated with
dysfunctionality and the constructionist one that suggests an association between complexity and
adaption.




                                              126
Poster Session A

Title:                 Self-Help Group Attendance Among Cocaine Dependent Patients
                       Receiving Psychotherapy and/or Drug Counseling in the NIDA Cocaine
                       Collaborative Treatment Study

Authors:               Margaret Griffin, Roger Weiss, and Robert Gallop

Address for Correspondence:

                       Margaret Griffin
                       McLean Hospital
                       115 Mill Street
                       Belmont, MA 02478
                       USA

                                           ABSTRACT

       Clinicians frequently refer their drug dependent patients to self-help (sometimes called
mutual-help) groups such as Alcoholics Anonymous or Narcotics Anonymous. Indeed, many
formal drug dependence treatment programs are largely based on the 12-step philosophy
characteristic of these groups. However, although some researchers have studied patterns of
Alcoholics Anonymous attendance and participation among individuals with alcohol use
disorders, virtually no research has been conducted examining self-help group attendance among
drug dependent patients.

        The National Institute on Drug Abuse Cocaine Collaborative Treatment Study compared
(1) Individual Drug Counseling plus Group Drug Counseling (GDC); (2) Supportive-Expressive
Therapy plus GDC; (3) Cognitive Therapy plus GDC; and (4) GDC alone, in 487 cocaine
dependent outpatients treated at five different sites. As part of this study, we examined patterns
of self-help group attendance and participation in this patient population.

        Patients completed the Weekly Self-Help Questionnaire each week during active
treatment, and at post-treatment follow-up assessments. This questionnaire examines frequency
of attendance and level of participation in self-help groups. Predictors of attendance and
participation will be reviewed, along with the relationship between self-help group attendance and
type of psychotherapy/drug counseling received.




                                               127
Poster Session A

Title:                Socially Impaired vs. Socially Non-Impaired Patients: Differences in
                      Symptoms and Interpersonal Problems

Authors:              R. Karig, S. Buse, N. Hartkamp, and N. Schmitz

Address for Correspondence:

              Roman Karig
              Witzelstr. 1a
              40225 Duesseldorf
              Germany
              E-mail: karig@uni-duesseldorf.de

                                         ABSTRACT

       It is a common belief, that social impairment leads to psychological problems and finally
contributes to medical illness. From this perspective it can be expected, that patients with
pronounced deficits of their social situation are more severely ill both psychosocially and
somatically.

       The present poster studies the relation of social impairment (loss of personal relations,
unemployment, low socioeconomic status), which was measured using a specially constructed
composite index, to symptoms and interpersonal problems of patients both from the
psychosomatic consultation-liasion-service of the HHU-Duesseldorf and from the University's
psychotherapeutic outpatient clinic.

       Symptomatic distress was measured using the SCL-90-R, interpersonal problems were
measured using the IIP (64 items version). Additional instruments were the Impairment-Score
(BSS), which is an expert rating of psychological, somatic and interpersonal/psychosocial
impairment, and questionnaires on sociodemographic variables.

       The results of our comparisons of the least impaired vs. the most impaired subgroups
support the notion of a differential influence of social impairment on somatic and psychological
problems.




                                             128
Poster Session A

Title:                 Supervision, Design of an Instrument That Permits to Reach a Comparable
                       Register of the Supervision Work

Authors:               Beatriz Dorfman Lerner, Clara López Moreno, Asociación Psicoanalítica
                       Argentina, and Andrés J. Roussos, Universidad de Belgrano

Address for Correspondence

                       Andrés J. Roussos
                       Research Department, Universidad de Belgrano
                       Zabala 1837, F12, B7 (1426), Buenos Aires, Argentina
                       Tel: (5411) 788-5400 ext.2564
                       Fax: (5411) 788-5400 ext.2533

                                           ABSTRACT

        The aim of this paper is to present the design of an instrument that permits to reach a
comparable register of the supervision work. This instrument intends to operationalize the
patient's signs and symptoms as they are taken by the therapist in the therapeutic interview with
the patient. This material is re-elaborated in the supervisory session. The principal themes of this
questionnaire are, among others: fixation points (or psychosexual evolution); object relations;
defense mechanics; primary and secondary process functioning (Freud); counter transference
(Racker) and predominant conflictual areas (Bleger). The questionnaire consists of two parts. In
the first, data referring to the patient's psychic structure are elaborated between supervisor and
supervisee; in the second, it is the data referred to the therapist's counter transference (in the
therapeutic session) and the supervisor's counter transference (in the supervisory session) which
are considered.

        This instrument is apt to evaluate the consistency of the diagnostic and prognostic
evaluation made by the therapist in the first interview with the patient, to which aim the same
questionnaire will be periodically administered along treatment. To assess its theoretical
relevance together with understandability and usefulness, a filled up questionnaire has been
already presented to 10 psychoanalytically oriented therapists, from whom it has been required to
give a psychopathological profile of the patient. Also, it has been asked from these therapists to
give their impression.




                                               129
Poster Session A

Title:                  Supervisory Alliance, and Trainee and Supervisor Introject

Authors:                Claire Lebourgeois and Conrad Lecomte

Address for Correspondence:

                        Conrad Lecomte
                        Full Professor
                        University of Montreal
                        Department of Psychology
                        C.P. 6128, succursale Centre-Ville
                        Montreal, QC H3C 3J7
                        Fax: 514-343-2184
                        Email: conrad.lecomte@umontreal.ca

                                           ABSTRACT

        Supervision and training continue to be a relatively unexplored domain of psychotherapy
research in spite of the clear consensus in literature that clinical supervision is the most important
ingredient in the training of therapists. Supervision may be defined as a learning alliance that
empowers the trainee to acquire therapeutic and interpersonal competences. Most empirical
efforts have focused on skill, theoretical orientation, supervisory processes and developmental
models. Very few studies have examined the supervisory alliance. One interesting recent finding
regarding working alliance is the influence of personal characteristics, in particular the introject,
on the formation of alliance.

        The influence of trainee introject on the supervisory alliance in a manualized training
program was investigated with twenty graduate trainees in master and doctoral-level psychology
programs. Groups were formed on the basis of introject as measured by the Intrex Introject
Questionnaire (Benjamin, 1988). Differences between the alliance's perception of trainees with
self-directed hostility (hostile introject) and trainees with self-directed friendliness (friendly
introject) were examined. Results show that introject influences the perception of supervisory
alliance. Implications for therapist training are discussed.




                                                130
Poster Session A

Title:                 The Assessment of a Psychosocial Support Program for Families of
                       Patients in the Initial Stages of Alzheimer's Disease: The Experience of the
                       Neurology Dept at Salamanca University Hospital

Authors:               M. Hemmings, J. Cacho, R. Garcia., J. Navarro

Address for Correspondence:

                       Martin Hemmings
                       C/Dorado Montero, 1-3 1º Izq
                       37006 Salamanca, Spain
                       Tel. (923) 22 10 35
                       Email:hemmeire@mail.iponet.es

                                          ABSTRACT

        Two programs of psychosocial support are currently underway at the Salamanca
University Hospital with a view to easing the psychosocial burden on the families of: 1) Bone
Marrow transplant patients, and 2) Patients in the initial stages of Alzheimer‘s disease. The
ongoing research being carried out into the psychosocial needs of these families, backed up by
clinical observation shows that these needs fall into two general categories:

         1) information
         2) support/peer support

In both of the psychoeducational programs mentioned above an attempt to meet these needs is
made using both an individual and a multi family group protocol. The following is the abstract of
the current study of the effectiveness of the individual protocol

        An investigation was carried out in order to find out the extent to which the program for
psychosocial support for the families of Alzheimer's Disease patients meet the family's
psychosocial needs and help them to manage the stresses and burdens which caring for a
chronically ill family member supposes during the first 6 months. The General Health
Questionnaire (Goldberg & Hillier1979) and the Family Burden Questionnaire (developed by the
members of the project) were both administered to the patient's families at the beginning of the
psychosocial intervention (diagnosis) and were then also administered 5 months later along with
the Usefulness/satisfaction questionnaire (also developed by the members of the project). The
results of which are currently under analysis.




                                              131
Poster Session A

Title:                 The Effects of Abuse, Neglect and Parental Involvement on the Cognitive
                       Functioning of At Risk Adolescents

Author:                Melinda Blitzer and Philip M. Drucker

Address for Correspondence:

                       Melinda Blitzcr
                       The Derner Institute, Adelphi University
                       Garden City, New York NY 11530
               USA

                                          ABSTRACT

        The aim of this study is to investigate the cognitive functioning of a sample of at risk
adolescents living in a residential treatment facility most of whom experienced protracted
maltreatment (i.e., physical and sexual abuse and neglect).
        The participants in the study were 114 adolescents (63 boys, 51 girls), ranging in age from
12 to17 years old (M = 14.4) who were treated at the Woodbridge Child Diagnostic Center in
New Jersey since 1994. The facility is a short-term (3 to 9 months) residential facility that
evaluates and treats adolescents that are placed there by the Division of Youth and Family
Services (DYFS). Cognitive functioning was measured by the Wechsler Intelligence Scale for
Children (WISC III) and the Kaufman Assessment Battery for Children (K-ABC).
        There was a high incidence of mothers that were chemically addicted (51%) compared to
fathers (30.7%). Sixty-two percent of the fathers had minimal contact with their child (less than a
quarter of the child's life) compared to 11.4% of the mothers. Almost half of the children (48.2%)
were diagnosed with a conduct disorder. Seventy-one percent of the neglected children had
chemically addicted mothers. Eighty-two percent of the children that experienced school problems
and 55% of the children that had suicidal symptoms had been sexually abused.
        There were observable gender differences, girls performed more poorly on all three WISC
scores and the K-ABC, than boys when there was minimal contact by their mothers. WISC and
K-ABC scores declined for both boys and girls when there was minimal contact with their fathers.
Neglected children tend to display the lowest WISC and K-ABC scores and the greatest
behavioral problems compared to children who experienced other types of maltreatment. However
females that were sexually or physically abused scored lower than neglected females. Thus, it
seems that the experience of neglect was more debilitating for males than females in this sample.
Perhaps such gender differences merely highlight commonly found differences between how the
sexes respond to traumatic experiences.
        The study will present information on other pertinent variables related to cognitive
functioning including the influence of parental addiction, the child's psychiatric diagnosis,
behavioral problems in school (truancy) and criminal history.




                                              132
Poster Session A

Title:                 The Identity of Psychotherapist

Authors:                Pirjo Lehtovuori, Jari Salo and Olavi Lindfors

Address for Correspondence:

                       Pirjo Lehtovuori
                       Orapihlajatie 21-27 a 3
                       00320 Helsinki, Finland
                       fax: +358-9-5876987
                       pirjo.lehtovuori@psykter.pp.fi

                                           ABSTRACT

     In this study we explored the elements and development of the professional and personal
identity of psychotherapists. The present study is a part of a large Finnish Helsinki psychotherapy
study, initiated in 1995. The participants were 50 Finnish psychotherapists, whose patients were
studied in the context of Helsinki psychotherapy study. The theoretical framework of therapists
included psychoanalytic, psychodynamic and systems theoretic perspectives. The assessment of
participants was done in two phases: First, participants filled in the Development of
Psychotherapist Common Core Questionnaire, which is a broad self-report instrument including
both structured and open-format questions. Second, they were interviewed with a semi-structured
procedure, which is based on Heinz Kohut‘s and Erik H. Erikson‘s theories and concepts. Themes
and qualities assessed with these two procedures will be later studied in relation to various client
and outcome variables, using both qualitative and quantitative methods. In this work we present
the initial results concerning the retrospective career development and current experience of
development of therapists. Furthermore, the dimensions describing the personal characteristics of
therapists will be reported and discussed.




                                               133
Poster Session A

Title:                 The Importance of Safety Behaviours in Social Phobia.

Authors:               Marina Cunha, José Pinto Gouveia, Maria do Céu Salvador

Address for Correspondence:

            José Pinto Gouveia
                       Núcleo de Estudos e Intervenção Cognitivo-Comportamental
                       Faculdade de Psicologia e de Ciências da Educação da Universidade de
                       Coimbra
                       Rua do Colégio Novo
                       3000 Coimbra, Portugal

ABSTRACT
     The designation of safety seeking behaviours refers to a set of behaviours with which social
phobics try to reduce social threat and prevent feared outcomes from occurring. The use of
safety behaviours by social phobics has been pointed out as an important maintenance factor of
social phobia (SP) (Salkovskis, 1991, Wells et al., 1995), once they prevent the disconfirmation of
the expectation that some of their feared behaviours (shaking, blushing, pausing in speech and so
on) will be negatively evaluated by others. In some cases, safety behaviours can even increase the
probability of the occurrence of the feared behaviour. Although the identification and change of
safety behaviours is an important component of cognitive therapy of SP, little attention has been
given to the assessment of social phobics' safety strategies and instruments for this assessment do
not exist.

    In the present poster the authors present a self-report instrument for the assessment of safety
behaviours in SP — The Social Phobic Safety Behaviours Scale. This scale has been developed
within a social phobia assessment protocol and has been studied in a sample of the general
Portuguese population and in a sample of Portuguese social phobics.




                                               134
Poster Session A

Title:                 The Most Feared Social Situations in Social Phobia: The Social Interaction
                       and Performance Anxiety and Avoidance Scale

Authors:               José Pinto Gouveia, Marina Cunha, Maria do Céu Salvador

Address for Correspondence:

            José Pinto Gouveia
                       Núcleo de Estudos e Intervenção Cognitivo-Comportamental
                       Faculdade de Psicologia e de Ciências da Educação da Universidade de
                       Coimbra
                       Rua do Colégio Novo
                       3000 Coimbra, Portugal

                                           ABSTRACT

     Diagnostic criteria for social phobia (SP) have suffered important modifications through the
two last versions of the DSM, resulting from both an increasing research and interest for this
disorder. Along with the definition of more accurate criteria there has been a search for more valid
and reliable instruments, in order to assess the multidimensional features of social phobia.

     Nevertheless, among the most used self-report questionnaires in SP very few are able to
assess the type of situations social phobics fear and avoid. Even these few, present important
limitations such as a small number of assessed situations (Fear Questionnaire), a low
discrimination validity with other anxiety disorders (SAD, FNE) or the impossibility of obtaining
separated scores for performance anxiety and interaction anxiety (Social Phobia and Anxiety
Inventory). An exception is made for the Mattick & Clarke's Social Interaction Anxiety Scale and
Social Phobia Scale, which assess anxiety in social interaction situations and in situations that
include being observed by others. Unfortunately, these authors do not present data concerning the
development of this scale.

     In the present poster the authors present development and validation data for the Social
Interaction and Performance Anxiety and Avoidance Scale which assesses experienced distress in
and avoidance behaviours of performance and social interaction situations. This scale has been
developed and studied in subjects from the general Portuguese population and in a sample of
Portuguese social phobics. The results suggest its usefulness in the assessment of SP.




                                               135
Poster Session A

Title:                 The Nature of Change in Psychodynamic Individual Child Psychotherapy

Author:                Gunnar Carlberg

Address for Correspondence:

                       Gunnar Carlberg
                       The Erica Foundation
                       Odengatan 9
                       S-114 24 Stockholm, Sweden
                       Fax: +46 8 10 96 91
                       E-mail: mail@ericastiftelsen.a.se

                                           ABSTRACT

     The lack of research on processes in psychodynamic child psychotherapy is evident. One
factor underlying this is a reluctance among clinicians to participate in research. A methodological
approach in which moments and episodes in therapies are thoroughly explored has, however, been
successful in engaging therapists in the research process.

     Four consecutive studies were performed on sessions the therapists had identified as "turning
point sessions". Data were collected from psychotherapies (n = 14) through interviews, process
records and questionnaires. In addition examples of important changes in a larger group of
therapies (n = 102) were collected through a questionnaire. The aim of the studies was to answer
questions about the nature and content of change and factors underlying change processes.

    It was concluded that different kinds of turning points can be described. The therapists‘
experiences of turning points can be seen as a part of their way of creating meaning. Differences
between the experiences of turning points in ongoing therapies versus terminated therapies
emerged in the data.

     The presentation will focus on these and additional findings concerning the nature of change
in child psychotherapy.




                                               136
Poster Session A

Title:                 The Portuguese Version of the Eating Disorders Inventory: Evaluation of
                       the Psychometric Properties

Authors:               Sónia Gonçalves, Paulo P.P. Machado, Carla Martins, & Isabel Soares

Address for Correspondence:

                       Paulo P.P. Machado
                       Universidade do Minho, Departamento de Psicologia
                       Campus de Gualtar
                       4700 Braga. Portugal
                       Tel#+351-53-604241
                       Fax#+351-53-678987
                       e-mail: pmachado@iep.uminho.pt

                                          ABSTRACT

     The Eating Disorders Inventory (EDI; Garner, Olmsted, & Polivy, 1983) is a measure of the
cognitive and behavioural characteristics of anorexia nervosa and bulimia nervosa. The
instrument is one of the most widely used in clinical practice and research with eating disorders.
The aim of this study was to evaluate the psychometric properties of this instrument in a
nonclinical Portuguese population. The results of the factor analysis reproduces the eight factors
found by Garner et al. (1983) in Canada, and internal consistency is very satisfactory (alpha de
Cronbach ranging between .69 to for the Perfectionism subscale up to .91 for the Drive for
Thinness and Body Dissatisfaction subscale). The inventory also have demonstrated criterion
validity by discriminating eating disorders subjects (anorexia and bulimia nervosa subjects) from
normal subjects. The data generally supported the internal consistency and factor structure of
the Portuguese version of the EDI and the utilisation of this instrument with the Portuguese
population.




                                              137
Poster Session A

Title:                 The Therapist Memories Questionnaire

Authors:               Eugénia Fernandes and Óscar Gonçalves

Address for Correspondence:

                       Eugénia Fernandes
            Departmento de Psicologia
            Int. Educaçao e Psicologia
            Campus de Gualtar- Universidade do Minho
            Braga, Portugal
            email:EugeniaF@iep.uminho.pt

                                           ABSTRACT

     This poster will present the validation study of our previous investigation about the impact of
the client recalling process, on the therapist‘s memories. In order to achieve this goal, we
constructed a Therapist Memories Questionnaire based on the emerged typical patterns of the
therapists‘ memories. Ten therapists with Psychotherapeutic Cognitive Narrative orientation
were invited to analyze their memories in session, by this questionnaire. In this poster, we will
present: the procedures of construction, administration and analysis of the questionnaire results.
We will discuss the results of this validation analysis on the context of therapeutic research.




                                               138
Poster Session A

Title:                    Theory-Driven, Phase-Specific, Manual-Guided, Clinically Meaningful
                          Aptitude-Treatment Interaction (ATI) Research Focusing on Client‘s
                          Non-Diagnostic Personality Variables

Authors:                  Georgios K. Lampropoulos & Paul M. Spengler

Address for Correspondence:

                          Georgios K. Lampropoulos
                          Department of Counseling Psychology, Ball State University,
                          Teachers College 622, Muncie, Indiana 47306, USA.

                                                ABSTRACT

      Empirical research findings in psychotherapy have shown equivalent outcomes between the
cognitive-behavioral and the psychodynamic-interpersonal tradition. In relayed attempts to dispel the Dodo
Bird Verdict (i.e., equivalence of psychotherapy outcomes), both personality-matched eclecticism and
phases of change-matched eclecticism alone have experienced difficulties to demonstrate consistent ATI
findings and provide a complete approach to treatment selection. This suggests the integration of these two
eclectic approaches, ideally in the context of a meaningful theory. Using the Cognitive-Experiential
Self-theory (CEST; Epstein, 1990, 1994, 1997) as a guiding theoretical frame, we are testing
empirically-supported brief interventions derived from cognitive-behavioral vs. experiential schools
searching for differential effects in psychotherapy.

     Based on the hypothesis that there are both cognitive and emotional aspects of awareness and insight
as well as different ways to achieve these change processes, we hypothesize personality variables, namely
client predominant thinking styles (rational vs. experiential) to provide optimal matching effects for
cognitive interventions (problem solving) and experiential interventions (2-chair dialogue) in the resolution
of decisional conflicts. In the first part of this study (the exploration phase of the treatment), only the steps
of problem solving that are related to the exploration, understanding and insight into the decisional conflict
and its solutions are compared against the two-chair technique, according to the number six 1986 NIMH
workshop recommendation for research in psychotherapy integration (Wolfe & Goldfried, 1988) that
suggests: "Inasmuch as change processes may vary with phase of treatment, comparative research on
psychotherapy process should focus on a comparable therapeutic phase." In the second part of the study
(the action phase of the treatment), the rest, action-oriented processes of the problem-solving intervention
are employed in all conditions (with special care to integrate the experiential and the problem solving
processes into a smooth sequential combination in the related conditions). This design allows additional
comparisons (i.e., an integrative experiential-behavioral intervention vs. problem solving).

     A pilot study with one client in each of the four conditions is underway (two clients matched and two
mismatched to the two empirically supported treatments). Client‘s differences in rational and experiential
thinking styles are measured by reliable self-report instruments such as The Rational-Experiential
Inventory (Epstein, Pacini, Denes-Raj, & Heier, 1996) and the Perceived Modes of Processing Inventory
(Burns & D'Zurilla, in press), while the interventions are administered according to manuals.
Poster Session A

Title:                    Training Undergraduate Students in Helping Skills

Authors:                  Clara E. Hill, Karen M. O'Brien, Misty R. Kolchakian, Julie L. Quimby,


                                                     139
                       Ian S. Kellems, Jason S. Zack, and Debra L. Herbenick

Address for Correspondence:

                       Clara E. Hill, Ph.D.
                       Dept. of Psychology
                       University of Maryland
                       College Park, MD 20742
                       USA

                                           ABSTRACT

     Although many helping skills models have been developed over the years (e.g., Brammer &
MacDonald, 1996; Carkhuff, 1969, 1983; Danish & Hauer, 1973; Egan, 1998; Ivey, 1971, 1994;
Kagan et al., 1965) and courses in helping skills are taught in most universities, research on the
effects of helping skills training has been largely abandoned in the past two decades. Furthermore,
the majority of the existing research has been on graduate students (see review by Baker, Daniels,
& Greeley, 1990) rather than undergraduate students. Training undergraduate students in helping
skills early in their careers before they have a lot of clinical experience makes sense, but many
questions remain regarding how to train undergraduate students in their first formative steps
toward becoming helpers.

     In this poster, we will present the results of a large project examining effects of training in
helping skills. Specifically, 45 students in helping skills classes were compared with 50 students
in introduction to counseling classes in terms of changes across the course of a semester in
counseling self-efficacy, anxiety about seeing clients, and the frequency and quality of their
helping skills. We also did interviews with students in the helping skills classes and then did
qualitative analyses of their experiences in learning and implementing the helping skills. We will
discuss the implications of the study for changes in the helping skills model and for future
research.




                                               140
Poster Session A

Title:                  Treatment Development in Psychodynamic-Interpersonal Psychotherapy
                        (Hobson‘s Conversational Model) for Chronic Treatment-Resistant
                        Schizophrenia: A Single Case Study

Authors:                Sarah Davenport, Robert Hobson, Frank Margison

Address for Correspondence:

            Frank Margison, Gaskell Psychotherapy Centre;
                     Manchester Royal Infirmary; Swinton Grove; Manchester, M13 0EU, UK
                      Email: frmargison@aol.com

                                            ABSTRACT

     Aims: To describe the development of PI (Conversational Model) therapy in chronic
treatment-resistant schizophrenia through an intensive single case-study.

     Background: PI therapy has been shown to be effective in somatisation, depression, and in
reducing costs and symptoms in chronically ill non-psychotic out-patients. There is considerable
evidence of effectiveness of cognitive-behavioural therapy for schizophrenia, but some patients
have difficulty engaging sufficiently to use the treatment method. In Finland, the ―needs-adapted‖
model has shown success in combining treatment modalities, but further work is needed in
defining the effective components of the treatment packages, particularly the elements of the
individual psychotherapeutic treatment. Hobson‘s Conversational Model (PI therapy) was
originally developed with a wide range of patients including those with schizophrenia, and the
current case study is part of the development of a modified form of PI which might be particularly
useful for use in severe illness where there are major difficulties in engaging the patient in even a
minimal treatment alliance.

     Case study: The poster presents details of the history and early treatment failure of a woman
of 37 who has had schizophrenia for 21 years and has shown little response to previous treatment.
The unit where the treatment took place is a high-dependency hostel ward for patients thought to
be at significant risk to themselves or others. The treatment approach is multi-modal and includes
medication, psycho-social interventions and a therapeutic milieu. In such a setting the additional
benefit of a psychotherapeutic intervention is difficult to disentangle and so qualitative analysis of
change is needed alongside serial data from instruments of known reliability and validity (which
include the KGV, REHAB and Social Behaviour Schedule). The case study shows that it is
possible to develop a therapeutic conversation with a patient with chronic psychosis using the
principles of PI therapy. This allows greater self-reflection and then engagement in the treatment
process. Changes in outcome measures are linked to changes in the therapy. It is argued that such
an approach is particularly effective with patients at the ―warded off‖ end of the assimilation
spectrum. The treatment approach is a prototype of the use of role-responsive and intersubjective
methods for use in patients who have been unresponsive to traditional treatment.
Poster Session A

Title:                  Treatment Utilization and Helpfulness Rated by Dual-Diagnosis Patients


                                                141
Authors:                Lisa M. Najavits, Amy E. Dierberger, Rebecca G. Winkel, Roger D. Weiss

Address for Correspondence:

                        Lisa Najavits, PhD
                        McLean Hospital
                        115 Mill Street
                        Belmont, MA 02478 USA
                        Lnajavits@hms.harvard.edu

                                           ABSTRACT

     Dual diagnosis patients are widely described as a ―difficult‖ treatment population (e.g., in
severity, treatment retention, and prognosis). In this study, we explored the mental health
treatment history of 46 women with posttraumatic stress disorder and substance abuse using two
measures: the Treatment Services Review (McLellan, 1989) and the Treatment Summary
(Najavits et al., 1995), completed at entry into a randomized control psychotherapy outcome
study. We evaluated two questions: (1) Utilization (what treatments had patients utilized
during their lives?); and (2) Helpfulness (how helpful did patients find their treatments?).
Results indicate three main findings. First, the most frequent treatments patients received were
individual psychotherapy (84%), psychopharmacology (71%), and group therapy (54%).
Second, the treatment patients found most helpful was couples and family therapy (M=1.33 on a
scale from -2 to +2); least helpful was drug and alcohol counseling (M=.50). The results are
discussed in light of issues such as the cost-effectiveness of treatment, systems issues that route
patients toward particular types of treatments, and how to intervene when a patient perceives a
treatment as unhelpful.




                                               142
Panel Session 15 - Overall Summary

Title:                 Family and Marital Therapy Research: State-of-the-Field Review

Participants:          Gary Diamond, Eric McCollum, and Ana Estrada

Moderator:             Jay Lebow

Address for Correspondence:

                       Jay Lebow
                       #651
                       Chicago Center for Family Health
                       445 East Illinois Street
                       Chicago, IL 60611
                       USA

                                           ABSTRACT

      The state of the field of family and marital therapy research will be considered. During the
first hour, panelists will address key questions posed by the moderator. During the final half
hour, members of the audience will be invited to respond with questions and comments. The
format is intended to stimulate an examination of issues related to the past performance, current
status, and future direction of family and marital therapy research.




                                               143
Panel Session 16 - Overall Summary

Title:                 Symbolic and Verbal Processing in Psychotherapy : A Single Case Study

Participants:          Dan Pokorny, Michael Stigler

Moderator:             Clara E. Hill

Discussant:             Clara E. Hill

Address for Correspondence :

            Michael Stigler
                       University of Lausanne
                Dept. of Adult Psychiatry
                1, rue du Tunnel
                CH-1005 Lausanne (Switzerland)
                e-mail : Michael.Stigler@inst.hospvd.ch

                                           ABSTRACT

       The basic question in this panel is: how does imagery contribute to the psychotherapy
process ?

        When imagery becomes a subject in psychotherapeutic work, it mostly stems from
recalled material from nightdreams. In this study, we use material from actively stimulated and
directly recorded imagery in a state of altered consciousness, as it is realized by Leuner‘s method
of Guided Affective Imagery. The advantage of this direct access to dreamlike imagery is to
obtain protocols that are more complete and more precise, and more authentic for the affective
ambience.

       For the analysis of the completely transcribed texts, rating methods (CCRT, DMRS) and
computerized instruments (RID, ADU, EAP, RA) are applied to compare sessions with and
without guided affective imagery. The patient, a 34 year-old woman suffering from panic disorder
having started one year before, had 19 sessions of brief dynamic psychotherapy including 6
sessions with imagery followed by elaboration. At the end of therapy she was consistently
improved, a result confirmed by follow-up through 3 years.

        The presentations of Dan Pokorny on relationship themes and mechanisms of defense, and
of Michael Stigler on computerized analysis of the session texts will be commented and discussed
by Clara E. Hill who has done much clinical and research work in the domain of the interpretation
of nightdreams (Hill 1996).




                                               144
Paper in Panel - Panel Session 16

Title:                 Computerized Text Analysis in Psychotherapy Using Imagery

Authors:               Michael Stigler, Dan Pokorny

Address for Correspondence:

               Michael Stigler
               University of Lausanne
               Dept. of Adult Psychiatry
               1, rue du Tunnel
               CH-1005 Lausanne (Switzerland)
               e-mail : Michael.Stigler@inst.hospvd.ch


                                           ABSTRACT

        The computerized text analysis methods applied in this study come from different
theoretical backgrounds and are based on specific constructs each, but their common territory of
interest is the processing from subsymbolic perceptual and emotional expression to symbolic
expression by images and narratives (as predominant in imagery sessions), to abstract reflection
and elaboration (as predominant in exclusively verbal sessions).

       The therapist is interested in the referential process (Bucci), e.g. the operation that
connects the multiple representational formats of the nonverbal system to one another and to
words.

       The place of an actively applied imagery method in fostering this process is investigated
by comparing the proportions of regressive imagery words (RID, Martindale 1975), emotion
words (ADU, Hölzer et al. 1992), emotion-abstraction patterns (EAP, Mergenthaler 1996) , and
words supposed to be characteristic of referential activity (CRA, Bucci 1997).

        Our hypothesis is that the specific contribution of imagery is a high degree of mobilisation
in the domain of emotions and intuitive actions that are made accessible to abstract verbal work
by the medium of images and concrete, action centered words.




                                               145
Paper in Panel - Panel Session 16

Title:                 CCRT and DMRS in Verbal and Imagery Sessions: Differences and
                       Analogies

Authors :              Dan Pokorny, Michael Stigler, Reinhard Denzinger

Address for Correspondence:

               Dan Pokorny
               University of Ulm
               Dept. of Psychotherapy and Psychosomatics
               Am Hochsträss 8
               D-89081 Ulm, Germany
               e-mail : pokorny@sip.medizin.uni-ulm.de


                                          ABSTRACT

       The hypothesis for applying the methods of CCRT and DMRS in this study is that
therapeutic daydream imagery is effective by reducing anxiety so that objects otherwise too
dangerous can be approached and treated sooner and easier.

       Both CCRT and DMRS have been rated for all 19 sessions (13 verbal, 6 imagery plus
elaboration) of this brief dynamic psychotherapy integrating Leuner‘s method of Guided
Affective Imagery.

         By the CCRT method, we aim at specific differences in the expression of central
relationship themes in the imagery as compared to the verbal condition. Differences may show up
in the issue of the relationship episodes (positive or negative responses from others and self) as
well as in the choice of wishes and responses relating to daydream versus real life objects.
Furthermore, we are interested in a possible evolution of CCRT components from session 1 to 19.

         The DMRS will allow us to test the hypothesis of a lower level of censorship in imagery,
facilitating the access to conflicts that otherwise would need much more and longer work. The
issue is open : we do not know if the mechanisms of dream-work like displacement and
symbolization let the objects appear less terrifying so that more mature defenses can be mobilized,
or if they lower the threshold for more archaic conflicts which then possibly lead to more
primitive defenses. As with CCRT, we are also interested in a possible evolution in the level of
defenses from session 1 to 19.




                                              146
Panel Session 17 - Overall Summary

Title:                  Aspects of Abstraction, Emotion, and Referential Activity Along with
                        Attachment Concepts and a Session Inventory

Participants:           Anna Buchheim, Stefanie Cornehl, Erhard Mergenthaler, Friedemann
                        Pfäfflin, Sylvia Gril, Marina Altman de Litvan, Montevideo

Moderator:              Sylvia Gril

Discussant:             Erhard Mergenthaler

Address for Correspondence:

                Sylvia Gril
                        Departamento de Psicología Médica
                Hospital de Clínicas Piso 15 Avenida Italia S/N
                Montevideo - Uruguay
                        Fax: ++598 2 2044707,
                         Email: sgril@chasque.apc.org

                                           ABSTRACT

        The presentations in this panel have the computer assisted approach of measuring
Abstraction, Emotion Tone, and Referential Activity in common. Additionally all of them utilize
a third measure to evaluate the clinical material.

        In the first presentation Anna Buchheim reports about a study where the Adult Attachment
Interview (Main) is analysed and the results are related to the attachment representation.

       In the second presentation Stefanie Cornehl reports a cross-sectional study comparing sex
offenders and neurotic patients.

       The third presentation by Sylvia Gril reports from a project that integrates the attachment
concept and the language measures to a praxis oriented approach for consulting mothers with their
psycho functional disordered babies.




                                              147
Paper in Panel- Panel Session 17

Title:                 The Relationship Between Adult Attachment Representation,
                       Emotion/Abstraction Patterns and Referential Activity: The Problem of
                       "Pseudo-Insight" in Insecure Preoccupied Attachment

Authors:               Anna Buchheim, Erhard Mergenthaler

Address for Correspondence:
                     Anna Buchheim
                     Department of Psychotherapy and Psychosomatic Medicine
             University of Ulm - Medical Faculty
             Am Hochsträß 8
             89081 Ulm, Germany
             anna@sip.medizin.uni-ulm.de

                                           ABSTRACT

        In this study we examine the relationship between adult attachment representation, coded
with the Adult Attachment Interview of Main (AAI, George et al. 1985) and its linguistic
components, assessed by the computer assisted language measures for Emotion-Abstraction
Patterns (EAP, Mergenthaler 1996) and Computer Referential Activity (CRA, Mergenthaler &
Bucci in press). Both of them have been successfully applied in psychotherapy research. In a
recent extension of the Therapeutic Cycle Model, Mergenthaler (in prep.) Additionally introduces
a qualitative dimension of Emotion Tone. The presence of positive emotion tone is seen as a
promising condition for creativity and problem solving (Izen et al. 1987), both essential aspects of
insight, whereas negative emotion tone rather will be seen in context with pseudo-insight. With
regard to narrative style the three major attachment categories are classified as: 1)
Secure-autonomous; narratives are coherent and open, responses are clear and relevant; statements
about childhood integrate and reflect emotional aspects. 2) Insecure-Dismissing; narratives are
incoherent and emotionally distant on a general, abstract level. 3) Insecure-preoccupied;
emotional conflicts in childhood are addressed lively but incoherent; use of pseudo-psychological
language without adequate distance to conflicts. Compared to the insecure classified subjects the
secure ones are expected to show a higher proportion of insight, measured as "Connecting", a
pattern where emotion tone and abstraction occur simultaneously, and also a higher level of CRA,
which represents a vivid narrative style. For the purpose of the study presented here from a larger
sample comprising mothers and fathers of premature infants, we randomly selected 20 subjects
classified as secure, 10 as dismissing, and 10 as being preoccupied. First results support that EAP
and CRA can identify dismissing subjects. It was unexpected, however, that EAP and CRA did
not differentiate between the secure and preoccupied subjects. With regard to the distinction
between positive and negative emotion tone we will consider the rich, but incoherent narrative
style of preoccupied subjects as being "pseudo-insight". This will be discussed in more detail
along with two single cases (secure versus preoccupied).
Paper in Panel

Title:                 The Interactional Dimensions of Key Moments or What Triggers Insight
                       in Therapies with Sexual Offenders Compared to Neurotic Patients?




                                               148
Authors:                Stephanie Cornehl, Friedemann Pfäfflin, Erhard Mergenthaler

Address for Correspondence:

               Stephanie Cornehl
               Sektion Forensische Psychotherapie
               Universität Ulm - Medizinische Fakultät
               89081 Ulm, Germany
               Fax: +49 731 502 5672
               cornehl@sip.medizin.uni-ulm.de

                                           ABSTRACT

       The present study investigates insight as the central phenomena of change in
psychotherapies. Especially we will focus on related dyadic aspects in the therapeutic relationship
and on the interactional repertories used by patients. The study will use a cross-sectional design.

        Subjects are eight forensic patients who were sentenced of sexual child abuse and treated
under court order in a high security hospital, opposed to eight clinical patients (Major Depression,
Dysthymia) in psychotherapy. Three hours of each therapy were evaluated using both, a
qualitative and a quantitative approach on a micro-analytic level. The computer assisted method
of measuring Emotion-Abstraction patterns in transcripts identifies Therapeutic Cycles and key
moments often understood as insight (Mergenthaler, 1996). Additionally we applied the
Stuttgarter-Kategorien-Inventar (SKI-II, Czogalik et al., 1987) as a qualitative tool to describe the
interactional patterns of patients and therapists.

        In an exploratory approach we expect to find differences in the frequency of key moments
such as insight due to the different motivational disposition of the forensic vs. clinical patients.
We also assume that different interactional structures can be identified and in a meaningful way
related to the phases of the Therapeutic Cycle.




                                               149
Paper in Panel- Panel Session 17

Title:                 Attachment and Narratives: The Relationship Between the Verbal
                       Exchange of Mother and Analyst and the Non-Verbal Interaction of
                       Mother and Baby

Authors:               Sylvia Gril, Marina Altmann de Litvan, Erhard Mergenthaler

Address for Correspondence:

                       Sylvia Gril
                       Departamento de Psicología Médica
               Hospital de Clínicas Piso 15 Avenida Italia S/N
               Montevideo - Uruguay
               Fax: ++598 2 2044707,
                        Email: sgril@chasque.apc.org

                                           ABSTRACT

        In our study we were investigating implicit and explicit factors contributing to clinically
observed effects in psychoanalytic oriented consultations with mothers and their babies with
psychofunctional disorders. Of special interest is the relationship between the verbal exchange
between mother and analyst and the non-verbal interactions between mother and baby. Emphasis
is put on emotional and reflective processes and the integration of narrative structures in the
therapeutic discourse. The mother-baby relationship is assessed with an attachment oriented
instrument (Massie-Campbell Scale, 1983).

        Based on the positive findings in a pilot study we expect that encouraging the mother to
recall narratives that integrate the baby's behavior during the consultations promotes more
intimacy with the baby. The improvement in the quality of the therapeutic cycles that took place
studying the psychotherapeutic discourse of the mother and the analyst was positively correlated
with the improvement in the attachment scores of the mother and the baby. The related emotional
and cognitive processes can be measured by means of the Cycles Model (Bucci 1997;
Mergenthaler 1996).

        We will present the findings with an extended sample of ten mother-baby dyads each
having two to three consultation sessions. The sessions were videotaped and transcribed following
the transcription standards for the Spanish language (Mergenthaler & Gril 1996). An important
goal of the project is to find relevant implications for clinical practice along with narrative
production. The sample of this study belongs to a group with high psychosocial risk which would
significantly benefit from brief and focused therapeutic interventions. Guidelines for an effective
intervention program with mother and babies are being developed along with this project and
shortly will be presented.




                                               150
Panel Session 18 - Overall Summary

Title:                  Karolinska Psychodynamic Profile (KAPP) as Predictor of Outcome

Participants:           Robert M. Weinryb, Barbro Thormählen, Sabrina Fossella

Moderator:              Robert M. Weinryb

Discussant:             Bernhard Strauss

Address for Correspondence:
             Robert M. Weinryb, MD, PhD
             Department of Psychotherapy
             Karolinska Institute
             Björngårdsgatan 25
             S-118 52 Stockholm, Sweden
             E-mail: robert.weinryb@knv.ki.se

                                           ABSTRACT

        The Karolinska Psychodynamic Profile (KAPP) is an instrument for making
psychodynamic assessment from clinical interviews. The purpose of the panel is to present data
about KAPP as a predictor of outcome both among somatic patients undergoing surgery and
patients in psychotherapy.

        Weinryb will present a longitudinal study of patients with ulcerative colitis describing the
relationship between psychodynamically assessed personality traits before surgery and
psychosocial adjustment 7 years later.

        Thormählen will report the results from a study predicting dropout from
Supportive-Expressive psychotherapy for personality disorders. Eighty patients who had not
primarily applied for psychotherapy were offered once a week time-limited
Supportive-Expressive psychotherapy for 40 sessions. The study compared the patients who did
not did not begin treatment, those that dropped out and those who completed treatment on the
KAPP, Inventory of Interpersonal Problems, and a measure of alexithymia.

       Fossella will present results from a study of personality change after 2 years of
psychodynamic psychotherapy or pharmacotherapy. After 2 years, patients in psychotherapy
reached a statistically significant improvement of 30%, when compared to patients treated with
psychotropic drugs alone (improvement of 2%). Moreover, the results indicated that
psychotherapy affects different areas of personality organization as measured by the KAPP
depending on whether the patients were initially neurotic, psychotic or personality disordered.

Paper in Panel - Panel Session 18

Title:                  Personality Change After Psychodynamic Psychotherapy: A Long-Term
                        Case-Control Study




                                               151
Authors:               Sabrina Fossella, Roberta Siani, Orazio Siciliani

Address for Correspondence:

                       Sabrina Fossella
                       Servizio di Psicoterapia (Psychotherapy Service)
                       Clinica psichiatrica (Psychiatric Clinic)
                       University of Verona
                       via delle Menegone 10
                       37134 VERONA (Italy)
                       E-mail: sabfos@borgoroma.univr.it

                                           ABSTRACT

       The aim of the present study was to examine personality change, assessed by Karolinska
Psychodynamic Profile (KAPP), after a 2-year psychotherapeutic treatment in a group of
psychiatric patients. 50 outpatients, with various ICD-10 psychiatric diagnosis, were randomly
assigned to two types of treatment: every third case was enrolled in the "control group", who
received only psychotropic drugs; the remaining 34 patients were admitted to an individual
psychodynamic psychotherapy - one session a week - according to Kohut's Self Psychology.
Among the psychotherapy group (10 psychotics, 14 neurotics, 10 personality disorders)
pharmacotherapy was combined in 90% of psychotics and in 30% of the neurotics and the PDs.
KAPP was used to provide a psychodynamic assessment of personality. KAPP interviews were
conducted by two blind raters at three different occasions: at the beginning of treatment, after two
months and after 2 years.

        The analysis of variance for repeated measures, carried out on KAPP total score taken as a
global index of personality change, indicated a significant interaction between treatments and
times. After 2 years, patients in psychotherapy reached a statistically significant improvement
(Sheffe test) of 30%, when compared to patients treated with psychotropic drugs alone
(improvement of 2%).

      Moreover, a non-parametric analysis performed on every single KAPP subscale
(Wilcoxon and Median tests) showed that psychotherapy affects different areas of personality,
depending on the diagnostic categories.




                                               152
Paper in Panel - Panel Session 18

Title:                 Personality Traits Predicting Adjustment 7 Years After Major Abdominal
                       Surgery

Authors:               Robert M. Weinryb, J. Petter Gustavsson, Jacques P. Barber

Address for Correspondence:

                       Robert M. Weinryb, M.D., Ph.D.
                       Department of Psychotherapy, Karolinska Institute
                       Björngårdsgatan 25
                       S-118 52 Stockholm, Sweden
                       E-mail: robert.weinryb@knv.ki.se

                                           ABSTRACT

        Very few studies have examined the relationship between preoperative personality traits
and long-term postoperative psychosocial adjustment. In a sample of 48 patients, we examined
the relationship between psychodynamically assessed personality traits before pelvic pouch
surgery for ulcerative colitis and psychosocial adjustment 7 years postoperatively, controlling for
the effects of surgical functional outcome and initial level of psychosocial adjustment. Personality
traits were assessed with the interview based Karolinska Psychodynamic Profile (KAPP). Surgical
functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used.

       Poor preoperative frustration tolerance, lack of alexithymia, high degree of conformism,
problems with sexual functioning and satisfaction, and excessive emphasis on bodily appearance
and function as sources of self-esteem were all found to predict poorer psychosocial adjustment
seven years after surgery, even after the effects of initial level of psychosocial adjustment and
functional surgical outcome were controlled for.

        The findings further support the predictive validity of the KAPP. They also strongly
suggest that preoperative personality traits are important predictors for long-term postoperative
psychosocial adjustment. Preoperative assessment can benefit by also taking personality factors
into account and, thus, alerting clinicians as to which patients are potentially at risk for poor
postoperative psychosocial adjustment.




Paper in Panel- Panel Session 18

Title:                 Predicting Dropout From Supportive-Expressive Psychotherapy for
                       Personality Disorders


                                               153
Authors:               Barbro Thormählen, Kristina Norén, Bo E. Vinnars, Jacques P. Barber,
                       Robert M. Weinryb

Address for Correspondence:

                Barbro Thormählen
                Department of Psychiatry, M57
                        Huddinge University Hospital
                        S-141 86 Huddinge, Sweden
                        E-mail: Barbro.Thormahlen@cnsf.ki.se

                                           ABSTRACT

        This study examined patient factors related to not starting in or dropping out from
psychotherapy. Eighty (55 women and 25 men, mean age 35 years) psychiatric outpatients with
personality disorders (Axis II, DSM IV), who had not primarily applied for psychotherapy were
offered once a week time-limited Supportive-Expressive psychotherapy for 40 sessions. Eight
patients (10%) did not begin treatment, 52 patients completed psychotherapy and 20 patients
(28%) dropped out.

        First, the non-starters were compared to the starters in psychotherapy. Then, the dropouts
were compared to the patients who completed their psychotherapy. Patients were compared on
age, sex, sociodemographics, psychiatric symptoms (SCL 90, Well-Being Profile), alexithymia
measures (Toronto Alexithymia Scale - TAS, Schalling-Sifneos Personality Scale) and DSM IV
axis II pathology. In addition, personality as assessed by the Karolinska Psychodynamic Profile
(KAPP), and interpersonal problems (IIP) were evaluated.

        The 8 non-starters were all women. Their main interpersonal problem on the IIP was in
being assertive with others, and they had significantly more problems than the starters in this
respect. In addition they were significantly more alexithymic (as measured with the TAS) than the
starters.

       The dropouts were significantly younger than the completers. They had significantly more
problems in handling aggressive affects with tendencies to act out, and they experienced fewer
problems with assertiveness than the completers did. In addition, they were more alexithymic (as
measured with the KAPP). There was also a tendency for patients with more serious personality
disorders (cluster A and B) to be dropouts.


Panel Session 19 - Overall Summary

Title:                 Factors of Effectiveness and Outcome in In-Patient Psychotherapy

Participants:          Udo Porsch, Annegret Eckhardt-Henn, Sven Olaf Hoffmann, Isa Sammet,
                       Henning Schauenburg, Wolfgang Wöller, Norbert Hartkamp, Veronika
                       Bergstein, Ute Schnierda, Johannes Kruse




                                               154
Moderator:             Wolfgang Wöller

Discussant:            H. Kordy

Address for Correspondence:

                       Dr. W. Wöller, Department of Psychosomatics and Psychotherapy
               University of Duesseldorf,
               Bergische Landstr. 2, D-40629 Duesseldorf
                       FAX: 0049-211-922-4709, e-mail: woeller@uni-duesseldorf.de

                                           ABSTRACT

          Psychodynamic inpatient psychotherapy is a multimodal type of therapy which includes
individual psychotherapy, group psychotherapy, sociotherapy, art therapy, music therapy,
body-oriented therapy and contacts with nurses. Moreover, the relationships with the fellow
patients are supposed to have therapeutic effects. The approach has been shown to be effective in
a variety of severely disturbed patients. However, little research has been done as to how
treatment effects come about and which are the most relevant factors of effectiveness. Likewise,
little is known about patient factors which determine a favorable outcome. Given this background,
the studies presented in this panel address these topics from different viewpoints.
          The first study presented by U. Porsch and coworkers investigates changes in self- and
object representations in the course of inpatient psychotherapy using Repertory-Grid technique.
Changes in self- and object representations were related to therapy outcome at a 1 year follow-up.
          The study by I. Sammet and H. Schauenburg focuses on the development of therapeutic
relationships during the course of inpatient therapy: the patients´ relationship to their individual
therapist, to the therapeutic team and to their fellow patients. The authors test the hypothesis that
changes in patients´ perceived relationships are of substantial relevance for their improvement.
          A similar approach is used by W. Wöller and coworkers who also developed an instrument
for weekly evaluating aspects of therapeutic alliance in the different settings of inpatient
psychotherapy. The research question addressed here was whether patients´ introject structure (as
measured by SASB-INTREX) exerts an influence on the development of the therapeutic
relationships.




                                               155
Paper in Panel - Panel Session 19

Title:                 Introject Structure and Therapeutic Alliances in a Multiprofessional
                       Inpatient Treatment Approach

Authors:               Wolfgang Wöller, Norbert Hartkamp, Veronika Bergstein, Ute Schnierda,
                       Johannes Kruse

Address for Correspondence:

                       Dr. W. Wöller
                       Department of Psychosomatics and Psychotherapy
                       University of Duesseldorf
                       Bergische Landstr. 2, D-40629 Duesseldorf
                       FAX: 0049-211-922-4709, e-mail: woeller@uni-duesseldorf.de

                                           ABSTRACT

        During treatment in a multimodal psychodynamic in-patient psychotherapy unit, the
patients are faced with a variety of therapeutic relationships which include individual
psychotherapy, group psychotherapy, sociotherapy, art therapy, music therapy, body-oriented
therapy, etc. As a consequence, they are expected to establish a variety of therapeutic alliances
with the persons contributing to the therapy.

The aims of the study were
2.    to investigate the influence of multiple therapeutic alliances on therapy outcome;
3.    to examine the influence of the patients´ introject structure on the development of
      therapeutic alliances.

        An instrument was developed for weekly evaluating aspects of therapeutic alliance in the
different settings of inpatient psychotherapy. Introject structure was measured using
SASB-INTREX questionnaire, outcome was evaluated in terms of symptomatic change as
measured by SCL-90-R.

        Data of 81 completed in-patient psychotherapies show (1) that perceived helping alliance
in individual therapy was the best predictor of therapy outcome and (2) that patients exhibiting a
self-supporting introject structure were more likely to develop a positive therapeutic alliance in
several relationships.




Paper in Panel- Panel Session 19

Title:                 The Development of Multiple Relationships During Inpatient


                                               156
                        Psychotherapy and Their Impact on Symptom Courses: A Process Study

Authors:                Isa Sammet & Henning Schauenburg

Address for Correspondence:

               Department of Psychosomatics and Psychotherapy
               University of Göttingen
               Von-Siebold-Str. 5, 37075 Göttingen, Germany
               e-mail: isammer@gwdg.de, hschaue@gwdg.de

                                            ABSTRACT

         Psychodynamic inpatient psychotherapy, as commonly practiced in Germany, is an
intensive treatment for patients with severe neurotic and personality disorders. It is characterized
by a therapeutic format integrating a variety of treatment methods (individual and group therapy,
art and body therapy). Thus, patients experience multiple relationships to different therapists and
to other patients, with whom they are living close together. The quality of the therapeutic alliance
is widely accepted to be associated with therapy outcome in individual therapy. By analogy, it can
be assumed for inpatient treatment, that the different therapeutic or nontherapeutic relationships
have important effects on the course of symptom reduction and therapy success.
         In this context, the purpose of the present study was to investigate how those different
relationships contribute to symptom courses, self-efficacy and therapy outcome. On the basis of
understanding the therapeutic process dynamically, it was our hypothesis, that mainly the change
in experiencing the therapeutic alliances or the relationship to other patients is relevant for the
patient´s improvement (in the sense of correcting experiences).
         Design of study: 80 patients with heterogeneous neurotic or personality disorders, treated
in our Department of Psychosomatics and Psychotherapy for 8 to 20 weeks, were given the
―Stationserfahrungsbogen SEB‖ (Sammet und Schauenburg, 1998) weekly to report the quality of
their relationships to their individual therapist, to the therapeutic team and to their fellow patients
together with their feeling of self-efficacy. Symptom development was simultaneously assessed
by the Brief Symptom Inventory BSI (Derogatis, 1993). We selected three groups, that had either
extremely positive, negative or neutral developments of their different relationships (according to
the slopes of their weekly relationship ratings). Then, we analyzed the correlations over time
between those courses of relationship ratings and the courses of symptoms and self-efficacy and
tested the three groups for differences in pre-post symptom measures (SCL90R, Derogatis 1977).
         The results point out the necessity of process research for better understanding the-rapeutic
change, especially in this field of inpatient psychotherapy with its multiple transferences. They
will be discussed with a critical view on methodological issues.
Paper in Panel - Panel Session 19

Title:                  Changes of the Self- and Object Representations in the Course of an
                        In-Patient Psychotherapeutic Treatment

Authors:       Udo Porsch, Annegret Eckhardt-Hen, Sven-Olaf Hoffmann

Address for Correspondence:



                                                157
                       Dr. U. Porsch
                       Department of Psychosomatics and Psychotherapy
                       University of Mainz
                       Untere Zahlbacher Str. 8, D-55131 Mainz



                                           ABSTRACT

        The study examines the changes of the self- and object representations in the course of an
inpatient psychotherapeutic treatment. The successful and less successful treated patients were
identified and examined in regard to the specific effective changes within their self- and object
representations. These results were put into relation with the psychopathological findings and the
quality of the therapeutic relationship.

        In addition to a symptom check-list (SCL-90-R), the patients were given an inventory of
interpersonal conflicts (IIP), a questionnaire in respect to helping alliance (TAB) and a modified
Repertory Grid.

       The catamnestic therapy evaluation occurred by means of the goal attainment scale (GAS).




                                               158
Panel Session 20 - Overall Summary

Title:                  Signs and Voices in the Assimilation Process: Distinguishing Problematic
                        Voices in the First Session and Tracing the Growth of Meaning Bridges

Participants:           Katerine Osatuke, Mikael Leiman, William B. Stiles

Moderator:              William B. Stiles

Address for Correspondence:

                         William B. Stiles
                        Department of Psychology
                        Miami University
                        Oxford, OH 45056, USA
                        Email: stileswb@muohio.edu

                                            ABSTRACT

         According to the voices formulation of the assimilation model, the problems that bring
clients to therapy can be understood as active voices that arise from the traces of traumatic or
otherwise problematic experiences. In effect, the problematic events reproduce themselves via
signs that are evident in clients' speech and behavior. In successful psychotherapy, problematic
voices, which at first are partly or completely dissociated or suppressed, express themselves, are
heard and understood, and join the multi voiced community that is the self. Problematic voices
can often be distinguished in clients' speech very early in therapy by their content, vocal qualities,
affective dispositions, and the circumstances that trigger them. Two of the presentations in this
panel (by Osatuke and by Leiman) illustrate methods by which such voices can be identified,
using the first sessions of two cases from distinct types of therapy. The third presentation (by
Stiles) illustrates the exchange of signs posited to build meaning bridges between voices, using
material from one of these cases.




Paper in Panel - Panel Session 20

Title:                  The Client as a Community of Voices: Analysis of a First Session of
                        Cognitive-Behavior Therapy




                                                159
Authors:                Katerine Osatuke, William B. Stiles, David A. Shapiro, and Michael
                        Barkham

Address for Correspondence:

                        Katerine Osatuke
                        Department of Psychology, Miami University
                        Oxford, OH 45056, USA
                        Email: osatukk@muohio.edu

                                            ABSTRACT

       The voices formulation of assimilation model views the client as a community of voices,
where each voice represents traces of different constellations of past experiences. Some voices
are dominant, while others may be kept separate (dissociated) or suppressed because they
represent problematic experiences that the client has not yet managed to integrate. Difficulties in
dealing with these problematic experiences bring people to therapy. In successful therapy, bridges
of meaning are built between previously separated voices, and the voices start communicating and
hearing each other. Thus, progress in therapy can be understood as successful assimilation of
previously ostracized or unheard voices into the community.

        Distinct voices emerge and can be identified in the first therapy session. Each voice has
its own personality profile, that is, a recognizable combination of vocal characteristics, affective
dispositions, contents that it expresses, and type of situations that trigger it.

        We report the analysis of the first session of the ultimately successful cognitive-behavioral
therapy of a 39 year-old woman who was treated for depression in the Second Sheffield
Psychotherapy Project, a comparative clinical trial of time-limited psychotherapies for depression.
Three distinct voices were identified by their vocal, affective, content, and trigger characteristics.
The first voice spoke in a medium pitch with smooth melodic patterns and few pauses, sounded
assured, and was used for information exchanges with the therapist. The second voice was low,
paused often, had exaggerated aspiration and abrupt melodic changes; it sounded sad or anxious,
and described problems. The third voice spoke fast, in a high pitch, with vacillating and sharply
ascending intonations; it expressed emotions from relief to joy, and spoke to change topics or
contradict what was said before. Describing these voices and characterizing their interrelations
represents a potentially useful approach to case formulation and a tool for investigating the
process of assimilation.


Paper in Panel - Panel Session 20

Title:                  Signs of the Warded-Off: A Dialogical Sequence Analysis

Author:                 Mikael Leiman

Address for Correspondence:

                        Mikael Leiman


                                                160
                        Department of Psychology
                        University of Joensuu
                        P.O. Box 111, 80101 Joensuu, Finland
                        Email: mikael.leiman@joensuu.fi


                                           ABSTRACT

        In the Assimilation model, problematic experience was initially defined as a
schema-inconsistent experience, i.e. as something people are unable to assimilate into their
available patterns of thinking or that is incompatible with their acceptable view of self. In the
recent reformulation of the model in terms of voices, problematic experience is seen as an active
force, represented by a voice that is, initially, rejected by the ‗dominant community of voices‘ that
makes up the person‘s self conception.

        A semiotic understanding of problematic experiences elaborates the reformulated
assimilation model by permitting a fine-grained analysis of the composition and content of a voice
in terms of signs. Events that account for the problematic experience reproduce themselves in the
signs of the event, now as a part of the problematic experience. In psychotherapy, the patient
expresses aspects of the problematic experience by using the signs that are its constituting units.

        Signs of traumatic events, suppressed memories, forbidden wishes, etc. are usually present
in the very first sessions of any psychotherapeutic encounter. The paper describes an experiment,
identifying such signs in the first fifteen minutes of the first session by using Dialogical Sequence
Analysis. The patient, Debbie, was treated by 16 session cognitive analytic therapy in the
Borderline Project conducted at Guy‘s Hospital, London, UK. It is argued that the method can be
used to reveal the meaning content of unarticulated or warded-off experiences very early in
therapy.




Paper in Panel - Panel Session 20

Title:                  Exchange of Signs and Construction of Meaning Bridges in a Case of
                        Cognitive Analytic Therapy

Authors:                William B. Stiles and Mikael Leiman

Address for Correspondence:

                        William B. Stiles
                        Department of Psychology,
                        Miami University
                        Oxford, OH 45056, USA


                                               161
                        Email: stileswb@muohio.edu

                                           ABSTRACT

         According to the voices formulation of assimilation model, traces of problematic past
experiences are active entities (voices) within clients. These problematic voices seek expression,
thus reproducing the problematic experience, which may appear in the form of symptoms, acting
out, and/or intense distress. As illustrated by previous papers in this panel (by Osatuke and
Leiman), such voices can be distinguished very early in treatment by their distinctive use of signs,
that is, the particular content of what they say and do, their vocal characteristics, their affective
dispositions, and their triggering circumstances.

        The self in this formulation is understood as a multi voiced community. Voices are
problematic -- and may cause distress -- when they are dissociated from the community, unheard,
or suppressed. In clients‘ speech and experience, transitions involving such separated, outcast
voices are abrupt and may be painful. In successful therapy, meaning bridges between the
separate voices are constructed using signs (verbal and nonverbal), allowing the voices to
communicate with the therapist and with each other. By exchanging signs, the separated voices
of the client come to hear and understand each other through a process of mutual assimilation.
Eventually, to the extent that this process is successful, the voices shift smoothly and
appropriately and can engage in coordinated action. Thus, in favorable circumstances, the
experiences may be transformed from problems into resources.

        This paper will illustrate this process of assimilation -- of building meaning bridges via
the exchange of signs -- using material from the case of Debbie, the patient treated with cognitive
analytic therapy in the Borderline Project conducted at Guy‘s Hospital, London, UK, whose first
session is the topic of Leiman‘s contribution to this panel.




                                               162
Panel Session 21 - Overall Summary

Title:                  The ‗Master Therapist‘ Construct: Qualitative and Quantitative
                        Approaches to its Conceptualization and Assessment

Participants:           Len Jennings, David Orlinsky, M. Helge Ronnestad, Thomas M. Skovholt

Moderator:              M. Helge Ronnestad

Discussant:             Irene Elkin

Address for Correspondence:

                        David Orlinsky
                        Comm. on Human Development, University of Chicago
                        5555 S. Everett Ave., Chicago IL 60637
                        Email: d-orlinsky@uchicago.edu

                                            ABSTRACT

        For many years, studies of psychotherapy and of development in psychotherapists utilized
samples consisting largely of clinicians in training or otherwise inexperienced practitioners. This
practice was clearly based more on the fact trainees and juniors could be induced to submit to
research demands than because they were considered likely to deliver high-quality treatment or to
exemplify optimal therapeutic attributes. More recently, some welcome efforts have been made to
counteract this tendency by studying ―master therapists‖ (e.g., Goldfried et al. 1998; Jennings &
Skovholt, 1999). However, this turn raises a number of other problems. Chief among these is the
question of how to define the concept of ―master therapist‖ and the related question of how to
assess therapists for the characteristics associated with this status. Studies so far have relied upon
reputational survey and peer nomination procedures instead of objective indices of mastery,
particularly indices based on proficiency of performance. Studies have also slighted differences
between treatment models, with the questionable implication that master therapists are more or
less the same across orientations and treatment modalities. This panel seeks to clarify the concept
of ―master therapist‖ and consider alternative approaches to research this construct.




Paper in Panel- Panel Session 21

Title:                  Definition and Characteristics of Master Therapists: A Qualitative
                        Approach




                                                163
Authors:                Len Jennings and Thomas M. Skovholt

Address for Correspondence:

                        Len Jennings
                        University of St. Thomas
                        3213 Bryant Ave South
                        Minneapolis, MN 55408
                        USA

                                           ABSTRACT

        Intensive qualitative analyses of interviews with 10 ―master therapists‖ in a major
Midwestern metropolitan area led to the identification of the cognitive, emotional, and relational
characteristics they share in common. These practitioners were identified through the nomination
of professional colleagues using a ―snowball sampling‖ technique, in which each person
nominated was asked to nominate three colleagues (other than themselves). Nomination of master
therapists was based on the following criteria: 1) This person is considered to be a ―master
therapist.‖; This person is most frequently thought of when referring a close family member or a
dear friend to a therapist because the person is considered to be the ―best of the best.‖; and 3) One
would have full confidence in seeing this therapist for one‘s own personal therapy. Overall, 212
nominations were made for 103 different therapists, and the 10 most frequently nominated were
selected for study. These included six doctoral-level Psychologists, three masters-level Social
Workers, and one Psychiatrist. Interview themes on which 8 of the 10 agreed were selected as
representative attributes of master therapists.




                                               164
Paper in Panel - Panel Session 21

Title:                  Definition and Characteristics of Master Therapists: A Quantitative
                        Approach

Authors:                David Orlinsky & M. Helge Ronnestad

Address for Correspondence:

                        David Orlinsky
                        Committee on Human Development
                        University of Chicago
                        5555 S. Everett Ave., Chicago IL 60637 USA
                        Email: d-orlinsky@uchicago.edu

                                            ABSTRACT

        Stimulated by the recent work of Jennings and Skovholt (1999) and by Goldfried, Rause,
and Castonguay (1998), and by critical reflections on it (Orlinsky, 1999), exploratory quantitative
analyses were undertaken utilizing an international data base of more than 4000 psychotherapists
of diverse professional background, theoretical orientation, and career level. This contains
extensive information about each therapist collected by members of the SPR Collaborative
Research Network with the Development of Psychotherapists Common Core Questionnaire.
Based on the professional and demographic characteristics reported by Jennings and Skovholt and
Goldfried et al., several empirical criteria were applied sequentially to select a small ―elite‖ group
of therapists. Results were noted at each stage of the selection process, and comparisons were
made between members of the final group of ―master therapists‖ and other therapist groups that
might provide meaningful contrasts.




                                                165
Panel Session 22 - Overall Summary

Title:                 New Developments in Group Psychotherapy Research

Participants:          Denise E. Wilfley, Ivan W. Miller, & Michael A. Friedman

Moderators:            Michael A. Friedman & Ivan W. Miller

Discussant:            Larry E. Beutler

Address for Correspondence:

                       Michael A. Friedman
                Brown University, Mood Disorders Program
                       Rhode Island Hospital/Potter 3
                       593 Eddy Street
                       Providence, RI 02903, USA
                       (401) 444-3920
                Michael_A_Friedman@brown.edu

                                          ABSTRACT

        Group treatments are becoming more widely used in clinical settings as alternatives to
individual psychotherapies. Reasons for the increased use of group interventions include the
recognition of the importance of patient social support in recovery, as well as the potential for
reducing expense and ultimately providing more cost-effective treatment. However, in
comparison to the extensive literature examining the efficacy of individual forms of
psychotherapy, relatively little work has been conducted to develop and test the efficacy of group
psychotherapy. More recently, group interventions aimed at increasing patient support, and
improving cost-effectiveness, are being developed and empirically tested for the treatment of
specific clinical disorders.

        The goal of this panel is to present new developments in empirical research and clinical
theory examining group psychotherapy. Dr. Wilfley will present work that examines the efficacy
of group interpersonal psychotherapy as compared to group cognitive-behavioral psychotherapy
for the treatment of binge eating disorder. Dr. Miller will describe research that examines the
relative efficacy of a multi-family group treatment as compared to individual family treatment for
the management of bipolar disorder. Dr. Friedman will discuss the development and initial
empirical study of a group program for major depressive disorder that utilizes an open-group
format, and integrates both individual and family components to the group treatment. Finally, in
his role as discussant, Dr. Beutler will examine this work in the broader context of psychotherapy
research, including potential future directions for the field.


Paper in Panel- Panel Session 22

Title:                 Cognitive Behavioral Therapy and Interpersonal Psychotherapy in the
                       Treatment of Binge Eating Disorder: A Controlled Comparison


                                              166
Authors:               Denise E. Wilfley, R. Robinson Welch, Jennifer Zoler Dounchis, Richard
                       I. Stein, Emily B. Spurrell, and Lisa R. Cohen

Address for Correspondence:

                       Denise E. Wilfley, Ph.D.,
                       SDSU/UCSD Joint Doctoral Program,
                       6363 Alvarado Court, Suite 103
                       San Diego, California 92120-4130, USA

                                          ABSTRACT

        Binge eating disorder (BED) is characterized by persistent episodes of binge eating and is
associated with adiposity and psychopathology. Treatment research for BED has been limited by
diagnostic imprecision, short-term follow-up, small sample size, and unidimensional assessment.
In the present investigation, 162 obese individuals meeting stringent diagnostic criteria for BED
were randomized to group cognitive behavioral treatment (CBT) or group interpersonal
psychotherapy (IPT). Given prior studies indicating that BED does not improve in untreated
patients, no waiting list control group was used. Treatment efficacy was examined at baseline
(BL), posttreatment (PT), and 1-year follow-up (FU), with assessments of binge eating, specific
and general psychopathology. Participants were 134 women and 28 men, who averaged 45 years
of age, a body mass index (BMI) of 37, and 17 days of bingeing/month. Binge eating and
associated eating disorder psychopathology were assessed by the Eating Disorder Examination
(EDE), and general psychopathology by the SCL-90-R. Interpersonal functioning and
psychotherapy process measures (alliance, group climate, and group cohesion) were administered
for both CBT and IPT over the course of treatment. Ninety-seven percent of subjects completed
assessment at PT and 84% at FU, with 18 still in FU. CBT and IPT were equally effective in
significantly reducing binge episodes and associated psychopathology over time. Binge episodes
decreased by 95% and 93% respectively from BL to PT and FU, and 78% and 69% of participants
reported abstinence from binge eating. Additionally, significant positive changes in interpersonal
problems and self-esteem were shown for both treatments. Data from the psychotherapy process
measures are currently being analyzed and will be discussed. These findings indicate that CBT
and IPT are effective treatments for BED and its associated specific and general psychopathology
in both the short- and long-term. Overall, findings from this study suggest that short-term,
focused group psychotherapies may be quite useful in the treatment of psychiatric disorders. The
implications for clinical and research settings will be discussed.


Paper in Panel - Panel Session 22

Title:                 Multi-Family Group or Family Therapy for Bipolar Disorder?

Authors:               Ivan W. Miller, Gabor I. Keitner, Christine E. Ryan, David Solomon

Address for Correspondence:

                       Ivan W. Miller, Ph.D.


                                               167
              Mood Disorders Program
              Rhode Island Hospital
              593 Eddy Street
              Providence, R.I. 02903
              USA
              (401)444-3918
              Ivan_Miller@brown.edu

                                         ABSTRACT

       Ninety patients with a DSM-IV diagnosis of bipolar disorder and currently in an episode
of mania or depression were randomly assigned to one of three treatment conditions: a)
Pharmacotherapy (medication + clinical management sessions), b) Family Therapy (Family
Therapy + Pharmacotherapy), or c) Family Group (Multi-family Psychoeducational Group +
Pharmacotherapy).

        During a four month ―acute treatment‖ phase, all patients received 6-10 clinical
management meetings with a psychiatrist and were prescribed psychotropic medication to: a) treat
their acute episode and b) prevent future episodes. Patients and their families in the Family
Therapy condition received 6-12 sessions of family therapy based on the McMaster Model of
Family Functioning. Patients and their families in the Family Group condition participated in an
six session multi-family group.

        Following this acute treatment phase, all patients were followed in a
Continuation/Maintenance phase for all additional two years. This presentation will focus on the
outcome at the end of the four month acute treatment phase. Data will be presented on the: a)
level of symptoms at the end of the four month acute treatment phase, b) percentage of patients
recovering from their acute episode, c) average level of symptoms during the four months, d)
endpoint and average level of overall functioning, and e) changes in family functioning.




Paper in Panel- Panel Session 22

Title:                An Integrative Group Treatment for Major Depression

Authors:              Michael A. Friedman, & Ivan W. Miller

Address for Correspondence:

                     Michael A. Friedman
              Brown University
                     Mood Disorders Program Rhode Island Hospital
                     Potter 3 593 Eddy Street
                     Providence, RI 02903, USA


                                             168
                       (401) 444-3920
                       Michael_A_Friedman@brown.edu

                                           ABSTRACT

         Major depression is one of the most serious mental health problems in the world, with
substantial consequences of human suffering, loss of life, and lost productivity. While there are
currently several well-developed and empirically-supported individual psychosocial treatments for
major depression, these treatments have significant limitations in terms of long-term efficacy,
transportability, and cost. Recent reviews of the literature suggest that group treatments for
major depression may significantly reduce cost as compared to individual psychotherapies.
However, little research has been conducted within the last decade to further develop and test the
efficacy of group treatment for depression. The goal of this presentation is to describe a group
psychotherapy program (Group, Individual, and Family Treatment - GIFT) for the treatment of
depression, and present pilot data examining the efficacy of this approach.
         The GIFT program is a social-learning based treatment that attempts to build upon the
innovations of existing group psychotherapies, but address issues that may limit their utility in
actual clinical settings. First, in order to foster the development of individual goals and treatment
adherence within a group setting, the GIFT program utilizes structured individual sessions in
addition to group meetings. Further, in order to mobilize patient social support, the GIFT
program includes multi-family group meetings in addition to standard group sessions. In
addition, the GIFT program has been developed specifically for use in an "open" group format
that allows for flexible patient flow. Finally, the GIFT program integrates a wide range of coping
strategies, including stimulus-control, cognitive, behavioral, and emotion-focused.
         This presentation will also focus on the results of an initial pilot study examining a)
treatment retention, b) rates of treatment response, and c) symptom reduction at post-treatment.
Future work on the further development and empirical evaluation of this treatment approach will
be discussed.




                                               169
Panel Session 23 - Overall Summary

Title:                  Assessment of Personality Organization and Structural Change

Participants:           Stéphane Sabourin, Louis Diguer, and Lina Normandin

Moderator:              Lina Normandin

Address for Correspondance:

                         Lina Normandin, Ph.D.
                         École de psychologie
                Université Laval, Québec, G1K 7P4
                Canada
                e-mail: lina.normandin@psy.ulaval.ca


ABSTRACT
         Several measures of personality disorders have been developed in the last 20 years. Some
are structured around the interview, namely the ―Personality Disorder Examination : PDE‖
(Loranger, Susman, Oldham, et Russakoff, 1987), the ―Diagnostic Interview for Borderlines: DIB
and DIB-R‖ (Gunderson, Kolb et Austin, 1981). Other are self-reported questionnaires like the
―Millon Clinical Multiaxial Inventory: MCMI‖ (Millon, 1977, 1987) or the ―Borderline
Personality Scale‖ (Perry et Klerman, 1980). However, all these instruments measure manifested
traits or behaviors while it is well acknowledge now that similar pattern of behaviors seen in two
different patients can originate from different psychic structures. The possibilities to study
relationship among different traits within a personality disorder or a similar trait across different
disorders are therefore reduced as much as the possibilities to analyze change throughout a
treatment.

        The aim of the panel is to present the results of three studies centered around a
self-reported questionnaire (The Inventory of Personality Organization; IPO : Kernberg et al.,
1997) and a method of analyzing relationship narratives (The Personality Organization Scale;
POS: Diguer, 1994) both devoted to assess personality organization and around a method of rating
patient transference and therapist counter transference to assess patient‘s structural change
throughout treatment. These studies originate from a collaboration between two research groups :
École de psychologie, Laval University, Canada (affiliation of the three main authors) and the
New York Hospital, Cornell University, USA.




Paper in Panel - Panel Session 23

Title:                  Structural Invariance of the Inventory of Personality Organization Across
                        Language, Sex and Clinical Status


                                               170
Authors:                Stéphane Sabourin, John Clarkin, Lina Normandin, Louis Diguer and
                        Pamela Foelsch

Address for Correspondence:

                        Stéphane Sabourin, Ph.D.
                        Ecole de psychologie
                        Université Laval
                        Sainte-Foy, Québec, G1K 7P4
                        Canada
                        email: stephane.sabourin@psy.ulaval.ca

                                           ABSTRACT

         This study examined the theoretical structure of the Inventory of Personality Organization
(IPO) and tested the invariance of this structure across language, sex and clinical status. Based
on the psychodynamic understanding of motivational structures underlying the personality
disorders model of Kernberg (1996), the IPO aims to assess structural aspects of personality. On
the first level, the IPO focuses on three core areas with respect to an object relation model of
personality organization i.e., Identity Integration, Defense Mechanisms and Reality Testing.
These core areas represent structural criteria used to distinguish neurotic, borderline and psychotic
modes of functioning. On the second level, a fourth concept, the Quality of Object Relations,
reflecting the interplay of diverse character traits, has been newly integrated to assess specific
interpersonal styles. More specifically, the IPO measures three types of neurotic personality
organizations (hysteric, obsessional, and depressive-masochistic) and five types of borderline
personality organizations (narcissistic, paranoid, antisocial, infantile, and schizoid).

        Confirmatory factor analyses were used to assess separately structural criteria, neurotic
and borderline modes of object relations on a sample of 954 subjects, recruited from graduate and
undergraduate students from a French-Canadian and an American universities and from a severe
personality disorders hospital unit. Conceptually, the structural criteria and the specific modes of
object relations are not different dimensions of a single concept, they represent two distinct angles
through which internal reality is apprehended. Consequently, they should not be amalgamated in a
general factor analysis. They need to be studied separately and our analytic strategy was
developed accordingly. Results of the confirmatory factor analyses supported the
conceptualization of personality disorders according to Kernberg‘s model. These results generally
proved to be invariant across sex, language, and clinical status.

Paper in Panel - Panel Session 23

Title:                  The Personality Organization Scale: An Overview of the Measure, its
                        Reliability and Validity

Authors:                Louis Diguer, Jean Descôteaux, Jean-Pierre Rousseau, Jean-Philippe
                        Daoust and Étienne Hébert.

Address for Correspondence:


                                               171
                        Louis Diguer, Ph.D.
                        Laboratoire de Recherches sur la Personnalité et la Psychopathologie
                        École de psychologie, Pavillon Felix-Antoine Savara,
                        Université Laval, Québec, G1K 7P4
                        Canada

                                            ABSTRACT

        The Personality Organization Scale (POS) (Diguer 1994) aims at evaluating personality
organizations through an analysis of relationship narratives. It is based on psychodynamic models
of personality organizations (Bergeret, 1974 ; Kernberg, 1984) that define 3 types of personality
organizations: Psychotic, Borderline, and Neurotic. The first section of the POS, the Structural
Analysis, combines concepts from cognitive psychology, semiotics, narratology, and it allows
us to break up the narratives into their structural units. The second section, the Psychodynamic
Analysis, aims at qualifying these units in psychodynamic terms.

        The goal of this study was to estimate the internal validity and the reliability of the POS
and to have a first look at its concurrent validity. Eighty (80) patients participated to this study.
All patients were asked to tell ten narratives about incidents or events involving them in relation
to another person, following the Relationship Anecdotes Paradigm (RAP) interview method
(Luborsky, 1984). The 763 narratives were transcribed and scored independently by raters who
were blind of the authors of the narratives. Intra-class correlations and weighted Cohen's Kappas
show good reliability between the 6 raters.

        Confirmatory factor analyses were performed to verify Kernberg's proposition that all
psychopathologies can be classified within a three-category model (psychotic, borderline and
neurotic personality organizations). Global adjustment indices for the specified model indicated
a very good fit. Preliminary results on concurrent validity are also presented (comparison with
SCID-I and SCID-II data).




Paper in Panel - Panel Session 23


Title:                  Transference Counter Transference Analysis (TCA) : A System to Assess
                        Structural Change in Severe Personality Disorders Throughout Treatment

Authors:                Lina Normandin and Pamela A. Foelsch

Address for Correspondence:

                        Lina Normandin, Ph.D.
                        École de psychologie
                        Université Laval, Sainte-Foy, Québec, G1K 7P4
                        Canada


                                                172
                        e-mail : lina.normandin@psy.ulaval.ca

                                            ABSTRACT

        The TCA (Foelsch & Normandin, 1997) is a modification of a rating system created by
Normandin (1991) to assess counter transference from the narratives produced by therapists after
a session. The current expansion of the system includes the patient transference in a mutifaceted
system which uses ratings of the patient transference and therapist counter transference to assess
three separate but interrelated concepts; (1) the therapeutic process within and across sessions, (2)
the therapist‘s level of adherence and competence to Kernberg‘s Transference-Focused
Psychotherapy (TFP), and (3) the patient‘s structural change throughout treatment.

         This study examines structural change in severe personality disordered patients as
measured by frequency of patient‘s reactive responses (unawareness of emotions or contradiction
in their expressions), rational responses (focus on external reality in a detached way) or forms of
reflective responses (levels of awareness and linkage between cognitive and affective components
in a contained way) with the hypothesis that patients who most improved in therapy (as measured
by a decrease in acting out, self-destructive behaviors, symptomatology, etc.) will show a high
proportion of reflective responses as compared to reactive and rational responses while working
through transferential issues.

         Ten patients diagnosed with Borderline Personality Disorder participated in Kernberg‘s
Transference-Focused Psychotherapy. Six video taped sessions were selected for each patient
(two consecutive sessions at beginning, middle and end of the first year of treatment). The
sessions are first segmented to identify transferential themes. Those portions of the sessions are
selected and rated for the therapist‘s attempts to link and to offer interpretation(s) of the patient‘s
split parts of self- and other-representations . The patient‘s responses to the therapist‘s elaboration
is also rated according to the TCA-structural change system.
Panel Session 24 - Overall Summary

Title:                  Linguistic Aspects and Clinical Applications of Computerized Referential
                        Activity (CRA)

Participants:           Mark Sammons, Philip Drucker, Markus Borner, Eyal Pavell
Moderator:              Wilma Bucci

Address for Correspondence:
                      Wilma Bucci
             Glass Institute,
             75 Varick Street, New York, N.Y. 10013 USA
                     (E-mail: bucci@panther.adelphi.edu)

                                           ABSTRACT
        This panel explores the properties of Referential Activity (RA) as manifest in its
computerized version (CRA). RA is the function of connecting nonverbal, including emotional
experience, with language, and is defined within the context of Bucci‘s (1997) multiple code
theory. RA assessment was initially carried out using scales rated by trained judges, following a
scoring manual developed for this purpose. The Computerized Referential Activity (CRA)


                                                173
measure was constructed empirically by Mergenthaler and Bucci by identifying a specific set of
lexical items that model the RA ratings of expert judges. RA and CRA assessment has been
applied and validated in many psycholinguistic, clinical and psychotherapy research studies,
including studies of psychodynamic, interpersonal and cognitive treatments. The CRA permits
assessment of aspects of the RA dimension in large sample and longitudinal psychotherapy
studies where judges‘ scoring would not be feasible, and also serves as a scanning procedure to
identify focal points where judges‘ ratings may then be applied.
        The correlation of CRA and RA ratings has been shown to average about .60 across a
wide range of discourse contexts. CRA thus accounts for only about a third of the variance in RA,
leaving substantial sources of variation to be examined. The three papers of this panel will
examine CRA as representing a construct in its own right, and will explore its linguistic,
psychometric and clinical features. Sammons, Drucker and Dahl examine the components of the
CRA word lists using a multi-dimensional scaling analysis; their results add to the construct
validity of this measure, as well as providing a basis for its further development. Borner and
Mergenthaler extend previous studies that have demonstrated the relation of CRA to narrative
discourse, and distinguish between the narrative structure of CRA peaks characterized as
successful or unsuccessful shift events, where shift event is defined as a transition from
dominating negative to positive emotion tone. Pavel looks at the relationship of the CRA to
cognitive-structural aspects of the psychoanalytic concepts of the primary and secondary
processes, using his newly developed computerized measure of the Primary Process Proportion
(PPP). He examines PPP fluctuation during the phases of the referential cycle as identified by
Bucci (1997) in 31 psychoanalytic treatment sessions of nine patients.
Paper in Panel - Panel Session 24

Title:                 Item Analysis of Computerized Referential Activity

Authors:                Mark T. Sammons, Philip Drucker, Hartvig Dahl

Address for Correspondence:
         Mark T. Sammons, M.A.
         Derner Institute, Adelphi University
         Garden City, N.Y. 11530
         USA

                                          ABSTRACT

   CRA is a computerized model of ‗referential activity‘ that has been applied in numerous
psychotherapy process studies. Two large text corpora: a ‗high RA‘ and a ‗low RA‘, set which
had been rated for referential activity by judges, were subjected to computerized content analysis
to derive characteristic vocabularies. The resulting 178 lexical items represent a model of
referential activity that correlates well with judged scores (Pearson r = .60), and that makes
practicable the analysis of large sets of data.

    In contrast to computerized content dictionaries developed from a priori considerations that
might logically be expected to represent the constructs they purport to measure (e.g..
Mergenthaler‘s Emotion Tone and Abstraction dictionaries), the words in the CRA dictionary
were derived empirically, and therefore must be studied to ascertain how they model RA judges‘
ratings. The connection between the semantic aspects of the CRA dictionary and the construct of


                                              174
referential activity has been explored informally by Bucci and Mergenthaler. A formal empirical
investigation of CRA‘s lexical items would produce an improved understanding of how CRA
works in psycholinguistic terms, and could throw light on the cognitive operations underlying
referential activity and the process of narrative construction to which RA has been linked.

   To this end, we adopted a Multi-dimensional Scaling procedure for categorizing the CRA
dictionary into subcomponents. A group of 29 raters were asked to sort the lexical items using
similarity as the criterion. Statistical analysis of raters‘ judgments resulted in lists of words
occupying discrete dimensions which define CRA‘s subcomponents. We produced computerized
dictionaries of these subcomponents and applied them to texts that were used in the original
derivation of the CRA dictionary. The output of the subcomponent dictionaries was correlated
with CRA in order to assess their relative contributions to the overall CRA ratings. Correlations
of CRA and its subcomponents with judges‘ ratings of RA and its four dimensions: Concreteness,
Specificity, Clarity and Imagery were also derived. Since the RA dimensions are based on
well-defined linguistic criteria, and have been related to aspects of cognitive functioning
described in Bucci‘s Multiple Code theory, they provide a useful metric for assessing how the
CRA dictionary models referential activity.
Paper in Panel - Panel Session 24

Title:                  Comparing Successful and Non-Successful Shift-Events

Authors:                Markus Börner and Erhard Mergenthaler

Address of Correspondence:

           Markus Börner
           Universität Ulm, Medizinische Fakultät
           Sektion Informatik in der Psychotherapie
           89081 Ulm; Germany

                                           ABSTRACT

     Narratives have been shown to be important components of psychodynamic psychotherapy.
They are considered to provide good access to pathological emotion schemas and to facilitate their
verbalization. (Bucci, 1997). From cognitive psychology it is known that positive feelings are
associated with a broad and flexible cognitive organization and facilitate problem solving and
creativity, which also can be considered as the appearance of new verbal associations through
activation of previously dissociated components of emotion schemas (Isen, Johnson, Mertz, &
Robinson, 1985). Mergenthaler (in prep.) has defined a ―Shift Event" as any event taking place in
the therapeutic process that is preceded by dominating negative emotional tone and followed by
dominating positive emotional tone. Shift events therefore enable or facilitate creativity or
problem solving which in the context of psychotherapy also can be seen as emotional insight.
Narratives are considered to be one of the most important class of shift events in verbal
psychotherapy.

   Within the study presented here narratives will be identified as peaks of CRA (Mergenthaler
& Bucci, in print) within all 28 session transcripts from a short term psychotherapy with a male
compulsive patient. It is hypothesized that those CRA peaks fulfilling the criteria of a shift event


                                               175
(successful shift event) are narratives that show the complete structure of a narrative as defined by
Labov and Fanshel (1977). CRA peaks that are non-successful shift events are expected to be
incomplete narratives.




Paper in Panel - Panel Session 24

Title:                  Cognitive-Structural Aspects of Primary and Secondary Processes and the
                        Referential Cycle

Author:                 Eyal Pavell

Address for Correspondence:

          Eyal Pavell
          Glass Institute of Basic Psychoanalytic Research
          75 Varick Street,
          New York, NY 10013
          USA

                                           ABSTRACT

     This study examined several cognitive-structural aspects associated with primary and
secondary processes and their co-occurrence during different phases of referential cycles in a
psychotherapy process study. The findings provide insight into cognitive processes that occur
during moments in therapy that are associated with symbolic change, insight and other associated
variables. Results are discussed from within a combined psychoanalytic and cognitive framework.

    Patients‘ verbatim psychotherapy narratives were examined using the Primary Process
Proportion (PPP), a measure consisting of a dictionary of words associated with the
cognitive-structural aspects of primary and secondary processes. These were defined along three
dimensions: determination of causality (contiguity versus causal logic), continuous versus
dichotomous thinking, and presence or absence of negation.

     The Computerized Referential Activity (CRA) measure, a text analysis instrument applied in
the identification of cycles of cognitive and emotional transformation, served as the independent
measure. The relationship between CRA and PPP levels of patient speech segments was
explored in 31 psychoanalytic treatment sessions of nine patients. The cognitive-structural aspects
of primary and secondary processes were observed as they co-occurred in segments of speech that
varied in their CRA level, differing in the degree of connection between various emotional and


                                               176
representational systems and in their potential for insight and transformation.




                                               177
Panel Session 25 - Overall Summary

Title:                 The York II Psychotherapy Depression Project: Comparing Therapeutic
                       Approaches, Assessing Narrative Change, and Looking at Follow-Up

Participants:          Lynne Angus, Rhonda Goldman, Leslie Greenberg

Moderator:             Rhonda Goldman

Discussant:            Germain Lietaer

Address for Correspondence:

                      Rhonda Goldman, Ph.D.
                       York University Psychotherapy Research Clinic
          4700 Keele Street,
                      North York, Ontario M3J 1P3
                       Canada
                       Telephone: 736-5115X66102
          Email: rgoldman@yorku.ca

                                          ABSTRACT

     Results and findings from the York University Psychotherapy Depression Project II are
beginning to pour in. With a larger sample size and greater specificity in research questions,
researchers are focusing on new questions such as how to assess narrative change and how to
prevent relapse. There is also a return to old problems such as how to convince others of the
efficacy of short-term experiential therapy for depression.

     The first paper on the panel presents initial findings from a study that compares two
Experiential approaches: Client-centered and Process-experiential therapy. The second paper
will present pilot data relating the in-session resolution of tasks related to self-criticism and
unfinished business with a significant other to outcome and follow-up. The third paper will
describe the development of a macro-narrative assessment interview procedure in the context of
the York II project. Preliminary findings emerging for the Macro-narrative Assessment
Interview procedure will be presented and the impact of this procedure on both clients and
therapists participating in the study will be addressed.




Paper in Panel - Panel Session 25

Title:                 Initial Results From the York II Comparative Study on Experiential
                       Therapy of Depression


                                              178
Authors:                Rhonda Goldman, Les Greenberg, Lynne Angus

Address for Correspondence:

                        Rhonda Goldman, Ph.D.
                        York University Psychotherapy Research Clinic
                        4700 Keele Street,
                        North York, Ontario M3J 1P3
                        Canada
                        Telephone: 736-5115X66102
                        Email: rgoldman@yorku.ca

                                            ABSTRACT

     A second study investigating the efficacy of short-term Experiential Therapy for depression is
underway. Two Experiential therapies, process-experiential (P/E) and Client-centered (C/C) are
being administered to 40 patients who have been diagnosed with a major depressive disorder.
Results from the York 1 depression study indicate that these therapies are very effective in
alleviating depression. The York 2 project represents an effort to convince the skeptics. More
importantly, this is an independent investigation, that will fulfill the criteria necessary to establish
these treatments as empirically-validated as set out by the APA task force. In this study, change
is being measured on the following outcome measures: the Beck Depression Inventory (BDI), the
Symptom Checklist 90-R (SCL-90R), the Rosenberg self-esteem scale (RSE), the Inventory for
Interpersonal Problems (IIP), and the Hamilton Rating Scale for Depression (HRSD). Initial
findings will be presented and emerging observations will be discussed.




                                                 179
Paper in Panel - Panel Session 25

Title:                 Does Emotional Resolution of Key Tasks Prevent Relapse in the
                       Experiential Therapy of Depression?

Authors:               L. Greenberg, L. Angus, R. Goldman

Address for Correspondence:

                       L. Greenberg
                       Department of Psychology
                       York University
                       4700 Keele Street
                       Toronto, Ontario M3J 1P3
                       Canada

                                           ABSTRACT

     Pilot data relating the in-session resolution of tasks, related to self-criticism and unfinished
business with a significant other, to outcome and follow-up will be presented. These findings
serve as a basis of the process research aspect of the York Psychotherapy 2 project on the
experiential therapy of depression. In this study the resolution of self critical tasks by patients
high on Self-criticism as the resolution of unfinished business by patients high on Dependence
will be related to outcome and 18 month follow-up. The patients type is measured on the
depressive experience questionnaire (DEQ) prior to treatment while the in-session process is
measured on the degree of resolution measures (DRS). The 16 session treatment is currently being
administered to 48 patients diagnosed as having a major depressive disorder.




Paper in Panel - Panel Session 25

Title:                 Assessing Narrative Change in Brief Experiential Psychotherapy:
                       Preliminary Returns From the York II Depression Study


                                               180
Authors:               Lynne Angus, Karen Hardtke, Les Greenberg, and Rhonda Goldman

Address for Correspondence:

                       Lynne Angus, Ph.D.
                       Associate Professor
                       Rm. 213, BSB, Psychology
                       York University
                       4700 Keele St.
                       North York, Ontario
                       M3J 1P3
                       Canada
                       Email: langus@yorku.ca

                                           ABSTRACT

     Developing from our intensive analyses of narrative process modes and relationship themes
in the York I Depression Study, we have developed a multi-level level strategy to assess
micronarrative (e.g. personal memories told in sessions) and macronarrative (e.g. post-session
analyses of therapy themes) change in the York II Depression Study. In particular, this paper will
focus on the development of the Macro-narrative Assessment Interview (Angus & Hardtke 1998)
which invites clients to undertake a multiperspectival analysis of a) how they would describe
themselves and provide a personal memory which exemplifies their description; b) how someone
who knows them well would describe them and c0 what, if anything, would they like to change
about themselves. The interview is undertaken after the first experiential therapy session
(client-centred or process-experiential) and audiotaped for subsequent replay. A second,
post-therapy Assessment Interview is conducted after completion of the final therapy session.
Using an Interpersonal Process Recall procedure, the initial Macro-narrative Assessment
Interview is replayed for the clients and clients‘ reflections and comments are audiotaped for
subsequent transcription and qualitative analyses. The post-therapy Narrative Assessment
procedure is designed to provide clients with an opportunity to reflect upon their experiences of
change in therapy generally as well as to specifically address change in views of self and/or
selves-in-relation-to-others (macronarrative change) as they relate to their therapy experiences.
Preliminary findings emerging for the Macro-narrative Assessment Interview procedure will be
presented and the impact of this procedure on both clients and therapists participating in the study
will be addressed.




                                               181
Panel Session 26 - Overall Summary

Title:                 Different Approaches to Assess Attachment in Adults

Participants:          Katri Kanninen, Audrey Lobo-Drost, Bernhard M. Strauss

Moderator:      Bernhard M. Strauss

Discussant:            Anna Buchheim

Address for Correspondence:

                       Bernhard M. Strauss
                       Institut f. Medizinische Psychologie
                       Friedrich-Schiller-Universitaet Jena
                       Stoystr. 3
                       D 07740 Jena, Germany
                       Fax: (+) 3641 936546
                       e-mail: STRAUSS@LANDGRAF.MED.UNI-JENA.DE

                                           ABSTRACT

       The application of attachment theory is one of the growth industries within psychotherapy
research of the recent years. The panel gives an impression of different approaches to assess adult
attachment research within different studies of the field.

       Based upon the data from a large scale study dealing with the rehabilitation of traumatic
experiences, Katri Kanninen will report results on an associstaion of attachment patterns and
emotional processing.

       The following papers will give an update of the development of a prototype rating of adult
attachment patterns, originally developed by Paul Pilkonis. The German version of the measure
has been modified to increase its validity. Data on these modification will be presented.

      Finally the application of the method will be illustrated in a presentation of Audrey
Lobo-Drost who will report on a large scale study dealing with the prediction of process and
outcome of inpatient group psychotherapies on the basis of intake attachment characteristics.

       The aim of the panel is primarily a discussion of methodological developments in adult
attachment research and their validity.




                                               182
Paper in Panel - Panel Session 26

Title:                 Attachment and Emotional Processing After Trauma

Authors:               Katri Kanninen, Raija-Leena Punamäki

Address for Correspondence:

                       Katri Kanninen
                       Department of Psychology/Applied Psychology Division
                       P.O. Box 4
                       FIN-00014 University of Helsinki, Finland
                       e-mail: Kkannine@helsinki.fi

                                           ABSTRACT

       In this study we aim at understanding how attachment relates to emotional processing.
Attachment is known to become activated in facing danger, and thus, we examined how
individuals with different attachment patterns process emotions related to their traumatic
experiences.

       The participants were 50 clients treated at rehabilitation center for trauma survivors in
Gaza. The clients´ attachment style was measured before entering the therapy by using a
semi-structured as a multilevel process, i.e. the emotional meaning given to the traumatic event,
emotional action readiness, subjective feeling states, and the emotional meta-experience.

        Concerning the course of therapy, this presentation reports the results of how different
attachment patterns associate with client's self-reported feeling states measured immediately after
the therapy session in the beginning, middle and end of the treatment.




                                               183
Paper in Panel - Panel Session 26

Title:                 Construction of a Clinical Measure of Adult Attachment – An Update

Authors:               Bernhard M. Strauss, Audrey Lobo-Drost

Address for Correspondence:

                       Bernhard M. Strauss
                       Institut f. Medizinische Psychologie
                       Friedrich-Schiller-Universitaet Jena
                       Stoystr. 3
                       D 07740 Jena, Germany
                       Fax: (+) 3641 936546
                       e-mail: STRAUSS@LANDGRAF.MED.UNI-JENA.DE

                                          ABSTRACT

         In view of the fact that the most common measure to assess attachment in adults, the Adult
Attachment Interview (AAI), is too „expensive― for the use in large scale psychotherapy studies,
our group has worked on the further development of the Adult Attachment Prototype Rating
(AAPR) by Paul Pilkonis. The AAPR provides a more economic way to assess attachment related
traits and to classify these into seven subtypes.

       The paper will describe the way from the German translation of the original AAPR to a
modified version which might provide a compromise between questionnaire measures of
attachment and the AAI.

        The paper reports some results on psychometric aspects of the method, a study testing the
concordance of the AAPR-results with AAI-categories and summarizes available data concerning
the validity of the measure.

       Based upon a description of the decision-making process in the prototype rating, it will be
shown that the AAPR is considered to assess relational styles as well as indicators of attachment
representations.




                                              184
Paper in Panel - Panel Session 26

Title:                  Prognostic Relevance of Inpatients´Attachment Characteristics for the
                        Process and Outcome of Psychotherapy

Authors:                Audrey Lobo-Drost, Bernhard M. Strauss

Address for Correspondence:

                        Audrey Lobo-Dorst
                        University of Hamburg, Psychological Institute III
                        Von-Melle-Park 5
                        D 20146 Hamburg
                        Germany
                        Fax: (+) 40 – 4123 6170
                        e-mail: lobo-drost@rrz.uni-hamburg.de

                                           ABSTRACT

        In the context of a multicenter-study the prognostic relevance of attachment patterns is
investigated for the outcome of group psychotherapy. In order to evaluate patterns of attachment,
the Adult Attachment Prototype Rating (AAPR) is used.

       In a first step, we look whether patients with a secure attachment pattern profit most likely
from psychotherapy globally as well as in relevant aspects of success, whereas patients with
insecure attachment patterns show deficits in some aspects.

        In a second and prospective step we try to integrate attachment patterns as a significant
factor for differential indication.

       In previous small sample investigations using the AAPR we found some hints for patients
with insecure patterns of attachment having a specific outcome. Results from the current
multi-center study will empirically confirm these preliminary trends. A further point of interest is
an investigation of the patients´interpersonal problems in relation to specific patterns of
attachment. This information may be used and integrated in the therapeutic process.




                                               185
Panel Session 27 - Overall Summary

Title:                  The Therapeutic Alliance and Interpersonal Process in Different
                        Treatments, Outcomes, and Populations

Participants:           J. Christopher Muran, Lisa Wallner Samstag, Richard N. Rosenthal

Moderator:              Arnold Winston

Discussant:             Adam Horvath

Address for Correspondence:

                        Brief Psychotherapy Research Program
                        Beth Israel Medic21 Center
                        First Avenue at 16th Street
                        New York, New York 10003
                        Fax: 212420-3442
                        Email: jcmuran@bethisraelny.org

                                           ABSTRACT

        The primary aim of the Brief Psychotherapy Research Program at Beth Israel Medical
Center remains to study the therapeutic alliance and interpersonal process in time-limited
psychotherapy, with particular attention to treatment impasse and failure. We have attempted to
do so in a number of ways, including naturalistic investigations of patient-therapist interactions,
the modeling of therapeutic alliance rupture resolutions, and the development of an integrative,
relational treatment model specifically designed to attend to and resolve alliance ruptures. This
symposium will present a sampling of recent findings from our continuing efforts. Specifically,
we will present findings from a comparative study of patient and therapist post-session reports or
perceptions of the therapeutic alliance and their interpersonal transactions with each other in three
brief psychotherapies (a cognitive-behavioral, psychodynamic, and relational model), including to
what extent they are concordant or discordant and the implications for treatment efficacy. Second,
we will present a study where the focus was on interpersonal processes of difficult
patient-therapist dyads and early identification of treatment failures. This study involved the
examination of cases categorized as premature drop-out, poor outcome, and good outcome in
terms of working -alliance, interpersonal complementarity, and narrative coherency. Finally, we
will present results from a study involving a collaborative effort between the Program and a
NIDA-funded program that examined the alliance (by a group climate measure) in a supportive
group psychotherapy for substance abusers with schizophrenia.




                                               186
Paper in Panel - Panel Session 27

Title:                 The Therapeutic Alliance, Interpersonal Perceptions, and Correlated
                       Perspectives in Three Brief Psychotherapies

Authors:               J. Christopher Muran, Eyal Rozmarin, Bernard Gotman, Jake Nagy,
                       Jeremy Safran, and Arnold Winston

Address for Correspondence:

                       Brief Psychotherapy Research Program
                       Beth Israel Medical Center
                       First Avenue at 16th Street
                       New York, New York 10003
                       USA

                                           ABSTRACT

        The present study examined patient and therapist repeat~ post-session reports of the
therapeutic alliance (as measured by the Working Alliance Inventory) and their interpersonal
transactions (as measured by a modified version of the Interpersonal Adjectives Scale) in three
30-session treatment conditions: a cognitive-behavioral (N=20), psychodynamic (N= 18), and
relational model (N=22). The specific aim was to investigate the relationship of these ratings and
the extent to which they are concordant (or discordant) to treatment efficacy. Outcome was
determined by a composite index of standardized residual gain scores from patient and therapist
rated Target Complaints and the Inventory of Interpersonal Problems, which were averaged
because they were highly intercorrelated. Results were based on a series of regression analyses of
repeated measures with a generalized estimating equations approach and a multilevel linear
modeling approach. In a previous study that exclusively examined cases in the relational
condition, we found that in addition to patient and therapist ratings of the alliance, the
session-by-session correlations of these ratings were predictive of outcome. In fact, the
concordance of patient and therapist ratings had a significantly stronger relationship to outcome
than that found in the separate analyses of patient and therapist ratings of alliance and outcome.
Similar results were found from analyses of patient and therapist perceptions of their interpersonal
transactions on the modified lag. In the present study, we will conduct a comparative analysis
with cases in two other treatments and determine whether or not the finding regarding correlated
ratings is specific the relational model.




Paper in Panel - Panel Session 27

Title:                 Interpersonal and Attachment Perspectives on Developing Therapeutic
                       Alliances: The Validity of SASB and Narrative Coherency in Predicting


                                               187
                          Brief Psychotherapy Treatment Failures

Authors:                  Lisa Wallner Samstag, J. Christopher Muran, Paul L. Wachtel, Arietta
                          Slade, Jeremy D. Safran, and Arnold Winston

Address for Correspondence:

                Brief Psychotherapy Research Program
                        Beth Israel Medical Center
                        First Avenue at 16th Street
                        New York, New York 10003
                        USA

                                               ABSTRACT

         The focus of this study was interpersonal processes of difficult patient-therapists dyads and early
identification of treatment failures in 30-session psychotherapy. Forty-eight dyads were equally divided
into premature dropout (DO), poor outcome (P0), or good outcome (GO) conditions. Groups were
compared on three measures of the relationship: (1) patient- and therapist-rated Working Alliance
Inventory, rooted in an ego-psychological tradition; (2) observer-rated Structural Analysis of Social
Behavior, from an interpersonal orientation; and (3) observer-rated Narrative Coherency adapted from the
Adult Attachment Interview for use with psychotherapy transcripts, comprising a neo-Bowlbian
perspective. Each measure significantly differentiated groups and the DO condition was not consistently
found to have the most difficult relationships, as hypothesized: DO's had the most problematic alliances
and most incoherent session narratives, while PO's demonstrated greatest hostile behavior between patients
and therapists. PO patients also reported fewer early attachment losses/traumas at intake. Significant
interrelations among measures were: (1) the greater the strength of patient-rated therapeutic bond, the
greater the degree of Native Coherency; (2) the greater patients' perception of agreement on goals and tasks
of therapy, the less hostile the behavior within dyads; (3) the greater therapists' perception of the overall
alliance, especially bond, the less hostile the behavior within dyads, and (4) the more coherent the narrative
in sessions, the more friendly and less hostile the behavior within dyads. Findings suggest differences
among outcome groups in quality of the relationship and that patients and therapists do not consider similar
aspects of the relationship to carry therapeutic importance. Moderate alliances of PO dyads enabled them
to engage in a relationship, albeit hostile, compared to DO dyads which could not engage enough for
patients to remain in treatment. Longer therapy may be required to work through hostile interpersonal
cycles, possible reflective of more classically defined transference/ countertransference interactions.
Narrative Coherency results might indicate links between a patient's attachment system and his/her
capacity to bond with a therapist. Overall, findings speak to the highly complex nature of the therapeutic
relationship and have clinical implications for time-limited treatment of patients at risk for treatment
failure.


Paper in Panel - Panel Session 27

Title:                    The Therapeutic Alliance in Group Treatments for Substance Abusers with
                          Schizophrenia

Authors:                  Richard N. Rosenthal, Christian R. Miner, David I. Hellerstein,
                          and J. Christopher Muran

Address for Correspondence:

                                                   188
                       Beth Israel Medical Center
                       First Avenue at 16th Street
                       New York, New York 10003
                       USA

                                         ABSTRACT

        Although treatment engagement and retention in severely mentally ill patients with
substance use disorders is a major clinical issue, research has rarely addressed the therapeutic
alliance in this population. In a NIDA-funded study, we examined changes in patients' therapeutic
alliance over time in an effort to identify "active ingredients" of the treatment process in a
sub-study of a randomized trial comparing twice-weekly outpatient group therapy (COPAD) to
group therapy plus community outreach visits (COPAD+TAO). Patients (N= 35) in 4 ongoing
treatment groups (2 Experimental, 2 Control) completed the Group Climate Questionnaire (GCQ)
following each group therapy session for 30 sessions. Individual Treatment Engagement subscale
scores were computed and the means for each session were computed by Group. A simple
Generalized Estimating Equations model for repeated measures tested the hypothesis that, over
time, patients' Engagement scores vary by Treatment Condition. Group members varied by
seniority in the treatment protocol, so time-in-treatment served as a covariate. Seniority in
treatment does not effect Engagement but the Group distinction does. With time-in-treatment held
constant, patients receiving Targeted Assertive Outreach demonstrate Engagement scores that, on
average, exceed those of control patients by 3.33 subscale points (z = 2.26, p < .01). Targeted
Assertive Outreach enhances the treatment alliance in group psychotherapy. Interactions between
Patient Engagement and Therapist Engagement will be explored and a formulation for using GCQ
data to predict treatment outcome will be presented.




                                             189
Panel Session 28 - Overall Summary

Title:                     Results of Empirical Approaches to Validity Aspects of the Operationalized
                           Psychodynamic Diagnoses (OPD)

Participants:              M. Cierpka, Gerd Rudolf, Wolfgang Schneider

Moderator:                 Wolfgang Schneider

Discussant:                John Clarkin

Address for Correspondence:

                  Professor Dr.Dr. Wolfgang Schneider
                           Klinik für Psychosomatik und Psychotherapeutische Medizin
                            Universität Rostock
                           Gehlsheimerstr. 19
                           18147 Rostock
                           Germany
                           Tel.: Germany 0381/4949671 Fax 0381/4949671
                           Wolfgang.Schneider@med.uni-rostock.de

                                                 ABSTRACT

         In 1996 the Operationalized Psychodynamic Diagnoses- System (OPD) was published after a
working- period of nearly five years of a big group of German psychotherapists who are engaged as well as
researchers and teachers of different German universities. The aim of the model was to make possible a
clinical oriented assessment of different important diagnostic dimensions of psychodynamic
psychotherapy. An important reason to develop this instrument was the opinion and clinical experience that
the major psychiatric diagnoses-systems like DSM or ICD-10 are not very useful in planning therapy.
Therefore the aspect of validity and especially treatment-validity was the central goal of our work.

          The following axis constitutes the OPD
         Axis I.: Experience of Illness and the patient`s preconditions for treatment
         Axis II: Relational-Style
         Axis III: Conflict
         Axis IV: Structure
         Axis V: Syndrome Diagnoses according to ICD-10

        In the development of the first version on OPD results of studies to reliability of the single Axis
were integrated. Since 1996 a great number of research-groups focused different aspects of validity on the
one hand or special theoretical or clinical questions for all five axis. In the panel three working-groups will
present their empirical findings to the axis I-IV.

        At first data from an Axis-I- study will presented which examined patients with special
sociodemographic characteristics, clinical diagnoses and from different clinical treatment conditions
(inpatients vs. outpatients). Further on the aspect of predictive validity of special Axis I- Items were
explored.

        The next paper will proof whether patients during inpatient treatment will reenact their
characteristic style of relationship. At least findings of the axis „structure― and the axis „conflict― are
presented. Especially data about the interaction of these dimensions will be discussed in this paper.


                                                     190
Paper in Panel - Panel Session 28

Title:                  Results of OPD -Axis I in Different Clinical Contexts

Authors:                W. Schneider, T. Klauer, J. v. Wietersheim

Address for Correspondence:
             Wolfgang Schneider
             Klinik für Psychosomatik und Psychotherapeutische Medizin
             Universität Rostock
             Gehlsheimerstraße 22
             18147 Rostock

                                            ABSTRACT
        OPD- Axis I (Experience of illness and the patient`s precondition for treatment) explores
different cognitive and affective resources of the patient in coping with the illness and his special
motivation for treatment. These aspects are important criteria in the process of indicating a
specific therapy for a patient. Therefore these perspectives are integrated in the OPD.

       At the Department of Psychosomatics and Psychotherapeutic Medicine of University of
Rostock (Germany) 420 Patients from different clinical fields were examined between January
1996 and December 1997 with OPD-Axis-I. These research activities were motivated for several
reasons:

1. We want to proof whether patients with different sociodemographic characteristics (e.g.
   age, gender) and different psychic or psychosomatic diseases show distinctive
   characteristics of OPD-Axis-I diagnoses. Our results showed that patients with different
   psychic diseases (e.g. depressions, anxiety disorders, somatization and personality
   disorders) have typical styles in coping with their problems and distinctive motivation for
   treatment. The age of the patients influence the OPD-Axis-I diagnoses too but we
   canned`t find an influence of gender in Axis-I diagnoses.

2. In a next step we examined OPD-Axis- I diagnoses of patients from our liaison services
    and compared them with our outpatients. We found characteristic differences between
    those two groups which are from our opinion above all reasoned in different kinds of
    disorders of both groups.

      A major function of diagnoses is reasoned in the aim of planning therapy. We
examined the question of treatment validity of Axis-I diagnoses in our setting of inpatient
psychotherapy. We found that special items of Axis-I can predict the effect of the
treatment in a good way.




                                                191
Paper in Panel - Panel Session 28

Title:                 Do Patients Reenact Their Typical Relationship Behavior During
                       Inpatient Treatment?

Authors:               Manfred Cierpka, Michael Stasch

Address of Correspondence:

                        Abteilung für Psychosomatische Kooperationsforschung und
                        Familientherapie Universität Heidelberg
                        Bergheimerstr.54,
                        69115 Heidelberg, Germany

                                           ABSTRACT

     Freud's idea that an individual perceives and forms relationships according to a persistent
general (transference) pattern, has continued to be highly relevant through the eventful history of
clinical theory in psychotherapy. In the diagnostic procedure of inpatient treatments it is assumed
that many of our patients‘ problems become apparent through the particular role they play in the
patients‘ relationships networks. It is clinically hypothesized that psychotherapeutic wards serve
as an experiential field where interpersonal conflicts of the patients are supposed to be reenacted.
Our study investigates whether patients do reenact their typical relationship behavior during
inpatient treatment.

     73 patients reported by means of relationship anecdote paradigm interviews their perceived
dysfunctional relationship behavior in narratives. These data were compared with observational
data of the staff assessing the patients‘ actual relationship behavior on the ward. The rating
method of dysfunctional relationship behavior is based on Axis II ―The assessment of relational
style‖ of the new system ‖Operational Psychodynamic Diagnosis - OPD-1. The categories of the
patient's habitual dysfunctional relational style are operationalized as items based on the
interpersonal cicumplex model.

    Correlational statistics of the data gained by the two rating procedures support the clinical
hypothesis.




                                               192
Paper in Panel - Panel Session 28

Title:                  The Axes ―Conflict‖ (III) and ―Structure‖ (IV) of the Operationalized
                        Psychodynamic Diagnosis (OPD) - Empirical Findings Under the Aspect
                        of Reliability and Validity

Authors:                G. Rudolf, T. Grande, C. Oberbracht

Address for Correspondence:

                        Prof. Dr. Gerd Rudolf
                        Psychosomatische Klinik
                        Thibautstraße 2
                        D-69115 Heidelberg
                        Germany

                                           ABSTRACT

        The ―Conflict‖ axis of OPD depicts the patient´s life-defining conflicts. In the
OPD-system the following 8 conflict types are defined: dependency versus autonomy,
submission versus control, need for care versus autarky, self-esteem conflicts, guilt conflicts,
oedipal-sexual conflicts, identity conflicts, and deficient awareness of conflicts and feelings. In
the OPD-Manual all of these conflicts are rated on a four-stage scale of their presence and
significance.

        The ―Structure‖ axis describes 6 different structural capacities. Each of them can be rated
on a four-stage scale with respect to the level of integration (from well integrated to
disintegrated). The following capacities are defined: self perception, self regulation, the capacity
for defense, object perception, communication and attachment.

        The presentation will show empirical findings with respect to the reliability and the
validity of both axes. The requirements and expenses of a good enough rating using this system
will be discussed. The study is mainly based on 100 patients with psychosomatic and neurotic
symptoms and/or personality disorders. The patients were psychotherapeutically treated in an
inpatient setting in the Dept. for Psychosomatic Medicine and Psychotherapy of the University of
Heidelberg. All patients were assessed with OPD at the beginning of their treatment, and half of
them were again assessed at the end of therapy.




                                               193
Paper Session 8

Title:                 Perceptions of Family Therapy Outcome Among Parents, Adolescents, &
                       Therapists

Authors:               Marna S. Barrett and Jennifer Lynch

Address for Correspondence:

                       Department of Psychology
                       Indiana University of Pennsylvania
                       Indiana, PA 15705
                       USA

                                          ABSTRACT

       Although research has confirmed the effectiveness of family therapy, assessments of
outcome have relied primarily on the perspectives of therapists or parents. Because family
therapy, in contrast to individual approaches, involves a number of participants and often focuses
on a child as the target problem, a more comprehensive picture of therapeutic outcome can be
obtained by assessing the perspective of multiple family members.

        The aim of the present study, therefore, was to assess the congruence of perception
between adult caregivers, adolescents, and therapists on measures of therapy outcome. In the
study, therapists at a university counseling center provided treatment to families using a
behavioral-strategic family therapy model. Global and specific measures of outcome were
obtained from adult caregivers, teens, and therapists after each of the first six sessions of
treatment.

        On the global measures of outcome, therapists and families reported significant reductions
in distress over the course of treatment. Moreover, adolescents were significantly less distressed
by the presenting problems of the family than either adult caregivers or therapists. In contrast,
specific measures of outcome revealed that adolescents reported greater difficulty dealing with
family members, peers, or school learning than that perceived by their adult caregivers. Such a
pattern provides support for the effectiveness of family therapy and raises the possibility that
adolescents, because of their developmental level, perceive global and specific measures of
outcome independently.




                                              194
Paper Session 8

Title:                 Doing Family Therapy Research in Community Agencies: Obstacles
                       and Opportunities

Authors:                Eric E. McCollum, Sandra M. Stith, Karen H. Rosen

Address for Correspondence:
                    Eric E. McCollum, Ph.D.
                    Department of Human Development
                    Virginia Tech – Northern Virginia Center
                    7054 Haycock Road
                    Falls Church, VA USA 22043
                    Phone: 703-538-8470
                    Fax: 703-538-8465
                    E-mail: e.mccollum@vt.edu

                                           ABSTRACT

       While efficacy research is needed to demonstrate that psychotherapy approaches work
under ideal research conditions, effectiveness research aims to demonstrate that the approach can
be taken out into the real world of practice. Conducting research on family therapy in
community agencies poses both opportunities and obstacles for researchers. In this paper, we
describe our experiences of both opportunities and obstacles while conducting research in
agencies as well as strategies for optimizing the advantages and working with the obstacles.
Between them, the authors have conducted 5 outcome and demonstration studies in community
agencies in the areas of family treatment for substance abuse and partner violence. Topics
covered include:

          Developing relationships with agency staff that help the research team enter the
            agency on a sound footing;
          Establishing the clinical credibility of the team without jeopardizing the
            requirements of the research;
          Supervising therapists in the use of a treatment manual;
          Recruiting research participants from a general agency population;
          Dealing with the wider social service community when testing a new and
            potentially controversial treatment

        To a large extent, doing this kind of research represents a "cross cultural" endeavor
where the cultures of psychotherapy research and day-to-day clinical practice meet. Both
"cultures" have valid concerns and goals some of which may be in conflict. However,
both the research view and the clinical view must find a way to coexist if research in
agencies is to be successful. This paper focuses on strategies to help both cultures coexist.
Paper Session 8

Title:                  Three Sessions of Brief Couples Therapy: A Clinical Trial



                                               195
Authors:               Gordon Davidson, Adam Horvath

Address for Correspondence:

                       Gordon Davidson
                       Independent Practice
                       101-3005 35 Avenue
                       Vernon, British Columbia, Canada V1T 2S9
                       Telephone (250) 542-0660
                       Fax (250) 549-2805

                                          ABSTRACT

        The effects of positive reframing and restraining in the context of time-limited brief
couples therapy were investigated. Forty couples were randomly assigned to either an immediate
treatment group or to a waiting-list control group that received delayed treatment. The
intervention had a positive impact on dyadic adjustment, target complaints, and conflict
resolution of treated couples compared to couples in the waiting-list control group. There were no
significant differences observed in the relationship beliefs and spousal attributions between the
treated and untreated couples. Thirty-nine percent of couples met L. Christensen and J.
Mendoza's (1986) definition of clinically meaningful improvement. Treatment gains observed at
the termination of the 3-session treatments appear to have been maintained at 6-weeks follow-up.
A positive relation was observed between couples' improvement and compliance with treatment
directives. Implications for time-limited brief therapy are discussed.




                                             196
Paper Session 8

Title:                 The Dynamics of Couples Therapy Sessions: Proximal and Distal
                       Predictors of Session Level Outcome

Author:                Adam O. Horvath

Address for Correspondence:

                        Adam Horvath
                        Simon Fraser University, Burnaby
                        British Columbia, Canada
                        V5A 1S6
                        Ph: (604) 291-3624
               Fax: (604) 291-3203
               e-mail: horvath@sfu.ca

                                           ABSTRACT

        Many outcome based evaluations of treatment focus on post therapy outcome or follow up
evaluation and its relation to a variety of process variables. At this level, most studies appear to
support the Dodo Bird‘s verdict: ―Everybody has won and all must have their prizes‖. Treatment
and outcome examined at such macro perspective, however, overlooks important aspects of the
actual dynamics of therapy. It may be the case that across diverse problem, client, and treatment
variables, in the long run, all differences among treatments will cancel out (in effect find their
home in the error term). However, it is also more than likely that different forms of treatment
produce their beneficial effect in dissimilar ways. It may well be the case that certain client
variables can be sequentially linked to predict good sessions and other sequences prognosticate
poor sessions. If we understood more clearly these micro effect sequences we may be better
able to develop treatment protocols uniquely effective in specific treatment situations.

       As a first step in building such model for couples therapy, we have examined the relation
of proximal and distal predictors of session level outcome. Forty two couples seeking therapy
were offered time limited (6 session) treatment. The majority of couples presenting complaints
were ―communication‖ ―parenting‖ or ―intimacy‖. Models for good as well as ―improving‖
and ―deteriorating‖ session outcomes will be presented and relation between session predictors,
session outcome and follow up data will be discussed.




                                              197
Paper Session 9

Title:                    The ―Agonias‖ of Portuguese Immigrants in the United States: An
                          Exploration of the Meaning and Treatment of the Phenomenon.

Authors:                  Susan James and Susanne Haskell

Address for Correspondence:
                    Susan James
                    Department of Psychology
                    Wilfrid Laurier University
                    Waterloo, ON     N2L 3C5, Canada

                                               ABSTRACT
         Understanding how to diagnose and conduct psychotherapy with clients from other cultures has
long been a major goal of cross-cultural psychologists. Cross-cultural researchers have demonstrated that
symptom expression varies from country to country and that besides the traditional psychiatric diagnoses
there are culture-bound disorders that are specific to one cultural community, such as ataques de nervios
in Puerto Rico and amok in Malaysia. The distinction is important because the treatment of culture-bound
disorders is often different from the treatment of psychiatric disorders and requires extensive knowledge
about indigenous culture and healing practices.

        This project investigated "agonias" (meaning "the agonies"), a culture-specific somatic
phenomenon of Portuguese, specifically Azorean, immigrants in the United States. This common
phenomenon is extremely confusing for psychotherapists because the meaning of agonias is remarkably
idiosyncratic, ranging from indigestion to someone literally ―on the brink of death‖. Members of the
Portuguese immigrant community (N=50) were interviewed and the narratives were coded and analyzed
using cluster analysis. The results indicate that the common symptom of agonias reported by all
participants was breathlessness, whereas accompanying symptoms varied widely from person to person,
including nausea, burning from within, loss of sight, inability to eat or sleep, and fever. Participants
reported almost as many causes of agonias as there were symptoms, including, inter alia, indigestion,
asthma, someone on the "brink of death," and a premonition of an impending catastrophe. The cluster
analysis revealed that there were three types of agonias (agonias of illness, agonias of death, and agonias
from a premonition) that each had their own cure.

         Clinicians who primarily treat Portuguese clients were also interviewed (N=10). In contrast to
the community participants, agonias had only one meaning for clinicians; panic disorder. The large
discrepancy between the meaning of agonias to participants and to clinicians will be explored. The
psychotherapists also reported that they did not have great success treating agonias with traditional
psychotherapy approaches. Some of the difficulty occurs because the cultural assumptions implicit in
traditional therapies are different from the cultural values held by the community members.
Recommendations for the treatment of Portuguese immigrants from the Azores will be presented.
Paper Session 9

Title:                    Therapeutic Effects of the Detection and Analysis of Cognitive Conflicts

Authors:                  Guillem Feixas, Vicente Sánchez-Rodríguez, and Luis Angel
                          Saúl-Gutiérrez




                                                   198
Address for Correspondence:

                        Luis Ángel Saúl-Gutiérrez
                        Avenida de la Merced, 109-131
                        37005-Salamanca, Spain
                        Telephone (9)23-294400 ext. 3327 / 3301
                        Fax (9)23-294607
                        e-mail: lasaul@gugu.usal.es

                                           ABSTRACT

        The aim of this study is to present some of the clinical applications of the detection of
cognitive conflicts through their therapeutic assessment and later elaboration. In the context of a
joint project involving researchers from three Spanish universities, we have developed a method
of detecting cognitive conflicts based on the repertory grid technique, and at this moment we are
working on a method of conflict analysis with patients with a view to their resolution.

       We will present two lines of research that we are currently using with regard to the
influence these conflicts have on resistance to change as well as research into the efficacy of
therapy focused on these conflicts.




                                               199
Paper Session 9

Title:                 Unhelpful Events in Psychotherapy: A Concept Mapping Approach

Authors:               Barbara Paulson, Derek Truscott, and Robin Everall

Address for Correspondence:

               Barbara Paulson
                       Department of Educational Psychology
                       6-123h Education North
                       University of Alberta
                       Edmonton, Alberta T6G 2G5
                       Canada

                                          ABSTRACT

        This process oriented research study focused on aspects of psychotherapy perceived as
unhelpful by clients undergoing therapy at a University training center. The aim of this study
was to increase our understanding of what clients experience as unhelpful in a manner that did
not restrict the research participants‘ responses.

        Concept mapping was determined to be the optimal way to gather, to organize, and to
understand clients' perceptions of unhelpful aspects of therapy without undue researcher bias.
As a research approach, concept mapping combines both qualitative and quantitative
methodology, and was used in clarifying the fundamental elements and the underlying structure
of unhelpfulness as experienced within this clinical population. It was also deemed important
that the research take place in a clinical setting with a heterogeneous group of clients from the
community. Thirty-five participants (9 male, 26 female) aged 18 and older who sought
psychotherapy were drawn from a clinical service affiliated with a large university. Clients with
a mean age of 34.15 years (range 18-56 years) who received 11.14 sessions (range of 1-23
sessions) completed the data generating tasks.

        A thematic structure which identifies both unhelpful characteristics of the clinicians and
unhelpful aspects of the actual psychotherapeutic interaction will be presented. Participants‘
responses also indicated that the time frame in which psychotherapy occurred impacts their
perception of helpfulness. More specifically, clients indicated that too few sessions and
premature termination are unhelpful in therapy. The delineation of specific types of unhelpful
impacts on clients increases the likelihood of more focused research on the relationship between
client experience, psychotherapeutic processes, and therapeutic outcomes. Furthermore,
developing a conceptual map of the unhelpful aspects of therapy that can be used in the training
and supervision of clinicians provides additional opportunities for the improvement of
psychotherapy.
Paper Session 9

Title:       What Do Psychotherapy Patients Want and Does it Make a Difference? An
                     Empirical Analysis



                                              200
Martin Grosse Holtforth and Klaus Grawe

dence:

Martin Grosse Holtforth
Psychotherapeutische Praxisstelle der Universität Bern
Mittelstrasse 42
3012 Berne
Switzerland
Email: grosse@ptp.unibe.ch

                                      ABSTRACT

We present an empirical taxonomy of treatment goals and their correlates. 1031 treatment goals of 300
               psychotherapy patients assessed by goal-attainment scaling (GAS) at an outpatient treatment
               clinic at the University of Berne served as the data base for our study. Because it showed that
               within a single GAS goal, semantically different goals were combined, each GAS goal was
               subdivided into several ―goal units‖, each representing an intended change from an undesired
               present state to a desired future state. In an iterative process, synonymous goal units were
               merged, resulting in 326 goal units in total. In order to reach a taxonomy of treatment goals that
               is close to the therapists‘ level of abstraction, 17 psychotherapists sorted the goal units into
               self-defined categories. Cluster analyses produced a hierarchical structure of the goal units as a
               summary of the individual taxomies. A literature-informed interpretation of the cluster-analysis
               data resulted in the proposed taxonomy of psychotherapeutic treatment goals. The following
               analyses of intake assessment, diagnostic, and outcome data try to answer the question, what the
               correlates and effects of different types of goals are.




                                                             201
Paper Session 10

               The Process and Outcome of Therapist Techniques: Advancing into the New
                      Millennium

Author:                          Elizabeth Nutt Williams

Address for Correspondence:
                    Elizabeth Nutt Williams, Ph.D.
                    Department of Psychology, St. Mary‘s College of Maryland
                    St. Mary‘s City, MD 20686
                    USA

                                           ABSTRACT

        A wide range of research has examined different types of therapist techniques to
understand which techniques work and which do not. Because several researchers have
suggested that therapist techniques in general account for only a small portion of the variance in
counseling outcome (Elliott, 1985; Hill et al., 1988), the research has shifted to examining
specific techniques in the context in which they occur. For example, several researchers have
looked into verbal response modes as a way of explaining therapeutic techniques. Others (e.g.,
Goldfried, Newman, & Hayes, 1989) have examined the focus of therapeutic interventions (i.e.,
intrapersonal, interpersonal, time frame, etc.). Still others have focused more on the specific
techniques therapists use (e.g., confrontation, self-disclosure, paradoxical interventions, etc.)
(Barkham & Shapiro, 1986; Hill, Mahalik, & Thompson, 1989; Olson & Claiborn, 1990;
Swoboda, Dowd, & Wise, 1990).

        Although much of the work has focused on external therapist techniques, much of what
therapists do is actually unseen. For example, therapists may choose to use silence or may focus
their work on particular intentions (Hill & O‘Grady, 1985). Although these covert behaviors,
such as therapist self-talk and intentions, may be an important moderator of therapist overt
behavior (Borders, Fong-Beyette, & Cron, 1988; Fuqua, Newman, Anderson & Johnson, 1986;
Morran, 1986; Nutt-Williams & Hill, 1996), it is still unclear how these covert strategies relate to
the techniques therapists use.

        The focus of this paper will be to review the research on therapist techniques, including
the impact of therapist covert behaviors, and to suggest areas for future research. As we enter a
new millennium, where the face of psychotherapy will continue to change, it seems prudent to
examine what it is that we do and ask what evidence we have for our effectiveness. We have
long since moved beyond asking whether therapy works; we have more recently been asking
what about it is about therapy that works, in what context, and to what extent research has
informed our practice (Grawe, 1997). We know that many therapists‘ techniques are effective,
but more empirical work on the counseling process is still needed. Future research and
implications will be discussed.
Paper Session 10




                                               202
Title:                  Treatment Adherence Process Research in Therapy for Depressed and
                        Substance Abusing Adolescents

Authors:                Gary M. Diamond, Guy S. Diamond, Aaron Hogue and Howard Liddle

Address for correspondence:

                        Gary M. Diamond, Ph.D.
                        Department of Behavioral Sciences
                        Ben-Gurion University of the Negev
                        P.O.B. 653, Beer-Sheva 84105, Israel

                                           ABSTRACT

        The use of an adherence measure as a process research tool has been relatively
unexplored. We will present research that uses adherence ratings, not only to establish treatment
integrity and differentiation, but also to examine patterns of therapist interventions over the first
five sessions of treatment with depressed and substance abusing adolescents.
        The first study involved developing an observer-based adherence instrument, the
Therapist Behavior Rating Scale - 3 (TBRS-3; Diamond, Hogue, Diamond, & Siqueland, 1998)
to measure unique and common therapist interventions across three treatments. The first
treatment, dynamic cognitive-behavioral therapy (DCBT; Turner, 1991), is a behavioral,
individual-based approach for treating adolescent substance abuse and related problems. The
second, multidimensional family therapy (MDFT; Liddle, 1991), is a multisystemic, family-based
approach for treating adolescent substance abuse and related problem behaviors. The third,
family therapy for depressed adolescents (FTDA; Diamond & Siqueland, 1995), is a
family-based approach for treating depressed adolescents.
        Items reflecting core DCBT and MDFT interventions were derived from an earlier
adherence instrument (TBRS-2; Hogue, Rowe, Liddle, & Turner, 1994). Items reflecting core
FTDA interventions were nominated by the model‘s developers and then refined and
operationalized through the observation of videotaped FTDA sessions. Pairs of coders rated the
extent to which therapists employed TBRS-3 interventions in 99 therapy sessions (33 from each
treatment model). Reliability estimates for individual items were obtained and a principal
components analysis was conducted to obtain efficient summary variables.
        The second study focused on therapist processes in the early stage of therapy. We used
the TBRS-3 to code the first 5 sessions from 20 cases (10 from FTDA; 5 MDFT; and 5 DCBT).
Analyses were conducted to determine the extent to which different treatments for different
populations elicited different therapist behaviors. Also, we examined how patterns of therapist
behaviors evolved over time within each treatment modality and how patterns of therapist
behaviors varied according to treatment modality. Particular attention was paid to the different
emphases and sequences found in family therapy with depressed adolescents versus family
therapy with substance abusing and delinquent adolescents.




                                               203
Paper Session 10

Title:                  Identifying Optimal Intervention Patterns

Authors:               Zoran Martinovich, Joanna S. Burg, Kenneth I. Howard, Renanah
                       Kaufman, Wolfgang Lutz, and John S. Lyons

Address for Correspondence:
             Zoran Martinovich
             Department of Psychiatry & Behavioral Sciences
             Division of Psychology
             Northwestern University
             303 E. Chicago Avenue, Suite 9-200
             Chicago, IL USA 60611

                                           ABSTRACT

         This study describes a technique for identifying intervention patterns which are optimally
related to different kinds of outcomes during different phases of therapy. The technique is
illustrated with data from the Northwestern/Chicago Psychotherapy Research Program, a
naturalistic study in a psychodynamically-oriented training clinic. Behavioral/directive,
interpretive/past-focused and affective/empathic interventions were measured at a first session
and at various points throughout therapy using the Therapeutic Procedures Inventory - Revised.
Optimal intervention patterns, referred to as ―optima,‖ were identified by an iterative algorithm
which seeks the pattern of intervention use for which ―closeness‖ to this pattern is most positively
correlated with treatment response. The resulting optima were estimated for several categories of
short-term outcomes (session 4) and long-term outcomes (session 17) based on Howard, et al‘s 3
phase model.

        Overall, the intervention pattern associated with the best outcomes depended on whether
the outcome goal was short-term or long-term, and on whether the goal was to ameliorate
immediate distress, eliminate particular symptoms, or improve a person‘s work or social
functioning. Affective/empathic interventions appeared as a ―common factor,‖ optimally set at
high levels for all short-term and long-term outcomes. Behavioral/directive interventions were
associated with immediate ―distress-reducing‖ outcomes at all phases of therapy; but were
contra-indicated at long-term sessions for eliminating symptoms and improving functioning
outcomes. A primarily past-focused/interpretive therapeutic process was only associated with
maximizing treatment response for sessions occurring after several months of therapy and when
the outcome goals were long-term. Early past-focused/interpretive work (e.g., sessions 1 or 3)
was associated with poorer short-term and long-term treatment response. The results were quite
consistent with clinical lore regarding what therapeutic procedures are optimal in long-term
psychodynamic treatment, and also may explain the negative correlation between interpretive
work and treatment outcome sometimes reported in other studies of psychodynamic therapies.




                                              204
Paper Session 10

Title:                 Therapist Interventions in Interpersonal and Cognitive Therapy Sessions
                       from the Treatment of Depression Collaborative Research Program
                       (TDCRP)

Authors:               Mary Beth Connolly, Paul Crits-Christoph, and Judith Levinson

Address for Correspondence:

                       Mary Beth Connolly
                       3600 Market Street, Room 770
                       Philadelphia, Pa. 19104-2648
               USA
                       Connolly@landru.cpr.upenn.edu


                                          ABSTRACT

        Psychotherapy manuals provide guidelines for psychotherapy sessions, yet detailed
descriptions of specific therapist interventions from manualized treatments are rarely reported.
The purpose of this investigation was to evaluate the types of therapist interventions used in the
interpersonal psychotherapy (IPT) and cognitive therapy (CT) sessions conducted as part of the
Treatment of Depression Collaborative Research Program (TDCRP). Four early sessions of
psychotherapy and 4 late sessions when possible were transcribed for each of 72 patients who
received either IPT or CT at 2 of the 3 treatment sites. For each session, a therapist statement
was defined as a unique therapist speaking turn for a total of 135,552 therapist statements
identified across the sample. Each therapist statement was categorized as a learning
statement/interpretation, clarification, question, restatement, informational statement,
self-disclosure, role play, or other statement by 3 out of 6 independent judges paired using a
balanced incomplete block design. Judges further rated the time frames included in each
statement and the people discussed in each statement. This investigation will examine the
interjudge reliability taking into account variance due to differences between treatments,
therapists, and sessions. We will evaluate the types of interventions used in the sessions, with a
focus on the similarities and differences in therapist interventions across the 2 psychotherapy
conditions.




                                              205
Paper Session 11

Title:                 The Change in the Content and Structure of Self and Object
                       Representations in the Course of Trauma Therapy

Authors                Jari Salo and Raija-Leena Punamäki

Address for Correspondence:

               Jari Salo
               University of Helsinki
               Department of Psychology
               P.O. Box 13
               00014 Helsinki, Finland
               Jari.Salo@Helsinki.fi

                                           ABSTRACT

         In this study we examined the content and structure of torture survivors‘ self- and object
representations during their recovery process. Our previous results showed that representation
profiles of torture survivors with clinical symptoms were characterized by extremely negative
content in self and mother representations, and low level of differentiation and conceptuality.
Thus, the objective of the present study was to further examine how these representation profiles
develop and change during the therapy process. We will also examine how these changes are
related to the outcome of the therapy. Our hypotheses were, first, that during therapy the content
of self and object representations will become more positive and neutral, and that the structure of
representations will change towards more integration and differentiation, and to developmentally
higher level of conceptuality. Second hypothesis was that the development towards more stable,
differentiated and mature representation profiles is positively related to favorable outcome of
therapy. Representations were assessed by using the modified version of a procedure developed
by Blatt and colleagues (Blatt, Chevron, Quinlan, Schaffer, & Wein, 1992), in which subjects
filled in semi-structured descriptions of their mothers, fathers, spouses, and themselves, which
were then scored by two independent judges. Subjects were 30 torture survivors seeking
therapeutic help in Gaza, and their matched controls. They were studied in the beginning, in the
middle, and in the end of the therapy. The analyses of the data are being currently conducted and
the findings will be discussed from theoretical and clinical viewpoints.




                                              206
Paper Session 11

Title:                  Effects of Selection of Psychotherapy Material for Process Research

Authors:                U. Schnierda, I. Bonde, B. Junkert-Tress, and N. Hartkamp

Address for Correspondence:

               Dr. U. Schnierda
               Klinik für Psychosomatische Medizin und Psychotherapie
               der Heinrich-Heine-Universität Düsseldorf
               Bergische Landstraße 2
               40629 Düsseldorf
               Germany
               FAX 0049-211-922-4707
               E-mail schnierd@uni-duesseldorf.de

                                           ABSTRACT

       Results of the Duesseldorf Short Term Psychotherapy Project, which examines dynamic
Cyclic Maladaptive Pattern (CMP) oriented short term therapies in different diagnostic groups,
have already been published several times in SPR.

        This paper examines effects of selection of therapy material for research, regarding both
varying times throughout therapy course and parts of sessions. We investigated the frequency and
quality of SASB-clusters and different types of specifically categorized interventions at different
times of therapy course (fourth and twentieth session) and early and late parts of sessions. Four
patients of three different diagnostic groups were selected at random, diagnostic groups being:
neurotic, personality disorders and psychosomatic disorders. Each first and last twenty minutes of
the fourth and the twentiest session for all twelve patients were examined. In the first step they
were analysed by Structural Analysis of Social Behavior (SASB). Secondly, all therapists'
interventions were examined, asking which type of intervention was used, and if the intervention
was specifically CMP-based, which part of the individual patient`s CMP it was referred to. If the
intervention was not CMP-based, we then asked what other type of intervention was used (such
as clarifications, confrontations, empathic understanding a.s.o.).

       Results reveal only a small difference in the amount and quality of used SASB-clusters
among all cases at different times in therapy, whereas the frequency of specific CMP-based
interventions incline, comparing both the first and last twenty minutes of each single session and
the course of therapy from the fourth to the twentieth session.

        As a conclusion, this paper shows that the selection of research material at either varying
times throughout therapy or parts of sessions may lead to different results in psychotherapy
process research.




                                               207
Paper Session 11

Title:                 Introject Patterns in Psychotic and Borderline Patients

Authors:               Åke Granberg, Kerstin Armelius and Bengt-Åke Armelius

Address for Correspondence:

                       Åke Granberg
                       Department of Applied Psychology
                       Umeå university
                       S-90187 Umeå, Sweden
                       Fax: +46 (0) 90 16 66 92
                       E-mail: ake.granberg@apsy.umu.se


                                          ABSTRACT

        This study examined the relation between introject patterns and the improvement in
psychotic and borderline patients in The Small Treatment home project in Sweden. Patients'
introject was assessed with Structural Analysis of Social Behavior (SASB). Introject patterns
were defined as the correlation between four different theoretical patterns two of which
correspond to Lorna Benjamins' attack- and control coefficients. The pattern coefficients were
used to define 7 different introject patterns: positive, negative, control, autonomy, brittle,
damaged and unstable. Improvement was measured in a number of different aspects combined
into ES-values for two different areas: judged and subjective. Judged changes captured different
functions such as identity, relations, symptoms, work and days at hospital and subjective changes
were based on the patient‘s ratings of symptoms and self-image.

        183 severely disturbed patients were diagnosed as having a neurotic (NPO), psychotic
(PPO) or borderline (BPO) personality organization according to Kernbergs Structural Interview.
A positive or brittle introject pattern was most common in the psychotic group and a negative or
damaged pattern in the borderline and NPO groups. After 5 years patients with a negative or
controlled pattern showed more improvement in judged functions, while patients with a positive
or autonomous pattern showed least improvement. Patients with a negative pattern also showed
most improvement in subjective ES-values together with patients that had a damaged introject
pattern. However, when data was analyzed for each personality organization separately there
was an interaction effect between introject patterns and diagnosis where for the BPO patients a
negative damaged and controlled pattern showed the best improvement. For the PPO patients an
unstable pattern gave the best result and for the NPO patients controlled or unstable patterns did
so. This suggests that the introject pattern is an important structure mediating treatment effects.




                                              208
Paper Session 11

Title:                 Patient Experience Over Time of Therapist-Offered Empathy: The Role
                       of Patient and Therapist Object Relations as Measured Using The
                       Structural Analysis of Social Behavior (SASB)

Authors:               Kenneth L. Critchfield and William P. Henry

Address for Correspondence:

               Kenneth L. Critchfield
               Department of Psychology
               University of Utah
               Salt Lake City, Utah 84112
               USA
               email: psykc@psych.utah.edu

                                          ABSTRACT

        The relationship between patient and therapist is formed in the context of their respective
interpersonal histories. This historical context helps create the perceptual lens through which the
patient and therapist view themselves and their relationship in therapy. This study presents an
analysis of patients‘ experience of their therapists and the therapeutic relationship over the
course of brief dynamic therapy, taking this perceptual and historical lens, into account.
Approximately 80 patients received 25 sessions of brief dynamic therapy as part of the
Vanderbilt (II) Psychotherapy Research Project. Prior to therapy, patients and therapists rated
their own introject (a measure of how a person treats him or herself, theoretically thought to
reflect the internalization of how they were treated by caregivers) as well as important
relationships in their lives via the SASB-based INTREX questionnaire. Patients completed a
modified version of the Barrett-Lennard Relationship Inventory at sessions 3, 8, 16, at
termination, and at one-year follow up. The results reveal that the introject of a patient is
significantly related to how they experience therapist-offered empathy over time. The therapist‘s
introject, however, was not found to be significantly related to their patient‘s experience of
empathy. Detailed results of this analysis as well as the implications of this research for
understanding the process of therapy from an object relational perspective (operationalized via
INTREX) will be discussed.




                                              209
Paper Session 12

Title:                      Continuous Projecting of High-Dimensional Questionnaires Data onto
                            Lower-Dimensional Spaces by Neural Maps for Data Analysis and Time
                            Series Prediction

Authors:                    Thomas Villmann and Aike Hessel

Address for Correspondence:
                    Dr. Thomas Villmann
                    University Leipzig, Klinik für Psychotherapie
                    Karl-Tauchnitz-Str. 25 04107 Leipzig - Germany
                    phone: +49 341 9718868 fax: +49 341 2131257
                    email: villmann@informatik.uni-leipzig.de

                                                    ABSTRACT

          During the therapeutic process questionnaires often are filled in by the patients or the therapists generating a
large number of values which describe their actual state of personality. Moreover, if there is used a set of such
instruments the number of respective values increases drastically. The obtained values frequently are noisy and/or
corrupted. On the other hand, the values are often correlated and, hence, the containing information should be
evaluable. However, because of the large number we have a high-dimensional problem which is often indicated by
the coarse of dimensionality. A further difficulty is that, in general, we have strong non-linear problems such that
most of the usual approaches for data investigation, as for example conventional statistic methods, will fail because
of either its linear character or the computational effort which is often related to numerical instabilities.
          We offer the application of neural maps to overcome these difficulties. In brain real neural maps occur in all
  sensoric areas where high-dimensional non-linear and noisy data are projected onto a more or less two-dimesional
       brain area (cortex) whereby we a continuous mapping (retinotopy in the visual cortex, somatotopy in the
   senso-motoric cortex, etc.) takes place. Several models were developed to describe these phenomena, the most
   known of which is the Self-Organizing Map (SOM) developed by T. KOHONEN. In technical context it can be
 taken as a non-linear continuous projection of a possibly high-dimensional input space R onto a lattice of units r
(so-called neurons) which are arranged usually on a low-dimensional hypercube A. This mapping, in fact, describes
    a non-linear principle component analysis which is robust against noise and also applicable for very large data
dimensions. For this purpose a weight vector w  R to each neuron r is associate and the mapping is realized by a
               winner take all rule determining the best matching neuron s:       (v) : s(v) = arg minv -w 
                                                            rA
for a given input vV . Before this, a self-organized learning process has to be done which distributes the weight
vectors w in a most faithful way, such that a continuous mapping can be achieved, if one additionally adapts also the
dimensionality and the edge length ratios of the hypercube A during learning.
          We applied SOMs to map 26-dimensional data vectors, obtained from set of questionnaires used in our
clinic which describes the actual state of a patient in the therapy. The SOM-approach yields a 5-dimensional
hypercube, i.e. the data are high-correlated. Hence, the intrinsic data-dimension is only 5 which coincides with the
postulation of the 5 psychological dimensions in the ‗big five‘. Moreover, applying the neural map projection 
to several state vectors of a patient, because of the continuity we are able to observe the process in the
low-dimensional hypercube. This suggests to try a time series prediction in the hypercube A followed by a back
transformation into the original data space V which then may be interpreted immediately by a therapist. This last
part of work, however, still remains to carry out as the next level.




                                                         210
Paper Session 12

Title:                A New Procedure for Content Validation of Dynamic Scales

Authors:              Kjell-Petter Bøgwald and Per A. Høglend.

Address for Correspondence:

                       Kjell-Petter Bøgwald
                       Department of Psychiatry
                       University of Oslo
                       PO Box 85 Vinderen
                       N-0319 Oslo
                       Norway
                       E-mail: k.p.bogwald@psykiatri.uio.no

                                         ABSTRACT

        Dynamic Scales is a new battery of scales developed for measuring change during
psychotherapy that goes beyond the patient‘s symptoms and global functioning. It has shown
promising properties with regard to interrater reliability, ability to capture moderate changes
during therapy and discriminant validity (Høglend et al. 1998). We will present findings from a
detailed study of aspects of the content validity of the scales, where 30 psychotherapists with
different theoretical orientations and from two different countries participated. Before
evaluating the different scales regarding their perceived comprehensiveness and clinical
importance, the psychotherapists independently constructed their own versions of the scales using
several variants of Q-sort methodology. The 30 «new» Dynamic Scales constructed had on
average excellent similarity with the existing edition of Dynamic Scales, consistent with good
content validity. However, the detailed information obtained by this procedure, enabled minor
revisions of some of the scales. The individual scales had acceptable Guttman scale structure (
as good as GAF). The participating psychotherapists gender, nationally and self-reported
theoretical orientation had little influence on their perception of the Dynamic Scales.

        This new procedure for validation of the content of scales, might be helpful in
development and validity testing of other psychological scales and can be used when revising
existing instruments and treatment manuals.




                                             211
Paper Session 12

Title:                 Going Beyond One's Normal Voice: Ipsative Standardization and Optimal
                       Process

Authors:               Fred Bryant and Robert L. Russell

Address for Correspondence:

                       Robert L. Russell
                       Loyola University Chicago
                       Department of Psychology - DH 624
                       6525 N. Sheridan Rd.
                       Chicago, IL 60626
                       email: rrussel@luc.edu

                                          ABSTRACT

         In this paper, we present methods that can be used to identify maximally optimal and
maximally suboptimal zones of process participation for therapists and for clients. Applications
of these methods require that discourse data for the therapists and for the clients be ipsatively
standardized, so that peaks and troughs around the clients' and therapists' normal levels of
participation can be examined for their optimality and for their suboptimality. Using data from
three high quality and three low quality child therapy sessions, we show how models of optimal
and suboptimal process, incorporating information both about the timing and strength of the
response, can be built to reliably distinguish between the two types of sessions. Further, we
show how such models of optimality and suboptimality can be tested for their likely
generalizability, through the use of Leave-0ne-Out analyses. Methodological developments are
discussed in terms of the need to build testable models of process which incorporate information
on both timing and strength of response. Substantive results are discussed in terms of the need
to train child therapists in how to calibrate their process interventions relative to their normal
levels of discourse participation as well as to their client's.




                                              212
Paper Session 12

Title:                 The Personal Questionnaire as a Client Change Measure in
                       Process-Experiential Therapy

Authors:               Robert Elliott, Michelle Urman, John Wagner, Elizabeth Nathan-Montano,
                       Emil Slatick, Helena Jersak & Cristina Gutiérrez

Address for Correspondence:

                       Robert Elliott
                       Department of Psychology, University of Toledo
                       Toledo, Ohio 43606 USA
                       email: fac0029@uoft01.utoledo.edu

                                           ABSTRACT

        The Simplified Personal Questionnaire (PQ) is an individualized change measure
constructed collaboratively by client and researcher during the pretreatment assessment process;
it consists of approximately 10 client-identified problems which are rated weekly on a 7-point
rating scale. Unfortunately, in spite of its promise as a change measure, very little in the way of
psychometric data have been presented on the PQ. In this paper, we present preliminary
psychometric data on the PQ using data from a general population of outpatient clients seeking
emotionally-focused psychotherapy at a training center for Process-Experiential (PE) therapy.
The CSEP sample consists primarily of clients suffering from major depressive disorder, with a
substantial proportion also diagnosed with some form of personality disorder.

        Using a sample of clients completing at least 10 sessions of treatment, Personal
Questionnaire internal reliabilities were found to be variable but acceptable (range: .61 to .88;
median: .79). One-week test-retest reliability for mean PQs was .90 when analyzed across
cases; however, when analyzed for each client separately, these correlations were much smaller
(range .14 to .50; median .36). This indicates low measurement error when used across cases as
a change measure. At the same time, relatively small autocorrelations indicate that the PQ to be
used to track change from session to session. Personal Questionnaire items were also content
analyzed using a set of standard categories (Barkham et al., 1996; rated by two raters) producing
the following distribution of client PQ problems (out of 234 problems from 26 clients): mood:
12%; work-performance: 27%; relationship: 26%; self-esteem: 11%; and symptoms: 25%. In
contrast, when grounded theory analysis was used to generate a more treatment-specific set of
categories for classifying the client problems, the following of categories emerged: self-related:
17%; emotion-related: 22%; problem behavior: 18%; symptoms: 6%; current life situation: 37%.

       We conclude with suggestions for using the PQ for evaluating outcome in research studies
and practice settings.




                                              213
Paper Session 13

Title:                 Tape Based Hypnotherapeutical Treatment in Sleep Disorders: Time
                       Course Data From Sleep Diaries

Authors:               O. Berndt Scholz and Ralf Ott

Address for Correspondence:

                       Prof. Dr. O. Berndt Scholz
                       Department of Psychology, University of Bonn
                       Roemerstrasse 164
                       D-53177 Bonn, Germany
                       e-mail: o.berndt.scholz@uni-bonn.de

                                          ABSTRACT

        Insomnia is one of the classical diseases which can be characterized by a strong indication
and frequent application of hypnotherapeutic techniques. Therefore this study stresses the
relationship between process- and effect-measures of a hypnotherapeutic intervention with help
of single-case analyses.

        In 21 patients suffering from chronic insomnia the efficacy of tape based
hypnotherapeutic treatment was examined. One half of the sample received a three week
treatment with seven audio tapes including different symptom specific (= SB) metaphors, the
other half received seven audio tapes including different symptom-unspecific (= UB) metaphors.
Each tape within the groups was changed after three days. During treatment, patients rated the
therapeutic quality of the tapes with help of standardized questions. The sequence of tape‘s
applications was matched for each of the two therapeutic groups. During 28 days - first week
was designed as baseline - patients recorded a sleep diary, which involved five sleeping
parameters: (1) latency of falling asleep, (2) feeling of recovery, (3) frequency of nightly
awakenings, (4) total time of nightly sleep and (5) time lying awake. To account for course data,
the records of sleep-diary were analyzed by time series analyses. The slope of the individual
time series characterizes the response as well as the speed of the therapeutic intervention.

        Independent of the metaphors (SB vs. UB), patients generally profit from
hypnotherapeutic tapes. Each of the five sleeping parameters show statistically significant
improvements, i.e. there is also a positive outcome for patients using the unspecific tapes.
However, SB metaphors are superior to UB metaphors related to the mean slope of the time
series and related to the total number of responders. More patients from SB group are
responders compared to the UB group. The discussion focuses on the application of this form of
a autohypnosis as an supplementary therapeutic technique.




                                              214
Paper Session 13

Title:                  Cognitive Behavior Therapy in Combination with MAO I in Panic
                        Disorder with Agoraphobia

Authors:                Bernd Lörch, Martin Hautzinger, Mechthild Graf-Morgenstern, and Otto
                        Benkert

Address for Correspondence:

                        Martin Hautzinger
                        Department of Psychology, Eberhard-Karls-University
                        Reutlinger Str. 12
                        D - 72072 Tuebingen
                        Germany

                                           ABSTRACT

        In the treatment of panic disorder with agoraphobia, moclobemide, a selective MAO
inhibitor, and cognitive behaviour therapy (CBT) were assumed to be effective singly no more
effective in combination.

         Method: Fifty-five patients were randomly assigned to a 8-week-treatment of either:

         1       Moclobemide plus CBT
2.                    Moclobemide plus clinical management (―psychological placebo―)
3.                    Placebo plus CBT
4.                    Placebo plus clinical management.

        Results: Comparisons between treatments revealed strong effects for CBT. Moclobemide
with clinical management was not superior to placebo. The combination of moclobemide with
CBT did not yield significantly better short-term results than CBT with placebo. The favourite
CBT results remained stable during 6 month follow-up, albeit a substantial proportion of placebo
plus CBT patients needed additional treatment in contrast to moclobemide + CBT.

        Conclusions: In contrast to clinical management and to moclobemide, CBT was highly
effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels
which were comparable to those of non-clinical controls.




                                              215
Paper Session 13

Title:                 Cognitive Behavioural Therapy for Panic Disorder: Clinical Utility and
                       Processes

Authors:               Americo Baptista

Address for Correspondence:

                       Americo Baptista
                       Universidade Lusofona de Humanidades e Tecnologias
                       Departamento de Psicologia
                       Av. Campo Grande, 376,
                       1700 Lisboa
                       Portugal
                       Fax: +351-1-751 55 71
                       E-mail: americo.baptista@ulusofona.pt


                                          ABSTRACT

         Research clinical trials has shown that cognitive behavioral therapy is highly efficacious
treatment for panic disorder patients. However the generalization of these results for the clinical
settings was not directly addressed. The present study analyzed the effects of 12 sessions of CBT
in a sample of 107 panic disorder patients, at the end of treatment and at a 6 month follow-up,
who were referred for treatment in a large psychiatric hospital. Effect sizes showed that the
treatment was efficacious both at the end of treatment and at the follow-up in all measures.
Using a more stringent criteria, the clinical significant change, only 43% at the end of treatment
and 37% at the follow up were considered successful. A discriminant analysis performed on the
pretreatment scores of the patients who responded, not responded and drop out of treatment was
statistically significant and the results showed that patients may drop out for different reasons:
demoralization or improvement and no need to complete therapy protocol. A structural equation
fitted the data of pre, post treatment and follow up and revealed the importance of the end of
treatment depression and catastrophic interpretations in the long term maintenance of treatment
results. None of the pre treatment pathology scores were related to the follow up status.




                                              216
Paper Session 14

Title:                 The Treatment of Depressed Patients in Primary Care: An Analysis of a
                       Telephone Intervention Program

Authors:               Joel F. Meresman, Enid Hunkeler, William Hargreaves, Michael Getzell,
                       Paul Feigenbaum, Elvie Mann, Ann Green, Jennifer Groebe, and Arlene
                       Kirsch

Address for Correspondence:

                       Joel F. Meresman
                       Department of Psychiatry
                       The Permanente Medical Group, Inc.
                       1333 Lawrence Expressway, Building 300
                       Santa Clara, California 9505 l
                       USA


                                          ABSTRACT

        This study compared the outcome of 256 depressed patients randomized to 1 ) usual care
(UC), which was composed of pharmacotherapy and office visits provided by the patient's
primary care physician (PCP) or 2) nurse support (NS), which was composed of thirteen
telephone contacts by trained clinic nurses in addition to UC. Nurses completed six hours of
training and were supervised by a psychologist weekly. Each telephone intervention lasted a
maximum of ten minutes and followed a protocol.

        The NS condition involved the following interventions: 1) patient education, 2)
continually reminding the patient of the importance of taking medication daily at the prescribed
dose, 3) behavior activation, 4) active listening, 5) reassurance when the patient experienced
benign medication side-effects, 6) consultation with the PCP when the patient experienced severe
side-effects or did not respond to treatment.

        Patients in both conditions yielded decreases in depression scores on the Hamilton
Depression Rating Scale (HDRS) and on other outcome measures after six months of treatment,
but patients in the NS condition were significantly less depressed and more satisfied with their
treatment, when compared to patients in the UC condition.

       Similarities and differences between an NS intervention and cognitive-behavioral
psychotherapy conducted by a mental health professional are discussed and analyzed.




                                             217
Paper Session 14

Title:                 The Relation Between Autobiographical Memories and Negative Mental
                       Models in Depression

Author:                Victor Claudio

Address for Correspondence:

                       Victor Claudio
                       Instituto Superior de Psicologia Aplicada
                       Rua Jardim. do Tabaco
                       44 1100 Lisboa, Portugal

                                          ABSTRACT

        This study is about the autobiographical memories in depressed subjects. Our objective is
to study the recall of autobiographical information in depressed subjects, relating this process of
construction and maintenance of mental models with negative characteristics that provoke or
reinforce the process of depression. In. this way we try provide a defer knowledge of the schemas
and mental models subjacent to a codification process and recall of information, allowing a better
psychotherapy intervention at depression.

        We compared 30 depressed subjects with 30 panic disorders subjects and 30 normal
subject. We use tile DSM IV diagnostic criteria. The depressed subjects are evaluated two times,
separate by three months. In the experimental evaluation. we applied an autobiographical
memory task, a forgetting directed task, the BDI, the Schemas Questionnaire, DAS, STAY,
Hamilton Scale for Depression. The interview we use is the ADIS, in the recent version adapts to
DSM IV.




                                              218
Paper Session 14

Title:                 Personality and Cognitive Dimensions in the Vulnerability to Depression

Author:                Elisabeth Banon

Address for Correspondence:
                    Mc Gill University and Institute of Community and Family Psychiatry
                    S.M.B.D.- Jewish General Hospital
                    4333 Cote St. Catherine Road
                    Montreal, Quebec
                    H3T 1E4, Canada
                                      ABSTRACT

         In recent years, much attention has been given to the psychotherapy of major depression.
Blatt and Beck have independently proposed that two personality or cognitive styles confer
vulnerability to depression. One style is affiliative and is known as Dependency (D) or Need for
Approval (NA.), the other is achievement-oriented and is referred to as Self-Criticism (SC) or
Perfectionism (P). Our objective was to confirm that these two styles are indeed factors of
vulnerability to depression in subjects receiving either short-term dynamic psychotherapy
combined with medication or either treatment alone for a current major depressive episode
(MDE). To do so, we looked to see whether these vulnerability factors were: 1) correlated with
pre-treatment measures of depressive severity, 2) temporally stable despite symptomatic
improvement with treatment and 3) predictive of remission status following treatment. We also
compared Blatt's and Beck's instruments: the Depressive Experiences Questionnaire (DEQ) and
the Dysfunctional Attitudes Scale (DAS). The study performed was a pilot yielding preliminary
data for a larger controlled study which will investigate personality dimensions and interpersonal
processes in the vulnerability to depression. The study had a naturalistic uncontrolled design.
Subjects with a current unipolar MDE entering treatment were administered the DEQ, DAS,
Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS-21) at
beginning and after 8 weeks of treatment. A brief clinical interview was performed at intake to
confirm diagnosis of MDE made by chart review and a brief follow-up diagnostic interview took
place at 8 weeks to assess remission from MDE. Our sample was as follows: two thirds male,
mostly unmarried, with a mean age of 33. Initial symptom severity was in the moderate range
(BDI=26 and HRDS=-26). Mean intake DEQ and DAS scores were comparable to those
previously reported in clinical samples with MDE. Pre-treatment SC and P were correlated with
initial depression severity (r=0.61 and 0.72) while D and NA were not (r-=0.12 and 0.19). The
contribution of personality factors to the development, persistence and recurrence of major
depression has been emphasized by many theoretical schools both psychodynamic and
cognitive-behavioral. The DEQ and DAS are instruments which may be tapping such
personality/cognitive vulnerability factors among depressed subjects receiving psychotherapy. If
so, they can be valuable in allowing us to identify those patients at risk of poor outcomes with
psychotherapy especially those at risk for non-response, recurrence or relapse. This information
can in turn be used to modify our treatments accordingly so as to optimize outcome with more
vulnerable patients.




                                              219
Paper Session 14

Title:                 The Course of Change in Bereavement: A Look at Complicated Grieving
                       and Counseling

Authors:               Robert J. Lueger and Carol H. Ott

Address for Correspondence:

                       Robert J. Lueger, Ph.D.
                       Department of Psychology
                       Marquette University
                       Milwaukee, WI 53201-1881, U.S.A.
                       E-mail: 6282LUEGERR@marquette.edu


                                          ABSTRACT

        The purposes of this study were to examine the natural course of change in mental health
status for adults in bereavement following loss of a spouse, and to examine the patterns of change
of complicated grievers and of grievers receiving counseling. The mental health status of 118
adults was assessed at three time points over a six-month period within two years following the
loss of the spouse using a cross-lag, sequential longitudinal design.

        The COMPASS Outpatient Assessment System was used to assess overall mental health
status and status in the three components of the phase model - remoralization of well-being,
symptom remediation, and recovery of life functioning. A best fitting log-linear regression
course of change was identified for each of the study participants, and mental health status values
were interpolated or extrapolated to produce estimated values up to 24 months following loss.
The Inventory of Complicated Grief was used to assess status at six months following loss.
Participants were asked whether they had sought and used counseling, about the process of
entering counseling, and how much benefit they had received from counseling.

        The observed pattern of change in overall mental health status in the course of
bereavement was similar to that of patients treated in outpatient psychotherapy. Immediately
following the loss of a spouse, bereaved participants were very similar to the average
psychotherapy patient at intake. Two years after the loss, participants were in the normal range
but not yet at the mean of a nonpatient sample. Patterns of change in well-being, symptoms and
functioning followed the phase model except that functioning was less impaired in bereaved than
psychotherapy samples. Complicated grievers showed a slower pattern of improvement
following loss. Of the 30% of the sample who had sought counseling, 83% reported that
counseling had helped. Reliable improvement and clinical significance analyses of the patterns
of change of grievers seeking counseling had confirmed that improvement had occurred. The
study results have important implications for assessing the effectiveness of interventions with
bereaved individuals.




                                              220
Paper Session 15

Title:                Development of Psychotherapists: Assessment and Treatment Practices
                      for Patients with Major Depression

Authors:              Roslyn Caldwell and Mary Malik

Address for Correspondence:

                       Roslyn Caldwell
                       Graduate School of Education
                       Counseling/Clinical/School Psychology Program
                       Phelps Mall, Room 1110
                       University of California at Santa Barbara
                       Santa Barbara, CA 93106
                       USA

                                          ABSTRACT

        This study examined the assessment practices and treatment recommendations preferred
by mental health professionals in the treatment of patients with major depression. The data were
collected as part of a larger survey mailed to 1,800 randomly selected members and fellows of
Division 29 of the American Psychological Association. An additional 234 surveys were sent to
other mental health professionals. Of the 2,034 surveys mailed, 541 were returned and useable,
for a response rate of 27%.

         In the survey, respondents were provided with a list of assessments used to evaluate
patients with major depression, and were requested to indicate the frequency with which they
employed each type of assessment in their practice. In addition, respondents were presented with
a list of depressive symptomology and asked the extent to which the condition might either
indicate or contraindicate each of ten different treatment approaches, including both
psychotherapeutic and biological interventions.

        The respondents' assessment and treatment recommendations were evaluated with respect
to therapist characteristics including professional identity, academic degree and theoretical
orientation. This paper will discuss the ratings of the respondents and compare the findings with
the research literature on the assessment and treatment of major depression.




                                             221
Paper Session 15

Title:                  Psychotherapy Trainees' Experience of Counterproductive Events in
                        Supervision: A Qualitative Analysis

Authors:                Jessica A. Walker, Laurie A. Gray, and Nicholas Ladany

Address for Correspondence:

                        Jessica A. Walker
                        111 Research Drive
                        Counseling Psychology, Lehigh University
                        Bethlehem, PA 18015
                        U.S.A.

                                           ABSTRACT

         The purpose of this paper is to present the results of a qualitative study that examined
psychotherapy trainees' experience of counterproductive events in supervision. A
counterproductive supervision event was defined as an event that was counterproductive,
hindering, unhelpful, or harmful in relation to the trainees' growth as a therapist. First, the
presenter will report on the theoretical and empirical literature related to trainees' negative
experiences in supervision (e.g., Hutt, Scott, & King, 1983; Ladany, Hill, Corbett, & Nutt, 1996)
and the resulting research questions. Then an overview of the qualitative methodology used to
examine 14 trainees' experiences of counterproductive events, that is, consensual qualitative
research (Hill, Thompson, & Williams, 1997), will be discussed. Essentially, following the
methodology guidelines, data was collected using a standard semi-structured interviews, coded
initially into rationally-derived domains which were modified based on the emerging data, used a
primary team of three judges and a method of consensus to arrive at all decisions about domains
and core ideas, used an auditor to check the work of the primary team, and compared data across
cases to determine consistency of findings within the sample. The presenter will then report on
the primary results of the qualitative analysis, focusing on the themes that emerged. These themes
included:

         (a) affective, cognitive, and behavioral reactions to the event,
         (b) antecedents to the event
         (c) ways in which the trainee would have preferred to have responded to the event
         (d) impact of the event on the supervisory relationship
         (e) influence of the event on supervision process and outcome
         (f) impact of the event on the trainees' work with clients
         (g) parallel processes
         (h) disclosures of the event to others

Examples from the data, and their relative frequency within each of the themes will be presented.
The empirical findings will be discussed in light of the limitations to research design.
Implications of these results for psychotherapy training will be also addressed.Paper Session 15
Title:                  From Journeyman to Independent Practitioner: A Longitudinal Study of
                        Therapists‘ Development

Authors:                 Dan Stiwne and Michael Rosander

                                              222
Address for Correspondence:

                        Dan Stiwne
                        Department of Education & Psychology
                        Linköping University
                        S- 58183 Linköping
                        Sweden

                                            ABSTRACT

       This study draws upon data from 22 Swedish journeymen psychotherapists who filled in
―the common core questionnaire on therapists‘ development (CCQ) – longitudinal version‖- on
two occasions – at the start and at the end of a three year education for becoming chartered as
independent practitioners. The study focuses on three domains for development: perspectives on
treatment goals, role relationship ideals and the therapists‘ judgement of change in their
professional skills.

         Since the 22 journeymen who filled in the CCQ the second time constitutes just 70% of
those who answered the questionnaire at the first occasion, the analysis start with an attrition
analysis. Second, the analysis of the therapists‘ treatment goal preferences is compared to the
results from an earlier study that, as a result from a factor analysis, suggested three treatment goal
factors: effective mastery, rational reasoning and autonomy. The therapists‘ change over time in
role relationship ideals is described both as how therapists would like to be and as how they
actually consider themselves to be in their therapeutic role. Finally, changes in opinion
considering their actual therapeutic skills and shortcomings are described as a result of
self-ratings of therapeutic capacities.

       The results are discussed in terms of therapists‘ development, therapists‘ professional
characteristics and in terms of educational impacts for good and for worse.




Paper Session 15

Title:                  Expertise in Psychotherapy Case Formulation and Treatment Planning

Authors:                Tracy D. Eells, Ken Lombart, L. Carolyn Turner, and Richard Morris

Address for Correspondence:



                                               223
                       Tracy D. Eells
                       University Psychiatric Services, P.S.C.
                       550 South Jackson Street
                       Louisville, KY 40202 USA
                       e-mail: eells@louisville.edu

                                           ABSTRACT

        The nature of psychotherapy expertise was investigated by adapting a cognitive science
paradigm designed to study chess masters. Seventy-two ―expert,‖ ―experienced,‖ and ―novice‖
psychotherapists who identify themselves as either cognitive-behavioral or psychodynamic
provided "think aloud" verbal protocols in response to six vignettes about patients entering
psychotherapy. The vignettes varied by the mental disorder described (anxiety, affective,
personality) and by prototypicality (high, low). The primary prediction is that the protocols of
experts, particularly for low prototypical vignettes, will display greater forward reasoning, which
involves reasoning from facts to hypotheses. In contrast, novices will exhibit greater backward
reasoning: generating hypotheses then searching for supporting facts. A question motivating
the study is whether expertise in psychotherapy case formulation is primarily a perceptual or a
reasoning task.




                                              224
Paper Session 16

Title:                 Countertransference and the Patient's Stories

Author:                Rolf Holmqvist

Address for Correspondence:

                        Rolf Holmqvist, Ph D,
                        Department of Education and Psychology,
                        Linköping University, 581 83 Sweden.
                        Email: rolfh@ipp.liu.se

                                           ABSTRACT

        The purpose of this study was to analyze the relations between the psychotherapist's
countertransference reactions and the patient's stories as told in therapy. Nine therapists were
asked to report about their reactions towards a number of patients on a feeling word checklist
after each therapy session. In addition, patient stories were systematically registered at the
beginning of the therapy, after each three month period, and at the end of the treatment. The
stories were analyzed with the CCRT method. Twenty-eight therapies, with a mean length of 52
sessions, were analyzed in this way. The data was analyzed in several ways. One of the main
results was that the therapist's own habitual style had a very large importance for the emotional
reactions. A discriminant analysis showed that 93% of the checklists could be correctly
classified according to therapist with the crossvalidation method. The discrimination power
within therapists according to patient was smaller. The study of relations between therapist
reactions and the content of patient stories gave weak and somewhat inconsistent results. The
results of the study were discussed as implying that it is hazardous to say that a specific patient,
and his or her way of telling about himself or herself, evokes specific countertransference
reactions, without saying who the therapist is. In a wider perspective, it could also be debated
whether psychotherapeutic process material can ever be presented without knowledge about the
psychotherapist.




                                               225
Paper Session 16

Title:                 Analysand's Perceptions of Psychoanalysts' Behavior and Changes
                       Engendered in Treatment

Authors:               Cynthia Field, Rebecca Curtis, Etnesto Mujica

Address for Correspondence:

                       Rebecca Curtis
                       Derner Institute of Advanced Psychological Studies
                       Adophi University
                       Garden City, NY 11530, USA
                       (212)4964128 or BigMac757@sol.com

                                           ABSTRACT

        This study examined 35 analysands and self-reports of their psychoanalysts' helpful and
hurtful behaviors and identified the stilient behaviors related to overall change during their
treatment. Respondents also rated how much they changed (from 'greatly deteriorated' to 'greatly
improved‖) in 78 areas appropriate m persons of good overall functioning, such as 'capacity for
pleasure,' and 'feelings of having no options in life‖ and in other traditional areas assessed by
scales such as the SCL-90, like sleeping problems, flashbacks, and alcohol use. Ten questions
regarding possible extra-therapeutic factors rated to perceived change during treatment we, re
also included.

        Only one respondent reported overall deterioration during analysis, Most respondents
reported being moderately to greatly improved. Twenty-two of the 68 analyst behaviors were
significantly correlated with perceived change. The analyst behaviors and qualifies most
correlated with overall change were related to acceptance (―was open to my ideas, experiences,
and feelings' and ―liked me') and affect (―was genuine,‖ ―was warm‖) and specific interventions
such as ―offered advice upon request' and ―confronted me with things that were difficult to
acknowledge.‖ Although ―understanding of recurrent patterns of interaction‖ . . . and provided
interpretations of interactions with others' were correlated with overall change, two transference
questions were not: 'encouraged exploration of my feelings about her/him and provided
interpretations of interaction between us. The relationship questions and specific interventions
contributed about equally to overall change.

         Significant patient changes occurred for questions related to ability and confidence,
realistic perceptions of self and others, and relations with others, whereas questions related to
sequellae of trauma, concerns about physical health, and substance use did not show significant
changes. Analysis was viewed as contributing more to change than extra-therapeutic factors.




                                              226
Paper Session 16

Title:                 Defense Style, Dynamic Capacity and Early Development of Therapeutic
                       Alliance

Author:                Anne Grete Hersoug

Address for Correspondence:

                       Anne Grete Hersoug
                       Department of Psychiatry
                       University of Oslo
                       P.O. Box 85 Vinderen
                       N-0319 0slo
                       Norway
                       E-mail: a.g.hersoug@psykiatri.uio.no

                                          ABSTRACT

        Change of defense mechanisms through brief dynamic psychotherapy ( BDP, maximum
40 sessions) is the main focus of the process and outcome analysis of this study. Defense
Mechanism Rating Scales ( DMRS, Perry) and Defense Style Questionnaire ( DSQ, Bond) are
used. Dynamic Scales ( DS, Hoglend), are clinician-rated psychological capacities. From a
previous study DS have been found to be sensitive enough to capture moderate change during
BDP, and to be clearly discriminable from general symptoms and dysfunction. Our hypotheses
are that use of more mature defenses will correlate substantially with the dynamic scales, but that
self-report measures will correlate only moderately with clinician-rated instruments.

       Ways of Coping Questionnaire (WCQ, Lazarus & Folkman) has been found to
discriminate between adaptive coping (problem-focused), and less adaptive coping (avoidance).
Our hypotheses are that higher- level defenses are correlated with problem-focused coping and
lower-level defenses (low ODF) highly correlated with less adaptive coping.

        The focus of this presentation is on the psychometric aspects of the pretreatment data for
41 patients in BDP. Pre-treatment assessment methods are compared, to explore overlaps and
discriminability. Descriptive psychopathology is characterized by DSM IV-axis I, II and V. The
patients' descriptions of duration and severity of the target complaints, and expectations to
therapy, are also included in the analyses.

       Therapeutic alliance is rated by Working Alliance Inventory (WAI), which is used
repeatedly from the 3rd session in therapy. Relations between pre-therapy assessments and early
development of therapeutic alliance will be presented.




                                              227
Paper Session 16

Title:                 Client Attachment, Personality, and Symptomatology: Relationship to the
                       Therapeutic Alliance and to Each Other

Authors:               Caroline Francoeur and Alexandra Bachelor

Address for Correspondence:

                       Alexandra Bachelor
                       Ecole de psycholgie
                       Universite Laval
                       Laval, Quebec
                       G1K 7P4
                       Canada

                                           ABSTRACT

        There is increased interest in examining characteristics of the therapy participants that
influence the formation of the helping alliance. The client's attachment organization has been the
focus of several current studies. Preliminary results indicate that early attachment experiences, as
tapped by the Client Attachment to Therapist Scale (CATS), influence the client's capacity to
form a productive working alliance (Mallinckrodt, Gratt, & Coble, 1995). The CATS appears,
however, to reflect primarily the emotional alignment between client and therapist and thus may
be associated mostly with the bond aspect of the alliance (Mallinckrodt et el., 1995; Robbins,
1995). Our study examines the influence of other personality variables on diverse dimensions of
the therapeutic alliance, as well as the relationship between attachment strategy and personality.

        Clients with different attachment styles are also found to exhibit different patterns of
interpersonal problems. Attachment experiences may also relate to subsequent psychopathology
(e.g., Paterson & Moran, 1988). We examine the relationship between clients' attachment
strategies and problematic functioning and explore the respective contribution of these
dispositional characteristics to the quality of the alliance. Finally, attachment strategies appear to
be influenced by the length of therapy, and the stability of the construct requires further
exploration (Robbins, 1995). Thirty-five clients consulting at a university Consultation Service
completed the following measures: Client Attachment to Therapist Scale; the Jackson Personality
Inventory (1982); the Brief Symptom Inventory (Derogatis & Spencer, 1982); the Working
Alliance Inventory (Horvath & Greenberg, 1989); the Helping Alliance Questionnaire (Alexander
& Luborsky, 1986); and the California Psychotherapy Alliance Scales (Gaston, 1991). Half of
these clients completed these measures early in therapy (sessions 1-3), and the other half later in
treatment (after the 12th session).




                                               228
Open Discussion 1

Title:                  Strengths and Weaknesses of the SPR Journal: Psychotherapy Research

Discussion Leaders: Bernhard M. Strauss and William B. Stiles

Moderator:              Mark Aveline

Address for Correspondence:

                        Bernhard M. Strauss
                        Institut f. Medizinische Psychologie
                        Friedrich-Schiller-Universitaet Jena
                        Stoystr. 3
                        D 07740 Jena, Germany
                        Fax: (+) 3641 936546
                        e-mail: strauss@landgraf.med.uni-jena.de

                                           ABSTRACT

        Psychotherapy Research, the Journal of the Society for Psychotherapy Research, has
existed for nearly a decade. How well is it doing? This discussion group is meant to open an
exchange between the editors and the members of SPR, with a long-term aim to enhance the
quality of the journal.

        Come and join current and former editors, supporters, and critics to discuss why you do or
do not: read your journal, cite it when you write, and submit your best work

         We intend to present the results of a membership survey.




                                              229
Open Discussion 2

Title:                 ―What I Wish Someone Had Told Me‖: Career Development Issues for
                       Psychotherapy Researchers

Discussion Leaders: Lisa M. Najavits, Clara Hill, Paul Crits-Christoph, and Elise Triffleman

Address for Correspondence:

                       Lisa Najavits, PhD
                       McLean Hospital
                       115 Mill St.
                       Belmont, MA 02478
                       USA
                       E-mail: Lnajavits@hms.harvard.edu

                                          ABSTRACT

       The goal of this discussion is to address career development issues in psychotherapy
research. The discussion leaders represent three types of settings (medical school, department of
psychology, and community-based) and two career stages (junior and senior) to provide a diverse
discussion of career issues. Each discussion leader will answer questions such as:

         What advice would you give to someone starting out today in psychotherapy research?
         If you could do it all over, what would you do differently?
         How have you balanced (if at all) work and family life?
         Dual careers?
         Where do you see the field heading?
         What has been best/worst about your career thus far?
         How did you decide to pick your current setting?
         What do you wish someone had told you?

       Recommended readings on career issues will also be provided. Audience questions and
discussion are invited.




                                             230
Open Discussion 3

Title:                  International Research Collaboration

Discussion Leaders:     Hans Kordy and Anna Mandenoff

Address for Correspondence:

                       Hans Kordy
                       Center for Psychotherapy Research Stuttgart
                       Christian-Belser-Str. 79a
                       D-70597 Stuttgart
                       Germany

                                           ABSTRACT

       The SPR in general and the Annual Meetings in particular provide excellent opportunities
to meet with researchers from all over the world, to exchange ideas and experience, to share the
pleasure and the effort of doing good research. A considerable number of international
collaborative projects were initiated at the Annual Meetings. Many researchers benefit from cross
national co-operation. And it could be many more, if funding possibilities would be known better.

       In this session we will inform on the programmes of the European Union for research
collaboration with particular emphasis on the 5th framework programme that is just being
published. Although the focus is on collaboration and funding in Europe, we invite also for
exchange on the possibilities and experience with transatlantic collaborative research. There are
many national or bi-national programmes, which could facilitate a fruitful co-operation. For
example, the DAAD (German Academic Exchange Service) and the Humboldt-Stiftung offer
various grants.

        As persons who are taking part in several international projects we are convinced that
international collaboration provides added value insofar that it enables research which cannot be
done on the national level. For example, the broad variety of conditions that result from the
differences between national health and insurance systems offer an excellent opportunity to
investigate the impact of such structural conditions on quality of psychotherapeutic services; the
collaboration itself could constitute a ‗natural‘ field experiment.

        We invite all those who are interested in international collaboration to discuss with us in
what way we can take more advantage of one of the strengths of SPR, namely the
internationality.




                                               231
Open Discussion 4

Title:                 Supervision- Special Interest Group (SUPSIG) Meeting

Discussion Leaders: Nicholas Ladany and Helge Rønnestad

Address for Correspondence:

                       Nicholas Ladany
                       111 Research Dr.
                       Counseling Psychology Program, Lehigh University
                       Bethlehem, Pennsylvania 18015
                       USA
                       Phone: 610-758-3253
                       Fax: 610-758-3227
                       Email: nil3@lehigh.edu

ABSTRACT

        Supervision plays a critical role in psychotherapy training and in the maintenance of
quality client services in both training and nontraining settings. In general, research in
supervision has lagged behind other domains of psychotherapy research and there are many
aspects of supervision yet to be examined.

       The Supervision Special Interest Group (SUPSIG) was formed to provide SPR members a
forum to exchange ideas related to supervision theory, research, and practice. This group is open
to educators, students, researchers, and practitioners interested in psychotherapy supervision.

       The primary objectives of this open discussion is for SUPSIG members to meet and
consider topics of interest to SPR members related to the domain of psychotherapy supervision.
Agenda items and topics for discussion include: (1) adding SPR members interested in
supervision to the SUPSIG, (2) informing members of our listserv and web site
(www.lehigh.edu/~nil3/supspr), (3) discussing areas of psychotherapy supervision in which
SUPSIG members are interested, and (4) discussing how SUPSIG members can form collaborate
research endeavors that focus on psychotherapy supervision.




                                              232
Open Discussion 5

Title:                 A First Experimental CD-ROM for Self Study Use in the Psychotherapy
                       Field

Discussion Leaders: Richard Evans, Alan Sparkes, Netta Jordan, Keith Reed Jones, Jim Chase
                    and Alex Curtis Jenkins.

Address for Correspondence:

                       Richard Evans,
                       The Metanoia Institute,
                       13 North Common Road, Ealing,
                       London W5 2QB England
                       Tel: 0181-579-2505.
                       Fax: 0181-566-4349.
                       E-mail RichE@metanoia.btinternet.com.

                                           ABSTRACT

        Self study systems utilizing CD-ROM‘s running on PC‘s or Mac‘s are becoming steadily
more widely used and two extensive meta-reviews have reported on them as being increasingly
cost effective. However, the subject areas covered by these CD-ROM‘s have to date mostly been
in fields such as technical or administrative skills. It has not been at all clear whether useful
CD-ROM based self study systems could ever be developed in a field such as psychotherapy.
        This paper is a progress report on an experiment over the last 3 years in developing a first
self study CD-ROM in the psychotherapy field. The CD-ROM provides up to about 10 hours of
self study in one of the most basic psychotherapeutic skills, ―Seeing and Hearing the Client‖ and
relies very heavily on the use of video recordings of therapist/client sessions to provide learning
material. It is designed to complement existing training methods and is not envisaged as replacing
them in any way. The CD-ROM is planned to enter a phase of formal testing by groups of
students in Spring 1998. Early pre-test feedback suggests that self study CD-ROM based systems
have the potential of making a significant contribution in the psychotherapy training field in the
years to come.
        Whilst it would be possible to talk about the principles involved in creating the CD-ROM
the authors take the view that it would be more productive for participants if they had the
opportunity to briefly try the CD-ROM out for themselves and then engage in a discussion based
upon that experience.
        The presentation of this paper therefore takes a rather unusual form. About 8 PC‘s will be
provided, each equipped with a copy of the experimental CD-ROM. Participants (perhaps in a
group of 3 or 4 around each PC) will be invited to spend 20 minutes trying it out as though they
were students. The remainder of the time allocated for the paper will be available for participants
to discuss their experience. The authors will be able to comment on their experience of designing
and authoring a self study CD-ROM of this type.




                                              233
Open Discussion 6

Title:                 Process-Outcome Research on Psychoanalysis: Suggestions for the Task
                       Force on Research of the American Psychoanalytic Association

Discussion Leader:     Sherwood Waldron

Address for Correspondence:

                       Sherwood Waldron
                       1235 Park Ave., #1B
                       New York, NY 10128
                       USA
                       Website: http://www.psychoanalyticresearch.org
                       E-mail: Sherwood_Waldron@compuserve.com.

                                          ABSTRACT

         President Robert Pyles of the American Psychoanalytic Association has just established a
―Task Force on Psychoanalysis and Science‖ led by Alan Compton. One central branch of this
effort is to investigate the possibilities for research on the efficacy of psychoanalysis. We plan
to coordinate efforts with other organizations sharing an interest in studying psychoanalysis and
long-term intensive psychotherapy. We are hoping for a stimulating exchange in this open
discussion group on how the American can contribute to the support of this goal. We also wish
to begin a dialogue with participants who may continue over the next two years to help formulate
recommendations to the leadership of the American Psychoanalytic Association.

       Waldron will be prepared to discuss the work of his research group, using the Analytic
Process Scales, as a contribution to the discussion of the issues in conducting such work. A
discussion of the Psychotherapy Process Q-Set of Enrico Jones, and the Columbia Analytic
Process Scale is also planned. (Please see our website for materials relevant to these studies).

       Critiques of these methodologies and discussion of other methodologies by members of
the audience will be most welcome. An overhead projector will be available.

        Discussion of the specific projects cited above will not be comprehensive, in order to
reserve time primarily for audience participation. Participants wishing to familiarize themselves
with the instruments and materials of the three studies mentioned are asked to consult the website
or other sources in advance. Advance suggestions for additional special topics for this meeting
are also welcomed.




                                              234
Open Discussion 7

Title:                 An Open Discussion on the Role of Students in SPR

Discussion Leaders: John L. Melton and Jason Zack

Address for Correspondence:

                       John Melton
                       Apt. 1a - 5480 S. Hyde Park Blvd.
                       Chicago, IL
                       60615
                       USA

                                          ABSTRACT

        Students that have been involved with SPR are familiar with the benefits and
rewards that are associated with membership. As students, we are treated as full members,
but we receive reduced memberships fees and are eligible for travel awards and conference
fee waivers. Membership in SPR offers students a forum to demonstrate their research
projects and receive critical and beneficial feedback from psychotherapy researchers
around the world. SPR offers students opportunities for publication at both the national
and international level. Students have the opportunities to attend research presentations
from investigators on the cutting edge of psychotherapy research. Networking within SPR
allows students to meet and discuss research ideas that later can lead to collaboration with
prominent researchers.

        The purpose of this discussion is to create a forum in which students can make
suggestions on their role within SPR. Can students play a more beneficial role to SPR?
How can students networking be enhanced to assist students in psychotherapy research? Is
there a way students can attract others into the exciting, but often difficult discipline of
psychotherapy research? Is there a need for a student organization within the structure of
SPR? The students in SPR have been accepted with open arms, but we can play a more
productive role for both the benefit of the students and SPR.

        This session is an informal discussion of what students would like to see as their
roles within SPR. Results from this discussion can be directed into a more formal report to
the executive committee.




                                              235
Open Discussion 8

Title:                 Semiosis: Signs, Voices, Dialogue, and Affect

Discussion Leaders: Mikael Leiman, Katerine Osatuke, Bent Rosenbaum, William B. Stiles,
                    and Sverre Varvin

Address for Correspondence:

                       Mikael Leiman
                       Department of Psychology
                       University of Joensuu
                       P.O. Box 111, 80101 Joensuu, Finland
                       Email: mikael.leiman@joensuu.fi

                                          ABSTRACT

        Semiotic processes lie at the heart of psychotherapy. Different schools prefer different
symbolic representations, yet all rely on sign-mediated interaction. Thus, the study of how
personally meaningful signs are created, how these signs attain ever-broadening meaning in the
therapeutic discourse, and how they eventually become the patient's personal tools for making
sense and directing her or his activities, offers a unifying methodological approach to many
current issues in psychotherapy research.

        This discussion will be about the study of meaning-making in psychotherapy. How can
we study meaning? How can qualitative or quantitative methods be brought to bear on this
issue? Viewpoints represented by the discussion leaders include the dialogic theory of Bakhtin,
the voice concept, affect/emotion theory, and psychoanalytic perspectives. Additional
viewpoints are invited.




                                              236
Open Discussion 9

Title:                 Combined Psychotherapy and Pharmacotherapy for the Treatment of
                       Mood Disorders

Discussion Leaders: M. Tracie Shea, John F. Clarkin, Ivan W. Miller, and Michael A.
                    Friedman

Address for Correspondence:

                       Michael A. Friedman
                       Mood Disorders Program, Brown University
                       Rhode Island Hospital
                       Potter 3- 593 Eddy Street
                       Providence, RI 02903
                       USA
                       (401) 444-3920
                       E-mail: Michael_A_Friedman@brown.edu

                                          ABSTRACT

        Clinical impression suggests that combining psychotherapy and pharmacological
interventions is a commonly utilized approach to the treatment of mood disorders. However,
despite its apparently widespread use, there is little consensus among practitioners regarding
which patients should receive combined treatment, and how combined treatment should be
delivered. Similarly, as compared to studies investigating the efficacy of either psychotherapy
or pharmacotherapy alone, relatively few studies have examined the efficacy of combined
treatment. Further, the evidence from these studies is mixed, with some studies finding that
combined treatment is more efficacious than single treatment, others finding no differences,
while still other studies have found that single treatment is more efficacious than combined
treatment.

        We believe that several competing conclusions may be reached from the existing clinical
and research literature. The conceptual foundation for this open discussion is that inconsistent
findings reflect an inconsistent phenomenon; that is, the efficacy of combined treatment will vary
across individuals and methods of treatment delivery. Consequently, clinicians and researchers
should then attempt to investigate who benefits from combined treatment, and how combined
treatment can be most adequately delivered to patients with mood disorders.

       The goal of this open discussion is to examine recent research and clinical theory
addressing three basic questions:
        1.     Who is combined treatment most appropriate for
        2.     How should combined treatments be administered
        3.     What research needs to be conducted to better inform clinicians as to how to
        administer combined treatment.




                                              237
Poster Session B

Title:                 A Multimedia System for Assessing Attachment and Heart-Rate in the
                       Strange Situation

Authors:               Joao Paulo Cunha, Isabel Soares, Li Zhan Jian, Lucia Neves and Carla
                       Martins

Address for Correspondence:

                       Joao Paulo Cunha
                       Departamento de Engenharia Electronica/INESC Aveiro
                       Universidade de Aveiro
                       Campus Universitario de Santiago
                       3810 Aveiro, Portugal
                       Fax: 351-34-370545
                       Email: jcunha@inesca.pt

                                           ABSTRACT

       In light of Bowlby‘s theoretical considerations about the biological function of the
attachment system, researchers have been interested to examine the relations between attachment
organizations and physiological processes.

         Our poster presents a multimedia system, a full digital solution, named BioBeAMS
(Bio-signal Behavior Attachment Multimedia System) for the assessment of mother-child
attachment organizations and heart rate during Ainsworth‘s Strange Situation. The Strange
Situation is an experimental procedure conceived as a stressful setting leading to the activation of
the attachment system. This procedure may be of special relevance for examining the relations
between attachment behavioral organization and heart-rate. For studying this issue, we developed
BioBeAMS that is an application which integrates the ECG, video/audio information of the
Strange Situation and the rater‘s coding procedure all together, running in the MS Windows 95
environment on a PC. Using this system, we can acquire the bio-signal and capture video/audio
in a synchronous way. It also enables the raters to analyze and to evaluate psychological and
physiological events and to explore possible relations. BioBeAMS provides a user-friendly
interface to support the workflow from bio-behavioral analysis to rating codes and classifications,
which simplifies greatly the research‘s work. Our poster will show how BioBeAMS works in a
real situation.




                                              238
Poster Session B

Title:                 A New Instrument for the Assessment of Early Maladaptive Schemas

Authors:               Daniel Rijo, José Pinto Gouveia

Address for Correspondence:

                       Daniel Rijo
                       Núcleo de Estudos e Intervenção Cognitivo-Comportamental
                       Faculdade de Psicologia e de Ciências da Educação da Universidade de
                       Coimbra
                       Rua do Colégio Novo
                       3000 Coimbra, Portugal

                                          ABSTRACT

        Despite the fact that dysfunctional cognitive schemas play a central role in the cognitive
conceptualization and treatment of personality disorders, most cognitive assessment instruments
are mainly focused on the assessment of cognitive products, rather than on the assessment of core
cognitive structures. Young's Schema Focused Cognitive Therapy is an exception in what
concerns the development of an instrument regarding the assessment of nuclear schemas — the
Schema Questionnaire (SQ) — named Early Maladaptive Schemas (EMS). These EMS are
postulated as developing early in life, resulting from dysfunctional relationships with significant
others; they are unconditional beliefs about oneself and others, which are self-perpetuating and
highly resistant to change, leading to psychological distress. EMS are usually activated by events
relevant to the particular schema and trigger high levels of negative affect.

       Although cognitive structures are, by definition, tacit and unconscious, they are usually
assessed by self-report instruments that require the capability of conscious self-knowledge.
Young's Schema Questionnaire (SQ), trying to assess EMS, is nevertheless a paper-and-pencil
instrument, thus ignoring the nature of cognitive structures.

         In this poster, the authors present the limitations of schema assessment by self-report
instruments and suggest new ways of enhancing the validity and reliability of this kind of
instruments. In trying to do this, they present a new EMS assessment instrument, specifically
built to overcome the limitations of traditional assessment methods. Finally, they present some
empirical data resulting from the application of this new instrument in comparison with the
results from Young's SQ.




                                              239
Poster Session B

Title:                 Code-A-Text Demonstration

Author:                Alan Cartwright

Address for Correspondence:

                       Dr Alan Cartwright,
                       Senior Lecturer in Psychotherapy, Kent Institute of Medicine and Health
                       Sciences, University of Kent . Canterbury. Kent CT2 7PD UK.
                       Telephone 01227 823691
                       Fax 01227 823224
                       Email A.K.Cartwright@ukc.ac.uk

                                          ABSTRACT

        Code-A-Text was developed to help investigators analyse psychotherapy discourses. It
can be applied to any form of text transcriptions of sessions, process notes or directly to
recordings held on the computer but its real power becomes apparent when working with sound
and transcriptions together. It offers the investigator four methods of coding texts (based upon
content , categorical and interval scales and interpretative methods of analyse) which can be used
together. It also supports the types of textual notations used in conversation analysis.

         The system was designed to be interactive, allowing the user the opportunity to ask
―questions‖ of a text or group of texts and receive quick responses from the programme which
are immediately intelligible. Thus the investigator might request that ―the programme identify
all the sections within a group of texts in which the patient rejected the therapeutic alliance (a
scale code) and the therapist responded within a give number of interventions (segment code)
with an interpretation (scale code) making sexual references (content code based on words in
text)‖. The programme would display all the sections of the texts which fitted this criteria and
play the relevant recordings if available. Other outputs are more analytical displaying
associations between codes and presenting graphical displays of sequences of codes.

               At this poster session examples of the new Code-A-Text interface will be
available including the Speech Analyser and new highly efficient method for indexing and cross
referencing process notes.




                                              240
Poster Session B

Title:                  An Examination of How Reframes Work Politically in Couples
                        Counseling

Author:                 Peter Muntigl

Address for Correspondence:

                        Peter Muntigl
                        Research Centre: Discourse, Politics, Identity
                        ZIIS
                        Alserstrasse 21/9
                        A-1080 Vienna, Austria

                                           ABSTRACT

        In this paper, how reframes work politically in couples counseling is examined. To
begin, it is suggested that the political in therapy is an interactional accomplishment that involves
disputes and struggles over competing ideas, interests, and goals. The way in which these
competing interests are managed by the therapist is given special attention. It is claimed that
therapists' reframes can play a special role in working politically by emphasizing and/or
minimizing differences between the couple.

        Three therapy sessions, each involving different therapists and couples, were analyzed.
The interdisciplinary approach used in analyzing reframes tries to match up aspects of political
theory, social constructionism, and conversation analysis. More specifically, interactional
sequences of talk between the therapist and couple are analyzed for instances of reframes and the
reframes, in turn, are examined in terms of their political function.

       A number of (political) discursive practices will be shown in which the therapist, through
reframes, either constructs a discursive space in which alternatives for action are created or
effaced.




                                               241
Poster Session B

Title:                 An Interpersonal Approach to Substance Abuse: Examining the
                       Attachment to the Drug of Choice

Authors:              Colleen M. Sandor, Lorna S. Benjamin, and Tina Rich

Address for Correspondence:

                      Colleen M. Sandor
                      Cornerstone Counseling Center
                      660 South 200 East #308
                      Salt Lake City, Utah 84111
                      USA
                      Fax: (801) 359-3244
                      e-mail - 75374.331@Compuserve.com

                                      ABSTRACT

        Current object relations formulations of substance abuse rest primarily on theory and
clinical observations. The present study operationalized several assumptions underlying the
object relations model of substance abuse. Specifically, it explored the adaptive function of
opiates and stimulants and addicts' attachment to these drugs.

        This study used the Structural Analysis of Social Behavior (SASB) Intrex to examine
drug addicts' relationship with the self and with their drug of choice in a sample of incarcerated
female opiate and stimulant addicts. Results indicated that addicts have a well articulated,
coherent relationship with their drug of choice. This attachment was examined in light of the
addict's relationship to the self.




                                              242
Poster Session B

Title:                 Assessing the Needs of Families of Children and Adolescents with
                       Developmental Disabilities

Authors:               John S. Lyons, M. Connie Almeida, Patricia Tennant Sokol, Zoran
                       Martinovich

Address for Correspondence:

                        John S. Lyons, Ph.D.
                        Director, Mental Health Services and Policy Program
                        Northwestern University Medical School
                        303 E. Chicago Avenue, Ward 9-200
                        Chicago, IL 60611 USA

                                               ABSTRACT
        This study reports on the first three stages of a project to develop a decision support tool
for ensuring that families of children and adolescents with developmental disabilities receive the
counseling and psychotherapeutic support services they need. There is ample evidence that
parenting a child with significant developmental or intellectual difficulties is challenging, these
challenges can become overwhelming when parenting capacity is impaired. Current systems of
care for persons with developmental disabilities attend to the intellectual, developmental, and
physical needs of the disabled but often ignore the needs of caregivers. This can be particularly
challenging for parents of children with developmental disabilities who often must balance
parenting responsibilities with jobs and other roles.
        In order to improve the match between these needs and services, the State of Texas has
undertaken a project to develop a decision support tool that identifies the needs and strengths of
children and their families. In this paper we present the initial development of this tool, which is
entitled the Child and Adolescent Needs and Strengths for developmental disabilities
(CANS-DD). Developed from focus groups of families and professionals, the CANS-DD has
45 items covering six domains including Functioning, Risk Behaviors, Co-Morbidities, Care
Intensity & Organization, Caregiver Capacity, and Strengths. It is these later two domains that
are novel to this measurement approach and the focus of the present poster.        After an iterative
developmental process in which drafts of the instrument were shared with stakeholders and
feedback was incorporated, initial reliability and validity testing was undertaken. Using six
different raters, inter-rater reliability of the overall measure was adequate with a kappa of 0.71.
Internal consistency of the total measure was 0.75. The Caregiver Capacity domain had an alpha
of 0.78. The Strengths domain had an alpha of 0.70. In a study of 133 children and
adolescents in care, both the Caregiver Capacity and Strengths were related to the presence of
Risk Behaviors and Co-morbidities and to out-of-home placements. Single parents had lower
levels of Caregiver Capacity and Strengths than two parent families. Additional details of the
validity study will be provided. Implications for service planning and service delivery also will
be discussed.




                                               243
Poster Session B

Title:                 Attachment Styles in Romantic Relationships of Clients with Anxiety
                       Disorders

Author:                Markos Maragkos

Address for Correspondence:

                       Markos Maragkos
                       Department of Clinical Psychology
                       University of Munich
                       Leopoldstr. 13
                       D-80802 Munich
                       Germany
                       Phone: +498921805179
                       Fax: + 498921805196
                       Email: maragkos@psy.uni-muenchen.de

                                          ABSTRACT

        The main purpose of this study was to investigate the adult attachment styles in romantic
relationships within a sample of clients (N=30) with anxiety disorders (PD(A), Social Phobia).

        The following questionnaires were administered to both the clients and their significant
others: SCL-90_R, Attachment Style Questionnaire by Ina Grau, Styles of Conflict Inventory.
We hypothesized a complementary attachment style which was confirmed by our results.

       A majority of clients show a dependent attachment style most of their significant others
were characterized by an avoidant attachment style. Implications for the therapy were discussed.




                                              244
Poster Session B

Title:                 Changing Objects: The Effects of Group Therapy on Addicts'
                       Attachment to Drug of Choice

Authors:              Tina Rich, Colleen M. Sandor

Address for Correspondence

                       Tina Rich
                       Cornerstone Counseling Center
                       660 South 200 East #308
                       Salt Lake City, Utah 84111
                       USA
                       Fax: (801) 359-3244
                       e-mail - 75374.331@Compuserve.com

                                     ABSTRACT

        The proposed presentation will present data from an ongoing study of drug addicts in
early recovery who are participating in an Intensive Outpatient Treatment (IOT) program in a
community mental health facility. The clients attend group therapy four nights a week, two
hours a night for a minimum of 6 weeks.

         Previous research has shown that addicts have a well articulated, coherent relationship
with their drug of choice. The present study tests the hypothesis that attachment to therapy
group predicts change in addicts' attachment to their drug of choice. The Structural Analysis of
Social Behavior (SASB) Intrex was used to measure addicts' relationship with drug of choice and
with therapy group on admission and after six weeks of intensive Outpatient Treatment. Change
in relationship with drug of choice was examined as a predictor of change in drug-using behavior
and adaptive function. The association of SASB Intrex change measures with pre-treatment
psychiatric symptom report and personality structure was also explored.




                                             245
Poster Session B

Title:                Group Psychotherapy for Depression: Comparison of Outcome and Active
                      Mechanism Specificity in Two Protocols for Treatment of Depression

Authors:              Russell J. Roberts and Tracy A. Ludlow

Address for Correspondence:

                      Russell Roberts
                      School of Psychology
                      Griffith University, Gold Coast Campus
                      Queensland, Australia 9726.
                      Email: r.roberts@mailbox.gu.edu.au
                      Fax: 61-7-55948291


                                         ABSTRACT


        Both Cognitive Behavioral Therapy and Interpersonal Therapy have been demonstrated
effective in the treatment of depression. Recent multi-site studies of psychotherapy for
depression have indicated gender differences in treatment outcome. However the design of these
studies could not differentiate a true effect of sex-specificity in treatment response from the
artefact of intra-group processes. In this study 36 males and 36 females were matched then
randomly assigned to either a Cognitive-Behavioral, Interpersonal Psychotherapy or a wait-list
control condition. The study utilised a 3 by 2 matched pairs design with gender and treatment
type the independent variables. Measures of mood, interpersonal problems, anhedonia, self
esteem and sex-role identity were taken both pre and post treatment. Post treatment measures
showed a clear advantage of both Cognitive Behavioral Therapy and Interpersonal Therapy over
wait list control. Further, the results indicated a strong gender X treatment interaction effect.
Implications of these results for treatment selection and programming are discussed.




                                             246
Poster Session B

Title:                 Contrasting Models for Estimating the Trajectory of
                       Cost-Effectiveness Change in a Clinical Trial Contrasting Structural
                       Ecosystemic Treatment with Structural Family Therapy and
                       Treatment-as-Usual for Drug Abusing Minority Youth.

Authors:               Frederick L. Newman, Daniel Feaster, Robert Williams, & Jose
                       Szapocznik.

Address for Correspondence:
                    Frederick L Newman, Ph.D., HSA/SPM, AC-I, Room 278A,
                    Florida International University-North Campus,
                    3000 NE 151st Street, North Miami, FL 33138 USA
                    FAX: 305-919-5848 email: newmanf@fiu.edu

                                         ABSTRACT

         The primary aim of the clinical trial is to compare the cost-effectiveness of Structural
Ecosystems Therapy (SET) relative to Structural Family Therapy (FAM) and Community
Control (CC) for drug abusing problem-behavior minority youth. It is hypothesized that
scores in: a) drug use, and b) conduct, delinquent, and other antisocial behaviors will change
at a faster rate yielding a better outcome for SET than for FAM, and for FAM than for CC.
It is also hypothesized that initial added costs of the SET intervention relative to FAM, and of
FAM relative to CC will be off-set by the reduction in costs to the health, mental
health/substance abuse (MH/SA), and juvenile justice systems within 12 months after
standard SET, FAM, or CC interventions are expected to end. It is predicted that behavioral
changes of the youth in SET, relative to FAM, and of FAM relative to CC, will be
accompanied or followed by decreases in the costs of health, Mental Health/Substance
Abuse, and Juvenile Justice services outside of the study.
         The presentation focuses on contrasting methods of analyses that address the concerns
of several perspectives: a) societal; b) state executive and state agency level policy makers,
and c) psychotherapy researchers. The analytic techniques applied to investigate the
cost-effectiveness differences among the three interventions over time include multivariate
repeated measures analyses, and growth curve analysis employing Structural Equations and
Hierarchical Linear Modeling. The paper contrasts these analytic approaches in terms of how
well they tests hypotheses concerning the trajectories of change in a) family interactions, b)
in how the family interacts with other segments of the community (e.g., with the youth‘s
peers, the school, extra-intervention Mental Health/Substance Abuse services, and the
Juvenile Justice system), and c) the costs to the Health, Mental Health/Substance Abuse, and
Juvenile Justice systems over time.




                                               247
Poster Session B

Title:                  Evolution of the Salamanca Data Bank

Authors:                Manuela Redero Sanchez, Silvia Rodriguez Oliva, and Alejandro
                        Avila Espada

Address for Correspondence:

                        Manuela Redero Sanchez
                        Unidad de Investigacion en Psicologia Clinica y Psicoterapia
                        Dpto. de Personalidad, Evaluacion y Trataminentios Psicologicos
                        Facultad de psicologia. Univesidad de Salamanca
                        Avda. de la Merced 109-131. 370005
                        Salamanca, Spain


                                         ABSTRACT

        Until recently there has not been a comprehensive bank of cases and text
(transcriptions of psychotherapy sessions) in Spain. Now, different professionals have
access to such a bank for their research work. Our objective has been to create a cases and
text bank similar to one previously developed at Ulm University (Germany) but also
improving it on several characteristics. After one year of work, we have collected three
types of text.

1.       Sessions of psychoanalytic psychotherapy: 246
                241 adults, 15 adolescents

2.       Fragments of single psychotherapy sessions: 2

3.       Thematic Apperception Test protocols: 145
               100 from individual administration, 45 from collective administration

        All of these materials are in their original language (Spanish). The present study
attempts to analyze a collection of the first clinical interviews of patients with several mental
disorders: phobias, personality disorders, neuroses, etc. Our objective is to structure the
thematic content. In the future, we expect to increase the number of cases and text in the
bank in a way that facilitates the work of many researchers. It will be open to all who are
interested in collaborating with us in our studies.




                                               248
Poster Session B

Title:                  Development of a Core Battery for the Assessment of Anxiety,
                        Affective, and Personality Disorders in an Outpatient Training Clinic

Author:                 David M. Todd

Address for Correspondence:

                        David M. Todd
                        Department of Psychology
                        University of Massachusetts
                        Amherst, MA 01002
                        USA

                                          ABSTRACT

        One of the general recommendations of the 1994 conference on core battery was to
"take into account settings in which research is conducted" (Strupp, Horowitz, and Lambert,
1997). Faculty and students at the University of Massachusetts have been engaged in the
design of a core assessment battery for the clinical psychology program training clinic, the
Psychological Services Center (PSC). A series of program meetings was held, drawing
heavily on reports and recommendations of the 1994 conference, including consideration to
"universal", "general", and "specific" levels of assessment.

        An early proposal in this process was to focus on affective, anxiety, and personality
disorders, the areas that were addressed in depth in the 1994 conference. The rationale for
maintaining this focus was that these are common diagnoses in outpatient clinics; that
comorbidity between these forms of disorder is high; that there is evidence that comorbidity,
especially when it involves personality disorder, may have strong implications for treatment
and training; and that there was significant faculty interest in each of these areas.

         Complementing this work of the 1994 conference, which emphasized the evaluation
of instruments within each of the diagnostic categories, we have concentrated on the creation
of an integrated core battery for our clinic. We are particularly interested in the utility of this
battery for the selection and assignment of cases, treatment planning, and therapist training
and supervision, as well as outcome assessment. The rationale, process, and results of these
discussions are summarized to provide one example of a core battery developed for this type
of setting, and remaining issues are described.




                                                249
Poster Session B

Title:                 Dialectic-Behavioral Psychotherapy (DBT) in Clinical Practice - An
                       Evaluation

Authors:               Brigit Steinbrenner, Martina Schonauer-Cejpek, Rudolf Hirsch

Address for Correspondence:

                       Martina Schonauer-Cejpek
                       Universitatsklinik fur Psychiatrie Graz
                       Auenbruggerplatz 22
                       A-8036 Graz,          Austria

                                        ABSTRACT

        This study examined psychotherapeutic benefits of using DBT- concepts in
combination with individualistic psychotherapy in borderline-patients.
        Regarding Marsha Linehan, dialectic-behavioral psychotherapy (DBT) is a very
specific way to treat patients with borderline-personality disorders using a multimodal
psychotherapy model combining techniques of various therapeutic schools. In follow-up
studies (Archives of general Psychiatry 1991, 1993) Marsha Linehan showed that using this
model of group psychotherapy leads to a reduction of self-injuring (parasuicidal gestures,
drug- and substance abuse, eating disorders) and internal stress as well as improvement of life
quality. DBT-concept is always a combination of skill training in groups and individual
therapy.
        At the University Hospital for Psychiatry in Graz, this concept has been advanced and
evaluated (this advanced concept is discussed in the surroundings of another poster).
        The Gunderson DIB-R semi-structured interview was used for diagnostic purposes.
All patients received complete information regarding their disorder. Personal concepts for
treatment were worked out together and build in a therapy contract, which was signed by
both patient and psychiatrist. Six females and one male patient were included in the program.
During the year of attendance of the psychotherapeutic group, every three months the patients
were examined by using the Munchner Lebensqualitat Dimensionsliste (MLDL) and other
questionnaires concerning their state of health. Intervision-groups (individual
psychotherapists, psychiatrists and other medical staff) were used to correlate observations of
individual psychotherapists with subjective declaration of patients. In the group, patients
should learn/improve capacities that help change patterns towards attitudes, feelings,
dispositions, which might lead to problems and emotional burdens in their lives.
        The results of this evaluation are to be shown in this poster.




                                              250
Poster Session B

Title:                 Dialectical Behavior Therapy for Treatment of Concurrent Borderline
                       Personality Disorder and Substance Use Disorders: A Pilot Study

Authors:               Shelley McMain and Lorne Korman

Address for Correspondence:

                       Shelley McMain
                       Centre for Addiction and Mental Health
                       Addiction Research Foundation Division
                       33 Russell Street
                       Toronto, Ontario M5T 1R8
                       Canada

                                        ABSTRACT

         To date, little attention has been directed toward the development of specialized
treatment services for clients diagnosed with borderline personality disorder and co-occurring
substance use disorders. In recent years, Linehan (1983; 1991; 1994) provided initial support
for the effectiveness of Dialectical Behaviour Therapy (DBT) for individuals with borderline
personality disorder (BPD). Linehan has extended her evaluation of DBT to the treatment of
individuals with concurrent BPD and substance use disorders. The results of these studies
have yet to be published. The current study was designed to evaluate the efficacy of DBT
with individuals diagnosed with BPD and co-occurring substance use disorders. The study
was intended to provide an objective evaluation of the effects of DBT by clinicians and
researchers who are independent of the Linehan research group. The specific aims were to
test the efficacy of DBT to a treatment-as-usual condition in a sample of 24 individuals
diagnosed with BPD and substance use disorders. Subjects were randomly assigned to a DBT
pilot treatment condition (N= 12) or to a treatment-as-usual condition (n= 12). Outcomes
targeted include reductions in frequency and severity of substance use, suicidal behaviours,
symptom distress, interpersonal behaviour, treatment retention and number of days
hospitalized The main outcome assessment battery is to be administered at pre-, 4-month,
8-month and 12-month treatment points. Preliminary findings pertaining to the outcome of
the first four months of treatment, will be discussed.




Poster Session B

Title:                 Effectiveness of Affect Arousal in Treatment of Depression–An
                       Exploration of Client Outcomes Using Voice Therapy


                                             251
Author:                Benny R. Martin

Address for Correspondence:

                       Benny Martin
                       Graduate School of Education
                       University of California at Santa Barbara
                       Santa Barbara, CA 93106-9490
                       Fax: 805-893-7594
                       Email: bmartin@education.ucsb.edu

                                         ABSTRACT

        This pilot study examined the effects of Voice Therapy, an experiential-process
approach, upon depression in an alternating treatments design using four subjects. It is the
first application of this therapy model on a clinical population. All subjects had a diagnoses
including moderate-to-severe depressive symptoms.
        Voice therapy utilizes the here-and-now experience to increase arousal of affect to
stimulate insights in the subjects with the goal of reducing depressive symptomatology.
voice therapy arises out of a combination of the process experiential approach along with
psychodynamic, separation, and object relations theories and derives its name from the
technique of prompting the client to "voice" self-criticisms in the second person, i.e., "you"
statements. This therapy assumes that self-punishing and self-nurturing thoughts can
combine to produce self-destructive behaviors in clients and are due to early family dynamics
and accompanying sociocultural and historical environmental issues. It is believed that
prompting clients to greater affect arousal leads to release of anxiety-laden material, which in
turn allows the client to gain insight into their own dynamics. It is suggested that after
identification of such insights that strategies can be developed to restructure a client's
self-definitions to be more positive.
        In the present study, voice therapy techniques were employed in a modified A-B-A-B
design which alternated sessions incorporating voice therapy techniques with sessions
featuring no voice therapy techniques. The purpose of the research was to determine if
limited application of voice therapy produced any clinically meaningful differences in the
subjects. The Beck Depression Inventory was used to assess client outcomes, and
qualitative comparisons of the data were conducted using graphs. The preliminary results
showed differentiating factors which warrant further study.




                                              252
Poster Session B

Title:                Emotional Episodes in Attachment Narratives of Eating Disorder
                      Patients

Authors:              Sandra Vilarinho, Isabel Soares & Paulo P. P. Machado

Address for Correspondence:

                      Paulo P. P. Machado
                      Universidade do Minho, Departamento de Psicologia
                      Campus Gualtar
                      4700 Braga, Portugal
                      Tel# +351-53-604241
                      Fax# +351-53-678987
                      e-mail: pmachado@iep.uminho.pt

                                       ABSTRACT

        Our study aims to examine the emotional content of attachment narratives of eating
disorder patients. This study was conducted within a larger project - the European
Collaboration on Effective Treatment of Eating Disorders (COST B6). Forty patients were
assessed using the COST B6 protocol that includes Patient Questionnaire (PQB), SCL-90-R,
EDI, and FPI. The Adult Attachment Interview was also administered and interview
transcripts were rated with the Attachment Q-sort developed by Roger Kobak. Protocols
were also rated for Emotional Episodes (Korman, & Greenberg, 1991). Results will be
discussed in light of attachment theory, patterns of emotional regulation, and patterns of
symptom expression of eating disorders.




                                            253
Poster Session B

Title:                  EUROVIHTA - A Program to Improve Life Quality and Adaptation of
                        People with HIV/AIDS

Authors:                Luis Carlos Escobar Pinzón, Julia Bock, Dieter Riemer, Martin
                        Hautzinger

Address for Correspondence:

                        Martin Hautzinger
                        Department of Psychology, Eberhard-Karls-University
                        Reutlinger Str. 12
                        D - 72072 Tuebingen
                        Germany


                                          ABSTRACT

        Based on therapeutic experience with self-help groups of national and regional
Aids-support-organizations in Spain and Germany, a group intervention program was
developed. The program integrates knowledge of psychoneuroimmunology, coping and stress
regulation, and psychotherapy research, to improve the quality of life for people with
HIV/Aids. It consists of six modules: relaxation, group dynamic techniques, behaviour and
cognitive oriented elements, problem solving skills to improve and use personal resources,
and crisis management. It is currently evaluated with the Project EUROVIHTA in five
countries.

         The program is made up of 16 sessions with each two hours following a very similar
structure. The trainer has specific topics to present during each session, but should leave
enough room for group discussion and exchange about the participants‘ own experiences.
The trainer is responsible in cooperation with the participants for the agenda, for scheduling
time and for structuring the problem-solving oriented process. Preliminary experience with
the program is promising and fits in with meta-analytic results of similar approaches with
clients.

        We‘ll present first results of the evaluation of 120 subjects treated in this
investigation.




                                                254
Poster Session B

Title:                    Existential Loneliness Questionnaire: Background, Development and
                          Preliminary Findings

Authors:                  Aviva Mayers, Sick Toon Khoo, Martin Svartberg, Gerd Inger
                          Ringdal

Address for Correspondence:
                    Aviva Mayers
                    Norwegian Centre for Child Research
                    University of Trondheim
                    N-7055 Dragroll, Norway

                                             ABSTRACT

         This poster describes the background, development and preliminary findings of the existential
loneliness questionnaire (ELQ-P) which was designed by the first author to test for the presence of
existential loneliness in parents infected with the HIV virus.
Empirical research on loneliness has focused almost exclusively on a condition determined by either
(1) circumstances (state) or (2) personality differences (trait). A third category, existential loneliness
which has been cited in the literature has generated relatively little discussion and no empirical
testing. It is a universal but often dormant feeling present in all of us. However, following such
universal experiences as separation from a loved one or an emotional loss, the feeling that we are
alone and helpless in the world may be triggered. Most people for much of their lives defend against
such feelings with denial based but adaptive strategies such as suppression, repression, displacement,
or belief in one's omnipotence, that detoxify death and the feelings of anxiety and loneliness that
accompany this. Certain conditions, however, may strip one of such defenses. This may be the case
with for example, persons suffering a terminal illness especially at a young age, possibly facing the
death. of their children in addition to their own or that of partners and friends, or transmitting a deadly
gene or virus to their partners or offspring. In view of the above, HIV+ parents seemed an ideal one
on which to test out this concept.

         The instrument is a 41 item 6 point Likert type scale which was administered to 51 HIV+
parents in New York City. The UCLA Loneliness Scale, the Beck Depression Inventory, the
Hopelessness Scale, and the Purpose in Life Scale were also administered in conjunction with the
Existential Loneliness Scale (ELQ-P). The purposes of this study were (1) to describe the
development of the ELQ-P (2) to evaluate its psychometric properties with special emphasis on item
performance and item selection using Mokken's (1971) nonparametric latent trait model for
unidimensional scaling (3) to delineate the boundaries of the construct of existential loneliness by
examining the relationship between ELQ-P on the one hand and measures of loneliness, depression,
hopelessness and purpose in life on the other. The relationship of AIDS symptomatology to existential
loneliness were also explored. The treatment implications of the ELQ-P for this and other populations
will be discussed.
Poster Session B

Title:                    Focus on Therapeutic Alliance: The Psychometric Properties of Six
                          Measures Across Three Treatments


                                                    255
Authors:               John Cecero, Lisa Fenton, Charla Nich, Tami Frankforter, and
                             Kathleen Carroll

Address for Correspondence:

                        John Cecero
                        Department of Psychology
                        Fordham University
                        113 W. 60th Street
                        New York, New York 10023
                        USA

                                          ABSTRACT

        This study compared the psychometric properties of six measures of therapeutic
alliance (California Psychotherapy Alliance Scales; Penn Helping Alliance Rating Scale;
Vanderbilt Therapeutic Alliance Scale; and the Working Alliance Inventory - therapist,
client, and rater versions) in a sample of substance dependent individuals participating in a
randomized clinical trial of three psychotherapies.

       Internal consistency, factor structure, interrater reliability by rater and by
instrument, and intercorrelations among the instruments were evaluated.

        Results supported the construct validity of the therapeutic alliance and indicated that
all six measures had acceptable reliabilities. Correlations between observer and participant
measures were comparatively low. Reliabilities did vary, however, by treatment condition,
and this new finding invites future research into matching alliance instruments to specific
treatments.




                                                256
Poster Session B

Title:                   Group Psychotherapy: A Single Case Process/Outcome Study

Author:                  K. Roy MacKenzie

Address for Correspondence:
                    K. Roy MacKenzie
                    201-1600 Howe Street
                    Vancouver, BC, Canada     V6Z 2L9
                    Tel:604 822 7669; Fax:    604 669 8873
                    E-mail: rmack@interchange.ubc.ca

                                           ABSTRACT

         The group psychotherapy research literature has grown in parallel with that of individual
psychotherapy but with a lag of about a decade. There is a small literature dealing with
process/outcome dimensions. However, many of these studies examine training groups or student
groups, and few deal with actual patient populations. This poster describes the findings in a
time-limited anti-depression group of 18 sessions.
         The Anti-depression Interpersonal Group is designed for patients who have experienced
repeated episodes of major depression and may have a history of significant dysthymia as well. The
focus of the group is on the connections between depression and interpersonal relationships: an
adaptation of Interpersonal Psychotherapy (IPT) for the group format. An intensive but
semi-structured approach to the current nature of important relationships is used. Group interaction
is emphasized and affective responses facilitated. The focus remains on current and future problems,
and extended discussion of topics related to past experiences is not encouraged (with the exception of
delayed grief reactions). Medications are not managed within the group. The group meets weekly
for 90 minutes for 18 sessions.
         The change measures consist of the Outcome Questionnaire (OQ-45), Inventory of
Interpersonal Problems (IIP) administered at intake, mid-point, termination and follow-up, and Beck
Depression Inventory (BDI) at monthly intervals. A Client Satisfaction Questionnaire is completed at
termination and follow-up.
         Process measures consist of the 12-item Group Climate Questionnaire (GCQ) and the 12 item
California Group-Psychotherapy Alliance Scale (CALPAS). These are administered at the end of
each group session. The GCQ asks for a description of the entire group, while the CALPAS asks for
the individual member's experience in the group. The results will be portrayed in a series of figures
focused on the following aspects of the group:
        (1) Mean session GCQ scores and group development
        (2) Mean session CALPAS scores and group development
        (3) Correlation between individual CALPAS scores and outcome
        (4) Correlation between individual GCQ scores and outcome
        (5) Critical events and shifts in GCQ and CALPAS ratings
        (6) Variations in member process profiles on subscales of the GCQ and CALPAS

Poster Session B




                                                 257
            Title:      How About the Relation Between the Brief Symptom Inventory BSI and the
                              Symptom Check List SCL90R in Assessing Symptoms?

Authors:             Sven Rabung, Isa Sammet, Henning Schauenburg

Address for Correspondence:
                 Sven Rabung
                 Department of Psychosomatics and Psychotherapy
                 University of Göttingen
                 Von-Siebold-Str. 5
                 37075 Göttingen, Germany
                 e-mail: srabung@gwdg.de

                                              ABSTRACT

Background and purpose of study: The Symptom Check List SCL90R (Derogatis 1977) is a widely
            accepted instrument for assessing patients‘ symptoms. It is often applied in pre-post-studies
            to evaluate symptom reduction. If frequent assessments are necessary as in process studies,
            it is essential to apply short instruments to maintain patients‘ compliance. The 53-item
            short version of the SCL90R is the Brief Symptom Inventory BSI (also known as SCL53,
            Derogatis 1993). It assesses the same dimensions of symptoms: somatization,
            obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety, anger-hostility,
            phobic anxiety, paranoid ideation, and psychoticism. For reasons of practicability, the BSI
            is often used to monitor the course of symptom change. Intending to bring those process
            results and outcome results assessed by SCL90R together, it is essential to know about the
            interrelations between the two instruments. It was the purpose of this study to investigate
            them.
Design of study: 55 in-patients with mixed neurotic and personality disorders, treated in our
            Department of Psychosomatics and Psychotherapy for 6 to 17 weeks, were given the BSI
            weekly to assess symptom development. Additionally they completed the SCL90R in the
            first and in the last week of treatment to analyze pre-post-effects in symptom change.
Pre-treatment scores of both instruments were tested on interrelations respectively differences.
            Correspondingly, pre-post-effect sizes of symptom reduction were calculated for both
            inventories and tested on differences.
Results: Pre-measures of SCL90R and BSI differed significantly in most of the symptom dimensions.
            Accordingly, effect sizes of symptom reduction assessed by the SCL90R were found to be
            significantly higher than those assessed by the BSI.
The poster will present these results and discuss them taking the different settings of application
            (pre-post vs. weekly) into account.




                                                          258
           Poster Session B

Title:               I‘m a Teenage Mother!: A Challenge for Prevention

Authors:          Barbara Figueiredo, Raquel Matos, Rute Matos, Rute Magarinho, Elizabete Loureiro,
                                  Fillpa Batista, Carla Martins, Clara Marques, Ines Jongenelen and
                                  Isabel Soares

Address for Correspondence:

                      Barbara Figueiredo
                      Universidade do Minho, Instituto de Educacao e Psicolgia
                      Campus de Gualtar
                      4719 Braga, Portugal
                      Tel: +351 53 604240 1 5
                      Fax: +351 53 678987
                      Email: bbfl@iep.uminho.pt

                                             ABSTRACT

Adolescent motherhood is considered a risk condition into the psychological well-being of the mother
           and the infant. Taking this in account a prevention program for adolescent mothers was
           developed and evaluated.

The study compares a group of 15 adolescent mothers submitted to a prevention program entitled ―I‘m a
           Teenage Mother!‖ with a group of adolescent mothers that didn‘t participate in the prevention
           program, attending both at the Maternidade Julio Dinis (Porto).

The prevention program was conducted during the 3rd trimester of pregnancy and the first three months
           of postpartum in group sessions coordinated by a multidisciplinary team, including social
           workers, nurses, obstetricians, paediatricians ans psychologists.

In terms of results the adolescent mothers included in the prevention program are compared, three
            months after childbirth. Differences between these 2 groups are examined in terms of
            mother‘s mental health status, quality of the home environment and the child care, quality of
            martial relationship, mother‘s family support in child care, mother‘s attitudes toward
            motherhood and the infant and postnatal adaptation. The infants of the adolescent mothers
            who were submitted at the prevention program are also compared in terms of behavioral
            difficulties, temperament and early signals of psychopathology.




                                                         259
            Poster Session B

Title:               Influence of Trainee Personality on Short- and Long-Term Effects of Training in
                                   Empathic Communication

Authors:    Per Nerdrum, Per Høglend

Address for Correspondence:
                 Per Nerdrum
                 Graduate School of Social Work and Social Research
                 Oslo College Pilestredet 52
                 N-0167 Oslo Norway
                 Email per.nerdrum@oks.hioslo.no

                                              ABSTRACT
For experienced lecturers of communication skills, it seems obvious that trainee personality influences
           the effects of training in empathic communication. Empirical research, however, has more or
           less disregarded this factor when investigating effects of such programs.

To investigate the impact of trainee personality on both short-term and long-term effects of a training
           program in empathic communication, we implemented a quasi-experimental study with two
           groups of students of social work. The level of empathic communication was measured from
           analogue data in both groups before training (T1), after the training period in the program
           group (T2) and at follow-up (T3) 18 months after training. Personality characteristics
           hypothesised to influence effects of training (neuroticism, extraversion and latent empathy)
           were assessed at T1. The program group participated in a 50-hour communication skills
           training course in addition to ordinary concept training, while the control group participated
           in social work concept training only. In the follow-up period, the groups received similar
           field practice.

Only one of the three personality characteristics hypothesised to influence effects of training of empathic
           communication did so. In interaction with presence or absence of training, Hogan Empathy
           Scale (HES), measuring latent empathy, had a fairly large (9 %) and significant influence on
           the short-term effects of training. This indicates that the level of latent empathy influenced
           post-test level in the program group, but not in the control group. HES influenced long-term
           effects of training in the same way, but to an even larger extent (12 %). Extraversion, and
           neuroticism did not influence training effects. Hogan Empathy Scale measures a combination
           of personal self-confidence in social situations, and openness, curiosity and non-judgmental
           attitude towards others.




                                                          260
            Poster Session B

Title:                Integrated Group Therapy for Patients with Bipolar Disorder and Substance Use
                                   Disorder: Outcome Results and Treatment Themes

Authors:           Roger Weiss, Lisa Najavits, and Shelly Greenfield

Address for Correspondence:
                    Roger Weiss
                    McLean Hospital
                    115 Mill Street
                    Belmont, MA 02478
                 USA

                                                ABSTRACT
Our research group has developed and pilot tested a 20-session manualized group therapy (Integrated
           Group Therapy, or IGT) for patients with coexisting bipolar disorder and substance use
           disorder. During this study, conducted under the auspices of the National Institute on Drug
           Abuse Behavioral Therapies Development project, 21 patients participated in the treatment;
           three different iterations of the therapy were conducted. Outcomes amount the patients
           receiving IGT were compared with those of 24 patients with the same diagnostic
           characteristics who received monthly assessment but no group therapy ("non-IGT"). Patients
           in the IGT cohort had significantly better outcomes on days of drug use, the drug composite
           score on the Addiction Severity Index, and consecutive months of abstinence.
A major goal of the therapy, which was based largely on cognitive-behavioral relapse prevention
           principles, was to identify behavior and thought patterns that were common to the recovery
           processes in both bipolar disorder and substance use disorder, and to contrast these with
           behavioral and thought patterns typical of the relapse processes for each disorder. In this
           regard, several key themes emerged during IGT. These included the following:
1. "It matters what you do" ( it matters if you get out of bed in the morning instead of pulling the covers
           over your head, it matters if you decide to get drunk today rather than abstaining from
           alcohol) vs. "May as well" thinking ( 'I may as well get high, I may as well skip my
           medication today; it doesn't matter').
2. "Snapshot" (I like the feeling I get after one or two drinks; I like the feeling of being a little
           hypomanic) vs. "Video" ('If I think through what will happen after the first two drinks, I
           realize that this will be followed by many more drinks and destructive consequences. Slight
           hypomania will be followed by severe mania and an inevitable nightmarish depression')
           thinking.

Results of the study and a review of central themes will be discussed.
Poster Session B

Title:                Internalization of the Therapist in Long-Term Psychodynamic Treatment of
                                    Chronic Schizophrenia

Authors:           Elizabeth A. Skowron and Donna L. Horn


                                                          261
Address for Correspondance:

                      Elizabeth A. Skowron
                      Department of Counseling Psychology,
                   University of Wisconsin
                      Milwaukee, Wisconsin 53201-0413
                      USA

                                               ABSTRACT

The purpose of this study was to investigate the process of psychotherapy transfer in the long-term
          treatment of chronic schizophrenia in order to elucidate the mechanisms by which patients
          work through the loss of a previous therapist and consolidate gains in functioning through
          work with a transfer therapist. We hypothesized that a patient‘s capacity to internalize
          aspects of the previous therapist lies at the core of successful therapy transfers and
          terminations. Internalization involves the patient taking in aspects of the therapist which
          serve to strengthen ego functioning (i.e., adaptive coping skills), and it is thought to serve a
          central role in the treatment of schizophrenic and other chronic mental illnesses (Barber &
          Crits-Cristoph, 1995; Orlinsky & Geller, 1993; Kernberg, 1972).

Twenty-four of 51 sessions conducted during a weekly, year-long psychotherapy were transcribed and
          subjected to intensive analysis using the Structural Analysis of Social Behavior (Benjamin,
          1979) and the Therapist Representation Inventory (Geller, Cooley, & Hartley, 1981).
          Analysis of initial interpersonal-intrapsychic complementarity between (a) transfer therapist
          and patient and (b) previous therapist and patient, and observed changes over the course of
          treatment were used to construct a conceptual model of internalization as an event in
          psychotherapy of schizophrenia. The pattern of therapist interventions and client
          performance in successful vs. unsuccessful events is described. Implications for training are
          discussed.




                                                           262
           Poster Session B

Title:               Interrelational Aspects of Body Image and its Changes in a Dream Series: A Case
                                   Study

Author:           Alfredo Lhullier

Address for Correspondence:

                      Dr. Alfredo Lhullier
                      Catholic University of Pelotas, Brazil
                      Pontifical Catholic University of Rio Grande do Sul, Brazil
                      Sen. Mendonca 301/405
                      96015-200/Pelotas RS
                      BRAZIL
                      email: lhullier@atlas.ucpel.tche.br or lhullier@voyager.com.br

                                             ABSTRACT

Many methods have been developed to measure interrelational shifts and changes in psychotherapy
         patients. One of them, the CCRT (Luborsky & Crits-Christoph), has been systematically
         found to be a reliable method of research for these aspects. This method has a quantitative
         part, related to frequency of some contents, and a part of content analysis of the narratives
         (relationship episodes). When analyzing small samples of narratives, like dreams, it is
         possible to emphasize the qualitative aspect of the method to study their variations, which
         could be important to the current study. Using the structure of CCRT (wish, response from
         other, response from self) and its standard categories in a content analysis methodology
         (qualitative approach) applied to a dream series of a successful analysis (Patient Eric Y, from
         Ulm Databank) the author examines the changes in the interrelational aspects related to
         body image. This correlation is considered as a possible indicator to process research in
         psychotherapy patients with body image distress.




                                                        263
            Poster Session B

Title:                Intra- and Interpersonal Characteristics in Anxiety Disorders

Authors:           Achim Wentzel, Markos Maragkos, Willi Butollo


Address for Correspondence:

                   Dr. Achim Wentzel
                   Department of Clinical Psychology and Psychotherapy
                   Ludwig-Maximilians-University Munich
                   Leopoldstr. 13
                   D – 80802 Munich
                   Germany
                   e-mail: wentzel@psy.uni-muenchen.de

                                                ABSTRACT

It is widely held that anxiety disorders represent a complex clinical syndrome. Comprehensive views of
             this syndrome are mostly based on clinical observations. However, empirical evidence is
             scarce. In this study, we analysed videotaped group-therapies for intra- and interpersonal
             characteristics (e.g. ego boundaries, emotions, introjects) in patients with anxiety disorders by
             using a newly developed rating system. We used the therapeutic work as a diagnostic tool,
             since psychological functioning often becomes evident only in the therapeutical process.

Here, data concerning the following categories is presented: coping with loss, emotional coping,
            self-support, need for control, enmeshment with parents, negative organisation of experience,
            introjects, and interactive styles. In all these categories, dysfunctional patterns of clinical and
            therapeutical importance were found. Interestingly, characteristics specific for distinct
            anxiety disorders have been observed.




                                                            264
           Poster Session B

Title:               Metacognitive Variations During the Psychotherapy of a Borderline Patient: An
                                 Analysis of Transcripts of a Whole Tape-Recorded Psychotherapy,
                                 According to the Scale for the Evaluation of the Metacognitive
                                 Function.

Authors:          Antonino Carcione, Giancarlo Dimaggio, Maurizio Falcone, Giuseppe Nicolò,
                                 Michele Procacci, Giuseppe Ruggeri, Antonio Semerari.

Address for Correspondence

                      Antonio Semerari
                      III Centro di Psicoterapia Cognitiva
                      Via Ravenna 9/c      00161 Roma
                      e-mail: terzocentro@iol.it
                      Tel/Fax 06/44233878

                                             ABSTRACT

Our hypothesis was that the psychotherapeutic change, i.e. the patient improved thanks to the
          psychotherapy, was promoted by some change in the patient‘s Metacognitive skills. At the
          beginning of therapy the patient lacked ability in several aspects of Metacognition: he was
          unable to integrate emotions, thoughts and schemes into coherent narratives, was partially
          unable to assume a not-egocentric point of view, and finally was unable to master his
          problematic state. At the end of the therapy the patient showed a global improvement of the
          Metacognitive function and in particular an increase in the Mastery subscale, that is to say
          that the patient was more capable to operate on the relational and psychological conditions of
          his suffering.




                                                         265
             Poster Session B

Title:                 Methodological Issues in the Use of Self-Report Questionnaires in Psychotherapy
                                   Outcome Research

Author:             John McLeod

Address for Correspondence:
                    John McLeod
                    School of Social and Health Sciences, University of Abertay Dundee Marketgait
                                House, Marketgait, Dundee, Scotland


                                                  ABSTRACT
 Although many psychotherapy outcome studies carried out in the 1950s were characterized by the use of
              different types of change measures, in recent years the trend appears to have been to rely
              mainly on data collected through self-report questionnaires. The use of these methods does
              not seem to have taken account of the development of theory and research in personality
              psychology and psychometrics. The aim of this paper is to highlight some methodological
              issues associated with the application of self-report questionnaires in this field. These issues
              are:
(i) the process of questionnaire construction embody a set of validity and reliability criteria originally
              developed in the context of personnel selection. These criteria are not wholly compatible with
              the goals of therapy outcome research;
(ii) the way that a person responds to a questionnaire has been shown to be influenced by social
              desirability, impression management and self-deception. This creates particular problems in
              the context of outcome research;
(iii) research into the process of answering a questionnaire item suggests that in responding the person
              activates cognitive schema relevant to the domain of behaviour being assessed. Therapeutic
              interventions may produce change in these schema without necessarily changing the pattern
              of behaviour;
(iv) psychometric self-report questionnaires are likely to be insensitive to qualitative change;
(v) the domain of trait-like personal information being accessed by self-report questionnaires does not
              reflect important aspects of therapeutic impact.
 The nature of these issues is briefly illustrated through consideration of the kinds of predictions about
              questionnaire response processes that might be derived from one well-known theory of
              therapeutic change - Stiles' assimilation model. In conclusion, it is argued that, in the absence
              of further research into these methodological issues, reliance on self-report questionnaires
              may represent a limiting factor in relation to the growth of knowledge about therapeutic
              outcomes. On practical, theoretical and policy grounds a more differentiated approach to
              research on outcomes is called for.
Poster Session B

Title:                 Methods and Techniques of Body-Movement Psychotherapy in the Treatment of
                                   Somatizations



                                                            266
Author:            María E. Moneta

Address for Correspondence:

                      Dept. of Psychiatry, Faculty of Medicine,
                      University of Chile, Las Hualtatas 6321, Vitacura,
                   Santiago, 6681631 Chile
                      e-mail: mmoneta@machi.med.uchile.cl

                                              ABSTRACT

The use of techniques seeking the contact with oneself through the body, via its movement and
            expression, is an effective therapeutic way to make manifest the feelings of anxiety at a
            somatic level. The use of verbalizations in the trained experience of the "felt body" and of the
            movements elicited is an important component during the therapeutic process. Through it the
            patient learns to transform his bodily experience in images and thoughts. This constitutes a
            learning that leads to a change in the unconscious body image and to a different relation with
            the body.

Stages of the therapeutical process and techniques used in body movement therapy working with groups
            of chronically somatizing patients are described. The group process in this type of approach
            is undergoing characteristic episodes: 1) Exploration, 2) Discovery 3) Acknowledgment 4)
            Connection and 5) Integration. The use of language or verbalization processes during
            movement therapy can support the orientation of the patients toward their own bodies.
            Quantity and quality of verbalizations are a function of the patient group, the working style of
            the therapist and the underlying therapeutical theory.




                                                           267
           Poster Session B

Title:               Narrative Psychotherapy with Adolescents: An Alternative Model of Identity
                                  Construction

Author:            Miguel Goncalves

Address for Correspondence:

                   Miguel Goncalves
                      Department of Psychology
                      University of Minho
                      4700 Braga
                      Portugal


                                              ABSTRACT

In this paper we present a model of narrative therapy with adolescents. Departing from re-authoring
            approach of White and Epston (1990) we suggest the use of therapeutic externalization of
            dysfunctional identities and the internalization of the preferred ones. We briefly present the
            re-authoring model and then described the process of identifying unique identities.




                                                          268
            Poster Session B

Title:                Predictive Models in Support of Adaptive and Selective Indication in
                                  Psychotherapy

Author:            Wolfgang Lutz, Zoran Martinovich, Kenneth I. Howard

Address for Correspondence:

                      Wolfgang Lutz, Ph.D.
                      Department of Psychology, Northwestern University
                  2029 Sheridan Road
            Evanston, IL. 60208-2710
                  USA

                                              ABSTRACT

Random coefficient regression models can be used to model the influence of initial clinical
         characteristics on individual patient‘s course of improvement over time. Given that method, it
         is possible to model the course of treatment for individual cases and for different outcome
         dimensions (well-being, symptoms, functioning) once initial information for a patient is
         available. In this presentation an extension of that profiling method will be presented, where
         patients process information will be included in the model to improve the original predictions
         during the course of treatment for an individual patient and to support adaptive clinical
         decisions.

Going a step further and using individual treatment-response predictions, a clustering model will be
           presented, which allows the definition of relatively homogeneous outcome clusters in terms
           of their predicted and observed courses of treatment. Using this clustering approach,
           probability estimates can be given to support treatment decisions; furthermore this method
           allows a single therapist to evaluate his or her caseload and to search for areas, where further
           training could be helpful. Extensions and specifications for using the method for different
           diagnostic groups will be discussed.




                                                          269
           Poster Session B

Title:               Protean Targets or Treatment Equivalence: Toward Target Validation

Authors:   Robert L. Russell and Cara Lanza

Address for Correspondence:

                      Loyola University Chicago
                      Department of Psychology-DH 624
                      Att.: Robert L. Russell
                      6525 N. Sheridan Rd.
                      Chicago, IL 60626
                      email: rrussel@luc.edu

                                              ABSTRACT

There has been a large body of meta-analytic data, in both the child and adult areas, which supports the
           worrisome conclusion that different treatments all have about the same level of efficacy for
           the "same" problem. Several authors have provided critical commentary as to why and how
           this finding may be misleading and derived from shortcomings in the research studies on
           which it is based. In this paper, we focus on one such shortcoming, namely the protean
           character of the supposed targets for intervention. Current practice often proceeds as if
           targets are adequately specified when identified at the syndromal level, when in fact within
           syndrome variability is alarmingly large - at the symptom level, the severity level, etiological
           level, pathogenic level, and at the level of the developmental pathway. Most treatments have
           relatively the same level of effectiveness because they each match up with only a small
           proportion of appropriate targets. Discovering the differential effectiveness of treatments
           first requires the arduous task of identifying and validating specific targets for intervention.
           We suggest criteria that can be used to validate targets, and indicate how such validation can
           lead to improved cycles of process-outcome studies. Application of our suggestive cycle
           will better identify matches between targets and interventions, through the use of comparative
           and dismantling paradigms of research.




                                                          270
            Poster Session B

Title:                Psychological Adjustment of Russian-Speaking Immigrants to the U.S.:
                                  Comparison to a Non-Immigrant Russian-Speaking Sample

Authors:           Katerine Osatuke and Mia W. Biran

Address for Correspondence:

                       Katerine Osatuke
                       Department of Psychology, Miami University
                       Oxford, OH 45056, USA
                       Email: osatukk@muohio.edu

                                              ABSTRACT

 It is a common conclusion in the literature on immigration that immigrants are at an increased risk for
             stress, adjustment problems, and psychological dysfunctions. This conclusion is always
             drawn from comparing immigrants to native populations of hosting countries. However, a
             comparison of immigrants to their own countrymen may provide a more valid baseline for
             evaluating their adjustment. This study compared Russian-speaking immigrants to
             non-immigrant Russian-speaking sample on 12 commonly used self-report measures of
             adjustment, personality, and stress levels. The immigrants were less stressed and better
             adjusted than the non-immigrants. Correlation analyses of the scores are presented, and
             implications for therapy with immigrants
are discussed.




                                                           271
           Poster Session B

Title:               PTSD After War in Bosnia: Implications for Diagnostics

Authors:          Rita Rosner, Steve Powell, Willi Butollo

Address for Correspondence:

                      Dr. Rita Rosner
                      Department of Clinical Psychology and Psychotherapy
                      Ludwig-Maximilians-University Munich
                      Leopoldstr. 13
                      D – 80802 Munich, Germany
                      e-mail: rosner@psy.uni-muenchen.de

                                              ABSTRACT

Background: The goal of this study was to estimate the extent of Posttraumatic Stress Disorder in the
          general population and in specific samples of clients in psychological or medical treatment in
          Bosnia-Herzegovina. Data on the lifetime prevalence of traumatic events, conditional
          probabilities for the development of PTSD and the point prevalence for PTSD were obtained.

Sample and Methods: 329 people surviving the siege of Sarajevo were assessed with a wide range of
          PTSD related measures (PSS-SR, IES, BDI, STAI). The subsamples consisted of a random
          sample (N=116), a sample of individuals in psychological treatment (N= 114) and a sample
          in medical treatment (N= 99).

Results: While virtually all individuals survived at least one traumatic experience, only 21.4 % of
           individuals in the random sample developed PTSD according to DSM-IV criteria. The rates
           in the other samples were 34 % in medical treatment and 44.2 % in psychological treatment.
           Based on observations made during the assessment and on the conditional probabilities for
           specific traumatic events, the hypothesis is put forward that the strict use of DSM-IV criteria
           leads to a substantial underestimation of traumatisation. Subjects usually report the loss of a
           family member as the most upsetting event, while intrusive symptoms are usually related to a
           different traumatic event. Therefore we conclude that in the case of multiple traumatisations
           the validity of the DSM-IV criteria suffers. Implications for treatment will be discussed.




                                                          272
            Poster Session B

Title:                Race, Culture, and the Therapeutic Relationship: Preliminary Investigations

Author:            Adil Qureshi

Address for Correspondence:
                 Adil Qureshi
                 Department of Counselor Education and Counseling Psychology
                 Western Michigan University
                 Kalamazoo, MI 49008
                 USA

                                                 ABSTRACT
This study examines psychotherapy process in the context of both race and culture. In recent years
            investigators have indicated that the psychotherapy process is of considerable importance in
            the context of what is termed cross-cultural or multicultural counseling or psychotherapy.
            Despite the interest in the area, there have been minimal empirical investigations of the
            pertinent issues and dynamics in the cross-cultural or multicultural context. The investigation
            will proceed by interviewing clients in an effort to identify basic themes pertinent to
            psychotherapy process in the context of race and culture.
Since the early 1980s, multicultural researchers have developed a framework for what are termed
            multicultural counseling competencies. Although there has been a great deal of interest in the
            area, few investigations have attempted to empirically validate the basic structure of these
            competencies. This paper is an effort to contribute to scholarship in this area. A basic
            assumption underlying the study is that multicultural therapist competencies must be
            discovered inductively; a qualitative investigation will allow themes to emerge relatively free
            of bias, be it of the investigator or of existing theory. The position taken in the paper is that
            the emergent process related themes are central to the notion of multicultural competencies;
            the themes inform issues pertaining to the therapeutic relationship and also to the therapist‘s
            overall responsiveness to the client.
Subjects are interviewed in a relatively loosely structured format. Because these are preliminary
            investigations, the goal is to allow the research participants to speak freely about their
            experiences in psychotherapy and about how race and culture may affect the process
            (although not necessarily the content).
The themes are then be explored in the context of existing investigations of the therapeutic relationship,
            and philosophical hermeneutics is proposed as a conceptual framework for both the
            therapeutic relationship and therapist competencies for effective work with clients of
            different cultural and/or racial backgrounds.




                                                           273
Poster Session B

Title:               Substance Abuse and Psychiatric Disorders (Dual Diagnosis) – One Year After
                                   Discharge From Compulsory Care

Author:    Håkan Larsson

Address for Correspondence:
                  Håkan Larsson
           Department of Applied Psychology Umeå University,901 87UMEÅ.
           Ph: + 46-90-786 78 37 Fax: + 46-90-786 66 92
           E-mail: hakan.larsson@apsy.umu.se

                                                        ABSTRACT

           The aim of this study is to examine, first, the effectiveness of treatment among the clients, and second we are interested in
           the clients opinions about the treatment they have received, especially the compulsory care according to the Care of
           alcoholics and drug abusers (certain cases) act. Third we want to examine the influence of early experiences of relations to
           significant others and how these relations in its turn have an impact on the clients possibilities to benefit from the
           treatment they have been offered. The empirical data in this report comes from interviews made with 31 clients who are
           dually diagnosed, i.e. they suffer from both substance abuse problems and psychiatric disorders. The interviews were made
           one year after discharge from compulsory care according to the Care of alcoholics and drug abusers act. The clients
           answered two questionnaires that were carried through as interviews, TSR, Treatment Service Review (McLellan, 1992)
           and EEQ, Early Experience Questionnaire (Henry, 1996).
           The clients were treated in two different settings (homes) which were compared (14 clients from Frösö treatment home and
           17 from Hessleby treatment home). The results showed that the two groups of clients had experienced very few days with
           problems during the year except for psychological, emotional problems. They have also answered that they have had few
           contacts with professionals except for their psychological and emotional problems. The interviewer ratings of the clients
           problems are similar to those made by the clients, i.e. they are quite low, except for psychological problems which are
           considered to be most serious. The results from the clients descriptions of their early experiences to important others
           (EEQ) showed that in relation to the mother, the clients feared that she should ignore and neglect and they wished that
           she should help and protect. There are differences between the two groups concerning the image of the father. The clients
           from Frösö treatment home rate their father as they rate their mother, i.e. they fear that he will ignore and neglect and wish
           that he should help and protect. They have also rated that they fear that he will attack and reject and wish that he should
           nurture and comfort. The clients from Hessleby treatment home fear that he will belittle and blame and wish that he should
           affirm and understand. When it comes to how the parents acted towards the clients when they were children the results
           shows that the image of the mother is more clearly positive at Hessleby. The image of the father is more vague for both
           groups, but it is more positive for the clients from Hessleby treatment home.
           Unfortunately we once again have to demonstrate that these clients with ―dual diagnosis‖ end up in a remote land of
           nowhere, where no first-rate quality service can be obtained. The Social Services consider that these clients do not belong
           to their responsibility because of their psychological problems, and the psychiatric sector does not want them because of
           their substance abuse problems. What the psychiatric care can offer is a short time detoxification. The serious consequence
           of this result is a situation where these clients ―only‖ receive substance abuse treatment or no treatment at all. Or first
           compulsory care, according to the Care of alcoholics and drug abusers act, then nothing, and then once again compulsory
           care. Over and over again in a permanent merry-go-round, because the substance abuse is more a result of the psychiatric
           disorder in stead of the contrary. Several of the former compulsory clients are coping with their situation pretty well. We
           can see some common patterns among those clients who do not immediately relapse into active substance abuse. It is
           evident that those clients who are coming out to some form of planned aftercare, have some reasonable living, and have
           contact with a committed social worker have much more possibilities to live a ―normal‖ life. For those on the other hand
           who are discharged to nothing, who are alone and without support, who do not have a good contact with the social services
           and who do not have somewhere to live, for them the road back to the slough is not very far.




                                                                         274
Poster Session B

Title:             Supervisor Style and Its Relationship to the Supervisory Working Alliance,
                                  Supervisor Self-Disclosure and Supervision Evaluation Method

Authors:   Jessica A. Walker, Nicholas Ladany, Deborah S. Melincoff

Address for Correspondence:

                      Jessica A. Walker
                      Lehigh University
                      Counseling Psychology Program
                      111 Research Drive
                      Bethlehem, Pennsylvania 18015-4794
                      USA

                                             ABSTRACT

           Supervisors tend to work with their trainees from a variety of approaches and roles.
           Friedlander and Ward(1984) highlight three interrelated styles that supervisors use when
           approaching supervision and responding to trainees. Supervisors adopting an attractive style
           tend to be warm and friendly; supervisors adopting an interpersonally related style tend to be
           invested and therapeutic; and, supervisors who adopt a task-oriented style tend to be focused
           and goal-oriented. The purpose of this investigation was to extend the empirical
           understanding of supervisory style in relation to supervision variables, specifically the
           supervisory working alliance (Bordin, 1983), supervisor self-disclosure, and supervision
           evaluation method. Data from 136 psychotherapy supervisors demonstrated a significant
           relationship between supervisory style and the supervisory working alliance. Specifically,
           supervisors who engaged in more attractive and interpersonally sensitive styles were
           perceived to have a stronger supervisory working alliance. In addition, supervisors who
           engaged in a more attractive and interpersonally sensitive style were more likely to
           self-disclose to their trainees. Further, supervisors who were more task-oriented and
           interpersonally sensitive tended to utilize live observation as a trainee evaluation method.
           Finally, supervisors who were more likely to use videotaping as an evaluation method were
           perceived to have a stronger supervisory working alliance with their trainee. Limitations and
           implications for psychotherapy supervision theory, research and practice are addressed.




                                                        275
Poster Session B

Title:                 Telephone Administered Cognitive Behavioral Therapy for the
                       Treatment of Depression in Multiple Sclerosis

Authors:               David C. Mohr, Anne C. Boudewyn, Peter Marietta

Address for Correspondence:

                        David C. Mohr, Ph.D.
                        UCSF/Mt. Zion Multiple Sclerosis Center
                        1600 Divisadero St.
         San Francisco, CA 94115-1642 USA
                        Telephone: (415) 885-3783
                        Email: dmohr@itsa.ucsf.edu

                                        ABSTRACT

Many patients with chronic illnesses experience depression, but, due to physical impairments,
are unable to attend regularly scheduled outpatient psychotherapy appointments. One option,
which previously has not be examined empirically, is to administer psychotherapy over the
telephone. This study examined the efficacy of eight weeks of telephone administered
cognitive behavioral therapy (CBT) in treating depression in multiple sclerosis (MS) patients.

All participants were patients in Kaiser Permanente Medical Care Group of Northern
California, USA and had confirmed diagnoses of multiple sclerosis (MS). Thirty-two patients,
who scored at least 15 on the POMS Depression-Dejection scale, were randomly assigned to
either the telephone CBT or to a standard of care (SoC) control group. The telephone CBT
group received a patient workbook entitled "Coping with MS." This workbook covered the
basics of CBT (e.g. activity scheduling and cognitive restructuring), as well as interventions
for common impairments in MS including fatigue management, pain management, and
coping with cognitive impairment. Patients received eight 50-minute sessions. The patient
workbook helped provide focus both during sessions and for homework between sessions.
Therapists were advanced graduate students who were supervised weekly by the first author.
The SoC group received the standard care offered by Kaiser Permanente.

Depression in patients receiving telephone CBT group was significantly reduced over the
eight weeks as compared to patients receiving SoC (p = .01). The implications of this study
will be discussed.




                                             276
Poster Session B

Title:                  The Alliance-Outcome Relationship in Patients with PTSD and
                        Substance Abuse

Authors:                Lisa Najavits, Rebecca Lurz, Rima Saad, Amy Dierberger, Roger
                        Weiss

Address for Correspondence:

                        Lisa Najavits, PhD
                        McLean Hospital
                        115 Mill St.
                        Belmont, MA 02478 USA
                        Lnajavits@hms.harvard.edu


                                         ABSTRACT

While the therapeutic alliance is a robust predictor of outcome for psychotherapy in general,
its predictive power for ―difficult‖ populations is less clear. Specifically, research on the
alliance in dually-diagnosed populations shows very mixed results thus far. As part of a
randomized controlled outcome study on women with posttraumatic stress disorder and
substance dependence, 22 outpatients and 4 therapists completed the Helping Alliance
questionnaire-II (Luborksy et al., 1996) at sessions 3 and 12 of a 24-session group treatment.
The treatment, Seeking Safety (Najavits, in press), is a manualized cognitive-behavioral group
psychotherapy designed to treat both disorders at the same time to help patients achieve safety
in their lives. Results for both sessions 3 and 12 indicate that the alliance was moderately
strong as rated by both patients and therapists (mean ranges 4.0-4.7). The patient and
therapist alliance were not significantly correlated at session 3, but were strongly correlated at
session 12 (r=.79). Further analysis of results will be conducted to determine the association
between the alliance data and outcomes on PTSD, substance abuse, psychiatric symptoms,
and functioning measures.




                                               277
Poster Session B

Title:                The Approach to Explication of the Transformation of the Dialogical
                      Sequences in Group-Analytic Psychotherapy

Authors:              Alexander Maslov, Olga Maslova, Marina Smirnova

Address for Correspondence:

                      Alexander Maslov
                      P.O.Box 54
                      193024
                      St. Petersburg
                      Russia
                      e-mail: mao74@AM2849.spb.edu

                                       ABSTRACT

This study examined the constructions of the psychotherapeutic conversations in two forms of
the group therapy: a short-term experiential intensive group work and a long-term
group-analytic psychotherapy. These therapeutic forms both are analytically-oriented
evocative and focuses on free-floating group discussion in order to facilitate emotional and
dynamic changes, combining aspects of the group-analytic and experiential approaches.

The Dialogical Sequences Analysis was employed to identify markers (or shifters) of Inner
Voices (and Internal Objects) and their transformations and also to assimilate the
problematic experiences by members of groups.

This study is a trial to find some formal signs of appearance of new Voices (and Inner
Persons) in utterances of clients and some changes in clients's present experiences. Another
task was to examine the connections between Metaphoric and Dialogical Sequences in client's
and therapist's speeches to determine how semiosis differed in short-term and long-term
group psychotherapy.




                                            278
Poster Session B

Title:                 The Effect of Art Therapy on Weight and Self-Concept in Children
                       Presenting With Eating Disorder Symptomatology

Authors:               Emily Piper, Sue Kuba, Lelia Veaco

Address for Correspondence:

                    Emily Piper
                    Department of Psychology
                    British Columbia‘s Children‘s Hospital
                    4480 Oak Street
                    Vancouver, British Columbia
                    V6H 3V4
                    Canada
                    (604) 875-2147 x8149

                                        ABSTRACT

A Single Case Design was used to assess the effectiveness of art therapy in treating children
with symptoms of eating disorders. Each child was treated with 12 psychodynamic art therapy
sessions. Therapy incorporated family involvement, and each participant engaged in three
family therapy sessions and nine individual therapy sessions. Participants were assessed, pre
and post intervention, for healthy weight attainment or maintenance, increased self-concept,
and cognitive development.

Each participant‘s height and weight were measured, the Piers-Harris Self-Concept Scale for
Children (1984) was used to assess self-concept, and the Developmental Teaching Objectives
Rating Form-Revised (1992) was used for developmental assessment. Developmental levels
were monitored to discriminate between gains made from therapy, and those attributed to
expected cognitive and social growth. One female participant met the goal of healthy weight
maintenance, and all three participants achieved increased levels of self-concept. Implications
for clinicians are discussed and treatment interventions are presented.




                                              279
Poster Session B

Title:                  The Effects of Supervision using the IECS-FAST on Novice
                        Therapists‘ Inner Experiences Over Time

Authors:                John Melton, Marilyn Susman, Martha Ellen Wynne, and Dawn
                        Nofzinger

Address for Correspondence:

          Dr. Marilyn Susman
         Department of Counseling Psychology
         Loyola University Chicago
         Wilmette, IL 60091
                         USA

                                         ABSTRACT

The Inner Experience Coding Scale-Field Adaption for Supervision and Training
(IECS-FAST) is a tool for the multidimensional assessment of supervisees‘ inner experiences.
The coding scale provides supervisors with a method to give objective and focused feedback
to supervisees following therapy sessions. The IECS-FAST enables supervisors to target
supervisees‘ thought processes, i.e., cognitive complexity, locus, and judgment during a
therapy session.

In a previous study, both supervisors and supervisees rated the helpfulness of the feedback
provided by using the IECS-FAST (ISPR, Snowbird, Utah, 1998). As a result of these ratings,
an expanded study focusing on the changes in inner experiences over time was undertaken.

In this study, a group of 32 novice master‘s students in counseling skills classes were divided
into four groups of eight: a group with no supervision, a group with written instructional
feedback, a group with traditional individual supervision, and a group with individual
supervision incorporating the IECS-FAST. Inner experiences of all students were collected
for three thirty minute sessions with recruited clients. These inner experiences were rated by
four coders who had been trained in using the IECS-FAST as a supervision tool in a counter
balanced design.

All inner experiences were coded on the above three dimensions (cognitive complexity, locus,
and judgment) using the IECS-FAST. Results of a 4 (Group) X 3 (Time) multivariate design
using repeated measures are presented.




                                               280
Poster Session B

Title:                     The Family Solutions Program: Outcomes of a Multiple Family Group
                           Intervention for Youth Offenders.

Author:                    William H. Quinn

Address for Correspondence:
                     William H. Quinn, Ph.D.
                     Dept. of Child & Family Development, Dawson Hall,
      University of Georgia
                     Athens, GA 30602-3622
      USA

                                                ABSTRACT

The Family Solutions Program (FSP) is a prevention/early intervention program for juvenile first offenders
that was initiated in 1992 in the State of Georgia (USA). The experiential/process model includes topics
of conflict-resolution, family communication, decision-making and consequences, family cooperation,
educational problems, anger management, and parent skill-building. In seven years, 325 families have
completed the program. Risk assessments at pre-treatment provide information on demographics, family
functioning, at-risk behaviors, peer group relations, parent-adolescent communication, and history of
family criminality. Post-intervention and follow-up data have been gathered on recidivism and family
functioning. Two comparison groups have been used to examine differences in patterns of re-offense.
One is a group of families who have been referred to the FSP but did not attend the program (N=145).
The other is a group of families from a geographic area in close proximity in which youth were
adjudicated for juvenile first offenses, but where there was no FSP available for them to attend, and
customary case review and disposition was conducted (N=65). Statistical analyses examining
comparisons across groups indicated no differences on demographic, family, peer group, history of family
criminality or seriousness of offense. Results indicate that the recidivism rate for youth who complete the
FSP is 25% lower than both comparison groups. ―Graduates‘ of the FSP have a 34% recidivism rate,
non-graduates have a 59% recidivism rate. Comparisons of FSP ‗graduates‘ and ‗non-graduates‘ also
indicate that this difference holds for each year, 1992-97, indicating that differences are not due to therapist
effects. In addition, the number of re-offenses by those youth who do graduate and re-offend is lower
(half) than the number of re-offenses by youth who do not complete the program. On average, the number
of re-offenses for the FSP ‗graduates‘ who do re-offend is 0 .95, the number of re-offenses for youth who
do not complete the program is 2.14. Family testimonials at ‗graduation‘ attest to the consistent favorable
view of the FSP as described by participants. Examples include: ‗you have all helped me realize that the
situation is not hopeless‘, ‗my son and I have an enjoyable relationship now‘, ‗I didn‘t think I could afford
the time for this program, now I realize I can‘t afford NOT to spend time with my child‘, and (from a son)
‗I want to tell you how much I appreciate you all being my friend in this program, and I hope we don‘t see
each other back here again!‘ Judges routinely refer to the FSP for all first offenders. The FSP is
currently being adopted in juvenile courts throughout the state, and communities in other states of the
nation are incorporating it into juvenile court services.




                                                      281
Poster Session B

Title:                 The Frankfurt-Hamburg Long-Term Psychotherapy Study: Process
                       and Outcome of Outpatient Behavior and Psychoanalytically Oriented
                       Long-Term Therapy

Authors:               Josef Brockmann, Thomas Schluter, and Jochen Eckert

Address for Correspondence:

                       Prof. Dr. Jochen Eckert
                       Universitat Hamburg
                       Psychologisches Institute III
                       Von-Melle-Park 5
                       20146 Hamburg
                       Germany

                                        ABSTRACT

The prospective study compares 31 patients in behavior long-term therapy (with an average of
63 sessions) with 31 patients in psychoanalytically oriented long-term therapy (with an
average of 185 sessions) in a naturalistic study design. All patients passed a diagnostic
interview (SCID) by an external interviewer. Only patients with depression and anxiety
symptomatic (Axis I of DSM Ill-R) were included in the study. Symptoms (SCL-90-R),
interpersonal problems (IIP) and goals (GAS) were examined at the beginning, after 1 year,
after 2 ½ years and 3 ½ years. After 3 ½ years patients also passed a follow-up interview by
another external interviewer.

We found that the characteristics of patients, who choose - or were devised to
-psychoanalytically oriented or behavior long-term therapy were different, even when their
diagnosis was comparable. For both treatments we can show significant change also between
1 year and 2 ½ years in symptoms and interpersonal problems. The change of goals during
therapy was examined. After one year of therapy 30% new goals had appeared.

At the time of the international SPR meeting we will have the complete results of the 3 ½
questionnaires and the follow-up interviews.




Poster Session B

Title:                 The Impact of Trauma-Stories: Therapist‘s Countertransference and
                       Basic Assumptions



                                             282
.
Authors:                Annemarie J.M. Smith, Wim Chr. Kleijn

Address for Correspondence:
                    Annemarie J.M. Smith
                    Centrum 45
                    Rijnzichtweg 35
                    2342 AX Oegstgeest, the Netherlands
                    email: asmith@worldonline.nl

                                           ABSTRACT
The confrontation with client‘s severe traumatic experiences has an impact on the therapist on
several levels. Besides primary traumatization of the therapist by aggressive behavior of the
client, the therapist has to come to terms with the violence he is confronted with in the client‘s
narrative. Traumatic countertransference, secondary traumatization and vicarious
traumatization are concepts used in the trauma literature for effects on the therapist of
working with traumatized people.
Former research showed that therapists in a trauma institute found their work emotionally
burdening. High emotional burden was associated with a strong emotional reaction in a
difficult situation, with some intrusive thoughts, avoidance and distancing behavior.
Countertransference and world view of the therapist were not related to emotional burden but
they were related to burnout. In comparison with client centered therapists, trauma therapists
reported less negative countertransference feelings and had more negative assumptions on the
‗good people‘ scale of the basic assumptions questionnaire. This could be an indication of
trauma specific reactions in the therapist.
The study reported on, concerns therapists' reactions to the confrontation with traumatic
material. Two groups of therapists (client centered therapists and trauma therapists
respectively) participated in the study. Before and after watching a video with a Vietnam
Veteran's account of his war experiences, a questionnaire on countertransference feelings and
world view was filled out by the therapists. The following questions will be considered:
1.    Do therapists report changes in countertransference feelings and world view after the
      confrontation with highly traumatic material?
2     Are there differences between the trauma therapists and the client centered therapists ?
The results will be discussed in view of the relationship between short term changes and the
long term effects that were found in the earlier study.




                                               283
Poster Session B

Title:                  The Influence of Postmodern Thought in the Field of Marriage and
                        Family Therapy

Authors:                Michael Negretti, Elizabeth Wieling, Laura Bryan, Faline Christensen,
                        Thomas Kimball, Sean Stokes

Address for Correspondence:
                    Michael Negretti, M.A.
                    101 North Wayne Ave.
                    Lubbock, TX 79416 USA
                    (806) 793-7988 E-Mail: Q5144@ttacs.ttue.du

                                           ABSTRACT
The primary objective of this study was to advance our understanding of postmodernism and
its influences in the field of Marriage and Family Therapy (MFT). According to the
literature, postmodernism has had a profound influence on many fields, including MFT.
There is, however, a scarcity of literature on how this influence is actually being implemented
in theory, research, practice, and training. This qualitative study helped clarify the actual
modes by which postmodernism is being rendered by investigating perceptions of doctoral
students in MFT. Another aim of the study was to identify how participants have
internalized postmodern tenets. Because postmodern thought may involve a considerable
paradigm shift, it is important to learn how it is being conceptualized and understood.
The influence of postmodern thought in MFT is most notably seen in the contemporary
theories that are grounded in social constructionism, hermaneutics, and narrative. These
approaches (Collaborative Language Systems, Narrative Family Therapy, Solution-Focused
Therapy, etc.) consider all knowledge and experience as being socially constructed through
language and existing only in language. Therefore the focal point in therapy is on
re-constructing, re-storying and re-creating alternatives to the problem saturated stories clients
typically are immersed in when they present for therapy. The postmodern movement has had
and continues to have a great deal of resistance in MFT. This study highlights the
contributions as well as the difficulties and dilemmas that scholars in the field of MFT have
with postmodern therapies. In addition, this study provides a picture of how postmodernism
is currently being understood and used in MFT.
Three focus groups (6 participants in two groups and 7 in one group) were conducted during
the month of October, 1998 with doctoral students from accredited MFT schools from around
the country. There are 13 accredited doctoral programs in the United States. We had
participants from 8 of these programs.
The Developmental Research Sequence (Spradley, 1979; Krueger, 1994) has been used to
analyze the data gathered in the three focus groups.

Poster Session B

Title:                  The Junghian Concept of the Dreams: Confirmation From the
                        Computer




                                               284
Authors:                Marco Zanasi, Enrico Fasanelli, Antonietta Filippo, Teresa Tenaglia

Address for Correspondence:

                        Marco Zanasi
                        Via G.Tomassetti 7 – 00161 Rome Italy
                        email: marco.zanasi@uniroma2.it

                                         ABSTRACT

In this research the authors used an unconventional approach to the study of dream activity,
considering the dream to be like a text produced by the dreamer's unconscious during the
night. Were studied 600 dreams coming from 4 Borderline patients by using TACT (Text
Analysis Computing Tools), a system of 16 programs for MS-DOS, designed to do
text-retrieval and analysis on literary works, as occurrences of a word, word pattern, or word
combination. The application of this specific software to a text allows not only the
identification of single individual words but also that of the meaning in that particular context
via the statistical processing of the meaningful correlations between different key words. It
has thus been possible to extract this type of information despite the bizarre, chaotic and
unstructured nature of dream material.

The more frequent words that recurred in the dreams were: I, Mother, Father, Earth, House
and Cross. These data are interpreted as a confirmation of Junghian hypothesis of the dream
as a "symbolical self-portrait of the internal state of the dreamer." Our research corroborates
the existence of invariant elements in dreams and thereby confirms the Junghian theory of a
collective unconscious.




                                               285
Poster Session B

Title:                 The Modified Concept of Dialectic-Behavioral Psychotherapy (DBT)
                       in the Treatment of Borderline-Personality Disorders

Authors:               Martina Schonauer-Cejpek, Rudolf Hirsch, Brigit Steinbrenner

Address for Correspondence:

                       Martina Schonauer-Cejpek
                       Universitatsklinik fur Psychiatrie Graz
                       Auenbruggerplatz 22
                       A-8036 Graz
                       Austria

                                         ABSTRACT

Regarding Marsha Linehan, Dialectic-Behavioral Psychotherapy (DBT) is a very specific way
of treating patients suffering from a borderline-personality disorder using a multimodal model
of combining techniques of various psychotherapeutic schools.

In follow-up studies (Archives of General Psychiatry, 1991, 1993) Marsha Linehan showed
that using this model of group psychotherapy leads to a reduction of self-injuring
(parasuicidal gestures, drug and substance abuse, eating disorders) and internal stress as well
as improvement of life quality. DBT-concept is always a combination of skill training in
groups and individual therapy.

At the University Hospital for Psychiatry in Graz, Marsha Linehan‘s concept was advanced,
by not having DBT-Psychotherapists working individually with patients, but bringing in
psychotherapists with different educations, who work in private practice with the patients that
are in the DBT-group at the hospital. Intervision-groups for the psychotherapists, together
with the psychiatrists who work with the group (Psychotherapy for patients with Personality
Disorders at the Psychiatric Hospital) on a regular basis ensure communication and sharing of
information.

This poster demonstrates the modified DBT-concept and its clinical usefulness,




                                              286
Poster Session B

Title:                 The Portuguese Version of Young's Schema Questionnaire:
                       Psychometric Properties and Validity

Authors:               Margarida Robalo, José Pinto Gouveia, Marina Cunha

Address for Correspondence:

                       Margarida Robalo
                       Serviço de Psiquiatria — Consulta de Psicoterapia
                       Cognitivo-Comportamental
                       Hospitais da Universidade de Coimbra
                       Praceta Professor Mota Pinto
                       3049 Coimbra Codex, Portugal

                                        ABSTRACT

The modification of dysfunctional cognitive structures remains a core issue in the cognitive
therapy of personality disorders. These structures, widely known as "schemas", influence the
way individuals think about themselves and others and the way they give meaning to their
experience.

The schema focused therapy (Young, 1991) uses the concept of "Early Maladaptive Schemas"
(EMS) as self-perpetuating dysfunctional cognitive structures developed during childhood,
resulting from dysfunctional relationships with significant others. Being unconditional
assumptions, these EMS guide the information processing in a dysfunctional way, selecting,
encoding, storing and recovering information consistent with the schema content and
overlooking schema-inconsistent information. These unconditional nature and distorted
processing is responsible for they being highly resistant to change. The development of EMS
during childhood reflects the attempt of the child to give meaning to her experience allowing
her to cope with the environment.

Based on his clinical experience with personality disorders, Young (1991) has identified 16
EMS, within 6 main groups: Instability and Disconnection, Impaired Autonomy,
Undesirability, Restricted Self-Expression, Restricted Gratification and Impaired Limits. In
the present poster, the authors present the psychometric properties, factorial and discriminant
validity of the Portuguese version of the Schema Questionnaire, administered to a sample of
the general Portuguese population and to a sample of a clinical population.




                                              287
Poster Session B

Title:                 The Prevalence of Eating Disorders in a Portuguese Female College
                       Population

Authors:               Sónia Gonçalves, Paulo P.P. Machado, Carla Martins, & Isabel Soares

Address for Correspondence:

                       Paulo P.P. Machado
                       Universidade do Minho, Departamento de Psicologia
                       Campus de Gualtar
                       4700 Braga, Portugal
                       Tel#+351-53-604241
                       Fax#+351-53-678987
                       e-mail: pmachado@iep.uminho.pt

                                        ABSTRACT

Eating disorders, anorexia nervosa and bulimia nervosa, are psychopathological disorders of
complex aetiology that affect mainly young women. Epidemiological studies show that the
prevalence of this disorders has increased in the last 20 years, mainly between the ages 15 to
25. In addition, college women seen to be at risk population for the development of these
disorders. The work aims to assess the prevalence of eating disorders in a female college
student population. Results showed that bulimia nervosa prevalence is relatively high
(5.88%) and consistent with the prevalence of other studies with the same population in other
western countries. The high prevalence of partial syndromes (Eating Disorders not otherwise
Specified) and dysfunctional eating behaviours may signal a potential increase of eating
disorders in the near future. No cases of full anorexia nervosa, however, were found, in this
population.




                                             288
Poster Session B

Title:                  The Relation Between Theoretical Assumptions of Analysts and Their
                        Narratives of the Therapeutic Processes

Authors:                Paulo L. R. Sousa, Ricardo E. Bernardi, Ricardo T. Pinheiro, Ricardo
                        A. Silva.

Address for correspondence:

                        Paulo L. R. Sousa
                        NUPPLAC – Research Center on Psychoanalysis and its Applications,
                        School of Pychology / Medicine, Universidade Católica de Pelotas,
                        Rua Alm. Barroso, 1202 sala 4, CEP 96010 – 280, Pelotas – RS –
                        Brazil.

                                          ABSTRACT

This study compares theoretical assumptions (level 1) of different analysts with the report
they make about what they think that have gone on in the sessions with patients (level 2). It
is generally accepted that there is a good rate of concordance between those two levels and
this is the hypothesis we examine in the study.

The empirical data we used were the clinical papers that advanced psychoanalytic candidates
must present to conclude their training and get membership in International Psychoanalytical
Association. In their works, they synthetically present: 1) the author‘s ideas they use for their
own theoretical support; 2) clinical material with patients reported from notes taken during
sessions.

In the study we perform a content analysis of discourses dealing with both levels (1 and 2),
searching for the degree of coherence between them. We utilize five relevant topics for
analysis: expressions of sexual drives, narcissistic drives, transference-countertransference
manifestations and aggressiveness. Results were discussed on the basis of psychoanalytic
theory and relevance theory.




                                               289
Poster Session B

Title:                  The Specific Central Relationship Themes of Groups with Different
                        Attachment Styles

Authors:                Carol Foltz, Michael Abrams, Fawn McNeil, and Jacques Barber

Address for Correspondence:

                        Jacques Barber
                        Center for Psychotherapy Research
                        University of Pennsylvania
                        3600 Market Street, Room 704
                        Philadelphia, PA 19104-2648, USA

                                           ABSTRACT
Psychotherapy researchers are increasingly recognizing the utility of the construct of
attachment as a means of understanding the etiology and treatment of specific clinical
disorders. The present study examined attachment status in relation to a clinically relevant
measure of interpersonal difficulty as a first step in understanding the role of different
insecure attachments in the etiology of certain types of psychopathology. A self-report
version of Luborsky's Core Conflict Relationship Theme method (CCRT), the Central
Relationship Questionnaire (CRQ), was used to assess interpersonal patterns, specifically,
individuals' Wishes or desires in their close relationships, their perceptions of others'
responses to them (ROs), and their own responses to both of these (RSs). The CRQ and a
measure of attachment style (Bartholomew & Horowitz, 1991) were administered to a sample
of 403 students and staff from an urban university and a second sample of 97 adults seeking
psychiatric services from an outpatient clinic at the same university. In accordance with
Bartholomew and Horowitz‘ model of adult attachment, the following predictions were tested
with multivariate analysis of variance: (a) secure individuals will perceive the responses of
both self and others in a positive fashion, although they will not feel more self-confident than
dismissing individuals; (b) preoccupied individuals will perceive the responses of others
positively but those of self negatively and will be characterized by the wish to be taken care
of by others; (c) fearful individuals will describe the responses of both self and others in
negative terms, especially self as feeling disliked and other as being hurtful and rejecting, and
will endorse highly both the wish to be close and the wish to be distant (d) dismissing
individuals will perceive others as hurtful while representing self as independent and will be
characterized by the wishes to be independent and distant from others. It is also predicted
that secure individuals will evidence the least conflict between antithetical Wishes relative to
insecure individuals. Finally, cluster analysis was used to depict the specific profiles of
Wishes, ROs, and RSs of each attachment style.




                                               290
Poster Session B

Title:                  Toward an Equivalent to Prospective Comparative Clinical Studies for
                        Process-Centered Psychotherapeutic Treatments

Author:                 Henri Schneider

Address for Correspondence:

                        Henri Schneider
                        Goldauerstrasse 42
                        CH-8006 Zurich
                        Switzerland

                                          ABSTRACT
A substantial number of psychotherapeutic treatments that are considered suitable for treating
severe psychological disorders can be termed "process centered". In this type of treatment,
change results largely from both the relationship and the events that occur between the patient
and the therapist, the therapist constantly adapting her or his interventions to the interactional
dynamics of the situation at hand. Such "emerging" processes can only be described after the
fact, i.e., they cannot be captured in advance in a manual. This raises the question as to
whether it is possible to investigate prospectively the effectiveness of treatments that can only
be described in retrospect. This paper shall present a preliminary sketch for such a
methodological procedure.

The summary retrospective reports that are culled by the treating therapists serve as the
starting point for this procedure. Drawing on both clinical knowledge and theoretical
concepts, the therapists then identify significant patterns in these reports and structure them as
process elements, i.e., specific therapeutic ingredients deemed essential to treatment outcome.
These process elements are filed in a documentation. As soon as an adequate number of
process elements are available in the documentation, it is possible to group highly similar
process elements that pertain to specific problems. Subsequently, the effectiveness of these
groups of similar process elements is subject to a comparative analysis.

The paper reports on initial experiences with the retrospective documentation of treatment
processes and the extracting of process elements. It also provides a list of questions relating to
the further elaboration of the methodological procedure outlined above, such as how the
therapist can observe and record changes in the patient, how these changes can be related to
process elements, and how a sufficient number of similar process elements that pertain to a
specific problem can be brought together -- questions that would need to be solved in order to
develop this tentative draft into a protocol for prospective comparative clinical studies.
Poster Session B

Title:                  Trauma and the Destruction of Meaning: Analysis of Semiosis in the
                        Psychotherapy of a Traumatized Patient

Authors:                Bent Rosenbaum



                                               291
Address for Correspondence:

     Associate Professor Bent Rosenbaum.
     Department of psychotherapy
     Psychiatric University Hospital in Aarhus
                      DK-8240 Risskov
     e-mail: PH.PH1.BR@aaa.dk

                                         ABSTRACT

A model is suggested in which subjective relating to the world is organized through three
dimension:
- a body-other dimension,
- a subject-group dimension and
- a subject-discourse dimension.

The three dimensions can be conceptualized as three forms of dynamic semiosis. The first
dimension organizes the subject according to the phenomenological lived experience. The
second dimension organizes the dynamics of the relationship between the subject the group
matrix. The third dimension organizes the dynamics of the symbolicity of the subject, i.e. its
position in the discourses of society (myths, philosophies, ideologies, ethics, morals, folklore,
poetry, literature, jurisdiction).

On the basis of this model we will examine how exiled and traumatized persons in the course
of psychotherapy organize their subjective understanding of the relationship to the world. We
will focus on the empirical analysis of a period in the psychotherapy with a male refugee who
developed paranoid ideation. This will be contrasted with schizophrenic and neurotic ways of
organizing relations to the world.




                                               292
Poster Session B

Title:                 Using Conversation Analysis to Identify the Psychodynamic
                       Mechanism of ‗Splitting‘ in Therapeutic Discourse

Author:                Georgia Lepper

Address for correspondence:

                       Kent Institute of Medical and Health Sciences
                       Kent Research and Development Centre
                       University of Kent, Canterbury CT 2 7PD
                       Great Britain
                       email: 101601.454@compuserve.com

                                         ABSTRACT

A feature of Borderline Personality Disorder commonly identified by psychodynamic
formulations is the use of ‗splitting‘ as a primary defence mechanism. Patrick et al (1994)
have shown that BPD subjects are highly likely to be classified as ‗disorganised‘ in AAI
interviews, and to provide highly incoherent life stories. The present research seeks to provide
empirical evidence of a link between these phenomena.

The study uses a method derived from Conversation Analysis (Sacks, 1992). Building on
Labov‘s sociolinguistic study of narrative structures, Sacks showed that story-telling is a
ubiquitous feature of naturally occurring conversation. He demonstrated that narrative
structure is employed not only in stories, but also in the building of descriptions about how
the world works, and that information about the way the world works (especially the social
world) is typically presented by care-givers to children in narrative form. Subsequent
research into the development of language and cognitive development (Nelson 1996)
confirms that earlier finding, and demonstrates that narrative competence is linked to
cognitive development.

The method used in the present study derives from Sacks observation about the function of
the ‗story evaluation‘ (proposed by Labov) in the construction of naturally occurring stories.
Drawing on analysis of psychotherapy sessions and Adult Attachment Interviews, this study
demonstrates that a particular dialogic pattern of evaluation, evidenced in the discourse of
BPD subjects, can be identified in the structure of their narratives. This pattern, it is
proposed, reveals how the mechanism of ‗splitting‘ manifests itself in spoken interaction,
and more particularly, in therapeutic interaction. Implications for psychodynamic theory and
practice are considered.




                                              293
Poster Session B

Title:                 What is a Question in Psychoanalysis ? ---- On Nature and Relevance
                       of Questions as Therapeutic Tools

Authors:               Ricardo A. Silva, Paulo L. R. Sousa, Ricardo T. Pinheiro

Address for Correspondence:

                       Ricardo A. Silva
                       NUPPLAC – Research Center on Psychoanalysis and its Applications,
                       School of Pychology / Medicine, Universidade Católica de Pelotas,
                       Rua Alm. Barroso, 1202 sala 4, CEP 96010 – 280, Pelotas – RS –
                       Brazil

                                        ABSTRACT

Questioning is scarcely studied in psychoanalysis and derivative procedures. Neither Freud
nor Klein examined questions as real interventions in the setting, although the first appeared
to use them freely in his analytic dialogues. Klein whose questions are almost absent from her
sessions, had an assertional style, on the contrary. Using a source of literary (Pablo Neruda‘s
Book of Questions) and clinical vignettes it was possible to identify that a projective
component is a relevant part of the communicative nature of questioning. Besides, according
to the sense attributed to questions, they may operate as an expansor or restrictor of the
preconscious systems in action, greatly influencing process development. An historical
overview of analytical dialogues in some areas of Latin America showed that questions
almost inexistance during Kleinian splendor in the 60‘s and thirty years later they expanded to
a 30% of all analytic interventions (in the 90‘s). Theory of communication and theory of
relevance were employed in the discussion.




                                              294
Poster Session B

Title:                    Working with Adolescents: Brief Counselling Service or
                          Psychotherapy?

Author:                   Carla Candelori

Address for Correspondence:

          Carla Candelori
          Dipartimento di Psicologia dei Processi di Sviluppo e
         Socializzazione. Facoltà di Psicologia.
         Università degli Studi ―La Sapienza‖, Roma.
         Via dei Marsi 78. 00185 Roma , Italy
         FAX: 06 / 49917652
         E Mail: aciocca @pelagus.it

                                            ABSTRACT

Psychotherapeutic work with adolescents can take different forms and have varied outcomes.
In this paper we will present some considerations about therapeutic work with adolescents in
the framework of a Service (Interdepartmental Clinical Center of Faculty of Psychology of
Rome) which undertakes brief (psychoanalytically oriented) interventions with young people,
that are usually self referred. Many authors have underline the opportunity to help adolescents
in difficulty with an intervention brief and offered quickly, but we know well that a number of
them require something more.

Our research is based on a retrospective review of 20 cases of patients (M and F), from 14 to
21 years of age, that have in common a fragility in structuring the experience around their
identity. We will discuss data from the initial clinical interviews with adolescents, in which
is possible to explore a large variety of aspects that need to be basically considered to value
the possibility of further psychotherapeutic treatment (personality organization, ego structure,
defensive mechanisms, not verbal communication, etc.).




                                                295
Panel Session 29 - Overall Summary

Title:                  Outcome in Clinical Studies of Group Psychotherapy

Participants:           Steinar Lorentzen, K. Roy MacKenzie

Moderator:              Anthony Joyce

Discussant:             Michael Lambert

Address for Correspondence:

         K. Roy MacKenzie
         201-1600 Howe Street,
         Vancouver BC, V6Z 2L9 CANADA
         Tel: 604 822 7669
                        Fax: 604 669 7783
                        Email: rmack@interchange.ubc.ca

                                         ABSTRACT

A series of review papers have documented the efficacy of group psychotherapy in controlled
studies, concluding that outcome appears to be in the same range as that of individual
psychotherapy. Despite these findings there is considerable reluctance to accept that group
treatments can be effective in clinical settings. The two papers presented in this panel provide
outcome data on the effectiveness of group psychotherapy in clinical practice settings in
Norway and Canada.

The papers survey a number of groups conducted by each of the authors. The first is based in
a private practice setting and utilizes broad criteria of psychological distress. The groups are
open with slow patient turn-over and treatment duration is over one year The second is
located in a mood disorders clinic where all participants were experiencing major depression,
but with many members also meeting other Axis I diagnoses. The groups are closed and
time-limited to 16 sessions. Both of these settings are reasonably representative of the usual
routes by which patients enter group psychotherapy treatment.




Panel Session 29 - Paper in Panel

Title:                  Change During Long-Term Analytic Group Psychotherapy




                                               296
Author:                  Steinar Lorentzen

Address for Correspondence:

                         Department Group of Psychiatry, University of Oslo,
                         P.O. Box Vinderen 85, 0319
                         Oslo, Norway

                                            ABSTRACT

      There are very few studies on long-term group psychotherapy. This study is a naturalistic
follow-up study on effectiveness of long-term analytic group therapy for patients in private practice.
Research questions:
      1. What is the effectiveness of analytic group therapy with patients in a psychiatric private
      practice?
      2. Do initial severity of disturbance, presence of personality disorder, and treatment length
      predict outcome?
      3. Are there other predictors of outcome to be found with an explanatory statistical analysis?
Material: By December 1998, sixty-seven patients have been included in three groups, Forty-five
have ended therapy and have been followed up one year after termination. Most patients have a
DSM-III-R axis I diagnosis, 69% have an axis II diagnosis, mostly cluster C. Diagnosis has for 20% of
the patients been conducted by independent SCID interviews by two psychiatrists, the rest by Spitzer‘s
LEAD standard (Two psychiatrists independently evaluating all data). Pretreatment status was GAF
57 (5.8), SCL-90 (GSI) 1.17 (.55), IIP 1.57 (.55). They are assessed before and after therapy, and one
year after termination on symptoms (SCL-90), interpersonal problems (IIP), social situation
(SAS-SR), global functioning (GAF), and three target goals. In addition they are evaluated on global
change at termination and follow-up. On two thirds of the patients I also have repeated measures on
SCL-90 and IIP during the treatment.

      Method: Pre-post differences and effect sizes are calculated. Patient characteristics are
correlated with outcome and by use of multiple regression analysis the more complex relationships
between patient characteristics, process and outcome are analyzed.

      Results: The drop-out rate was very low (2 patients<6months). The patients stay on average 27
(15) months in treatment. The sample improves on all outcome variables to a significant degree during
treatment, and improvement continues statistically significant during the follow-up year on most
measures. The results will be discussed with regard to criteria for selection of patients to the group,
to evaluation/preparation before starting treatment and to recent literature in the field.

Panel Session 29 - Paper in Panel

Title:                   Anti-Depression Interpersonal Psychotherapy Groups: Preliminary
                         Effectiveness Data

Author:                  K. Roy MacKenzie

Address for Correspondence:
      201-1600 Howe Street,
      Vancouver BC, V6Z 2L9 CANADA



                                                  297
        Tel: 604 822 7669 Fax: 604 669 7783
                       Email: rmack@interchange.ubc.ca

                                              ABSTRACT

       This study reports the outcome of 10 time-limited groups designed to treat patients with
treatment-resistant depression. The theoretical model is an adaptation for group use of Interpersonal
Psychotherapy (IPT). Each member receives two assessment interviews, sixteen 90-minute weekly sessions
and a four-month individual follow-up interview.
       The assessment process includes a general psychiatric assessment with an emphasis on depressive
episodes, response to treatment interventions and co-morbid conditions. A survey of family-of-origin
relationships is conducted and the presence of specific difficult events identified. Particular attention is
focused on psychosocial issues including triggering events, loss or bereavement experiences and current
state of social functioning, regarding both intimate relationships and general social/occupational
involvement. A standard change measures battery is administered. The final portion of the second
assessment interview is a collaborative discussion of the major issues that will need attention. These are
later entered into a Focus Areas sheet (Target Goals format) for later use in the group.
       The Anti-depression Interpersonal Group is designed for patients who have experienced repeated
episodes of major depression and may have a history of significant dysthymia as well. This group model
is not suitable for patients with a bipolar diagnosis or severe psychotic depression, nor for those
experiencing acute major suicide risk. The group begins with a full exploration of the depressive
syndrome and its impact on members‘ lives. This includes attending to daily lifestyle patterns that will
help to combat isolation. The focus then shifts to the connections between depression and interpersonal
relationships. These connections are seen as a complication of depression, and no assumptions are made
regarding cause or effect. An intensive but semi-structured approach to the current nature of important
relationships is used. Group interaction is emphasized and affective responses facilitated. The focus
remains on current and future problems, and extended discussion of topics related to past experiences is not
encouraged (with the exception of delayed grief reactions). Medications are not managed within the
group. The group meets weekly for 90 minutes for 16 sessions. No new patients are admitted after the
third session.
       The change measures consist of the Outcome Questionnaire (OQ-45), Inventory of Interpersonal
Problems (IIP) and Beck Depression Inventory (BDI) administered at intake, mid-point, termination and
follow-up, plus a Client Satisfaction Questionnaire at termination and follow-up. Results are reported for
the entire patient population and for each group separately.




                                                    298
Panel Session 30 - Overall Summary

Title:                  Working With Dreams

Participants:           Ursula E., & Oberst Ramon, Marianne Eberhardt, Andreas von
                        Heydwolff

Moderator:              Horst Kaechele

Discussant:             Clara Hill

Address for Correspondence:

         Abteilung Psychotherapie und Psychosomatische Medizin
                        Universitätsklinikum Ulm
         Am Hochstraess 8,
         89081 Ulm, FRG
         e-mail: kaechele@sip.medizin.uni-ulm.de. http://sip.medizin,uni-ulm.de/

                                         ABSTRACT

      Dreams as topic of psychotherapy research have not held a prominent place. Clara
Hill´s clinical and research oriented work has contributed to re-open this issue also for SPR
members.

      For European psychotherapists from a psychodynamic perspectives dreams have remain
a fascinating issue. Not always the royal road to the unconscious it remains a fascinating
material to work with in clinical practice. The more it is incumbent to open a research
perspective.

      The panel proposes three contributions featuring different approaches to the material
offered by dreams. A constructivistic approach (Oberst) of dream interpretation, a study of
dream process in a audio-recorded psychoanalytic case (Eberhard et al.) is sided by a study on
therapists experience with dreams of their own (Heydwolf).




Panel Session 30 - Paper in Panel

Title:                  Amalia´s Dreams - Dream Series Analysis as Process Tool

Authors:                Marianne Eberhardt, Marianne Leuzinger-Bohleber, Horst Kächele



                                              299
Address for Correspondence:

                       Abteilung Psychotherapie und Psychosomatische Medizin
       Universitätsklinikum Ulm
                       Am Hochstraess 8
                       89081 Ulm, FRG
       e-mail: kaechele@sip.medizin.uni-ulm.de http://sip.medizin,uni-ulm.de/

                                        ABSTRACT

       Even if most discussions about dreams in clinical practice are focused around a single
dream it is evident that reporting of dreams during a psychoanalytic treatment belongs to one
of the most regular and repetitive phenomena of that kind of therapy. Patients dream more or
less, and analysts differ to the extent they use the dreams offered by the patient. As a
compromise formation a non-conscious, non-intential agreement on the relevance of dreams
for the treatment between patients and analysts is established. Very few studies have studied
systematically the process of change as represented in dream material.

      This study uses a large sample of dream material of one patient to test for models of
change over the whole course of a psychoanalytic treatment. The findings are based on more
than 250 audio-recorded sessions and the ratings based on a cognitive model have been
reliably evaluated by three external raters.




                                             300
Panel Session 30 - Paper in Panel

Title:                  Constructivist Approaches of Working with Dreams: Comparative
                        Study of Two Qualitative Interpretation Procedures

Author:                  Ursula E., & Oberst Ramon

Address for Correspondence:

                        Llull University Barcelona (Spain)

                                         ABSTRACT

      This study is embedded in a constructivist investigation paradigm and compares two
different constructivist approaches of interpreting dreams, one as a standardised interview
technique among investigator/therapist and subject/client and the other as a discourse analysis
of the dream narrative. The interview technique is derived from a integrative theoretical
model developed by the author as a combination of Individual Psychology (Alfred Adler) and
Personal Construct Psychology (George Kelly), following Neimeyer's (1992) proposition of
integration in psychotherapy. This model is elaborated into a manual that can be used by the
therapist in a standardised way for working with dreams in therapy. In the first period of the
present investigation, a trained co-investigator applies this technique to volunteer (normal and
clinical) subjects who present the recollections of their dreams in written form. The interview
is tape-recorded and a final conclusion of the personal meaning of the dream for the subject is
drawn. Then, the subject is asked about the relevance of the result for his/her personal issues.

      As a second step, the dream recollections are submitted to discourse analysis, a
qualitative constructivist procedure for text interpretation, by another co-investigator who is
blind for the results of the first step. Finally, the results of both procedures (interview and
discourse analysis) are compared and their pragmatic value for reflecting the personal
meaning of the dream is evaluated.




Panel Session 30 - Paper in Panel

Title:                  Therapists´ Dreams and Their Relation to Therapeutic Work - A
                        Survey




                                               301
Author:                 Andreas von Heydwolff

Address for Correspondence:

                        E-mail: 106624.446@compuserve.com

                                          ABSTRACT

      A questionnaire covering demographic, cultural, educational, and training/qualification
characteristics of subjects, as well as variables concerning their theoretical preferences, own
dreaming history and behavior, caseload, experience, professional setting, and further items
was given in English and German respectively to the mixed international group of 3000
therapists who attended the first congress of the World Council for Psychotherapy in Vienna
in 1996. The same questionnaire was handed out or sent to German Jungian analysts in 1997.
The returns were relatively few in the first instance (n=123 of 3000) but n-1 came from
subjects highly interested in dream work. In the second instance the return rate was much
higher (n=52 of 390). Processing and analysis of the data has begun, and the absolute
number of responses makes it possible to search for patterns of factors influencing therapists'
choice of dream work as a mode employed regularly in their work with patients.

       The results will shed light on the extent of the utilization of dream work by the subjects,
their experience of different teaching formats and settings for dream work, and factors
contributing to the occurrence of nightmares in therapists. A comparison of Jungian
participants with their known emphasis on dream work and therapists with backgrounds in
other methods can yield further specific results. The study serves as a basis for the generation
of more specific hypotheses about circumstances on the therapists' side under which dreams
may enter therapy.




                                               302
Panel Session 31 - Overall Summary

Title:                  Social Phobia - Cognitive-Behavioral Approaches and the Underlying
                        Change Mechanisms

Participants:           David Clark, Ulrich Stangier, Ulrike Willutzki

Moderator:              Ulrike Willutzki

Address for Correspondence:

                        Ulrike Willutzki
                        Department of Psychology
                        Ruhr-University Bochum
                        D-44780 Bochum
                        Germany

                                           ABSTRACT

     Social phobia has been a recognized diagnostic entity for only two decades now. While
exposure as a treatment approach for phobias was shown to have some effects also in social
phobia, a sizeable number of patients reported only partial or no improvement.

This deficit has led more elaborated conceptualizations in the last years, particularly the
cognitive model of social phobia developed by Clark and Wells (1995).

By looking at the nature of negative self-imagery in social phobia compared to other patients
David Clark validates a salient aspect of the model. Moreover, the conditions under which
therapeutic change is more likely to occur in video feedback are described and explored.

Group therapy has long been advocated in the treatment of social phobia as an ideal setting
that provides exposure and thus enhances change. Ulrich Stangier, Thomas Heidenreich and
Monika Peitz will compare the change processes occurring in individual resp. group therapy.

Social phobia is accompanied by strong self-dejective tendencies that contribute to further
demoralization. Ulrike Willutzki, Hilde Haas and Barbara Neumann report on a treatment that
combines cognitive-behavioral approaches with an emphasis on patients resources.




                                               303
Panel Session 31 - Paper in Panel

Title:                 Negative Self-Imagery in Social Phobia and its Treatment

Author:                David M. Clark

Address for Correspondence:

                       David M. Clark
                       Department of Psychiatry
                       University of Oxford
                       Warneford Hospital
                       Oxford
                       OX3 7JX
                       UK

                                         ABSTRACT

Clark and Wells (1995) proposed a cognitive model of social phobia which places particular
emphasis on the role of negative self-imagery in the maintenance of the disorder.

Two structured interview studies which investigated spontaneously occurring images in social
situations are reported. Compared to non-patient controls, patients with social phobia are
more likely to report negative, distorted, observer-perspective images of themselves. The
images appear to be linked to early memories of traumatic social encounters and show little
evidence of updating in the light of more recent experience.

Several cognitive therapy techniques for modifying social phobia related images are
described. One of the most potent techniques is video feedback. An experimental study
demonstrating the importance of careful cognitive preparation for facilitating the effects of
video feedback is presented.

Simply viewing a video of onself after giving a speech had a modest effect on distorted
self-perception. Cognitive preparation, as advocated in the Oxford Cognitive Therapy
Programme, substantially enhanced this effect.




                                              304
Panel Session 31 - Paper in Panel

Title:                 Process of Cognitive-Behavioural Individual and Group Treatment in
                       Social Phobia

Authors:               Ulrich Stangier, Thomas Heidenreich, Monika Peitz

Address for Correspondence:

                       Ulrich Stangier
                       Institut für Psychologie
                       J.W.Goethe-Universität
                       Postfach 11 1932 Fach 120
                       D-60054 Frankfurt am Main
                       Germany

                                        ABSTRACT:

Cognitive-behavioural therapy of social phobia includes exposure to critical social situations
and modification of dysfunctional cognitions. However, the effect of group vs. individual
treatment setting might be different on challenging negative thoughts and exposure to
anxiety-provoking situations. For instance, it has been suggested that the participation in
group sessions and discussion of problems might be associated with an exposure to social
phobia itself. The present study compares the effectiveness of cognitive-behavioural
individual and group therapy with a waiting-list control group. Based on the therapy
rationales developed by Clark (1997) and Wells (1997) treatments include the development of
a model of social phobia, manipulation of safety behaviours and externalisation of attention,
use of video feedback to reconstruct a realistic representation of self, behavioural experiments
to test dysfunctional beliefs, and identifying and challenging basic assumptions. Both group
and individual treatment comprise 15 treatment sessions and a maintenance program for
relapse prevention.

Treatment effects were assessed using self-rating and behavioural ratings at pre-treatment,
posttreatment and nine-month follow-up. Process variables included weekly ratings of social
phobic cognitions and anxiety level.

At the symposium, data on process variables will be presented on 15 subjects in each of the
treatment conditions.




Panel Session 31 - Paper in Panel

Title:                 Patients‘ Resources in the Treatment of Social Phobia




                                              305
Authors:                Ulrike Willutzki, Hilde Haas, Barbara Neumann

Address for Correspondence:

                        Ulrike Willutzki
                        Department of Psychology
                        Ruhr-University Bochum
                        D-44780 Bochum
                        Germany

                                          ABSTRACT

Social phobia is commonly associated with a particularly negative self-image and a tendency
to devaluate oneself. Patients do not see and use their resources and potential any more;
moreover they do not differentiate between them and avoidance tendencies resp. safety
behaviors. This devaluation of one‘s potential contributes to a vicious circle between negative
experiences, negative self-image and an avoidant or passive stance towards social situations.

In this panel the rationale for treatment strategies that focus on patients‘ resources and are
also informed by current cognitive-behavioral approaches will be described.

The impact of this treatment on patients‘ self-relatedness (Orlinsky & Howard, 1986), the
self-efficacy judgement and their use of self-directed exposure in the therapy process will be
explored.




                                               306
Panel Session 32 - Overall Summary

Title:                  How Much Dynamic Change in Long-term Psychotherapy and
                        Completed Psychoanalysis ?

Participants:           Carmella A. Roy, Serge Lecours, J. Christopher Perry

Moderator:      J. Christopher Perry

Address for Correspondence:

                McGill University at
         The Institute of Community & Family Psychiatry
         S.M.B.D. Jewish General Hospital
         4333 Chemin de la c6te Ste-Catherine
         Montreal, Quebec H3T 1E4 (Canada)

                                        ABSTRACT

The effects of long-term treatment are not well described because of the difficulty of
conducting long term studies. The aim of this panel is to present results from two samples of
patients in long-term treatment. The first is a collection of completed psychoanalyses and the
second an ongoing study of individuals in long-term dynamic psychotherapy. Both studies
were naturalistic and prospective, in which sessions were audiotaped and later transcribed for
study. Both studies used dynamic treatments and so we examine basic psychopathology and
its change from a dynamic model.

Dr. Roy will present changes in defensive functioning in the collection of cases of completed
psychoanalyses. Dr. Lecours will present a new instrument that quantifies the mode of
expression and level of regulation by specific affects. He will examine changes in affect
regulation over time in long term dynamic psychotherapy. Finally, Dr. Perry will present data
on changes in defenses in the same long-term therapy sample. All data will be summarized in
a comparable way using effect sizes.

It is clear that changes occur over the course of psychoanalysis and long-term dynamic
psychotherapy, and that dynamic changes in particular occur slowly. While experimental
comparison to other short and long-term treatment types is a highly desirable step, these
naturalistic samples can illuminate the issues in understanding dynamic change.




                                              307
Panel Session 32 - Paper in Panel

Title:                 Changes in Defensive Functioning in Completed Psychoanalyses: The
                       Penn Psychoanalytic Treatment Collection

Authors:               Carmella A. Roy, J. Christopher Perry, Lester Luborsky, Elisabeth
                       Banon

Address for Correspondence:

               The Institute of Community & Family Psychiatry
         S.M.B.D. Jewish General Hospital
         4333 Chemin de la cote Ste-Catherine
         Montreal, Quebec H3T 1E4 (Canada)

                                           ABSTRACT
Psychoanalysis encompasses both a theory of psychopathology and treatment. Psychoanalytic
psychopathology includes conscious and unconscious motives, defenses, and object relations.
The treatment includes classical analysis, a number of modifications of psychoanalysis, and
the psychoanalytically oriented psychotherapies. Theory predicts that patients completing
psychoanalysis should improve in their dynamic functioning as well as other descriptive
psychopathology and functioning. Our aim is to examine whether a sample of patients
completing psychoanalysis improve on one dynamic measure, their defense mechanisms.
The sample includes 15 cases from the Penn Psychoanalytic Treatment Collection which were
designated a priori by their analysts as research cases and which had audio recorded sessions
that were later transcribed. We selected sessions 1, 3 and 5 for early assessment, and two or
three sessions at the 90% point of completion. Patients were generally seen 4 times weekly
and the total number of sessions at completion varied from 400 to 1500. Descriptive measures
of functioning (e.g. HSRS, GAF) were rated by two raters. Defenses were subsequently rated
by raters blind to other data, using the Defense Mechanism Rating Scales (DMRS). The
number/date of each session was disguised and presented in random order to prevent bias
attributable to knowing the session number.
We examined the changes in individual defenses, defense levels, and Overall Defensive
Functioning from early to late session. We specifically tested the hypothesis that patients
should use fewer lower level (e.g. acting out) and more high adaptive level (e.g. suppression)
defenses, with some improvement in neurotic level defenses (e.g. repression) as well. Change
in defensive functioning was also compared to change in descriptive functioning. Together
these data portray how much change occurs in a naturalistic sample of outpatients who
completed psychoanalysis, and indicate that psychoanalysis does improve defensive
functioning.


Panel Session 32 - Paper in Panel

Title:                 Changes in Affect Regulation over three Years of Dynamic
                       Psychotherapy: A Preliminary Report from The McGill Psychotherapy
                       Follow-Along Study



                                             308
Authors:               Serge Lecours, J. Christopher Perry

Address for Correspondence:
             The Institute of Community & Family Psychiatry
      S.M.B.D. Jewish General Hospital
      4333 Chemin de la cote Ste-Catherine
      Montreal, Quebec H3T 1E4 (Canada)

                                             ABSTRACT
Affect plays a central role in psychodynamic and other psychological theories. One of the
characteristics of health is the ability to tolerate distressing affects and express them in
constructive ways. Affects have generally been characterized either by their content (e.g.
sadness, anger) or by their formal properties (e.g. Dahl's three dimensional system), but not
by a system that combines content, form and the regulation of affect. Dynamic theory
suggests that symptom psychopathology, such as depression, should be associated with
disturbances in the regulation and expression of certain affects, and that these specific
disturbances should improve with successful treatment. This report offers a preliminary test of
this hypothesis.
The sample includes 10 patients from the McGill Psychotherapy Follow-along Study who
have completed up to three years of individual dynamic psychotherapy with experienced
therapists. All sessions were tape recorded. Subjects were admitted with either depression
(either major depression or dysthymia or both), an anxiety disorder, or personality disorder.
We examined two early sessions (number 3, 5) and two at about three years. Sessions were
transcribed, and the subject's verbatim were rated by the Grille d'l~laboration Verbale de
l'Affect (GI~VA) [English title, Verbal Elaboration of Affect Scales], which contains two
dimensions. The first describes the Channels or Modes of Representation of affect, including
somatic, motor, imagery and verbalization. The second dimension is the Level of Tolerance
which varies from the lowest level 1, disruptive impulsion, to the highest level 5), meaning
association. Raters first identified the affect segments in the text. Next, the affect segments
were rated for the GP, VA categories, and finally for the specific affect content. Data were
analyzed separately by specific negative affect (sadness, fear, anger, shame, guilt) comparing
the G~VA categories at the outset and at three years of treatment.
Problems regulating specific negative affects differed across subjects. Improvement at three
years was more marked for the most problematic affects than the others. Although
preliminary, the results are consistent with the hypothesis that improved regulation of affect
following treatment is one aspect of healthier functioning.
Panel Session 32 - Paper in Panel

Title:                 Changes in Defensive Functioning After Both Six Months and Three
                       Years of Dynamic Psychotherapy: A Preliminary Report from The
                       McGill Psychotherapy Follow-Along Study

Authors:               J. Christopher Perry, Michael Bond, Natali Sanlian, Judy Kolmeir,
                       Suzanne Marcotte

Address for Correspondence:



                                              309
        McGill University at
        The Institute of Community & Family Psychiatry
        S.M.B.D. Jewish General Hospital
        4333 Chemin de la cote Ste-Catherine
        Montreal, Quebec H3T 1E4 (Canada)

                                            ABSTRACT

The aim of this report is to examine change in defensive functioning in a cohort of adults receiving
long-term psychotherapy. Evidence to-date suggests that an individual's defense mechanisms change
quite slowly. This is especially true for individuals with moderate to serious psychopathology.
Defense mechanisms are an excellent measure to examine because individuals tend to use
characteristic defenses, and they can be quantitatively identified in psychotherapy sessions, and yield
good summary measures, such as Overall Defensive Functioning (ODF). We predicted that minimal
change would be evident after six months of therapy (effect size less than .3), whereas change would
be substantial at 3 years (effect size greater than 1). Further we hypothesize that mot of the
improvement would be seen in the low defense levels. The sample includes 30 patients from the
McGill Psychotherapy Follow-along Study who have completed six months to three years of
individual dynamic psychotherapy with experienced therapists. The study design allowed treatment for
up to three years. All sessions were tape recorded. Subjects were admitted with either depression
(either major depression or dysthymia or both), an anxiety disorder, or personality disorder. We
examined three early sessions (number 3,4,5) and three at six months. We also examined three
sessions at three years for patients who attained that length of treatment. Sessions were transcribed,
and each subject's transcript was rated using the Defense Mechanism Rating Scales (DMRS). This
yields quantitative ratings of 28 individual defenses, divided into 7 defense levels hierarchically
arranged by their general level of adaptiveness (e.g. acting out is low, whereas suppression is high).
ODF, the weighted average of all defenses, is an excellent summary measure of defensive healthiness,
which varies from a low of I to 7.

We present our results on change in defenses and discuss which defenses change, and how the order of
improvement helps us understand what psychotherapy does in its early and later phases.




                                                 310
Panel Session 33 – Overall Summary

Title:                 Haven‘t We Heard Enough About Non-Specific Factors? New
                       Approaches to Understanding the Therapist‘s Interpersonal
                       Contribution

Participants:          Hans H. Strupp, Larry E. Beutler, and Timothy Anderson

Moderator:             Timothy Anderson

Address for Correspondence:
                     Department of Psychology
      Ohio University
      Athens, OH 45701 USA
                     Phone: 740-593-1062
                     FAX: 740-593-0579

                                         ABSTRACT

This panel will explore new approaches to what has been traditionally referred to as
―non-specific factors,‖ especially those involving the relationship skills of the therapist.
Each of the panelist begin from the assumption that therapist relationship skills provide a
significant contribution to the development of an alliance and outcomes. Yet each panelist
resists the conventional non-specific factors explanation for these therapist qualities and each
suggest innovative ways of seeing this problem in a new light.
Strupp suggests that partitioning the therapist‘s actions as non-specific and specific does an
injustice to the complexity of the therapeutic experience. That is, the ―new experience‖ that
a therapist may provide to a patient is misunderstood, and ultimately minimized, when
attempting to define the therapist‘s role as a ―dosage‖ of treatment. He argues that new
models of therapy, beyond the traditional medical model, are needed.
Beutler largely concurs with this argument, but also explores the unique contribution of
therapist relational qualities. Relational qualities are minimized when examined in isolation
of the larger therapeutic environment and an aptitude X treatment model may help to clarify
the significance of the therapist‘s contribution. He presents data that demonstrates that when
treatment method is matched with client characteristics such as defensiveness, the effect of
therapist relational skills is greatly enhanced. These data support Beutler & Clarkin‘s
Systematic Treatment Selection model.
Anderson also suggests that the traditional non-specific factors explanation is inadequate, but
approaches the problem through greater specification of the therapist‘s interpersonal skills.
He presents the results of a study in which therapists were selected by their level of
interpersonal skills. The therapists in the study either had some training or were complete
novices.




                                              311
Panel Session 33 - Paper in Panel

Title:                 Toward Some Clear Thinking about Specific and Nonspecific Factors

Author:                Hans H. Strupp

Address for Correspondence:

                       Department of Psychology, 301 Wilson Hall
                       Vanderbilt University
                       Nashville, TN 37240 USA
                       Phone: 615 - 322 - 0049
                       FAX: 615 - 343 - 8449

                                          ABSTRACT

One would think that by this time there would be general agreement that the
specific-nonspecific dichotomy is an attempt to solve a pseudo problem. I suggest, as I have
done in various places (e.g., Strupp, 1998) that some misapprehensions, like the preceding
one, never seem to fade away although research, coupled with some clear thinking, should
have led us to that conclusion.

The term "nonspecific" is merely a synonym for ignorance, and the therapeutic influence
cannot sensibly be broken down, as has been attempted in the past. In this presentation I shall
try to approach this thorny problem from a somewhat different perspective:

In particular, I will consider that the therapist influences the patient in many ways, of which
"empathy," "warmth," on one hand, and "techniques," on the other, are only a part. To solve
the problem by statistical means unfortunately has not taken us very far. By contrast, efforts
to treat psychotherapy by analogy to learning and education may be more promising than
following the medical model yet we must acknowledge that psychotherapy, at its best, serves
a healing function. In any case, there is a long way to go before significant headway is made.




Panel Session 33 - Paper in Panel

Title:                 The Differential Role of Therapist Relationship Skills and Techniques
                       in Effective Psychotherapy

Author:                Larry E. Beutler




                                              312
Address for Correspondence:

                         Department of Education
                         Counseling/Clinical/School Psychology Program
                         University of California
         Santa Barbara, CA 93106 USA
                         Phone (805) 893-8064
                         FAX (805) 893-7264

                                         ABSTRACT

It is commonly assumed that therapist relationship skills are "non-specific" in the equation
that leads to effective treatment outcomes. An analysis of 284 cases drawn from archival
data representing a wide variety of treatment models, however, reveals that the importance of
relationship and interactive skills may depend on how well the therapist's approach "fits" the
needs of the patient. An analysis of the Systematic Treatment Selection model of
intervention proposed by Beutler and Clarkin reveals that relationship quality and
interpersonal style alone are not strong predictors of treatment benefit. However, when the
method of intervention is suitably fit to the patient's level of defensiveness and level of
subjective distress, the power of the relationship qualities are greatly magnified. Thus,
non-specific qualities may be an indirect indicator of how well matched the treatment is to the
patient and in the case of a good fit, serve as mediators of benefit.




Panel Session 33 - Paper in Panel

Title:                   Specifying ―Non-Specifics‖ in Therapists: The Effect of Facilitative
                         Interpersonal Skills on Outcome and Alliance Formation

Author:                  Timothy Anderson

Address for Correspondence:
                    Department of Psychology
    Ohio University
    Athens, OH 45701 USA



                                               313
                       Phone: 740-593-1062
         FAX:          740-593-0579

                                           ABSTRACT
This study focuses on the interpersonal qualities of the therapist, which has recently been
noted as a neglected variable in psychotherapy research. Past studies have attempted to
isolate these ―non-specific‖ qualities from specific techniques by comparing untrained
‗therapists‘ with therapists who have been trained in specific techniques. The assumption
has been that a variety of therapist ―non-specific‖ factors were equivalent in both groups,
isolating the effects of specific techniques and training. Strupp & Anderson (1997)
questioned this assumption and Strupp (1996) argued that trained and untrained therapists
differ in numerous other ways. Thus, rather than specifying techniques, the present study
specified the interpersonal skills of the therapists.
Twenty therapists with little to no training were selected based on their level of interpersonal
skills and training (i.e., Skills X Training). Therapists were grouped into high and low skill
groups based on their score from a paper-and-pencil measure of social skills. Final
placement in the high and low interpersonal skills group was made through a performance
analysis, a structured task in which therapists responded to videotapes of ―difficult‖ patients
(hostile and dependent patients who either attacked, or asked to be nurtured by, the therapist).
Also, half of the therapists were clinical psychology graduate students and the remaining half
were graduate students in a discipline other than clinical psychology or related fields (e.g.,
biological sciences). Each therapist saw 2 clients for 7 individual sessions
Outcome was assessed with the Outcome Questionnaire (OQ), the Inventory of Interpersonal
Problems, and the SCL-90-R at pre-treatment, termination, and a 3-month follow-up. The
therapeutic alliance was also assessed at these intervals with the Working Alliance Inventory
(WAI), which was completed by both clients and therapists. In addition, the OQ and WAI
was administered at sessions 1, 3, 5, and 7 for more refined tracking of the alliance and
symptomatic change. Results will be related to the notion that therapist interpersonal skills
are an important foundation, perhaps a pre-requisite, for training in therapeutic techniques.

Panel Session 34 - Overall Summary

Title:                 Psychoanalysis and Creativity: A Longitudinal Investigation of a
                       Creative Writer

Participants:          Erhard Mergenthaler, Donald H. Baucom, Alan Stern

Moderator:             Alan Stern

Discussant:            Wilma Bucci

Address for Correspondence:
                    Alan Stern, Ph.D.
                    Lucy Daniels Foundation
                    9001 Weston Parkway
                    Cary, NC 27513 USA
                    astern100@aol.com



                                              314
                                            ABSTRACT

This panel will focus upon the research activities of the Lucy Daniels Foundation, emphasizing (a) the
psychotherapy process, (b) creative writing, and (c) the relation between psychoanalysis and creativity
for Patient 247, a creative writer. In accomplishing this task, the panel will rely upon several sets of
integrated data gathered on this patient during the same time period. First, Mergenthaler will examine
changes in the therapeutic process in relation to the patient's creative writing for first two years of
treatment using computer-based indexes of emotion-abstraction and referential activity applied to both
types of material.. Second, Baucom explores changes in the patient's creative activity during the
same period ,and using an observational coding system applied to a series of work interviews .These
work interviews occurred each six months, the same time period as the other measures gathered for the
panel presentation. The observational coding system allows for an evaluation of the patient's
changing motivations for writing, affect about writing, the use of approach and avoidance strategies in
addressing writing, and the patient's overall attachment to writing. These changes in attachment to
writing will be related to Mergenthaler's evaluations of the therapeutic process and the writing samples
at the same time period. Third, Stern will provide an additional perspective on the therapeutic process
of this same patient, based on an in-depth evaluation of each therapy session by the analyst, employing
the Analyst's Session Evaluation Form. This form provides the analyst's evaluation of the patient's
behavior, emotion, defense mechanisms, transference reactions, etc. on a session-by-session basis. In
addition, the patient evaluates the therapy process each six months. These analyst and patient
perspectives on the therapeutic process will be viewed relative to (a) changes in Mergenthaler's
computer-based analysis of session transcripts, (b) changes in the writing samples using
Mergenthaler's same measures, and (c) the changes in relationship to writing assessed by the writing
interviews. Across the three presentations, the panel will provide an integrated, multimethod
perspective on the relationship between psychoanalysis and creativity. Bucci will provide a
discussion of this multimethod approach to treatment and creativity.




                                                  315
Panel Session 34 - Paper in Panel

Title:                  Patterns of Therapeutic and Creative Activity Using Computer
                        Measured Concepts

Authors:                Erhard Mergenthaler, Wilma Bucci, Alan Stern, Donald H. Baucom

Address for Correspondence:

                       Erhard Mergenthaler
                       Universitat Ulm,Medizinische Fakultat
                       Sektion Informatik in der Psychotherapie
                       Am Hochstrasse 8
                       89081 Ulm, Germany
                       merg@sip.medizin.uni-ulm.de

                                         ABSTRACT

This study presents the results of a computer-based text analysis of psychoanalysis and
creativity in a single case. Patient 247 is a creative writer who has been treated for four years
in psychoanalysis. In addition to treatment four days a week, the patient has submitted a
sample of his creative writing every six months. He also provided a novel completed before
he started analysis.

The presentation assesses two years of treatment using blocks of 8 transcribed sessions
selected to coincide with 6 month submissions of writing samples .Both sets of data are
analyzed using the Therapeutic Cycle Model(Mergenthaler 1996) which includes an
examination of emotion-abstraction patterns(EAP) within and across therapy sessions. Special
attention will be given to "Shift Events" such as narratives and measured as computer
referential activity(CRA, Mergenthaler and Bucci,in press).

The uniqueness of this presentation stems from the availability of creative writing samples
during this same time period as the session samples. Thus, the presentation will also focus on
the symmetries and discrepancies between the patient's behavior within the therapy sessions
and his creative writing as measured by EAP and CRA.




                                               316
Panel Session 34 - Paper in Panel

Title:                  A Creative Writer's Changing Relationship to Writing Over the Course
                        of Psychoanalysis

Authors:                Donald H. Baucom, Alan Stern

Address for Correspondence:

                        Donald H. Baucom, Ph.D.
                        Davie Hall, CB#3270
                        Psychology Department
                        University of North Carolina
                        Chapel Hill, NC 27599-3270 USA
                        don_baucom@unc.edu

                                         ABSTRACT

This study has two major goals. First, it will present descriptive and psychometric
information about a new observational coding system developed to assess a writer's
relationship to his/her creative writing, The Relationship to Writing Coding System (RWCS).
The RWCS is a reliable measure that codes a semi-structured interview in which creative
writers describe their motivations for writing, their affect about writing, behavioral
approach/avoidance strategies in writing, and overall attachment to writing.

Second, the study will present the application of the RWCS to Patient 247 over the course of
four years of psychoanalysis. The patient participated in a one-hour semi-structured
interview about his creative writing every six months during the course of psychoanalysis to
date. The findings will be presented to demonstrate how his approach and relationship to
writing has changed during treatment. This information about creative writing was obtained
at the same time as (a) the psychotherapy process data and creative writing samples to be
presented by Mergenthaler and (b) the analyst evaluations of treatment sessions presented by
Stern in this same panel session.

Therefore, the current findings regarding relationship to creative writing will be related to the
changes demonstrated in psychoanalysis, along with a textual analysis of
the writing samples during these same time periods.




Panel Session 34 - Paper in Panel

Title:                  The Patient's Perspective and the Analyst's Perspective Over the
                        Course of Treatment

                                               317
Authors:               Alan Stern, Donald H. Baucom

Address for Correspondence:

                       Alan Stern, Ph.D.
                       Lucy Daniels Foundation
                       9001 Weston Parkway
                       Cary, NC 27513 USA
                       astern100@aol.com

                                         ABSTRACT

A major shift in contemporary psychoanalysis is the widespread agreement on the mutual
influence of analyst and patient on the form and outcome of treatment. As yet, there are few
empirical studies of such interaction over the life of a long in-depth treatment. In addition to
the audiotaping of all sessions , the Lucy Daniels Foundation has utilized some existing
instruments and designed some new research tools to help track this patient/analyst
interaction. The Analyst's Session Evaluation Form(ASEF), completed by the analyst
immediately after each therapy appointment, was created by the current investigators. It
includes sections on the analyst's perception of the patient's and his or her own feelings, self
states, transference reactions, defense mechanisms, etc. In addition to the analyst's
evaluation of each session, the patient provides an evaluation of therapy every six months. In
addition to these assessments of the therapeutic process and patient/analyst relationship, the
patient and a significant other provided evaluations of their relationship every six months.

The current paper provides an evaluation of the therapeutic process employing the ASEF
completed after each session by the analyst and Patient's 247 perception of the therapeutic
process. Changes in the therapeutic relationship also are examined relative to the patient's
relationship with a significant other over a four year period. Most importantly, this
assessment of the therapeutic process is examined relative to Mergenthaler's and Baucom's
findings on the same patient during the same time period. Thus, this final paper will provide
a synthesis of the therapeutic process and creativity across the three papers.




                                              318
Panel Session 35 -Overall Summary

Title:                  Spirituality and Psychotherapy Research: Some Recent Findings,
                        Challenges and Dilemmas

Participants:           Colin Purcell-Lee, David Orlinsky, David Smith, William West

Moderator:              William West

Address for Correspondence:

                       Dr William West,
                       Counselling Research & Training Group,
                       CEN, Faculty of Education,
                       University of Manchester, Oxford Road,
                       Manchester M13 9PL, England.
                       tel: 0161 275 3397
                       fax: 0161 275 3548.
                       email: william.west@man.ac.uk

                                         ABSTRACT

This panel, whilst presenting some recent findings into the religiosity of psychotherapists, will
consider anew the challenge to spirituality and psychotherapy research and practice of the
work of Martin Buber, and finally issues around qualitative research into spirituality and
psychotherapy are explored.




                                               319
Panel Session 35 - Paper in Panel

Title:                 The Implications of Martin Buber‘s Work for Psychotherapy

Author:                Colin Purcell-Lee

Address for Correspondence:

                       Dr Colin Purcell-Lee,
                       Counselling Research & Training Group,
                       Centre for Educational Needs,
                       School of Education,
                       University of Manchester,
                       Oxford Road,
                       Manchester M13 9PL.
                       England.

                                         ABSTRACT

The genuine person-to-person, here-and-now nature of the therapeutic relationship is
universally acknowledged as the sine qua non in counseling and psychotherapy with the
possible exception of behaviour therapy. The I-Thou relationship also is widely
acknowledged in the counseling and psychotherapy literature across a range of
humanistic/existential orientations and practice particularly: Gestalt Therapy, Client-Centered
Therapy, Existential Psychotherapy, Transactional Analysis and Robert Hobson's
Conversational Model of Psychotherapy. However, much confusion and misinterpretation
regarding Buber's formulation of the I-Thou relationship seems to exist that suggests a failure
to recognize that Buber seems to be talking about the ontological realm when he alludes to the
I-Thou relationship. Another difficulty, and not one simply of semantics, concerns the
apparent interchangeability in some of the literature of the term I-You for I-Thou. The
author will consider a method of clarifying the I-Thou relationship based on Buber's
I-Thou/I-It distinction. This paper acknowledges several central issues regarding the I-Thou
relationship: (i) the I-Thou relationship deals with different ways of knowing; (ii) it is
maintained that the I-Thou relationship concerns the hidden and mysterious nature of being
itself and cannot be willed or analyzed, (iii) the nature or content of this type of
relationship is non-verifiable, (iv) the I-Thou relationship is predominantly ontological rather
than epistemological. This study will consider several of Buber's concepts in relation to
psychotherapy and spirituality including: hallowing of the everyday; religion and
religiousness as presence; the realm of the interhuman and the largely unknown yet highly
congruent themes of presence and availability/unavailability.




                                              320
Panel Session 35 - Paper in Panel

Title:                  Relationship of Spirituality to Professional and Personal Characteristic
                        of Psychotherapists

Authors:                David Smith & David Orlinsky

Address for Correspondence:

                        Prof. David Orlinsky
                        Committee on Human Development,
                        University of Chicago,
                        5730 S. Woodlawn Ave.,
                        Chicago IL 60637, USA.
                        email: d-orlinsky@uchicago.edu.

                                          ABSTRACT

This study addresses the role that religion and spirituality play in the personal beliefs and
professional beliefs and practices of psychotherapists. It asks whether most psychotherapists
are irreligious or "secular," as is commonly believed, or do in fact regard themselves as
religious or spiritual persons in some sense. It does this by examining the extent to which
therapists value various aspects of religion and spirituality, and by distinguishing the
orientations to religion and spirituality underlying their reported experiences. Two basic
dimensions of therapists' experience are identified, and are used to construct a typology of
orientations to religion and spirituality. The study then examines the reported personal
religious development of therapists for each of these orientations, and asks whether
therapists reporting different orientations to religion and spirituality feel that their experiences
in that regard influence their therapeutic practice. Finally, the study asks whether therapists
who differ in their orientations to religion and spirituality also tend to differ in their
theoretical orientations and typical treatment goals. The results indicate that while the
psychotherapists in this study lean toward a secular orientation the majority value some public
or private aspect of religion or spirituality, close to a third score high on two dimensions of
religious experience (i.e., public and private). In general, they indicate a moderate influence
of religious/spiritual experience on their practice of psychotherapy. Religious and spiritual
orientations do not significantly relate to therapeutic orientation nor therapeutic goals. Much
of the results support previous research on the religious characteristics of mental health
workers. Further research is indicated to examine the meaning of religious influence on
therapy and to compare and explicate the characteristics of the various styles of religiosity
among psychotherapists.




                                                321
Panel Session 35 - Paper in Panel

Title:                  Facing the Challenge of Qualitative Research into Spirituality and
                        Psychotherapy

Author:                 William West

Address for Correspondence:

         Dr William West,
                        Counselling Research & Training Group,
                        CEN, Faculty of Education,
                        University of Manchester, Oxford Road,
                        Manchester M13 9PL, England.
                        tel: 0161 275 3397
                        fax: 0161 275 3548.
                        email: william.west@man.ac.uk

                                          ABSTRACT

Researching psychotherapy and spirituality using qualitative methodologies presents a
number of challenges which include: defining what spirituality is, and its relationship to
psychotherapy; dilemmas around the role of the researcher including that of bracketing; and
finally specific difficulties relating to spirituality - for example the ineffability of spiritual
experiences. Drawing on two recent research studies by the author Moustakas' heuristics will
be considered as one possible way of researching psychotherapy and spirituality that
addresses rather than avoids these challenges.




                                                322
Panel Session 36 – Overall Summary

Title:                  The Therapeutic Alliance Measures: Why Do They Sometimes Not
                             Predict Outcomes of Treatments?

Participants:           Louis Diguer, Kathleen Carroll, Lester Luborsky

Moderator:              Lester Luborsky

Discussant:             Adam Horvath

Address for Correspondence:

                        Lester Luborsky
                        Center for Psychotherapy Research
                        3600 Market Street, 7th Floor
                        Philadelphia, PA 19104-2648
                               (215) 662-2822
                               luborsky@landru.cpr.upenn.edu

                                         ABSTRACT

        Especially in the past 25 years, the therapeutic alliance measures have been widely
used as predictors of the outcomes of psychotherapy, with fairly consistent significant levels
of prediction (around .30). But there are some unusual non-significant predictive studies and
there are now enough of such studies to examine what contributes to non-significance. At
the present point of the analysis, 4 factors are identified: 1.) the range and variability of the
alliance and outcome measures, 2.) the different interactions of treatment type with the
alliance, 3.) the level of reliability of the alliance and the outcome measures, and 4.) the
time point in the early sessions for the alliance measures as predictors. We have examined
the combination of these factors in significant versus in non-significant studies and
identified which are most explanatory.

        The aim of the panel is to bring together the results of studies of the therapeutic
alliance so as to highlight both their usual level of prediction, as well as the reasons for
occasional non-prediction. The panel will concentrate on the discussion of the alliance
studies of 3 groups of researchers: Louis Diguer et al., Kathleen Carroll et al., and Lester
Luborsky et al.

       The discussant will integrate the reports of the three alliance studies with the help of
an update of his original review of alliance-outcome studies (Horvath & Symonds, 1991)
and with a focus on examining the characteristics of statistically significant versus
non-significant studies.

Panel Session 36 - Paper in Panel

Title:                  Factors That May Contribute to Non-Significant Prediction Based
                        on the Therapeutic Alliance in the Treatment of Major Depression

                                                323
Authors:               Louis Diguer, Lester Luborsky, Elizabeth Krause, Jenna Ermold,
                       Jacques Barber, Jill Levine and Alex Bloom.

Address for Correspondence:

                       Lester Luborsky
                       Center for Psychotherapy Research
                       3600 Market Street, 7th Floor
                       Philadelphia, PA 19104-2648
                       (215) 662-2822
                       luborsky@landru.cpr.upenn.edu

                                         ABSTRACT

        The aim of this study was to compare the predictive capacity of two types of alliance
measures: the self-report format (Helping Alliance Questionnaire: HAq-I) and the
observer-ratings-of-sessions format. The observer ratings of sessions by the Helping Alliance
Counting signs (HAcs) and the Helping Alliance Rating (HAr) methods were applied to a
sample of early sessions (session 3 & 5) for 19 patients by 2 judges independently. The
patients were in 16-session once weekly supportive-expressive psychotherapy (Luborsky et
al., 1995). 1.) The two types of predictors correlated with each other at only r =.5. 2.)Neither
one of these types of alliance methods produced significant levels of prediction of outcome of
supportive-expressive psychotherapy for major depression. 3.)The main explanatory factors
considered contributed in different degrees to the non-significance.




                                              324
Panel Session 36 - Paper in Panel

Title:                 A Grand-Scale but Just Barely Significant, Therapeutic Alliance Study

Authors:               Kathleen Carroll, Charla Nich, John Cecero, Lisa Fenton, and Tami
                       Frankforter

Address for Correspondence:

                       Kathleen Carroll
                       34 Park Street, SAC 208
                       New Haven, CT 06519 USA
                       (203)974-7595
                       kathleen.carroll@yale.edu

                                        ABSTRACT

        Project MATCH (Project MATCH Research Group, 1997) is the largest randomized
clinical trial of psychotherapies conducted to date, involving over 1726 individuals in 9
settings. While substance abuse and other patient outcomes were generally quite positive, the
therapeutic alliance, as measured by the Working Alliance Inventory, accounted for a
significant, but comparatively small percentage of variance in outcome. Factors that may be
associated with the alliance‘s limited predictive ability in this study will be discussed.

        To shed further light on this finding, data from a new study comparing the relative
psychometric properties of 6 measures of the therapeutic alliance (WAI-T, WAI-O, WAI-C,
CALPAS, Vanderbilt Therapeutic Alliance Scale, and Penn) in three types of manualized
therapies for the addictions will be presented. One major finding to emerge is that, while all
measures appeared to tap a similar general construct, the psychometric properties of the
instruments, and more importantly their relationships with patient outcomes, differed to some
extent across treatment type.




                                              325
Panel Session 36 - Paper in Panel

Title:                 Factors That May Contribute to Non-Significant Prediction Based on
                       the Therapeutic Alliance in the Treatment of Cocaine Addiction

Authors:               Lester Luborsky, Jacques Barber, and Robert DeRubeis

Address for Correspondence:

                       Lester Luborsky
                       Center for Psychotherapy Research
                       3600 Market Street, 7th Floor
                       Philadelphia, PA 19104-2648
                       USA
                       (215) 662-2822
                       luborsky@landru.cpr.upenn.edu

                                        ABSTRACT

        In the pilot study of the NIDA Cocaine Collaborative study, the alliance measures
only correlated with outcome measures at the 1-month outcome point (Barber et al., 1998). In
the clinical trial of the NIDA Cocaine Collaborative study (Crits-Christoph et al., in press),
we found a significant positive correlation for the alliance for the Supportive-Expressive (SE)
group and a significant negative correlation for the Cognitive Therapy (CT) group! The
combination was non-significant. We are currently scoring a session-based measure of the
alliance (HAcs) on a sample of the SE and CT groups that may reveal the basis for the
opposite direction of the correlations.

        This report is primarily a re-examination of 3 groups—cognitive therapy,
supportive-expressive therapy and drug counseling—both in the pilot and in the clinical trial
in terms of the main factors that show promise of explaining the unusual predictive
correlations, both separately and in combination.




                                              326
Panel Session 37 - Overall Summary

Title:                Recent Advances in the Measurement and Tracking of Therapeutic
                      Factors in Group Psychotherapy

Participants:         Addie Fuhriman, Scott Seaman, Sally Barlow, Germain Lietaer and
                      Paul Dierick

Moderator:            Gary M. Burlingame

Discussant:           K. Roy MacKenzie

Address for Correspondence:

                      Gary M. Burlingame
                      Department of Psychology, Brigham Young University
                      238 TLRB, Provo, UT 84602--USA
                      e-mail: gary_burlingame@byu.edu

                                       ABSTRACT

       Therapeutic factors are an ever present and important feature of the group
psychotherapy literature. While theoretical importance remains high, there is some question
regarding the adequacy of how these important constructs can and should be measured. The
two papers making up this panel provide an international ―snap shot‖ of recent empirical
advances in measuring these important group psychotherapy processes.

       The first reflects a statistical approach to ―uncovering‖ the common and unique
variance found in responses from 600 group psychotherapy members to a 155 item
questionnaire on therapeutic factors. The second involves a ―grounded theory‖ approach that
generates an underlying theory and subsequent anchored behavioral rating scale for three
therapeutic factors (insight, cohesion & catharsis). The discussant provides critical
commentary from a theoretical and empirical perspective.




Panel Session 37 - Paper in Panel

Title:                Client Perception of Therapeutic Factors in Group Psychotherapy:
                      Factor Structure and Validity Characteristics of Questionnaire

                                            327
                        Subscales

Authors:                Germain Lietaer and Paul Dierick

Address for Correspondence:

                      Germain Lietaer
               Counseling Centrum, K.U. Leuven
                      Blijde Inkoomststraat 13
               3000 Leuven, Belgium
                      e-mail: germain.lietaer@psy.kuleuven.ac.be

                                          ABSTRACT

        As a part of the Leuven Group Psychotherapy Process Project 600 members from 80
groups filled out a 155 item questionnaire on therapeutic factors as experienced during a
series of about 8 sessions (in the beginning or later phases of the group process). The groups
under study were highly diversified as to orientation (Behavioral, Client-centered, Gestalt,
Psychoanalytic, Psychodrama) and setting (Clinical, Outpatient, Growth groups for students
in clinical psychology and for trainees). Cluster- and factor-analyses yielded 28 basic scales,
7 second order clusters and 2 main factors (Climate and Psychological work).

        The 28 basic scales will be described and commented on as to the following aspects:
their position in the 2-factor structure, their intercorrelations and internal consistency, their
average levels of applicability, their degree of subjectively experienced importance, the
correlation between level of applicability and degree of importance, and the correlation
between level of applicability and some (client and therapist) measures of intermediate
outcome.

       Our findings will be compared with Yalom‘s theoretical view and with data from a
few other cluster/factor-analytic studies.




Panel Session 37 - Paper in Panel

Title:                  Validating a Behavioral Measure of Catharsis, Cohesion & Insight in
                        Group Therapy

Authors:                Addie Fuhriman, Scott Seaman, Sally Barlow & Gary M. Burlingame

Address for Correspondence:

                                                328
                       Gary Burlingame
                       Department of Psychology, Brigham Young University
                       238 TLRB
                       Provo, UT 84602
                       e-mail: gary_burlingame@byu.edu

                                          ABSTRACT

        Therapeutic factors in group psychotherapy process have received considerable attention
in the past twenty to twenty-five years. Measuring these curative processes has been
problematic as few instruments have been developed or currently exist; those that are available
are mainly self report in nature. Three of the factors deemed most helpful to personal growth
and therapy group members are catharsis, cohesion, and insight. Two--catharsis and
insight--have been minimally investigated empirically, yet are recognized as key components in
the achievement of positive therapeutic outcome (Freud, 1981; Neubauer, 1978; Perls, 1949;
Yalom, 1975) and group member satisfaction (Butler and Fuhriman, 1983). Cohesion, despite
receiving much attention and numerous definitions (Beeber and Schmitt, 1986; Festinger, 1950;
Lott, 1961; Alexander et al., 1984), still suffers from the self-report dilemma as well as a
definitive explication of its specific components.

        The purpose of this study was to validate three instruments that behaviorally measure
catharsis, cohesion, and insight. Articulation of a theoretical rationale and definition of each
factor led to a multidimensional model from which three constructs emerged. 150 group
clinicians were asked to rate statements selected from actual group therapy sessions representing
each of the three factors along their relevant dimensions. Using a set inter rater agreement
(80%) standard, unproductive items were eliminated and the constructs refined. A separate
sample of 50 group clinicians was chosen to assess the validity of the selected construct items of
the rationally- derived rating system.

        The purpose of the paper will be to present the resultant behavioral measure of group
process and discuss the implications of its use within the field of group psychotherapy. The
resulting data analysis and implication for the measurement and application of these measures
will be discussed.




                                              329
Panel Session 38 - Overall Summary

Title:                 Emotion and the Process of Change in Experiential Psychotherapy

Participants:          Elizabeth Bolger, Serine Warwar and Alberta Pos

Moderators:            Leslie Greenberg

Address for Correspondence:

                       Elizabeth Bolger
                       York University Psychotherapy Research Clinic
                       Department of Psychology
                       York University
                       Behavioural Science Building,
                       Room 409A 4700 Keele Street
                       North York, Ontario
                       Canada, M3J 1 P3
                       Telephone: 416-487-7475
                       Fax: 416-487-8430
                       E-mail: lizbol@connection.com

                                          ABSTRACT

         There is a growing interest in the importance of the role of emotion in the process of
therapeutic change. A key principle of emotionally-focused treatment (Greenberg & Paivio,
1997) is that the therapeutic restructuring of clients emotion schemes is related to changes in
clients' emotional experience. This panel focuses on demonstrating that the ability to process
emotion more deeply in therapy relates to better outcomes. The researchers on this panel
examine changes in clients' emotional processing from the beginning to the end of therapy and
how these changes relate to the final outcome of 16 weeks of Process-Experiential Therapy for
depression.

         Warwar & Greenberg, and Pos & Greenberg use the Emotion Episode Method (Korman
& Greenberg, 1996) to identify emotions expressed or reported by clients in therapy. They relate
changes in emotional experiencing from early to late in therapy, to the alleviation of depression
and final outcome. Warwar & Greenberg will focus specifically on the role of emotional arousal,
depth of experiencing, and clients' reflection and understanding of their emotional processing in
relation to therapeutic change. Pos and Greenberg will discuss changes in clients emotional
experiencing with a particular focus on whether the depth of experience in emotion episodes
relates to client' s core themes. Bolger & Greenberg will present qualitative data on two clients
receiving PE therapy for depression. They will highlight the role of working through painful
emotion in the change process, and illustrate a two phase model of working through pain.
Panel Session 38 - Paper in Panel

Title:                 Working Through Pain: A Two Phase Model

Authors:               Elizabeth Bolger and Leslie Greenberg

                                             330
Address for Correspondence:

                        Elizabeth Bolger
                        York University Psychotherapy Research Clinic
                        Department of Psychology
                        York University
                        Behavioural Science Building,
                        Room 409A 4700 Keele Street
                        North York, Ontario
                        Canada, M3J 1 P3
                        Telephone: 416-487-7475
                        Fax: 416-487-8430
                        E-mail: lizbol@connection.com

                                           ABSTRACT

        Some theorists and researchers have suggested that a great deal of what we do in
psychotherapy is focused on helping "pain phobic" (PerIs, 1969) people suffer through pain and
distress that has been avoided by individuals because originally it appeared too overwhelming to
tolerate (Greenberg & Safran, 1987). Moreover, psychological problems are frequently
considered to arise as a result of avoiding pain and suffering that emerges as a consequence of
living. Psychotherapy, then, often involves undoing the damage created as a result of avoiding
painful feelings, and in resolving personality conflicts which complicate allowing of painful
experience (Greenberg & Paivio, 1997).

        Pain has recently been defined as a feeling of Brokenness (Bolger, 1996). Working
through emotional pain involves two interrelated processes, Allowing Brokenness and Staying
with Brokenness. This distinction represents two phases of the process. Phase one refers to the
involuntary processes that clients experience when a painful event is initiated. Phase II refers to
processes that the individual chooses to engage in once overcoming the barriers to Allowing
brokenness. This presentation will illustrate the therapy process for two clients who are working
through painful emotional experience underlying their depression. Clients received 16 sessions
of Process Experiential therapy. Therapy transcripts were analysed to see how well their therapy
process reflected the model previously developed from a grounded analysis by Bolger (1996)
and the performance model of Greenberg & Paivio (1997). Clients were also interviewed at the
end of therapy regarding their painful therapy experiences. The presentation will illustrate the
distinction between the two phases in the process and highlight the specific client and therapist
tasks that mediate successful outcomes.
Panel Session 38 - Paper in Panel

Title:                  Changes in Emotional Processing Related to Psychotherapy Outcome

Authors:                Serine Warwar and Leslie Greenberg

Address for Correspondence:

                        Serine Warwar

                                               331
                       Department of Psychology
                       York University
                       4700 Keele Street
                       Toronto, Ontario
                       M3J 1P3, Canada
                       E-mail address: serine@yorku.ca

                                          ABSTRACT

        Although there has been an increasing focus on the function of emotion in psychotherapy
and an acknowledgement of its importance, we still lack a clear understanding of its role in the
therapy change process. The aim of this study is to specify emotional processes involved in
psychotherapeutic change. This study hypothesizes that changes in the way emotions are
processed from the beginning to the end of therapy relate to the alleviation of depression and to
final outcome. Specifically, it is expected that deeper levels of emotional arousal in conjunction
with reflection and understanding in relation to the arousal is related to better therapeutic
outcome. Subjects in this study received approximately 16 sessions of client-centered or
process-experiential therapy. Therapy sessions from early, middle, and late in therapy are
selected in good and bad outcome cases and expressed emotions are identified using the Emotion
Episode Method (Korman & Greenberg, 1996). These emotion episodes are rated on the Client
Experiencing Scale (Klein, Mathieu, Gendlin, & Kiesler, 1969) which is used to measure the
depth and quality of client self-exploration. In addition, emotion episodes are rated on the Client
Emotional Arousal Scale (Machado, Beutler & Greenberg, in press) which assesses both verbal
and gestural aspects of expressed emotions. Final outcomes are measured by comparing pre- and
post-treatment scores on the Rosenberg Self-Esteem Scale, the SCL-90-R, the Beck Depression
Inventory, and the Inventory of Interpersonal Problems. The results of this study are discussed
with the goal of specifying the role of emotional arousal in relation to therapeutic change.




Panel Session 38 - Paper in Panel

Title:                 Depth of Experience of Emotion Episodes and Outcome

Authors:               Alberta Pos and Leslie Greenberg

Address for Correspondence:

                       Alberta Pos
                       Department of Psychology
                       York University
                       4700 Keele Street
                       Toronto, Ontario
                       M3J 1P3

                                              332
                       E-mail: alberta@yorku.ca

                                          ABSTRACT

         In an effort to specify more exactly the role of emotion in therapeutic change we are
attempting to measure change in emotion over therapy and relate these changes to outcome. It is
important that people change emotional states over treatment, for example, from more dysphoric
or dysfunctional ones to more therapeutically productive ones. It is also important to demonstrate
the critical processes involved in emotional change, and to relate these processes to treatment
and outcome. We examined depth of experience of emotion episodes and whether emotions are
processed more deeply during therapy than at the onset of therapy. More specifically, we also
examined depth of experience in emotion episodes relating to clients' therapeutically meaningful
core themes. This will further contextualize change in emotional processing within particularly
meaningful content, demonstrating that the ability to process emotion more deeply to solve
relevant problems relates to outcome. This will illuminate how therapy works.

       This presentation will report results of a study of study relating experiencing (Klein,
Mathieu, Gendlin & Kiesler, 1969) on emotion episodes ( Korman & Greenberg, 1996) to
outcome. The sample consists of thirty-four clients from the York Experiential Therapy of
Depression Project. Both early and late session experiencing on emotion episodes and change in
experiencing early to late in therapy will be presented. In addition, depth of experiencing on
emotion episodes on core, theme-related, episodes will be related to outcome. Depth of
experience marks increasing levels of integration of emotion and cognition. It distinguishes
episodes in which people talk at an external and superficial level about their experience from
episodes in which they are processing the personal relevance of their emotions and using the
information gained in a manner that helps solve problems.



Panel Session 39 - Overall Summary

Title:                 Systematized Learning From Huge Data Sets in Quality Management

Participants:          Wolfgang Hannover, Matthias Richard, Joanna S. Burg, Michael J.
                       Lambert

Moderators:            Michael J. Lambert, Hans Kordy

Discussant:            Robert J. Lueger

Address for Correspondence:

                Michael J. Lambert
                Department of Psychology
                Brigham Young University
                284 TLRB
                Provo, Utah 84602
                USA

                                              333
                                           ABSTRACT

        Psychotherapy, regardless of its theoretical background, is a highly effective intervention.
However, there is still a substantial number of patients who do not benefit from it, or benefit as
much from it, as is possible. This leaves room for further improvement. And this is what modern
quality management is tackling on; learning from shortcomings.

        Optimism relies on the rapidly growing data-sets available from every-day clinical
practice. This optimism is being confirmed by the samples that are becoming available at
different places. At the same time, a lack of methods and models for systematic learning is
realized. Methodology in psychotherapy research was quite creative to overcome the problem of
small samples, but rarely was confronted with the difficulties of learning from – very – large
samples. Even less experience is available about how to bring the message from data to those
people who can make use of it. The four presenters of the panels introduce new developments
which facilitate systematic learning from huge data sets. They demonstrate empirically suitable
methodological approaches as well as new ways of giving feedback.

       The panelists come from various research centers which are well recognized for their
methodological developments in the area of quality management and service research. They are
brought together by SPR and in cooperation for years. Insofar this panel is not only reporting
new research but also demonstrating exemplarily trans-atlantic cooperation between young
researchers.




                                               334
Panel Session 39 - Paper in Panel

Title:                  What Makes a Signal Case a Signal Case? - Application of the CART
                        Algorithm on Quality-Management Data to Predict Psychotherapeutic
                        Outcome

Author:                 Wolfgang Hannöver

Address for Correspondence:

               Wolfgang Hannöver
               Research Center for Psychotherapy
               Christian-Belser-Straße 79a
               70597 Stuttgart ,Germany
               Telephone: +49 (0)711 - 6781-400
               e-mail: hann@psyres-stuttgart.de

                                           ABSTRACT

         So far most tools in quality assurance work in a posteriori way; i.e., therapists learn from
past treatments for future treatments. Obviously there is a need for strategies that enable
therapists to use aggregated information from past treatments in active treatment planning. One
hope related to quality-management systems is that the large numbers of documented treatments
can be used as a basis for models for treatment planning.
         The Stuttgart-Heidelberg model of quality management is well established in Germany. It
is used in more than 20 hospitals specialized in psychotherapy and psychosomatic medicine. The
focus is on detection of so called signal cases, i.e. treatments with outcomes less favorable than
usually expected. The software package AKQUASI comprises an algorithm for the detection and
a module to feedback the information to whom it concerns.
         The Classification and Regression Trees (CART) algorithm has proven its practicability
in other fields with huge sample sizes. The resulting models are simple and of intuitive structure,
that is, easy to communicate to practitioners. On the other hand they allow for the highly
complex interaction effects between possible predicting variables.
         The CART algorithm is applied on data from over 500 documented inpatient treatments.
About 22 % are identified as signal cases by the quality management system. CART is used to
model the interaction of patient and treatment characteristics for the prediction of signal cases.
The predicting variables and their interactions are explained. Each node and leaf of the resulting
classification-tree give the proportion of signal cases, thus providing risk-estimates for each new
patient receiving similar treatment according to his or her characteristics.




                                               335
Panel Session 39 - Paper in Panel

Title:                  What Can We Learn From Early Treatment Response?

Authors:                Matthias Richard, Hans Kordy, Project TR-EAT

Address for Correspondence:

               Matthias Richard
               Center for Psychotherapy Research
               Christian-Belser-Str. 79a
               70597 Stuttgart
               Germany

                                           ABSTRACT

         Which kind of treatment gives an individual patient the best chances for what outcome?
This standard question guided outcome research and treatment planning for decades. The
literature provides a long list of predictors. However, all known predictors together do not
account for an overwhelming large percentage of the variance to be explained. From beginning
of treatment we cannot predict the outcome of a particular individual patient, given treatment A,
with 100% probability. Could we learn more by continuously monitoring the patient's
development during treatment – and if so, how?

         In this study we examine the relation between treatment response and outcome in
N=1171 anorectic and bulimia patients who received psychodynamic inpatient treatment.
Treatment response is conceptualized on the basis of the symptomatic development during the
first 4 to 8 weeks of therapy, using monthly brief assessment forms. Patients are classified into
four categories: fast and slow responders as well as non or negative responders. Outcome at 2.5
year follow-up is defined longitudinally by applying the concepts of remission, recovery, relapse
and recurrence on the basis of the Longitudinal Interval Follow-up Evaluation (LIFE) Interview.

        Discrete Time Survival Analysis is used to model the hazard functions of remission and
relapse in relation to treatment response, controlling for important patient characteristics at
intake. Preliminary analysis show that early treatment response, in addition to patient
characteristics, does contribute substantially to prediction; the preliminary findings suggest that
responders have a higher chance of remission at an earlier time point after discharge than
non-responders.




                                               336
Panel Session 39 - Paper in Panel

Title:                  Practical Issues: Using Outcomes Data to Improve Psychotherapy
                        Effectiveness

Authors:                Joanna S. Burg, Renanah Kaufman, Zoran Martinovich, and John S.
                        Lyons

Address for Correspondence:

               Joanna S. Burg, PhD
               Outpatient Treatment Center
               Stone Institute of Psychiatry
               Northwestern Memorial Hospital
               446 E. Ontario Street, Suite 800
               Chicago, IL 60611
               USA

                                           ABSTRACT

         Outcomes monitoring is a relatively new phenomenon in mental health services thought
to be important for improving service quality. There is currently little research on how best to
present outcomes data to mental health service providers and support staff. In this presentation,
we will discuss the current literature as well as our own experiences collecting and disseminating
outcomes data in a clinical setting.
         The process of building an outcomes management system can be described by three
(overlapping) stages: clinic preparation, data collection, and outcomes feedback. The preparation
stage is critical for creating a culture where outcomes data are seen as service enhancing.
Particularly in the early stages, both positive and negative feedback concerning the use of
outcomes data should be encouraged and incorporated into the development of the management
system.
         The second stage, data collection, requires the development of a procedure for acquiring
data that will be minimally intrusive and burdensome to both patients and service providers.
Determining what data to collect and who to gather it from is an iterative process involving
recurring feedback from patients and clinicians.
         This presentation will particularly focus on the third stage, feedback. We will consider
the variety of potential uses for outcomes data, and who stands to benefit from feedback (e.g.
providers, patients, and supervisors). In addition, we will consider what data to present (or not to
present) to these interested parties, as well as how best to convey statistical results (e.g., graphic
methods, conversions to percentile ranks, odds ratios) to service providers and staff with varying
statistical expertise. Finally, we will discuss future research that is needed to evaluate which
feedback strategies can be most effective in varying circumstances.




                                                337
Panel Session 39 - Paper in Panel

Title:                  An Actuarial Approach to Monitoring Therapy Outcome

Authors:                Nathan Hansen and Michael J. Lambert

Address for Correspondence:

               Michael J. Lambert
               Department of Psychology
               Brigham Young University
               284 TLRB
               Provo, Utah 84602
               USA

                                           ABSTRACT

        The current study applies an actuarial method of summarizing and analyzing data to the
dose response relationship in psychotherapy to address the question of "how much therapy is
enough?" For the current study, a selection of over 9000 subjects from a variety of sources
throughout the United States, including managed health care organizations, employee assistance
programs, state funded mental health programs, and community mental health centers has been
used to create actuarial tables based on a life table format. All subjects were followed throughout
the course of treatment and administered the Outcome Questionnaire (OQ-45) prior to each
session of therapy. The resulting tables allow several questions pertaining to the dose-response
relationship to be addressed, including: (1) the probability of reaching clinical significant
improvement at each session of therapy, (2) a projection for how many sessions are still needed
to reach clinically significant improvement by patients who do not improve during a particular
session, (3) and the ability to make comparisons between various treatment sites and their
corresponding probabilities for improvement. A comparison between actuarial tables and
survival analysis will also be made. Finally, the utility of actuarial tables for quality management
will be reviewed.




                                               338
Panel Session 40 - Overall Summary

Title:                  Mental Representation and the Ability to Reflect on Self and Others‘:
                        Structural Changes in the Therapeutic Process

Participants:           Sidney J. Blatt, John S. Auerbach, John F. Clarkin, Audrey J. Clarkin,
                        Pamela A. Foelsch, Günter H. Seidler, Thorsten Jakobsen, & Nina
                        Sauer-Krempien

Moderator:              Günter H. Seidler

Address for Correspondence:

                        Günter H. Seidler, MD
                        Psychosomatische Klinik der Universität Heidelberg
                        Thibautstr. 2, 69115 Heidelberg
                        Germany
                        guenter_seidler@ukl.uni-Heidelberg.de

                                            ABSTRACT

        The problem in the treatment of seriously disturbed patients is that both, the ability to be
related on self and others‘ and a stable psychic structure are missing, which is in contrast the
presumption for the treatment of less seriously disturbed patients.

        The three abstracts of this panel present the development of those abilities due to
intensive inpatient or long-term outpatient treatment. They show instruments for their assessment
and reveal connections of those therapeutically achieved abilities and other indicators of
therapeutic success.




Panel Session 40 - Paper in Panel

Title:                  Changes in the Content and Structure of Mental Representations During
                        Long-Term, Intensive, Inpatient Treatment of Seriously Disturbed Young

                                               339
                        Adults

Authors:                Sidney J. Blatt, & John S. Auerbach

Address for Correspondence:

                        Sidney J. Blatt, Ph. D. Professor
                        Departments of Psychiatry and Psychology
                        Yale University
                        25 Park St. (Rm 612-13)
                        New Haven, CT 06519
                        USA


                                            ABSTRACT

        Forty seriously disturbed, treatment-resistant, young adults seen in an intensive
long-term, inpatient treatment program were asked periodically (every 6 months beginning at
admission and ending at termination) to describe their mother, father, therapist, and themselves.
These open-ended descriptions were rated by independent judges for the thematic content of the
descriptions as well as for the structural (cognitive) organization and the degree of
differentiation-relatedness of these descriptions. Aspects of these ratings were significantly
associated with independent judgments of the degree of therapeutic change. Particularly
impressive were changes in the degree of differentiation-relatedness in the descriptions and their
association with therapeutic progress. The results also indicate the importance of changes in the
patients' representation of their therapist. Overall, the results indicate the importance of assessing
structural dimensions of mental representation and their change in the treatment process.




                                                340
Panel Session 40 - Paper in Panel

Title:                  Changes in Personality Organization in Therapy with Borderline Patients

Authors:                John F. Clarkin, Audrey J. Clarkin, & Pamela A. Foelsch

Address for Correspondence:

                        John F. Clarkin, Ph. D.
                        The New York Presbyterian Hospital-
                        Westchester Division
                        21 Bloomingdale Road
                        White Plains, NY 10605
                        USA


                                           ABSTRACT

       In a treatment development study of transference focused psychotherapy for patients with
borderline personality disorder, we examined structural changes in 10 patients who underwent
treatment for a one-year duration. Structure and structural change were measured in two different
ways. A self-report questionnaire of personality organization, the Inventory of Personality
Organization (IPO), was given to the patients at the beginning of treatment and one year later.
This instrument has scales measuring structural characteristics of patients with borderline
personality organization such as identity diffusion and use of primitive defenses. In addition, we
scored early and late therapy session transcripts for reflective functioning, a construct related to
attachment theory, that captures the subjects‘ ability to reflect on self and others‘ internal
experience.




                                               341
Panel Session 40 - Paper in Panel

Title:                  Assessment of Reflective Functions in Psychoanalytic Group Therapy by
                        the Extrospectional Instruments ―Clinical Ratings of Self-Referentiality‖
                        (RSR) and ―Changes in the Experience of Relations‖ (CER)

Authors:                Günter H. Seidler, Thorsten Jakobsen, & Nina Sauer-Krempien

Address for Correspondence:

                        Günter H. Seidler, MD
                        Psychosomatische Klinik der Universität Heidelberg
                        Thibautstr. 2, 69115 Heidelberg
                        Germany
                        guenter_seidler@ukl.uni-heidelberg.de

                                           ABSTRACT

       Over the course of one year 76 patients in a three month inpatient setting for
psychotherapy were included in a project assessing structural changes in self-relatedness and
changes in somatic, social and psychic symptoms. The new developed instruments RSR and
CER were compared with established instruments.

         The aim of this project was: (1) to test the new developed instruments clinically; (2) to
test their ability to document the achieved structural changes occurring during the three month
inpatient seating; and (3) to reveal possible connections between structural changes of
self-relatedness and changes of symptoms.

         This project was done in a naturalistic design. Assessments took place at 4 times. The
changes of self-relatedness were examined by video recorded group sessions with the RSR and
CER. An extrospectional instrument SUK assesses the symptomatology and the experience of
illness in a short interview. The established instruments were IIP-D, SAM, ISO and PSKB-Se-R.

       The results show that the construct of self-relatedness is suitable to assess structural
changes occurring during inpatient psychotherapy. The reliabilities of the newly developed
instruments were acceptable. A decrease of somatic and social symptoms is correlated with an
increase of self-relatedness. This result demonstrates an increase of self-referentiality. A
decrease of psychic symptoms doesn‘t correlate with an increase of self-referentiality.




                                               342
Panel Session 41 - Overall Summary

Title:                  Attachment Approaches in the Assessment and Treatment of Stress and
                        Disease

Participants:           Silke Schmidt, Roger Kobak, and Isabel Soarez

Moderator:              Bernhard M. Strauss

Discussant:             Len Horowitz

Address for Correspondence:

                        Bernhard M. Strauss
                        Institut f. Medizinische Psychologie
                        Friedrich-Schiller-Universitaet Jena
                        Stoystr. 3
                        D 07740 Jena
                        Fax: (+) 3641 936546
                        e-mail: STRAUSS@LANDGRAF.MED.UNI-JENA.DE
                                           ABSTRACT

       This panel provides an illustrative overview of studies dealing with the use of attachment
theory and research in the assessment and treatment for different conditions that might be
promising for the future.

        The panel starts with a report on a study testing the relationship between attachment and
coping strategies. This study aims to empirically support the theoretical assumption that
individual differences in coping styles might have their roots in developmental interpersonal
differences.

       In the second paper, Kobak will give a case example showing the heuristic value of
attachment approaches in the treatment of distressed families. This report will show the
usefulness of attachment issues for the planning of treatments.

        Finally, the study of Soares and her colleagues will illustrate differences of attachment
strategies in a larger sample of patients suffering from eating disorders.

       The panel hopefully will further clarify the potential of attachment theory and research in
psychotherapy.




                                               343
Panel Session 41 - Paper in Panel

Title:                  Attachment and Coping Styles in Chronic Disease

Authors:                Silke Schmidt, Bernhard M. Strauss

Address for Correspondence:

                        Silke Schmidt
                        Institut für Medizinische Psychologie
                        Klinikum der Friedrich-Schiller-Universitaet
                        Stoystr. 3
                        D 07740 Jena, Germany
                        e-mail: sischmidt@landgraf.med.uni-jena.de

                                           ABSTRACT

       In this study the impact of the attachment styles "secure", "anxious-ambivalent" and
"anxious avoidant" on coping modes is evaluated in a sample of 150 chronically ill patients.

        The aim of this investigation was to explain ways of coping with chronic disease from a
developmental perspective. It was expected that insecurely attached patients would cope with
their disease less adaptively, i.e. by using less coping modes, however using these modes more
intensely. We also assumed that persons with an avoidant attachment style would show a
tendency towards avoidant or distracting coping modes while those with an ambivalent style
would rather rely on vigilant or overly emotion-focused ways of coping.

        To be sure that the attachment-coping relationship is not confounded with the kind of
disease we included patients of three diagnostic categories: first patients with chronic leg
ulcers, the final stage of chronic venous insufficiency, second patients with early breast cancer,
and third patients with alopecia (diffuse hair loss).

       We identified adult attachment styles using the modified Adult Attachment Prototype
Rating. To assess coping modes we used the Bernese Coping Forms (Heim & Valach, 1996), an
observer and self-rating scale devised to elicit 30 coping modes. Adjustment, subjective distress
and well being were measured with the Nottingham Health Profile (Hunt et al., 1981) as well as
disease specific quality of life instruments. The results will be presented in the paper.




                                               344
Panel Session 41 - Paper in Panel

Title:                  An Attachment Approach to the Assessment and Treatment of Distressed
                        Families

Author:                 Roger Kobak

Address for Correspondence:

                        Roger Kobak
                        Department of Psychology
                        University of Delaware
                        Newark, DE 19716
                        USA

                                           ABSTRACT

        Attachment theory and research provide a potentially valuable guide to assessing and
interventing with distressed family relationships. Research suggests that when either children or
adults perceive their attachment figures as unavailable they experience 1) increased feelings of
anxiety, anger, or sadness, 2) narrowed attention to the environment and reduced coping
capacities, 3) defensively distorted communication that results in symptomatic expressions of
negative emotions. As a result, the initial focus for assessment of child problems involves
identifying perceived threats to the availability of attachment figures in the family. Such
assessment must consider marital as well as parent-child attachment relationships. Therapeutic
goals derived from the attachment approach include increasing awareness of fear and anger
associated with perceived threats to the availability of attachment figures, increasing anticipatory
control over dysfunctional feelings, and restoring confidence that attachment relationships can
serve their normal protective functions.

        This paper will use a case study to illustrate the heuristic value of an attachment approach
to assessment and treatment of distressed families. I will suggest that attachment theory and
research can provide a framework for treatment of distressed families that integrates therapeutic
techniques drawn from experiential, emotion focused, and narratives approaches to therapy.




                                               345
Panel Session 41 - Paper in Panel

Title:                  Attachment Strategies and Eating Disorders

Authors:                Isabel Soares, Armando Pinho, Carla Marins, and Paulo Machado

Address for Correspondence:

                        Isabel Soares
                        Departmento de Psicologia
                        Universidade do Minho
                        Campus de Gualtar
                        4700 Braga – Portugal
                        Fax: 351 - 53 – 678987
                        e-mail: isoares@iep.uminho.pt

                                           ABSTRACT

        Clinicians and researchers are beginning to acknowledge the relevance of integrating a
developmental perspective into the understanding of psychological disorders. During the past
decade, within the clinical field, the interest for examining attachment relationships in disordered
populations has been growing. At the same time, in research, attachment theory is being used to
elucidate clinical issues of assessment, classification, and treatment of psychological disorders.
Bridging the gap between attachment theory and research and psychopathology may be of
special relevance for integrating theoretical issues about developmental pathways with
empirically and clinically based knowledge of psychological disturbances.

        Our study aims to examine attachment strategies in a group of eating disorders patients.
This study was conducted within a larger project – the European Collaboration on Effective
Treatment of Eating Disorders (COST B6). Forty patients were assessed using the COST B6
protocol which includes: the Patient Questionnaire (PQB), the Symptom Checklist (SCL-90-R),
the Eating Disorders Inventory (EDI), and the Freiburg Personality Inventory (FPI). The Adult
Attachment Interview (AAI) was also administered and interview transcripts were rated with the
Attachment Q-Sort developed by Roger Kobak.

        Results will be discussed in the light of attachment theory and research giving particular
attention to the different patterns of symptom expression as well as to the relation between
attachment strategies and reports of eating disorders symptoms.




                                               346
Panel Session 42 - Overall Summary

Title:                 Truly Long-Term Psychotherapies - Research Design Considerations,
                       Outcomes, and Therapist Factors

Participants:          Jorma Hannula, Johan Blomberg, Rolf Sandell, Anna Lazar

Moderator:             Rolf Sandell

Address for Correspondence:

                       Rolf Sandell
                       Department of Education and Psychology
                       Linköping University
                       S-581 83 Linköping
                       Sweden
                       e-mail: rolsa@ipp.liu.se
                       fax: +46 13 28 21 45

                                           ABSTRACT

        As the review of Grawe, Donati and Bernauer (1994) shows, psychotherapy outcome
research has almost exclusively focused on brief treatments, and almost as exclusively neglected
long-term outcome follow-up. Generalizations of its findings to long-term outcomes of
long-term treatments are therefore dubious indeed. This is all the more serious as long-term
treatment with long-ranging goals is probably still the treatment of choice in the regular clinical
setting. In this paradoxical and unfortunate situation, experiences with two Scandinavian
research projects, specifically addressing the long-range outcomes of long-term psychotherapy
and psychoanalysis, will be offered in this panel.




Panel Session 42 - Paper in Panel

Title:                 The Efficacy of Truly Long-Term Psychotherapies - Light in the
                       Horizon: Review of Ongoing Studies

                                              347
Authors:               Jorma Hannula

Address for Correspondence:

                       Department of Psychiatry
                       University of Helsinki
                       Tukholmankatu 8C
                       00290 Helsinki
                       Finland
                       e-mail: jorma.hannula@helsinki.fi
                       fax: +358 9 471 5471

                                           ABSTRACT

        There has been much criticism towards the lack of solid empirical evidence for the
efficacy and clinical effectiveness of truly long-term psychotherapies, including psychoanalysis
proper. Much of this critique is well justified, although the historical background and
epistemological issues have also to be taken into account. The main share of previous outcome
research on long-term psychotherapies lacks scientific rigor. Most of the studies are retrospective
or grossly ‖naturalistic‖ in their designs, leaving the results open to several alternative
explanations. Internationally proven instruments are seldom used and group sizes are too small
to yield sufficient power. Clinically meaningful comparative designs are rare. Long-term
therapies are clinically highly valued, and there is previous research claiming to support their
efficacy. Long-term psychotherapies would earn a fair judgment with adequate scientific
methods. There is a movement in the field towards these aims. New studies are on their way, and
others are under consideration. In this presentation some of these new developments are being
reviewed, with special interest put on design issues.




Panel Session 42 - Paper in Panel

Title:                 What Changes and What Doesn´t in Psychoanalytic Psychotherapy?

Authors:               Johan Blomberg, Rolf Sandell, and Anna Lazar

Address for Correspondence:



                                              348
                       Johan Blomberg
                       Department of Education and Psychology
                       Linköping University
                       S-581 83 Linköping
                       Sweden
                       e-mail: jo.blomberg@telia.com
                       fax: +46 13 28 21 45

                                          ABSTRACT

       The goals of psychoanalytic treatment are under constant discussion. To some,
psychoanalysis is primarily a therapeutic treatment of malfunctioning, to others, rather an
educational-like development of self-understanding and self-tolerance. Still others emphasize the
development of object relations and their effects on social relationships. In this study we
compared different such aspects of outcome of long-term psychoanalytic psychotherapy and
psychoanalysis. Results suggest that psychoanalytically oriented treatment in general is more
successful in alleviating symptoms and personality disturbances than in improving social
performance. At the same time, there are findings to indicate important qualitative differences in
outcome between psychoanalytic psychotherapy and psychoanalysis proper.




Panel Session 42 - Paper in Panel

Title:                 Dimensions of Psychotherapeutic Experience and Their Relations to
                       Treatment Outcome

Authors:               Rolf Sandell, Johan Blomberg, and Anna Lazar

Address for Correspondence:

                       Rolf Sandell
                       Department of Education and Psychology
                       Linköping University

                                              349
                       S-581 83 Linköping
                       e-mail: rolsa@ipp.liu.se
                       fax: +46 13 28 21 45

                                          ABSTRACT

        Meta-analytic studies have concluded that psychotherapeutic experience, whether
measured in years of experience or in terms of level of training, has at most a weak relation to
treatment outcome. Assuming a less simplistic view on therapeutic experience, we studied the
relations among a number of experience-related variables in a sample of more than 200 licensed
psychotherapists and psychoanalysts in the Stockholm area and could identify at least three,
more or less independent dimensions or aspects of therapist experience. When these were related
to patient outcome data in a sample of more than 300 of the same therapists‘ cases, a systematic
differential pattern of associations was found. Variables related to experience in private practice
had generally positive associations to outcome; whereas variables related to psychotherapeutic
experience in psychiatry in general were unrelated to outcome. Experiential practice (related to
supervisory experience and training therapy or analysis) was associated to outcome in a mixed
way, with some variables being even negatively related to patients‘ development in
psychotherapy.




                                              350
Panel Session 42 - Paper in Panel

Title:                  Sickness, Ability to Work, and Well-Being

Authors:                Anna Lazar, Rolf Sandell, and Johan Blomberg

Address for Correspondence:

                        Anna Lazar
                        Stockholm County Council Institute of Psychotherapy
                        Björngårdsgatan 25
                        S-118 52 Stockholm
                        Sweden
                        e-mail: anna.lazar@psti.csso.sll.se
                        fax: +46 8 615 97 06

                                            ABSTRACT

        Psychotherapy research has so far paid scant attention to measures of sickness, health
care utilization, inability to work, productivity and similar factors as parameters of outcome.
Discussions about the cost-effectiveness of psychotherapy have intensified during the last years
and made the lack of relevant findings offensively conspicuous. Our work on official and
self-reported data on health- and performance-related variables in the Stockholm Outcome of
Psychotherapy and Psychoanalysis Project (STOPPP) have primarily revealed their complicated
or even limited quality as parameters of therapeutic outcome. What is most striking in the data
patterns is their instability over time, their meager interrelations, and their paradoxical relations
to treatment and other outcome indications.




                                                351
    Panel Session 43 -Overall Summary

    Title:                   The Interplay of Transference Work and Narrative Style: New Assessment
                             Techniques

    Participants:            Annette DeMichele, Julian Pessier

Discussant:              Lester Luborsky

    Moderator:               Wilma Bucci

    Address for Correspondence:

                    Wilma Bucci,
                    Glass Institute,
                    75 Varick Street, N.Y., N.Y. 10013 USA
                    (E-mail: bucci@panther.adelphi.edu)

                                                   ABSTRACT

             The panel focuses on the interplay between patient and therapist work in the transference and the
    kinds and qualities of narratives patients tell during psychodynamic psychotherapy sessions. The
    premises of this research are that narrative style and contents vary depending on whether the patient is
    talking directly about the relationship, or telling narratives about other people that may or may not refer
    implicitly to the relationship, and that effective therapeutic work depends on working back and forth
    among these modes. The two studies covered here present preliminary findings on the development of
    two new measures, built on previously established approaches, that address critical aspects of productive
    work in the transference. The measures will be applied to the same data set and will be looked at in
    relation to one another and to Bucci and Mergenthaler‘s computerized language measures of referential
    activity, emotion tone, and abstraction.

              DeMichele presents a modified version of Gill & Hoffman‘s (1982) PERT (Patient‘s Experience
    of the Relationship with the Therapist), which was initially designed to identify both explicit references
    and implicit allusions to the therapeutic relationship in patient and therapist speech. The original PERT
    measure has, however, barely been used in psychotherapy research primarily because adequate interrater
    reliability was not achieved. DeMichele‘s coding scheme addresses the issue of reliability by more clearly
    delineating the initial PERT variables. Her method also adds new categories and distinctions that
    elaborate and expand the initial measure.

            Pessier expands Luborsky‘s concept of Relationship Episodes to include types of characteristic
    experiences that occur outside the context of interpersonal relationships, and provides new segmentation
    procedures and narrative coding schemes. His study, applied to the same data set, uses the general
    methodology of Luborsky‘s symptom-context method to look at characteristics of the patient‘s narrative
    material preceding and following either transference productions by the patient or transference
    interventions by the therapist.

            Luborsky will discuss the conceptual and methodological problems encountered in the study of
    transference and patient narratives, and the solutions offered by these new methods.
    Panel Session 43 - Paper in Panel

    Title:                   Classifying Patient Narratives in Psychodynamic Psychotherapy



                                                      352
Author:                 Julian Pessier

Address for Correspondence:

               New School for Social Research, Department of Psychology
               65 Fifth Avenue, Room 340
               New York, NY 10011 USA
               (E-Mail: Julian1470@aol.com)

                                           ABSTRACT

        This study proposes a new method for identifying and categorizing the narratives patients
tell during psychotherapy sessions. The method has three purposes:

1) To expand upon Luborsky's (1997) concept of Relationship Episodes, defined as the
narratives patients tell about specific interactions with other people, to include narratives about
characteristic self-experiences that occur outside the context of interpersonal relationships.

2) To develop a segmentation procedure to capture topic shifts in patient speech that may reflect
salient moments in the patient's experience of the therapeutic situation.

3) To code narratives, including both relationship events and narratives about self-experiences,
along three dimensions: a) the person or general topic being discussed, b) the degree of
specificity; i.e., is the patient describing a circumscribed event or discussing her general
experience of a particular relationship, and c) the temporal focus; is the story about past events
or feeling states, more focused in the present, or is the patient comparing past and present
experiences?

        Preliminary results will be presented for a sample of nine sessions, consisting of three
consecutive sessions from each of three psychodynamic cases. Excellent reliability was found
for transcript segmentation and the coding of narratives for topic, specificity and temporal focus.
Qualitative within-session analyses were performed to examine the relationship between the
narrative categories and the overt and covert references made by the patient and therapist to the
transference, as measured by a modified version of Gill and Hoffman's PERT measure
(DeMichele, this panel); and Bucci (1997) and Mergenthaler's (1996) computerized language
measures of referential activity, emotion tone, and abstraction.




                                               353
Panel Session 43 - Paper in Panel

Title:                  A Method for Assessing Patient and Analyst Work in the Transference

Author:                 Annette DeMichele

Address for Correspondence:

                        The City College of New York
                             The Psychological Center,
                             Convent Avenue at 138th Street
                             NAC Building/Rm. 8-101
                             N.Y., N.Y. 10031 USA
                             (E-Mail: Feigelson@aol.com)

                                            ABSTRACT

        This study proposes a method for capturing and characterizing the ebb and flow of the
patient's explicit and implicit work in the transference. In addition, the method categorizes
analyst interventions based on whether and how they address the patient‘s transference
productions. The goal is to generate a systematic assessment of patient and analyst work in the
transference.

         The method presented here is a modified version of a psychoanalytic process measure
known as the Patient's Experience of the Relationship with the Therapist (PERT), which was
originally developed by Gill and Hoffman (1982). As initially conceived, the goal of PERT was
not only to rate patient and analyst speech that explicitly concerned the treatment relationship,
but also to code the implicit, often unconscious, references patients make to the transference. A
central impediment to using the original PERT was difficulty in obtaining adequate interrater
reliability. The modifications address those difficulties by more clearly delineating the existing
PERT variables. Moreover, new variables are incorporated in an effort to track the subtle ways
in which patient and analyst speech either invoke the treatment relationship or focus on the
immediate therapeutic process.

        The study uses a data set comprised of nine psychotherapy sessions, three consecutive
sessions from each of three psychodynamic cases, for the first application of the measure.
Interjudge reliability of ratings on all variables is assessed. An exploratory quantitative analysis
is presented regarding the relationship between the PERT variables and the kinds of narratives
told by patients, as coded by Pessier (this panel), as well as levels of referential activity, emotion
tone and abstraction derived from the application of Mergenthaler and Bucci‘s computerized
language measures (In press).




                                                354
Panel Session 44 – Overall Summary

Title:                 Predictors and Mediators of Treatment Outcome and Retention in the
                       NIDA Collaborative Cocaine Treatment Study

Participants:          Jacques P. Barber, Paul Crits-Christoph & Lynne Siqueland

Moderator:             Paul Crits-Christoph

Discussant:            Cathy Carroll

Address for Correspondence:

                       Paul Crits-Christoph, Ph.D.
                       Center for Psychotherapy Research, Rm 700
                       Department of Psychiatry
                       3600 Market Street
                       Philadelphia, PA 19104-2648, USA
                       crits@landru.cpr.upenn.edu

                                          ABSTRACT

        The 3 papers in this presentation will examine predictors and mediators of treatment
outcome and retention in the NIDA Collaborative Cocaine Treatment Study. Dr. Paul
Crits-Christoph will present on treatment specific mediators of outcome. Dr. Jacques Barber
will present in the role of alliance in relation to outcome and retention. Dr. Lynne Siqueland
will present on predictors of, and reasons for, dropout.




Panel Session 44 - Paper in Panel

Title:                 The Role of Alliance in Predicting Outcome and Retention in the NIDA

                                              355
                       Collaborative Cocaine Treatment Study

Authors:               Jacques P. Barber, Lester Luborsky, & Robert Gallop

Address for Correspondence:

                       Jacques P. Barber
                        Center for Psychotherapy Research
                       Department of Psychiatry
                       3600 Market Street
                       Philadelphia, PA 19104-2648, USA
                       Barberj@landru.cpr.upenn.edu

                                          ABSTRACT

        We examined the relationship between alliance, retention and outcome in the NIDA
Cocaine Collaborative Treatment Study. We found that alliance was similar across
supportive-expressive therapy, cognitive therapy and individual drug counseling and improved
similarly from session 2 to session 5. In addition, alliance was not a significant predictor of
outcome in this sample of 364 cocaine dependent outpatients, but it predicted completion of
treatment. Finally, we found an interaction between treatment conditions, strength of alliance
and retention-in-treatment on outcome. These complex interactions will be presented.




Panel Session 44 - Paper in Panel

Title:                 Treatment Specific Mediators in the NIDA Collaborative Cocaine
                       Treatment Study

Author:                Paul Crits-Christoph

                                              356
Address for Correspondence:

                       Paul Crits-Christoph
                       Center for Psychotherapy Research
                       Department of Psychiatry
                       3600 Market Street
                       Philadelphia, PA 19104-2648, USA
                       crits@landru.cpr.upenn.edu

                                         ABSTRACT

        This paper will examine the role of treatment specific mediators in predicting drug use
outcome in a longitudinal design. Treatment specific mediators were identified for all 4
treatment conditions and measures used to assess these mediators were administered monthly
along with monthly assessments of drug use outcome. Change in beliefs about addiction was
hypothesized to mediate change in drug use in Cognitive Therapy. Change in
self-understanding of interpersonal patterns was hypothesized to mediate change in drug use and
social/interpersonal functioning in Supportive-Expressive therapy. Change in participation and
belief in the 12-step approach to addiction recovery was hypothesized to mediate the effects of
individual and group drug counseling in drug use outcomes. To test the mediational
hypotheses, we applied the model described by Baron and Kenny (1986) but with longitudinal
outcome data.




Panel Session 44 - Paper in Panel

Title:                Predictors of Dropout in the NIDA Collaborative Cocaine Treatment
                      Study

Author:               Lynne Siqueland

Address for Correspondence:



                                             357
                       Lynne Siqueland, Ph.D.
                       Center for Psychotherapy Research
                       Department of Psychiatry
                       3600 Market Street
                       Philadelphia, PA 19104-2648, USA
                       siquelal@landru.cpr.upenn.edu


                                         ABSTRACT

        This paper will examine the demographic, drug severity and psychological severity
predictors of dropouts in the NIDA Collaborative Cocaine Treatment Study. Predictors of
completing different phases of the clinical trial will be compared. We will discuss which
treatment information seekers come for an intake appointment, which treatment initiators come
back for a second appointment and start treatment, and which patients who start treatment for
cocaine dependence complete it. Initial analyses suggests that demographic and severity factors
are more potent predictors of engaging in treatment than completing treatment. In addition, we
will examine the role of time in treatment and the impact of dropout on immediate and
short-term outcome for cocaine dependent patients. Finally, we will look at the reasons given
for dropout and assess whether the patients who say they are improved really have improved.




                                            358
Panel Session 45 - Overall Summary

Title:                   Advances in Psychodynamic-Interpersonal Psychotherapy (Hobson‘s
                         Conversational Model)

Participants:            Frank Margison, Else Guthrie, Dan Beales and Hannah Mackay

Moderator:               Sarah Davenport

Discussant:               Bill Stiles

Address for Correspondence:

                          Frank Margison, Gaskell Psychotherapy Centre; Manchester Royal
                         Infirmary; Swinton Grove; Manchester M13 0EU; UK
                         Telephone: +44 161 273 2762
                         Email: frmargison@aol.com

                                              ABSTRACT
 Aims: To describe recent developments in PI therapy using three approaches:
 1.     Analysis of competencies required for effective delivery of PI therapy and development of
        measures
 2.      Early results of a study of training counsellors using videotape feedback in delivering PI therapy
        in a primary care setting
 3.      Early Assimilation in PI therapy and its relation to outcome
        Recent research in the Conversational Model of Robert Hobson, a psychodynamic-interpersonal
approach, has used a variety of methods to clarify the central components of a model which has
previously been shown to be clinically effective in depression, somatisation and in reducing the cost of
treatment of chronic psychiatric clinic patient. This panel reports on three complementary approaches
drawing on the current research programme.
        Paper 1: reviews the work carried out jointly between Manchester, Sheffield and Leeds in
developing a reliable method for rating adherence and competence in the model. Adherence can be
measured using a reliable scale, but the assessment of clinical competence requires reference to the
quality with which interventions are made, and ultimately need to be linked to outcome.
        Paper 2: presents an outline and preliminary results of a study in progress which measures the
effectiveness of using a focused training method with counsellors who work in a primary care (family
physician) practice setting. The method has been shown to work with psychiatrists in training, and the
learned model persists over a two-year follow-up period. This programme teaches experienced
counsellors the basic principles of PI therapy and assesses their interview behaviour using case
simulations in uncomplicated depression, depression with suicidal thoughts, and patients with somatic
complaints.
        Paper 3: presents the results of assessment of the Early Assimilation Rating Scale on eventual
outcome with 8-session PI therapy in-patients with chronic psychiatric difficulties seen as part of a RCT.




                                                  359
Panel Session 45 - Paper in Panel

Title:                 Analysis of Competencies Required for Effective Delivery of PI Therapy
                       and Development of Measures

Authors:               Frank Margison, Else Guthrie, Michael Barkham, Gillian Hardy, David
                       Shapiro and Mike Startup

Address for Correspondence:

                       Frank Margison, Gaskell Psychotherapy Centre; Manchester Royal
                       Infirmary; Swinton Grove; Manchester M13 0EU; UK
                       Telephone: +44 161 273 2762
                       Email: frmargison@aol.com

                                          ABSTRACT

Aims:         To summarise the work carried out on developing measures of adherence and
              competence in PI therapy (Conversational Model).

Content:      Startup and Shapiro (1992) have developed a reliable method of assessing
              adherence. Their method was based on the earlier work from the NIMH
              Collaborative Study of Depression but extended to cover the PI mode as well.
              Further work has since been done to identify competent performance of the
              model. This involves using some adherence items above an agreed threshold,
              supplemented by specific measures of competent delivery of therapy under
              difficult conditions, and some items that are proscribed (anti-therapeutic)
              behaviours. A further scoring sheet has been developed for use in supervisory
              situations, which addresses the ability of the therapist to achieve 1) recognition, 2)
              replication, 3) use in basic situations and 4) use in complex situations for the key
              therapeutic interventions.

               This part of the panel summarises the recent developments in assessing
              competence and the links between assessment (by self, supervisor and client),
              teaching and supervision. The work is part of the programme of development for
              PI therapy which includes manuals for treatment of depression, somatisation and
              deliberate self-harm.

Discussion:   The discussion will focus on the general applicability of this model of competence
              for other modes of therapy.




                                              360
Panel Session 45 - Paper in Panel

Title:                    Early Results of a Study of Training Counsellors Using Videotape
                          Feedback in Delivering PI Therapy in a Primary Care Setting

Authors:                  Hannah Mackay, Else Guthrie, Frank Margison, Jim Moorey, Carolyn
                          Chew, Graeme McGrath

Address for Correspondence:
                     Frank Margison, Gaskell Psychotherapy Centre; Manchester Royal
                    Infirmary; Swinton Grove; Manchester M13 0EU; UK
                    Telephone: +44 161 273 2762
                    Email: frmargison@aol.com
                                      ABSTRACT

        Aims: To summarise progress to date on a current project to teach psychotherapeutic skills in
psychodynamic–interpersonal therapy to primary care counsellors. The project aims to develop
competence in therapeutic skills so that effective and evidence-based therapies become part of the routine
practice of primary care counsellors.

        Method: 24 counsellors are to be trained in two cohorts of 12. The teaching method uses three
videotapes and written material to teach basic skills supplemented by a series of workshops and
role-plays teaching according to a newly developed manual. The videotapes have been used previously in
teaching psychiatrists and mental health specialists. The whole package develops skills beyond the
normal level of expected competence for a counsellor (in working with suicidal patients and somatisers)
using manuals derived from earlier RCTs). The structured teaching will be followed by a second phase
where actual practice is supervised in groups of 3 using feedback on performance from audiotape.

        Measures: The adherence scale developed by Startup and Shapiro is the main change measure
supplemented by ratings of clinical competence. The counsellors performance will be measured on three
20-minute interviews (covering minor affective disorder, depression with suicidal ideation and
somatisation), all three tasks being repeated on three occasions (but with different role players and
different scenarios): before training; after structured teaching and after supervision of practice. The
interviews are with trained role players (actors) to standardise the task difficulty, and a balanced design is
used to reduce the variability due to role player and ―case‖ difficulty.

         Analysis: By the time of the presentation partial results will be available in the form of changes in
mean values of the key behaviours, and feedback from the role-players and the counsellors on the
feasibility of the training procedure with counsellors. Later a full analysis using analysis of variance (time
by case by skill level primarily) will be carried out.

        Discussion: The discussion will focus on the role of enhanced skills in primary care settings for
generic counsellors in the context of the UK National Health Service.




                                                    361
Panel Session 45 - Paper in Panel

Title:                Early Assimilation in PI therapy in Relation to Outcome

Authors:              Dan Beales, Else Guthrie, Frank Margison

Address for Correspondence:

                       Frank Margison, Gaskell Psychotherapy Centre; Manchester Royal
                      Infirmary; Swinton Grove; Manchester M13 0EU; UK
                      Telephone: +44 161 273 2762
                      Email: frmargison@aol.com

                                         ABSTRACT

Aims:         To replicate earlier work using the Early Assimilation Rating Scale (EARS) as a
              predictor of outcome in psychotherapy. The study is based on the outcome data
              available from a RCT study of 8-session PI therapy given to chronic attenders at a
              psychiatric outpatient service.

Method:       The EARS scale is rated on the early part of the first session with the treatment
              group from the original outcome study. Reliability of the EARS has been good in
              other studies and will be reported for this study. The outcome data in the form of
              SCL-90(R) and IIP scores, Euroqol (a quality of life measure), and SF36 a
              standardised health outcomes measure, plus healthcare utilisation measures.

Analysis:     Ratings on the EARS will be used to predict outcome on the main outcome
              measures.

Results:      The main results will be available by May 1999. In addition the tapes of the
              sessions will be examined for other possible predictors of outcome in this group,
              who were by definition chronic service users who had not changed with treatment
              previously, and who had never been referred for psychotherapy.

Discussion:   The main focus of the discussion will be the relationship between the Assimilation
              model and the ability of patients who have long-standing illness to achieve change
              following a very brief intervention.




                                             362
Panel Session 46 - Overall Summary

Title:                  Change in Couples Communication and its Relationship to
                        Couples Therapy Outcome

Participants:           Ana Estrada, Jim Wasner, Lorey Wheeler

Moderator:              Ana Estrada

Address for Correspondence:

                        Ana Estrada, Ph.D.
                        Department of Family Resources and Human Development
                        Arizona State University
                        Tempe, AZ 85287-2502
                        USA
                        e-mail: aestrada@asu.edu

 ABSTRACT
        Changing of dysfunctional communication has been seen as an essential component of
successful outcome in couples therapy. Unfortunately, there has been limited linkage between
these theories of change and the growing empirical research on the communication variables
which distinguish between successful and unsuccessful couples in non-therapeutic contexts.
This panel will explore the issue of couples communication and its relationship to therapy
outcome.

        Wasner will review past research in which communication and process factors predict
success and stability in couples and will discuss the relationship of these findings to the general
process and outcome studies from couples therapy. Wheeler and Estrada will discuss how
specific attribution biases affect spouses' perceptions of communication processes. They will
identify specific patterns of positive self-serving biases and negative partner-centered biases in
36 distressed couples presenting for marital treatment.

        Finally, Estrada and Belanger will present findings from a recent pilot study which target
and examine changes in couples' positive and negative communication patterns across short-term
marital therapy. The extent to which couples' therapy outcome research can benefit from the
empirical research on couples' communication processes will be discussed.




Panel Session 46 - Paper in Panel

Title:                  Theories on Couples Communication and Outcome in Couples Therapy:
                        A Brief Review of the Literature

                                               363
Author:                Jim Wasner

Address for Correspondence:

                       Jim Wasner, Ph.D.
                       Illinois School of Professional Psychology/Meadows Campus
                       1701 Golf Rd., Suite 101
                       Rolling Meadows, IL 60008
                       USA
                       e-mail: jwasner@juno.com

                                           ABSTRACT

        Changing of dysfunctional communication has been seen as an essential component of a
successful outcome in couples therapy. Unfortunately, there has been limited linkage between
these theories of change and the growing empirical research on the communication variables
which distinguish between successful and unsuccessful couples in non-therapeutic contexts. This
presentation will review past research in which communication and process factors predict
success and stability in couples and will discuss the relationship of these findings to the general
process and outcome studies from couples therapy.




Panel Session 46 - Paper in Panel

Title:                 Perceptual Disagreements in Positive and Negative Communication
                       Processes in Distressed Couples

Authors:               Lorey A. Wheeler and Ana Estrada



                                              364
Address for Correspondence:

                        Ana Estrada, Ph.D.
                        Department of Family Resources and Human Development
                        Arizona State University
                        Tempe, AZ 85287-2502
                        USA
                        e-mail: aestrada@asu.edu

                                           ABSTRACT

        This presentation will address specific attribution biases that affect spouses' perceptions
about marital communication processes. More specifically, the proposed project focuses on the
patterns of husbands' and wives' perceptions about themselves and their partners related to
positive and negative communication processes that occurred during a standard 15-minute
interaction task. Guided by the theories of Egocentric Bias and Sentiment Override, statistical
analyses will test for specific patterns of positive self-serving biases and negative
partner-centered biases in 36 distressed couples presenting for marital treatment.




Panel Session 46 - Paper in Panel

Title:                  Changes in Couples' Communication Patterns over the Course of Marital
                        Treatment

Authors:                Ana Estrada and Catherine Belanger

Address for Correspondence:

                        Ana Estrada, Ph.D.

                                               365
                       Department of Family Resources and Human Development
                       Arizona State University
                       Tempe, AZ 85287-2502
                       USA
                       e-mail: aestrada@asu.edu

                                           ABSTRACT

        This project attempts to contribute to the ongoing discussion between communication
processes in couples and the extent to which these processes can be identified and targeted for
change in marital therapy. This work includes 40 couples who have identified communication
difficulties with his/her spouse as a targeted complaint and as a goal in couples' therapy. We will
track the couples' changes in positive and negative communication patterns across short-term
marital therapy and assesses the role of the therapeutic alliance with the couple in facilitating
such change. Results will be discussed in terms of informing marital therapy work with the
empirical research on couples' communication processes.




                                              366
             Panel Session 47 – Overall Summary

              Title:                   What Can Be Gained By Psychoanalysis? Research on the
                                       Specific Effects of Analytic Long Term Psychotherapy

pants:                 T. Grande, G. Rudolf, C. Oberbracht, W. Keller, M. Beutel, M. Leuzinger-Bohleber, U.
                                      Stuhr, M. Rasting, B. Rüger, D. Huber, G. Klug

ator:                  Tilman Grande

ss for Correspondence:

                              Dr. Tilman Grande
                              Psychosomatische Klinik
                              Thibautstraße 2
                              D-69115 Heidelberg
                              Germany

                                             ABSTRACT

             The panel presents the methodological concepts and first results of three ongoing research
             projects investigating analytic long term psychotherapy. Along with the purpose of showing the
             effectiveness of psychoanalysis (which is among others directed towards health insurances and
             political institutions in Germany), the projects are guided by the interest in an investigation of
             processes, the specific effective mechanisms, and the outcome of psychoanalysis.

             All three projects analyze the effects of psychoanalysis which materialize only after long and
             intensive treatment and can be clinically defined as ―structural change‖ of the patients‗
             personality. Processes of structural change cannot be registered by those research instruments
             which are only directed to symptomatic and to overt behavioral change. Instead, the research of
             psychoanalytic therapy requires special qualitative and quantitative research methodologies to
             analyze structural change and its consequences in the patients‗ lives. The panel will depict
             different research strategies dealing with this important methodological question.

             The participants of the panel are psychoanalysts doing research in process and outcome
             psychotherapy research. All projects analyze long term therapies undertaken in private
             psychoanalytical practice. They aim at giving an overview of as well the considerable difficulties
             in this research field as the state of conceptual and methodological solutions.




                                                           367
             Panel Session 47 - Paper in Panel

                            A Research Strategy for Measuring Structural Change in Psychoanalysis and
                                   Psychotherapy – Concept and Some Empirical Results of a Prospective
                                   Study

rs:                 T. Grande, G. Rudolf, C. Oberbracht, W. Keller

ss for Correspondence:

                    Dr. Tilman Grande
                    Psychosomatische Klinik
                    Thibautstraße 2
                    D-69115 Heidelberg
                           Germany

                                             ABSTRACT

             A research strategy is presented which can be used to identify ―structural change‖. This strategy
             was developed to add a psychodynamic level of investigation to the measurement of
             symptomatic or behavioral change. The aim of long-term psychoanalytic therapies is to induce
             change at the structural level of personality. The assumption is that the specific effects of such
             therapies can only be depicted adequately by analyzing this specific kind of change.

             The first step of this strategy consists of assessing the patient, following a special interview with
             regard to his or her central maladaptive relationship pattern, his or her important intrapsychic
             conflicts, and the structural vulnerabilities resp. capacities. These are measured by a diagnostic
             system which has been developed during the last years especially for psychoanalytic
             requirements. This system is called ―Operationalized Psychodynamic Diagnosis‖ (OPD).

             In a second step, five individual and central problems are selected for each patient from the
             OPD-profile which are the basis to observe change in the course of therapy. Defining them as
             central problems puts them into the position of case-related psychodynamic hypothesis
             specifying a patient‘s change-relevant characteristics. In a third step we note the processes of
             structural change that have taken place in the patient with regard to the above mentioned
             problem areas. For this purpose we use a modified form of the ―Assimilation of Problematic
             Experiences Scale‖of Stiles and colleagues.

             In our research project this strategy is applied to a sample of 30 psychoanalyses and 30
             psychotherapies (one hour per week). The presentation will show empirical findings with respect
             to the reliability and validity of the concept.




                                                             368
Session 47 - Paper in Panel

                              Effects of Psychoanalysis and Psychotherapy: A Representative Follow-Up Study
                                       Based on Patient, Analyst and Expert Assessments

rs:                 M. Beutel, M. Leuzinger- Bohleber, U. Stuhr, M. Rasting, B. Rüger

ss for Correspondence:

                    Prof. Manfred Beutel
                    Klinik für Psychosomatische Medizin und Psychotherapie
                    Ludwigstr. 76
                    35392 Gießen
                            Germany

                                            ABSTRACT

             A representative sample of 401 patients was recruited from former patients treated by analysts of
             the German Psychoanalytic Association (DPV) 5 to 8 years before. We included only long-term
             treatments (psychoanalysis and psychotherapy) conducted by experiences analysts. We wanted
             to inquire: 1) the patients‗ perspectives on the course and outcome of their treatments, 2) their
             analysts‗ views on process and outcome and 3) the assessments of expert raters.

             We used follow-up questionnaires (e.g. SCL-90R, Sense of Coherence Scale) and structured and
             open-ended questions to study all of the former patients and their analysts. A representative
             sample of 123 former analysands (120 randomized, 3 extreme cases) and 71 former therapy
             patients (67 randomized, 4 extreme cases) is currently studied by two tape-recorded
             psychoanalytic follow-up interviews. Expert ratings include the Scales of Psychological
             Capacities (Wallerstein) as assessments of psychological structure. With the patients‗ consent
             health care utilization data are obtained from their insurance companies.

             Questionnaire outcome data are discussed with regard to treatment setting, post-analytic course
             and intervening life events. Comparisons are drawn between them and the analysts‗ view.
             Results from qualitative analyses of the patients‗ responses to open questions regarding their
             treatment motivation, course and curative factors are also discussed.




                                                          369
Session 47 - Paper in Panel

                              Measuring Process and Outcome of Long-Term Psychoanalytic
                              Psychotherapy: The Munich Psychotherapy Study (MPS)

rs:                 Dorethea Huber and Günther Klug

ss for Correspondence:

                              Dr. Dorothea Huber
                              Poliklinik für Psychotherapeutische Medizin
                              Klinikum rechts der Isar, TUM
                              Langerstr. 3
                              D-81675 München
                              Germany

                                             ABSTRACT

             Outcome and process of psychoanalysis and psychotherapy will be compared in a prospective
             longitudinal study of a homogenous sample of 30 depressed patients for each treatment modality
             in a stratified controlled trial. The treatments are carried out by experienced and well-trained
             psychotherapists in private practice. The outcome measurement comprises standardized
             questionaires and semistructured interviews as well as a goal attainment scaling to have an
             additional individualized measure of outcome.

             These outcome measures are adapted to the SPR core-battery, being up to the standards of
             international psychotherapy research. The study emphasizes the measurement of the
             mode-specific effects of psychoanalysis, viz. structural change. Measurement points will be
             pre-treatment, post-treatment and at least the first and second year after termination of treatment.

             Furthermore every session will be audiotaped and very briefly rated by the therapist to have a
             basis for the investigation of the psychotherapeutic process on a session level. In order to provide
             another source of data of the ongoing process every half a year the therapist gives a global
             assessment of the most important parameters of the psychotherapeutic process.

             It is the aim of this study to fulfil empirically oriented standards as much as possible and at the
             same time the special concerns of psychoanalytic practice.




                                                            370
              Panel Session 48 - Overall Summary

                              Changing Inducing Patterns in Therapy Sessions

pants:               Daniel Regli, Emma Smith, Andreas Dick

ator:                Klaus Grawe

ss for Correspondence:

               Klaus Grawe, Ph.D.
               Institut fur Psycholgie
               Muesmattstr. 45
               CH 3009 Bern
               Switzerland
               Fax: 0114131 631 8212
               Email: klaus.grawe@psy.unibe.ch

                                              ABSTRACT

              Based on an theory of effective ingredients of psychotherapy by Grawe (1997, 1998) an
              instrument called ―Change Inducing Pattern Analysis (CIPA)‖ was developed and applied to the
              analysis of ten-minute-segments of therapy sessions. 875 segments from 175 therapy sessions
              were analyzed by trained raters. Productive and unproductive sessions according to patient‘s
              ratings in a post session questionnaire, selected from ten-session- phases characterized by strong
              vs. no improvement in patient‘s well-being were compared with each other.

              The panel consists of three related contributions by members of our Bernese research group
              which report on different aspects of results. The paper by Regli et al. is a basic report on which
              aspects of the therapy process postulated by Grawe‘s theory to have change inducing properties
              are actually significantly related to the session outcome. The paper by Smith et al. reports on a
              test of an explicit hypothesis about the relation between resource activation and problem
              activation derived from Grawe‘s theory. The paper by Dick et al. reports on interesting
              interventions effects that have been found between specific therapeutic interventions and certain
              preconditions on the side of the patient that lead to clinically relevant therapeutic decision rules.




Session 48 - Paper in Panel

                              What Makes Therapy Sessions Effective?

rs:                  Daniel Regli, Klaus Grawe, Emma Smith

                                                              371
ss for Correspondence:
               Daniel Regli, Ph.D.
               Psychotherapeutische Praxisstelle
               Universitat Bern, Mittelstr. 42
               CH 3012 Bern, Switzerland
                             Fax: +41 31 631 41 55
                             Email: daniel.regli@ptp.unibe.ch

                                                ABSTRACT

                In the present study we analyzed 175 therapy sessions with a rating instrument for the
                measurement of change inducing patterns (CIPA) of effective ingredients of psychotherapy.
                The instrument is based on the five dimensional system of psychotherapy proposed by Klaus
                Grawe (1997). Half of the sessions were selected from productive therapy phases (self-rated
                changes in the patient‘s well-being), the other half from unproductive phases. The dimensions
                analyzed are: (1) working on problems vs. activating resources (2) clarification of meaning vs.
                coping and mastery (3) analysis of present state vs. orientation towards change (4) individual vs.
                interpersonal perspective (5) problem actualization vs. problem discussion.

                The aim of the present study was to find patterns of these elements of the therapy process which
                lead to improvement. We report on the results for the following hypotheses:

essful therapy sessions have significantly higher values for the realization of a good therapeutic relationship as
                well as for the therapist‘s and patient‘s contribution to the joint therapeutic effort.

ccessful therapy phases the focus is more on changing problems (coping and mastery) than on analyzing
                problems (clarification).

ccessful therapy phases the analysis of problems (clarification of meaning) is explicitly combined with problem
                actualization.

ccessful therapy phases we more often find a clear focus in the treatment of the patient‘s problems.

                The results propose ‗research informed‘ adaptive decision rules as guidelines for therapeutic
                work.




                                                               372
              Panel Session 48 - Paper in Panel

                              Characteristics of Successful Problem Actualization: How to Help Patients
                                      Experience and Solve Their Problems

rs:                  Emma Smith, Daniel Regli, Klaus Grawe

ss for Correspondence:

                              Emma Smith
               Institut fur Psychologie
               Muesmattstrasse 45
               CH-3000 Bern 9
               Switzerland
               Email: emma.smith@psy.unibe.ch

                                             ABSTRACT

              This study takes a closer look at the role of problem actualization in successful therapy sessions.
              Based on the hypothesis that the experience of difficult emotions is a necessary but not in itself
              sufficient condition for positive change, we ask the question: Which additional criteria must a
              therapy session fulfill in order to help the patients make use of these emotions in a constructive
              way?

              To answer this question we selected 60 therapy sessions, half of which had been judged by the
              patients themselves as emotionally difficult but not very helpful, the other half having been
              judged as emotionally difficult, yet leading to clarification of meaning and feelings of mastery
              and competence. These two groups of sessions were subsequently analyzed using the newly
              developed process rating instrument ―WifA‖ and compared with regard to their different patterns
              of realized change mechanisms.

              The results demonstrate the importance of a good cooperative therapeutic bond and of a strong
              focus on the patient‘s resources if problem actualization is to succeed. They also point out the
              necessity of adapting the therapeutic procedure tot he situation and condition of the patient,
              which varies from session to session. From these results we derive practical guidelines to help
              therapists realize more effective problems actualizations.




Session 48 - Paper in Panel

                              How to Deal with Difficult Preconditions During Therapy Sessions: Depressed or
                                     Anxious Patients, Low Patient Motivation, Low Patient Aptitude, No

                                                             373
                                     Progress

rs:                 Andreas Dick, Klaus Grawe, and Patrizia Heim

ss for Correspondence:

              Andreas Dick
              Universitat Bern
              Institut fur Psychologie
              CH-3000 Bern 9
              Switzerland
              Email: andreas.dick@psy.unibe.ch

                                            ABSTRACT

             This study examines the possibilities of adapting the therapy process during therapy sessions to
             difficult preconditions. We looked at the differences of the therapy process between successful
             and unsuccessful sessions for the following difficult situations: symptoms of depression or
             anxiety, low motivation of the patient to cooperate with the therapist, low aptitude of the patient
             for the joint therapeutic work, low interest of the patient to work on his problems and no
             progress or even deterioration of the patient‘s well-being between therapy sessions.

             175 selected therapy sessions were analyzed according to our rating instrument CIPA, which is
             based on Klaus Grawe‘s theory on general change mechanisms. Sessions from productive and
             unproductive therapy phases (self-rated changes in patient‘s well-being) were compared to each
             other. The results chow the importance of specific adaptations of the therapy process in
             sessions with difficult preconditions in order to avoid unsuccessful therapy sessions.




                                                            374
              Panel Session 49 – Overall Summary

                              Psychotherapy in Primary Care

pants:               Johannes Kruse, Claudia Heckrath, Wolfgang Wöller, Wolfgang Tress, Kurt Fritzsche,
                                   Ulrike Armbruster, Michael Wirsching, Beate Clar

ator:                Johannes Kruse and Kurt Fritzsche

ss for Correspondence:

                             Johannes Kruse
               Klinik für Psychosomatische Medizin und Psychotherapie der HHU, Bergische Landstraße 2
                                     D-40629 Düsseldorf
                             Fax.: 0049-211-922-4709    mail: kruse@uni-duesseldorf.de

                                             ABSTRACT

              Patients with psychological disorders usually are diagnosed and treated by primary care
              providers. In Germany the general practitioner (GP) has an important screening function in the
              treatment of these patients. He has two different functions:

a)            the GP can motivate his patients and send them to a psychotherapist and

b)            a great number of patients receive Psychosomatic Basic Care by the GP himself e.g. cancer
                            patients or patients with Somatoforme disorders.

              This field which is very important for psychotherapeutic care still lacks empirical knowledge.
              The speeches held during this panel are dealing with three studies concerned with the following
              questions:

              First Mr. Kruse will report about a study treating the GP´s indication for psychotherapy. The
              importance of variables of the physician, the patient and their interactions will be examined.

              In the second speech Mr. Fritzsche will treat the question how patients judge their GP´s
              Psychosomatic Basic Care. He investigates what kind of psychosocial intervention the patients
              expect.

              The third speech is hold by Mrs Clar. She reports on a study, which investigates the question
              how to modify GP´s attitudes and interactional behaviour.



Session 49 - Paper in Panel

                              Recommendation on Psychotherapy and Psychosomatic Basic Care in Primary
                                    Care



                                                            375
rs:                 Johannes Kruse, Claudia Heckrath, Wolfgang Wöller, Wolfgang Tress

ss for Correspondence:

               Johannes Kruse
               Department of Psychosomatic and Psychotherapy,
               University of Düsseldorf
               Bergische Landstraße 2 D-40629 Düsseldorf
                             Germany
               Fax.: 0049-211-922-4709
                             e-mail: kruse@uni-duesseldorf.de

                                             ABSTRACT

             Patients with psychological disorders usually are diagnosed and treated by primary care
             providers. In Germany the general practitioner (GP) has an important screening function in the
             treatment of these patients. The GP has also a central function in motivating and initiating a
             psychotherapy. It is not known to which patients psychotherapy is recommended by the GP and
             which factors have an impact on his decision.

             The study aims at identifying factors influencing the GPs´ decision to recommend
             psychotherapy, Psychosomatic Basic Care or somatic care only.

             572 patients of 18 general practitioners were examined by the GP and by a psychotherapist
             (SKID, BSS). The GPs documented their diagnosis and their proposals for treatment (EVAS) .
             Symptoms of the patients were measured by questionnaires using the Symptom-Check-List
             (SCL-90-R) and the General Health Questionnaire (GHQ-12). 200 doctor-patient interactions
             were audiotaped, transcribed and analysed.

             Results: A psychotherapy was taken into consideration for 3,3% of the GPs` patients, a
             consultation in the sense of Psychosomatic Basic Care for 11,5%. Patients are only sent to
             psychotherapists if the GP has diagnosed a psychological disorder, if the patients have developed
             severe symptoms and if the Patients have a psychological theory of illness. Only if the
             doctor-patient conversation exceeds 8 minutes, GPs recognises psychological symptoms and
             recommends psychotherapy. Further contexts of interactional parameters will be demonstrated.



Session 49 - Paper in Panel

                              Patient's Expectations in Psychosocial Primary Care

rs:                 Kurt Fritzsche, Ulrike Armbruster, Michael Wirsching

ss for Correspondence:

                              Kurt Fritzsche,
                              Department of Psychosomatics and Psychotherapeutic

                                                            376
                              Medicine, Hauptstr. 8, D-79104 Freiburg,
                              Germany
                              Tel. 0761/270-6871,
                              Fax: 0761/270-6885,
                              E-Mail: Kunz@pss1.ukl.uni-freiburg.de

                                             ABSTRACT

             This study was done within the framework of the evaluation of the training program
             Psychosocial Primary Care (PPC). Ten general practitioners were selected by chance. A total of
             n = 220 patients were surveyed in the waiting room about their expectations concerning
             psychological counselling.

             More than half of the patients (54 %) rated the counselling on psychological aspects of their
             illnesses as "important" to "very important". Two thirds of the patients also believed in a healing
             effect or in a symptomatic improvement also for physical illnesses.

             Eighty-five percent of the patients wanted to utilise the PPC services. Counselling was
             considered most important (65 %). The general practitioner plays an important role especially for
             elderly and less educated patients. He is usually accepted as the only reliable and competent
             partner.

             Strongly motivated patients and patients with experiences in psychotherapy were "unsatisfied".
             Lack of time was the most frequent reason (54 %) that the counselling did not take place. The
             results show that most of the patients prefer an integrated offer of psychosocial care.
             Consequently, training in psychosocial competence in primary care should be offered more
             frequently.




Session 49 - Paper in Panel

                              Improving Psychosocial Counselling Skills in General Practitioners

rs:                 Beate Clar, Johannes Kruse, Claudia Heckrath, Wolfgang Wöller, Wolfgang Tress

ss for Correspondence:

                              Johannes Kruse
                              Department of Psychosomatics and Psychotherapy,
                              University of Düsseldorf
                              Bergische Landstraße 2 D-40629 Düsseldorf
                              Germany
                              Fax.: 0049-211-922-4709

                                                            377
              e-mail: kruse@uni-duesseldorf.de

                              ABSTRACT

Cancer is always connected with a great number of psychosocial problems. Oncological patients
often wish to have emotional relieve and a supporting relationship with their doctors, who treat
them because of their somatic symptoms. As the first persons consulted by cancer patients these
doctors have to fulfil the important function of recognising and treating those psychosocial
problems. However studies reveal a variety of problems in treatment of these patients.

This controlled study poses the question how training-courses for GPs can contribute to the
improvement of their Interactional abilities and consequently to the improvement of the
psychosocial care for oncological patients.

Design: During a model-project 50 resident doctors of the city of Moenchengladbach are trained
in a 26-sessions course for a more patient-centred conversation. The control group is formed by
50 doctors, who had attended a single 6-hours training session. Before and after the training
course the doctors are consulted by a simulated patient (actor) about a psychosocial problem.
The conversations are audiotaped and transcribed, the interactional behaviour is evaluated using
a coding system (MIPS). Furthermore the doctors are asked about their sense of competence
before and after the training. Correlations between the doctors sense of competence and the
judgement of their interactional behaviour are reported and changes during the training are
demonstrated.




                                             378
             Panel Session 50 - Overall Summary

                               So How Do You Teach, Learn, Implement, and Judge Outcome of a Manualized
                                     Treatment? Experiences with Transference-Focused Psychotherapy
                                     (TFP)

pants:                Laura Bartocetti, Peter Buchheim, John F. Clarkin, Gerhard Dammann, Diana Diamond,
                                     Pamela A. Foelsch, Kenneth Levy, Lina Normandin, & Frank
                                     Yeomans

ator:                 Pamela A. Foelsch

ss for Correspondence:
                              Pamela A. Foelsch, Ph.D.
                              Weill Medical College of Cornell University, Westchester Division
                              21 Bloomingdale Road,       White Plains, NY 10605 USA
                              E - Mail: PFOELSCH%WESTNYH@NYH.MED.CORNELL.EDU

                                                  ABSTRACT
             Collaborators from the United States, Germany, Italy, and Canada will present the latest research findings
             from the Borderline Psychotherapy Project based at Cornell, regarding the manualization of
             Transference-Focused Psychotherapy (TFP), the training of psychotherapists, the ratings of therapist‘s
             adherence and competence to TFP, and assessment of outcome of patients with Borderline Personality
             Disorder following one year of TFP treatment. The first paper, ―Training of therapists in a manualized,
             transference focused psychotherapy for borderline patients‖ by Gerhard Dammann, Peter Buchheim, & John F.
             Clarkin will focus on selection of therapists and their training. They will report on the general as well as
             specific problems with the process of recruiting and training thirty therapists who will participate in a
             comparative psychotherapy study in Munich. Emphasis will be on those issues particular to the transfer of a
             treatment to a site , other than that of the originator, with a different language, culture, and health-care delivery
             system. The second paper, ― A multimethod approach to measuring adherence and competence of therapists
             to a manualized treatment for severe personality disorders‖ by Pamela A. Foelsch, Lina Normandin, Frank
             Yeomans, and John F. Clarkin reports on the means and methods employed to assess whether a therapist is
             actually doing what they are supposed to do based on the manualized treatment, and with what level of skill.
             Emphasis is placed on the necessity to use several methods to accurately assess the domain relevant to
             determining whether a therapist is adherent to the manualized treatment. The third paper, ―Attachment and
             personality organization: Measures of structure and change in TFP treatment‖ by Diana Diamond, Laura
             Bartocetti, Kenneth Levy, John F. Clarkin, & Pamela A. Foelsch uses the model of attachment and Kernberg‘s
             model of personality organization to assess patient‘s internalized object relations at the beginning and end of
             one year of TFP treatment. This paper elucidates the ways in which attachment organization and personality
             structure changes during treatment in addition to the ways in which the initial organization effects the
             therapeutic process, particularly during specific phases of treatment. Additionally, reflective function and
             developmental level of self and object representations are discussed as further areas to assess change and
             differential effectiveness. In sum, these three papers articulate aspects of the development of a manualized
             psychodynamic treatment, the integration of clinical understanding and empirical assessment, with emphasis
             on areas of particular relevance to the assessment of the treatment‘s effectiveness.




                                                                    379
Session 50 - Paper in Panel

                              Training of Therapists in a Manualized, Transference Focused Psychotherapy for
                                      Borderline Patients

rs:                   Gerhard Dammann, Peter Buchheim & John F. Clarkin

ss for Correspondence:

                              Dr. Gerhard Dammann
                              Department of Psychosomatic Medicine and Psychotherapy
                              Technical University Medical School
                              Langerstr. 3
                              D - 81675 Munich, Germany
                              E - Mail: G.Dammann@Irz.tum.de

                                             ABSTRACT

              Thirty psychotherapists and psychoanalysts have been trained in a manualized, psychodynamic
              psychotherapy for Borderline patients (Transference-Focused Psychotherapy (TFP); Clarkin,
              Yeomans, & Kernberg, 1998) since spring of 1997 in Munich to prepare for a comparative
              psychotherapy study. Preliminary results of this empirically supported training in TFP are
              presented.

              This specific treatment requires a far-reaching change of therapist‘s attitudes: dealing with
              aggression, rapid interpretations in the here-and-now, establishing a therapy contract, and the
              need to deviate occasionally from technical neutrality, in addition to continuous supervision, and
              video taping of sessions.

               The problems, the personal experiences and the professional development of the therapists
               (CCQ, David Orlinsky) are described at initial and final stages of training.
l present the most important elements phases in the training in a manualized and empirically informed
               treatment and how that has been accomplished. They are : (1) recruitment of psychoanalytically
               experienced therapists who are open-minded to psychotherapy research, (2) specific information
               about the theory and practice of TFP learned in successive and intensive training seminars (held
               in Germany by Otto Kernberg, John Clarkin & Michael Stone from the Personality Disorders
               Institute, Cornell), (3) Training in the diagnosis of Borderline Personality Disorder (BPD) and
               borderline personality organization (BPO), (4) training for the ―Structural Interview‖ (including
               videos) , (5) training of the contract setting phase and the identification of the predominant
               object relations themes (including videos) and (6) teaching adherence and competence rating to
               the therapists which included the training of two supervisors from Munich in White Plains
               regarding their reliability in using the adherence and competence rating scale.




                                                            380
Session 50 - Paper in Panel

                              A Multimethod Approach to Measuring Adherence and Competence of
                                     Therapists to a Manualized Treatment for Severe Personality Disorders

rs:                  Pamela A. Foelsch, Lina Normandin, Frank Yeomans, & John F. Clarkin

ss for Correspondence:
                              Pamela A. Foelsch, Ph.D.
                              Weill Medical College of Cornell University, Westchester Division
                              21 Bloomingdale Road
                              White Plains, NY 10605 USA
                              E - Mail: PFOELSCH%WESTNYH@NYH.MED.CORNELL.EDU

                                                ABSTRACT
             As part of our ongoing Borderline Psychotherapy Research project we have developed three assessment tools
             to enhance and rate therapists‘ adherence to Transference-Focused Psychotherapy (TFP), a manualized
             psychodynamic psychotherapy for persons with severe personality disorders (Clarkin, Yeomans, & Kernberg,
             1998). These three instruments assess therapists‘ degree of adherence and competence using different
             methods and are specific to different phases of treatment as well. The treatment contract setting phase is
             specific to TFP and essential for setting the structure of how therapy will proceed. If the contract negotiation
             has a low rating, this has potential negative consequences on the treatment process and outcome. The
             treatment contract is rated using transcriptions of those sessions designated as ―treatment contract sessions.‖
             This rating is made only during that phase of treatment and can be used as a covariate to determine therapist
             adherence during the subsequent therapy process. A supervisor‘s rating of therapist adherence and
             competence is made throughout the therapy process. The ratings use a series of questions specific to aspects of
             technique and process. These are answered using both a dichotomous and visual analog scale. These ratings
             are used in both individual supervision and peer group supervision and usually are made using a combination
             of therapist verbal report and excerpts of audio or video session material. These ratings are useful for
             monitoring therapist adherence in a timely way and allows for informative and corrective discussions which
             may assist the therapist in improving his or her adherence and effectiveness in conducting the therapy. The
             third method of assessing therapist adherence and competence involves rating video session material using the
             Transference Countertransference Analysis method (Foelsch & Normandin, 1997).
             Taken together, the three methods taken together give the most accurate measure of a therapist‘s adherence
             and level of competence to the manualized treatment. The treatment contract rating supplies an understanding
             of the minimum level of adherence possible as it supplies the structure for the therapy process to proceed.
             Supervisor‘s rating supply immediate assessment of a therapist‘s level of adherence and competence and may
             be used correctively to assist a therapist to become more adherent and more effective. However, those ratings
             can be biased by the relationship between the supervisor and therapist. Thus, the addition of a rating system
             which allows for blind ratings, without discussion, and with complete and random session material (not relying
             on ―problem‖ sessions brought to supervisors) provides a more objective assessment of a therapist adherence
             and competence. It is the use of multiple methods of assessment, using varied data sources, which provides
             the most complete and useful determination of a therapist‘s level of adherence and competence.




                                                                 381
Session 50 - Paper in Panel

                              Attachment and Personality Organization: Measures of Structure and Change in
                                     TFP Treatment

rs:                  Diana Diamond, Laura Bartocetti, Kenneth Levy, John F. Clarkin, & Pamela A. Foelsch

ss for Correspondence:
                          Diana Diamond, Ph.D.
                    135 Central Park West, Suite 1N
                    New York, NY 10023
                          USA
                                          ABSTRACT
             Transference-Focused Psychotherapy (TFP) is an object relations model of understanding the patient with
             a severe personality disorder, and thus hypothesizes that different internal personality organizational
             structures exist and will be observed in patient‘s relationships with other people, including within the
             transference in psychotherapy. We have utilized several methods to measure patient‘s internal object
             representations, including the Adult Attachment Interview (rated for classification as well as reflective
             function), the Object Relations Interview, and the Inventory of Personality Organization. This paper
             will present preliminary findings from the Borderline Psychotherapy Project of patients who have
             completed one year of TFP treatment.
             The Inventory of Personality Organization (IPO) assesses personality organization as hypothesized by
             Otto Kernberg (and which is the focus of treatment in TFP). This instrument identifies three different
             levels of personality organization (the neurotic, borderline, and psychotic) as well as object relations
             types. The IPO was completed by patients at the beginning and end of treatment. Two hypotheses were
             tested on an N of 15. First, that the IPO (particularly the object relations types) could predict patient
             drop-out versus participation in treatment. Second, that changes in internal structure as measured by the
             IPO relate to treatment outcome (as measured on the social adjustment scale). Data from two patients
             will be presented to illustrate the relevance of knowing personality organization as it affects treatment
             outcome.
             Attachment classification has been found to discriminate among subtypes of borderlines, and to predict
             differential responses to treatment among these patients. We have tracked the process and outcome of
             TFP by assessing change in attachment organization, reflective function, and developmental level of self
             and object representations. We have also assessed the extent to which attachment organization affects
             the ways in which patients negotiate and respond to the stages of TFP, including the initial contract
             setting phase, the nature and quality of the affects, and the emergence of object relationship dyads in the
             transference. Clinical and research data will be presented and integrated, with particular emphasis on the
             above two patients, one classified as Preoccupied/Unresolved for trauma, and one as Dismissing on the
             Adult Attachment Interview.
             Attachment classification and personality organization will be discussed as theoretical constructs and
             empirical tools for understanding patient change and psychotherapy outcome.




                                                               382
             Panel Session 51 - Overall Summary

                              Computer Applications for Documentation and Quality Control in Psychotherapy

pants:              Norbert Schmitz, Norbert Hartkamp, Carsten Brinschwitz and Silke Michalek

ator:               Norbert Hartkamp

sant:               David M. Todd

ss for Correspondence:

               Norbert Hartkamp
               Clinic for Psychosomatic Medicine and Psychotherapy
               Heinrich-Heine University
               Bergische Landstr. 2 , H19
               D-40605 Duesseldorf
               Germany
               Email: hartkamp@uni-duesseldorf.de

                                            ABSTRACT

             Psychotherapists are faced with increasing requirements for documentation and evaluation of
             psychotherapeutic treatments. The rapid development of microcomputer technology offers new
             possibilities for quick, safe and easy collection and analysis of diagnostic data, process-related
             and other relevant data. This panel addresses the difficulties and possible solutions of using
             microcomputers in the framework of documentation and quality control of psychotherapies.

             A first presentation reports on an experimental study of the effect of computer vs.
             paper-and-pencil administration of the Symptom-Check-List (SCL-90-R), which found a good
             overall acceptance of the computerized presentation and no systematic differences between the
             two groups studied.

             A second presentation explores the benefits of integrating functions of analysis of psychometric
             data and measures of quality-control into one easy-to-use computer system, which makes it
             possible to support ongoing therapies through a report-card system and quick, "online" feedback
             of process-oriented data.

             The discussion focuses on the necessity to supplement such integrative database systems by
             narrative and qualitative data, which so reflect open-endedness of psychotherapeutic processes.

Session 51 - Paper in Panel

                              Computerized Administration of the Symptom Check List (SCL-90-R) in
                                    Psychosomatic Outpatients

rs:                 Norbert Schmitz, Norbert Hartkamp, Carsten Brinschwitz and Silke Michalek



                                                            383
ss for Correspondence:

              Norbert Schmitz
              Clinic for Psychosomatic Medicine and Psychotherapy
              Heinrich-Heine University
              Bergische Landstr. 2 , H19
              D-40605 Duesseldorf
              Germany
              Email: schmitzn@uni-duesseldorf.de

                                            ABSTRACT

             Computerized administration of psychological questionnaires has rapidly increased. The
             transition from paper-and-pencil format to computer implementation should preserve the
             valuable qualities of the original tests. The American Psychological Association has
             recommended that the equivalence between paper-and-pencil and computer-based versions of a
             test should not be taken for granted. Instead, it should be subject of investigation in every case.

             This study investigated whether administration mode (computer vs. paper-and-pencil) influenced
             mean scores on the Symptom-Check-List (SCL-90-R). 300 subjects were randomly assigned
             either to a control group (paper-pencil version) or to a experimental group
             (computer-administered version). Statistical equivalence tests were used to examine
             psychometric equivalence. No systematic differences were observed in group means for any of
             the subscales. The overall acceptance of the computerized version was good. Some limitations
             on the generality of our results are discussed, and directions for future research are outlined.




                                                            384
Session 51 - Paper in Panel

                              Computer Assisted Integration of Psychotherapy Documentation and Quality
                                    Control of Psychotherapeutic Treatments

rs:                 Norbert Hartkamp, Norbert Schmitz, and Silke Michalek

ss for Correspondence:

               Norbert Hartkamp
               Clinic for Psychosomatic Medicine and Psychotherapy
               Heinrich-Heine University
               Bergische Landstr. 2 , H19
               D-40605 Duesseldorf
               Germany
               Email: hartkamp@uni-duesseldorf.de

                                            ABSTRACT

             There have been several efforts over the last years to develop standards for a core battery of
             psychometric instruments for documentation and quality control of psychotherapeutic
             treatments. Core batteries which may include standard instruments like symptom questionnaires
             or personality questionnaires are often supplemented by specially tailored questionnaires for the
             use in a given institutional context.

             This presentation discusses the requirements for computers-systems which integrate standard-
             and non-standard-instruments. The integrated "klindo"-computer system is presented, which is
             easy to use for non-specially-trained staff, which is easily adaptable to different core
             battery-standards, a system which is scalable, highly configurable, network-compliant, capable
             of analyzing different psychometric questionnaires including printed output, and including
             possibilities to generate process-oriented report cards for ongoing psychotherapeutic treatments.
             The system includes validation of input-data, advanced data retrieval capabilities, basic and
             advanced capabilities for graphical and statistical analysis, and an interface which allows to write
             data into native SPSS- and spreadsheet data files.




                                                            385
              Panel Session 52 - Overall Summary

                               Psychodynamic Base-line Diagnostics of the Patient and its Potential Use for
                                      Outcome Research in Psychotherapy

pants:                Uwe Hentschel, Juris Draguns

ator:                 Uwe Hentschel

sant:                 Lester Luborsky

ss for Correspondence:

                            Uwe Hentschel
              Department of Psychology
                            University of Leiden
                    Wassenaarseweg 52
              2333 AK Leiden, The Netherlands

RACT
              The concept of cognitive styles was developed and elaborated on by G. S. Klein and his co-workers. They
              were able to show relationships between cognitive styles and defense mechanisms in nonpathological
              samples. Later this relationship found support also in a larger clinical sample (cf. Hentschel, 1980).
              Whereas in pedagogical psychology cognitive styles have survived as applied constructs and are used
              fruitfully e.g. for the matching of individual learning styles with different forms of instruction, in
              psychotherapy research cognitive styles hardly ever have been included in test batteries as potential
              predictors. Defense mechanisms -registered by ratings and tests -have been used as descriptors of change
              achieved in psychotherapy, but also in this case hardly as predictors for change. If one assumes that all
              psychotherapy requires some kind of learning, then comparable to pedagogical psychology a matching of
              preferred learning styles and the actual learning requirements in the therapy should result in demonstrable
              positive effects. There are studies indicating differences in the Serial Color-Word Test for psychosomatic
              patients. Berglund and Smith (1988) found a higher suicide rate in depressive patients who at the time of
              testing had shown no defensive signs in the Meta-Contrast Technique. This kind of information, available
              since a rather long time, is not used for therapeutic applications, neither for outcome research nor for
              definition of therapeutic goals. This leads to the question whether it simply is a fact that this information
              can not at all be adapted to therapeutic strategies or that it really could be useful in case only a good
              'translation' into psychotherapeutic strategies would be provided. The panel forms a first attempt to find
              out whether cognitive styles and defenses have faded out on good grounds in psychotherapy research or if
              their potential predictive value unduly is underestimated.
              In the first paper of the panel examples will be given for differences found in patient groups in regard to
              cognitive styles and defense mechanisms (Uwe Hentschel). The second paper will concentrate on
              change-related thinking in psychotherapy, how changes are conceptualized and how important base-line
              informations, i.e. the starting point for therapy, are in this context. It will be tried to describe changes in
              terms of "learning", in the broadest sense of the meaning (Juris Draguns). The task of the discussant
              (Lester Luborsky) will be to give an evaluation of the potential impact of cognitive styles and defenses
              for psychotherapy research.

Session 52 - Paper in Panel



                                                                  386
                              On the Diagnostic Validity of Defense Mechanisms and Cognitive Styles

r:                   Uwe Hentschel

ss for Correspondence:

               Uwe Hentschel
               Department of Psychology
               University of Leiden
               Wassenaarseweg 52
               2333 AK Leiden
               The Netherlands

                                            ABSTRACT

              In the first paper of the panel the basic assumptions regarding the postulated relationships
              between cognitive styles and defense mechanisms will be summarized. On the basis of clinical
              studies, examples for differences between patient groups in terms of cognitive styles and defense
              mechanisms will be given. Diagnostic results will be presented for psychosomatic patients,
              depressive inpatients and a mixed clinical group of nonpsychotic patients.

              The main aim of this paper is to show the range of diagnostic validity of the - mostly
              experimental - test instruments (among others the Serial Color-Word Test and the Defense
              Mechanism Test) in this tradition of psychodynamic research.

              A short remark will be made with regard to pedagogical psychology where, in contrast to clinical
              psychology, cognitive styles are still alive.




Session 52 - Paper in Panel

                              Defense Mechanisms in Research and in Psychotherapy

r:                   Juris G. Draguns

ss for Correspondence:


                                                           387
 Juris G. Draguns
 Department of Psychology
 Pennsylvania State University
 410 Moore Building
 University Park, PA 16803, U.S.A.
 Email: jgdl@psu.edu

                               ABSTRACT

Recent burgeoning of research-based writings on defense mechanisms suggests that this body of
findings is ripe for application in the clinical conduct of psychotherapy. Yet no such applications
appear to have occurred so far. Against this background attempts will be made to: (1) formulate
testable hypotheses about the relationship of predominance of certain defense mechanisms and
the effectiveness of, and preference for, certain styles and modes of psychotherapy; (2) propose
process and outcome investigations of defense mechanisms in psychotherapy and the clients'
responses to various therapy techniques and interventions; (3) initiate the development of
focused and brief interventions tailored for specific combinations of presenting problems and
defense mechanisms.




                                              388
             Panel Session 53 - Overall Summary

                             Trauma in the Psychotherapy Researcher‘s Armchair: Supervision and
                                    Countertransference in a Posttraumatic Stress Disorder Treatment Study

pants:               Denise Hien, Lisa Litt, Gloria Miele, Lisa Najavits

ator:                Lisa Litt

ss for Correspondence:
                          Denise Hien, Ph.D.
                   Director, Women‘s Health Project,
                          St. Luke‘s-Roosevelt Hospital Center
             1111 Amsterdam, Minturn 4, New York, NY 10025 USA
                          212-523-4853, Fax: 212-523-2140, drhien@aol.com

                                               ABSTRACT

             Along with increasing sophistication in the treatment of trauma, there is a developing clinical literature on
             vicarious traumatization in therapists who work intensively with abuse survivors. In particular, clinicians
             recognize how crucial supervision and personal analysis are to understanding the countertranferential
             experiences- emotional reactions that arise specifically from working with traumatized patients- as an
             essential element of the treatment process. In sharing our clinical research work with others who study the
             epidemiology and treatment of chronic victimization and posttraumatic stress disorder (PTSD), we have
             taken part in informal dialogues during technical meetings and conferences about the necessity of
             supervision which is sensitive to vicarious traumatization of staff members at every level of clinical
             research--from screening to assessment to treatment. Yet we have found no formal literature which
             addresses this important topic.
             This panel will present and explore the supervisory issues specific to the assessment and treatment of
             female drug abusers with posttraumatic stress disorder in the context of a comparative psychotherapy
             outcome study. Dr. Miele‘s paper will examine the importance of diagnostic and clinical supervision of
             interviewers who conduct assessments for PTSD. Her paper will discuss the necessity of providing a
             supervisory experience that includes attention to the interviewer‘s reactions to diagnostic case material to
             facilitate reliable and valid assessment. Dr. Najavit‘s paper will focus on key issues in training and
             supervising PTSD research therapists to work with this difficult treatment population, including strategies
             to increase empathy, countertransference, selection of therapists, cross-training and other training
             dilemmas. Finally, Drs. Hien and Litt will present the preliminary findings of a National Institute on Drug
             Abuse-funded randomized clinical trial comparing two individual cognitive-behavioral treatments for
             female drug abusers with PTSD (a combined PTSD and drug abuse treatment versus standard relapse
             prevention) which has employed these supervisory processes in the research.
             Working with women with coexisting PTSD and drug abuse provides multiple challenges in selecting,
             training, supervising and supporting research assessors and therapists. Our aim is to open discussion of
             these important issues for consideration in the conduct of clinical research with trauma survivors .




                                                                389
Session 53 - Paper in Panel

                              Supervision of Clinical Interviewers in PTSD Psychotherapy Research

r:                   Gloria M. Miele

ss for Correspondence:
               Gloria M. Miele, Ph.D.
               New York State Psychiatric Institute/
               Columbia University College of Physicians and Surgeons
               1501 Riverside Drive, Unit 123
               New York, NY 10032
                            USA
               212-781-1678
               e-mail: gmm23@columbia.edu

                                               ABSTRACT
              A great deal of literature exists on treatment and countertransference issues that arise for the
              therapist who conducts psychotherapy with individuals who experience traumatic stress and
              PTSD. However, little attention has been paid to the experience of clinical interviewers who
              conduct semi-structured assessments of individuals with PTSD. This paper will address the
              importance of diagnostic and clinical supervision of clinical interviewers who conduct
              assessments for PTSD psychotherapy research studies, including issues involved in the
              assessment of PTSD in substance using populations. Examples from an ongoing supervision
              group will illustrate these issues.

              Diagnostic issues that commonly arise in supervision will be discussed. While seemingly
              straightforward, the definition of a traumatic event is often complex, especially in substance
              using populations who tend to experience many traumas. Substance use may mask or
              exacerbate PTSD symptoms, making their assessment difficult. The impact of diagnostic
              decision-making for PTSD psychotherapy research will be discussed.

              The clinical and countertransference issues that arise for interviewers who assess PTSD are very
              similar to those that arise for therapists who treat PTSD patients. Enduring intense affects, such
              as rage, helplessness, and fear, identifying with the victim or perpetrator, manifesting resistance
              to dealing with traumatic events, and developing PTSD-like symptoms are all common
              interviewer experiences. Using the supervision to identify and process these reactions faciltiates
              the interviewer‘s ability to make an accurate assessment. The interviewer-interviewee
              relationship is also unique in that the immediate goal is not to alleviate suffering but to elicit
              reliable and valid assessment data for use in assigning the interviewee to the appropriate
              treatment. Teaching interviewers how the interaction can be therapeutic while still focused on
              the goals of assessment is an important aspect of the supervision that can enhance PTSD
              psychotherapy research.




                                                             390
             Panel Session 53 - Paper in Panel

                              PTSD and Substance Abuse: Training Therapists to Work with a ―Difficult‖
                                    Population

r:                  Lisa M. Najavits

ss for Correspondence:

               Lisa Najavits, PhD
               McLean Hospital
               115 Mill St.
               Belmont, MA 02478 USA
               Lnajavits@hms.harvard.edu

                                            ABSTRACT

             This presentation will focus on key issues (and possible solutions) in training therapists to work
             with what is typically considered a ―difficult‖ treatment population: patients with the dual
             diagnosis of posttraumatic stress disorder (PTSD) and substance abuse. Issues to be discussed
             include: cross-training, countertransference, developing video-based training, adherence,
             strategies to increase empathy, selection of therapists, and typical training dilemmas. The
             author will draw on her training of nine therapists as part of a treatment outcome study testing a
             new cognitive-behavioral psychotherapy developed for this population.

             The treatment, Seeking Safety (Najavits, in press), is a manualized cognitive-behavioral
             psychotherapy for individuals or groups, that is designed to treat both disorders at the same
             time to help patients achieve safety in their lives. As part of this presentation, study data on
             the therapists‘ alliance with patients, adherence to the protocol, and emotional responses to the
             patients will be discussed.




Session 53 - Paper in Panel

                              Comparison Treatment for PTSD and Substance Dependence in Inner-city
                                    Women: Preliminary Outcome Data

                                                           391
rs:                 Denise Hien, Lisa Litt

ss for Correspondence:

                          Denise Hien, Ph.D.
                   Director, Women‘s Health Project, St. Luke‘s-Roosevelt Hospital Center
             1111 Amsterdam, Minturn 4, New York, NY 10025 USA
                          212-523-4853, Fax: 212-523-2140, email: drhien@aol.com

                                               ABSTRACT
             The high incidence of co-occurring posttraumatic stress disorder (PTSD) and substance use
             disorders (SUD) has received increasing attention in the literature. Research has documented
             rates of PTSD in substance abuse samples, ranging from 30-59%, as well as higher rates of
             substance abuse in individuals with PTSD than in those without. The rate of SUD in the
             presence of PTSD appears to be even greater among women than among men.
             Appropriate and empirically validated treatment for this dually diagnosed population, however, is
             only now being pursued. Treatments that may be useful for either disorder alone, may be
             inadequate for comorbid diagnoses. Studies have demonstrated that women with both PTSD and
             substance use disorders frequently evidence poorer treatment outcomes.
             This paper will discuss current psychotherapy outcome research comparing the relative efficacy
             of an integrated approach to simultaneously reducing substance use and PTSD symptomatology
             (―Seeking Safety‖ designed by L. Najavits), with a widely used cognitive-behavioral treatment to
             achieve and maintain abstinence (relapse prevention therapy designed by G. Marlatt and J.
             Gordon).
             The current study, which is now in the middle of its treatment phase, is a randomized two-armed
             clinical trial with an additional non-randomized ―treatment-as-usual‖ (TAU) condition.
             Participants are recruited from outpatient treatment settings and newspaper advertisements in the
             New York metropolitan area and are largely minority women of lower socio-economic status.
             Women are assessed pre- and post-treatment, as well as at 3 and 6 months post-treatment, and are
             seen in treatment twice weekly for 3 months.
             In this paper we will present preliminary outcome data on approximately 50 women who have
             been assigned to treatment. Initial analyses will address relative efficacy of the two treatments
             compared to one another and the TAU condition. Specific outcomes that we will focus on
             include: reduction in substance use, treatment compliance and retention rates, decreases in
             trauma related symptoms, and reduction in HIV risk behavior.




                                                          392
              Panel Session 54 –Overall Summary

                              Treatment Resistant Depression: A Research Challenge

pants:               Marjorie Klein, Karla Moras, Timothy Strauman

ator:                Karla Moras

sant:                Ivan Miller

ss for Correspondence:

                              Karla Moras
                              3600 Market Street, Rm. 701
                              Philadelphia PA 19104
                              USA
                              Fax: 215 349-5171; Email: Morask@landru.cpr.upenn.edu

                                             ABSTRACT

              Treatment resistant depression (TRD) is the focus of a recent, multi-million dollar research
              initiative of the U.S. National Institute of Mental Health (NIMH). TRD refers to a
              widely-observed clinical phenomenon: a notable percentage of depressed patients do not
              respond, or do not fully respond, to available treatments.

              Most of the existing data on TRD are from antidepressant medication studies, conducted by
              pharmacologically-oriented researchers. Data suggest that the problem is, indeed, a common
              one. The NIMH has cited estimates that up to 60-70% of clinically depressed patients
              experience only partial symptom improvement when treated with antidepressant medication.

              Interest appears to be increasing in the use of combined medication and psychotherapeutic
              interventions for TRD. Also, more psychosocially-oriented treatment researchers have begun
              to study TRD.

              The panel papers will describe some suggested directions for treatment research on TRD.
              Preliminary observations from an ongoing treatment development study for TRD also will be
              presented.




Session 54 - Paper in Panel

                              Treatment Resistant Depression: Therapeutic Implications of Comorbid
                                     Personality Pathology


                                                            393
rs:                 Marjorie J. Klein, Gregory G. Kolden, and Sarah Chisholm-Stockard

ss for Correspondence:

                            Department of Psychiatry
                            University of Wisconsin
                            6001 Research Park Blvd.
                            Madison, WI 53719 USA

                                            ABSTRACT

             In general, the presence of personality pathology has been associated with poorer outcomes for
             Axis I conditions, especially depression. Moreover, the presence of personality disorders has
             been associated with a greater risk of relapse for depression. This presentation will explore the
             role of comorbid personality pathology in the problem of treatment resistant depression.

             In previous work, we addressed the question of whether personality disorder comorbidity
             influences treatment outcome simply because of additional severity/impairment, or whether the
             effect of comorbidity is more specific. Comorbid conditions could involve different
             pathogenesis and/or might interfere in specific ways with the treatment processes associated with
             intervention strategies. Our previous findings support the notion that the negative effect of
             comorbidity on treatment outcome is at least in part due to disruption in therapy change
             processes.

             This paper will explore the implications of these findings for the development of effective
             strategies for psychotherapeutic intervention in treatment resistant depression.




                                                           394
Session 54 - Paper in Panel

                              Treatment Resistant Depression?     It Is, But What Is It?

rs:                 Karla Moras, Edward Schweizer, Cory Newman, Catherine Ratto, Nicholas DeMartinis &
                                  John O‘Reardon

ss for Correspondence:

                              Clinical Research Center for the Study of Psychotherapy
                              Department of Psychiatry
                              University of Pennsylvania
                              3600 Market Street, Rm. 701
                              Philadelphia PA 19104
                              USA

                                             ABSTRACT

             Preliminary observations and research suggestions will be presented from an NIMH-funded
             treatment development study on drug resistant depression (DRD).

             Our aim is to develop a treatment strategy to enhance the efficacy of combined medication and
             cognitive therapy for DRD.     Study patients meet stringent operational criteria for DRD that
             were developed by pharmacologically-oriented researchers (e.g., > 3 attempted trials of
             medications or somatic treatments for depression; > 2 classes of medications tried, including a
             tricyclic; no complete response to medications for at least 5 years prior to study entry).

             A relatively long and intensive treatment experience is provided: 6 months of weekly
             schema-focused cognitive therapy, plus weekly medication sessions for the first 3 months, then
             every 2 weeks for 3 months. The treatment strategy involves close collaboration between the
             psychotherapist and psychopharmacologist to help optimize the potential effects of each
             component of a combined treatment.

             Observations so far clearly indicate the importance of conducting research on treatment resistant
             depression. The typical study patient to date: is between 40-55 years old, has marked
             functional impairment (e.g. longstanding work dysfunction), has chronic problems in family and
             close relationships, and is subject to very negative and painful self-evaluation (ready to write self
             off).

             Treatment compliance, including medication compliance, has not been a problem. Achieving
             clinically-significant change in 6 months, on any standard depression outcome measure, has been.




                                                            395
Session 54 - Paper in Panel

                     Treatment Resistant Depression: A Self-Regulation Perspective

r:                   Timothy J. Strauman

ss for Correspondence:

                              Department of Psychiatry
                              University of Wisconsin
                              6001 Research Park Blvd.
                              Madison, WI 53719-1176
                              USA

                                              ABSTRACT

              Over the past decade, research on the psychology and neurophysiology of self-regulation has
              provided numerous insights into the nature and treatment of depression. In brief, self-regulation
              refers to the process of pursuing motivationally significant goals and adjusting one's behavior
              depending on whether important goals are being met. Self-regulation is an ongoing process with
              significant implications for momentary affective and motivational states as well as for long-term
              adaptation to the social environment. The neurophysiological, motivational, and cognitive
              aspects of self-regulation are all of relevance to the etiology and treatment of depression.

              This presentation applies a self-regulation perspective to the problem of treatment resistant
              depression. Specifically, it will be argued that chronic, treatment-refractory depression
              represents a chronic failure in self-regulation that affects the individual's mood, capacity to
              experience and pursue positive outcomes, beliefs, and interpersonal behavior. Patients with
              treatment resistant depression are likely both to manifest biological and psychological risk factors
              for depression as well as breakdowns in the self-regulation process itself as a result of having
              been depressed.

              The implications for treatment of a self-regulation perspective on refractory depression follow
              logically from the role of self-regulation in interpersonal adaptation. Both comprehensive
              assessment of neurophysiological (e.g., HPA axis dysfunction, sleep architecture changes),
              motivational (e.g., neurovegetative symptoms, loss of sensitivity to reward cues), cognitive (e.g.,
              catastrophizing, perfectionism) and interpersonal (e.g., marital conflict, self-defeating behavior)
              symptoms and coordinated treatments addressing these problems are indicated.

              Implications for treatment of first-episode depression, as well as for prevention, also will be
              discussed.




                                                             396
              Panel Session 55 -Overall Summary

                                  Integrative Psychotherapy of Individuals with Schizophrenic Symptoms and
                                            Schizoaffective Disorder

pants:                  Konstantia A. Zgantzouri, Argyroula A. Kalaitzaki, Ahmad T. Qadamani

ator:                   Joannis N. Nestoros

s for Correspondence:
                                Laboratory of Clinical & Social Psychology,
                        Department of Psychology, School of Social Sciences,
                        University of Crete, University Campus Gallos,
                        Rethymno 741 00, Crete, Greece,
                        Tel. & Fax: ++30 831 77528, Email: nestoros@fortezza.lanr.uoc.gr

                                                       ABSTRACT
                         In the Laboratory of Clinical and Social Psychology, University of Crete, Greece, we study the integrative
              psychotherapy of schizophrenia. The principles characterizing this psychotherapeutic approach are the following: 1)
              Schizophrenia is amenable to psychotherapy. 2) The integration of different approaches to the treatment of schizophrenia is
              possible and has many advantages over conventional one-sided approaches. 3) Schizophrenic symptoms are best understood as
              the result of many different factors (biological, psychological, familial, social, etc.) according to the stress-diathesis
              vulnerability model. 4) Schizophrenic symptoms by themselves are not as bad as the individual‘s or society‘s reactions to them.
              5) Schizophrenic symptoms belong to a continuum starting from normal behavior at the one end. 6) Paranoid schizophrenic
              symptoms are rapidly eliminated by reducing anxiety through anxiolytic medication or other means. 7) Individuals with
              schizophrenic symptoms are not 100% disturbed or ‗‘crazy‘‘, that is, they have a logical part which can collaborate with the
              psychotherapist. 8) Psychotherapy is a very complex process requiring special conditions, which have to be applied in the case
              of schizophrenia consistently over a long period of time. 9) The schizophrenic condition is often characterized by a state of
              increased potential. Eighty (80) individuals suffering from positive and negative symptoms, who received the DSM-IV
              diagnosis of schizophrenia paranoid type or schizoaffective psychosis, are treated for more than two years, with weekly
              individual sessions, by an experienced psychotherapist. The individuals are assessed by the following measures: 1)the
              M.M.P.I., at baseline and every three months, 2) the 90 Symptom Checklist, the State-Trait Anxiety Inventory and the Visual
              Analogue Scale for general somatic condition, general psychological state, anxiety, depression, psychosomatic well-being,
              energy level and euphoria, weekly or biweekly, 3)              the Brief Psychiatric Rating Scale and the Scale for the Assessment
              of Negative Symptoms and the Scale for the Assessment of Positive Symptoms, at least once a month. This panel presents the
              studies of three (3) Ph.D. students in Clinical Psychology, from the Postgraduate Training Program, University of Crete,
              Greece, focusing on the following issues: A. Psychotherapy process research in schizophrenia paranoid type: The role of
              anxiety in delusion formation (K.A. Zgantzouri & J.N. Nestoros). This study stresses the role of anxiety in delusion formation
              in schizophrenia paranoid type, through the study of six psychotherapy sessions, fully transcribed and assessed by eight raters.
              Results as well as the methodological considerations and implications for further research are discussed. B. Formulation of
              hypotheses for the evaluation of intrafamilial relating (Argyroula E. Kalaitzaki, Joannis N. Nestoros, & John A. Birtchnell).
              This presentation investigates the intrafamilial relationships of families with one member with schizophrenic symptoms and the
              way these relationships change with integrative psychotherapy. Through the sixteen (16) new questionnaires based on the New
              Interpersonal Theory by Birtchnell (1990), which we have developed, we formulate the hypotheses regarding the way a person
              with positive and negative schizophrenic symptoms, in a certain phase of his/her illness, relates to his/her family (state of
              relatedness). C. The usefulness of a new Anxiety Scale and a Visual Analogue Schizophrenia Scale in monitoring the effects
              of psychotherapy (Ahmad T. Qadamani, Joannis N. Nestoros & Nionia G. Vallianatou). This paper presents our attempt to
              standardize in the Greek population two instruments, a 365 items Anxiety Scale and a 28 items Visual Analogue Schizophrenia
              Scale. These Scales are standardized, so that they can be applied to assess the effects of psychotherapy. The psychometric
              properties of these Scales will be further discussed at this presentation.




                                                                            397
Panel Session 55 - Paper In Panel

Title:                      Psychotherapy Process Research in Schizophrenia Paranoid Type: The
                            Role of Anxiety in Delusion Formation

Authors:                    Konstantia A. Zgantzouri, & Joannis N. Nestoros

Address for Correspondence:

                            Konstantia A. Zgantzouri
                            Laboratory of Clinical & Social Psychology,
                            Department of Psychology, School of Social Sciences,
                            University of Crete, University Campus Gallos ,
                            Rethymno 741 00, Crete , Greece
                            Tel. & Fax: ++30 831 77528
                            Email: zgantz@fortezza.lanr.uoc.gr & zgantz@psy.soc.uoc.gr

                                                  ABSTRACT

          The aim of the present study is to investigate the role of anxiety in delusion formation in schizophrenia
paranoid type, through the study of psychotherapy sessions. According to previous research carried out in the
Laboratory of Clinical and Social Psychology, University of Crete, Greece, five (5) mechanisms were formulated to
account for the formation of most delusions in schizophrenia paranoid type and schizoaffective disorder:
1. A misinterpretation of somatic and psychological disturbances caused by high levels of anxiety.
2. A misinterpretation of the external environment caused by high levels of anxiety.
3 An evolutionary useful reaction.
2. A ―defense‖ against high levels of anxiety.
3. A consequence of self-fulfilling prophecies in individuals with very negative experiences in their real life.
      In the present study, six (6) psychotherapeutic sessions, conducted by an experienced integrative
psychotherapist with a person suffering from paranoid type schizophrenic symptoms, were selected. Three of the
sessions had a good outcome and the other three had a poor outcome, as it was assessed with the pre-post
comparisons of the SCL-90 ratings. The six psychotherapy sessions were fully transcribed and assessed by eight
(8) raters. Four raters were registered, well-experienced psychiatrists and four were clinical psychologists, with a
Masters degree. The clinical psychologists had at least two years of theoretical background and supervised
experience in Integrative Psychotherapy. They were graduates from the Postgraduate Training Program in Clinical
Psychology, University of Crete, Greece, which provides theoretical training and clinical practice in diverse
theoretical perspectives, in accordance with the contemporary view of the integrative psychotherapy movement.
      A brief structured interview schedule was developed containing the statements of the above five hypotheses
and other statements. Then, it was given to the eight judges in order to describe what happened during the sessions
leading to successful outcome, concerning the therapist operations and the client performances, while they
scrutinized the delusional ideas.
      Results indicated the role of anxiety in the formation of delusions in paranoid type schizophrenia.
Implications for further research on the issue of psychotherapy process research in paranoid type schizophrenia
are discussed, as well as the methodological considerations for the study of delusion formation.




                                                       398
Panel Session 55 - Paper in Panel

Title:                     Formulation of Hypotheses for the Evaluation of Intrafamilial Relating

Authors:                   Argyroula E. Kalaitzaki, Joannis N. Nestoros, John A. Birtchnell

Address for Correspondence:
            Argyroula E. Kalaitzaki
   Laboratory of Clinical & Social Psychology,
            Department of Psychology, School of Social Sciences,
            University of Crete, University Campus Gallos,
            741 00, Rethymnon, Crete, Greece.
   Tel. & Fax: +30 831 77528
            Email: akalaitzaki@psy.soc.uoc.gr & argyro@fortezza.lanr.uoc.gr

                                                 ABSTRACT
       In the Laboratory of Clinical and Social Psychology, University of Crete, Greece, we have studied intrafamilial
relationships of families with one member with schizophrenic symptoms and how these relationships change with
integrative psychotherapy. For this purpose, 16 new questionnaires based on the New Interpersonal Theory by
Birtchnell (1990) were developed.
       In this presentation we formulate the hypotheses, which can be tested with the aforementioned questionnaires,
regarding the way a person with positive and negative schizophrenic symptoms, in a certain phase of his/her illness,
relates to his/her family (state of relatedness).
       The New Interpersonal Theory considers that all human relating can be represented in two axes. The horizontal
axis concerns the disposition of one person toward another (regulating distance) and the poles of this dimension are
called Distance and Closeness; the vertical axis concerns the relative power, in terms of seeking to exercise control
over another or being controlled by others (upwardly versus downwardly directed behaviour) and the positions on
this axis are called Upperness versus Lowerness. The combination of the four poles of the two axes and the insertion
of those four intermediate points (Upper Close, Lower Close, Upper Distance, Lower Distance), gives rise to the
Interpersonal Octagon.
       Considering that members with schizophrenic symptoms are involved in a maladaptive way of relating, since
their symptomatology has a disruptive effect on their interrelating, we formulated the following hypotheses:
 The symptomatology (positive and negative schizophrenic symptoms) and the phase of their illness will affect
    the way of their -maladaptive- relating.
 In the acute phase of their illness, where the positive symptoms are dominant, they will be involved in
    Egocentric relating (lack of respect or lack of consideration for the other).
 In the remission phase, where the negative symptoms are prominent, they will be adopting an Avoidant
    (extremely preoccupied with distance) or Insecure (constantly checking the other wanting to remain close) way
    of relating.
. The interaction of their symptomatology (positive and negative schizophrenic symptoms) and the phase of their
    illness will also determine the specific way of their maladaptive relating, as a result of a high score on certain
    octants of the Interpersonal Octagon.
 Members with positive schizophrenic symptoms will score high, mainly, on the octants of Upper, Distant
    and/or Upper Distant form of relating.
 Members with negative schizophrenic symptoms will score high, mainly, on the octants of Lower, Distant
    and/or Lower Distant form of relating.
           The available data will permit us to study the influence of positive and negative schizophrenic symptoms
on the way of the interrelating of a member to his/her family, evaluating the state of relatedness with the new
questionnaires constructed.




                                                       399
Panel Session 55 - Paper in Panel

Title:                  The Usefulness of a New Anxiety Scale and a Visual Analogue
                        Schizophrenia Scale in Monitoring the Effects of Psychotherapy.

Authors:                Ahmad T. Qadamani, Joannis N. Nestoros, Nionia G. Vallianatou

Address for Correspondence:

                       Ahmad T. Qadamani
                       Laboratory of Clinical & Social Psychology, Department of Psychology,
                       School of Social Sciences, University of Crete, University Campus Gallos
                       Rethymno 741 00, Crete , Greece
                       Tel. & Fax: ++30 831 77528
               Email: a_qadamani@hotmail.com

                                           ABSTRACT

        In our Laboratory of Clinical and Social Psychology at the Department of Psychology,
University of Crete, we are interested in the role of anxiety in positive and negative schizophrenic
symptoms. In order to measure anxiety, we have developed a 365 items Anxiety Scale and in
order to assess schizophrenic symptoms we have developed a 28 items Visual Analogue Scale. In
this study we attempt to standardize these instruments in the Greek population.

       Method: Both instruments, along with the Minnesota Multiphasic Personality Inventory
(MMPI), which has already been standardized in the Greek population, were administered to a
sample of 1000 subjects representative of the entire Greek population, to 100 patients with
DSM-IV diagnosis of Paranoid Schizophrenia or Schizoaffective Psychosis and to 100 patients
with Anxiety Disorders. There was a re-administration of both the Anxiety Scale and the Visual
Analogue Scale, seven days later.

        Results and Conclusions: The psychometric properties of these scales will be presented
and discussed at the congress. Although we are still in the phase of the statistical analyses of our
data, we believe that both scales are reliable and valid. Moreover, they appear useful in clinical
practice as tools to monitor the effects of psychotherapy.




                                               400
Panel Session 56 - Overall Summary

Title:                 A Comparison of Process-Experiential and Cognitive-Behavior
                       Therapy in the Treatment of Depression

Participants:          Jeanne C. Watson, Laurel B. Gordon, Freda Kalogerakos, Shari Geller

Moderator:             Irene Elkin

Address for Correspondence:

                       Department of AECDCP
                       OISE / University of Toronto
                       252 Bloor Street West
                       Toronto, Ontario
                       M5S 1V6
                       Canada

                                           ABSTRACT

    Numerous treatment approaches, including cognitive-behavioural, interpersonal, and
pharmacological, have been found to be effective in the treatment of depression (Elkin et al,
1989; Dobson, 1989). While there is some evidence that client-centered and process-experiential
approaches are also effective, it is nonetheless important to test the efficacy of experiential
approaches against accepted treatments. This panel will present preliminary data from the
University of Toronto Depression Project. The focus of the study is a comparative analysis
between cognitive-behavioural, and process-experiential therapy. Process-experiential
approaches emphasise clients' access, differentiation, and expression of emotion in the session. In
contrast, cognitive behavioural treatments focus on clients‘ cognitions to help clients challenge
them and to consider alternative perspectives and evaluations in the light of objective evidence.

       Watson's paper will present an overview of the study including methodology, followed by
comparative outcome data for 20 participants in each modality in terms of their levels of
depression (BDI, SCL 90-R), self-esteem (RSE), and interpersonal problems (IIP). Gordon's
paper will look at changes in clients' styles of coping and dysfunctional attitudes over the course
of treatment. Kalogerakos' presentation will examine differences in the development and
maintenance of the working alliance in the two approaches and its relationship to outcome.
Geller will present data on therapists' experience of presence in the cognitive-behavioral and
process-experiential sessions, and examine therapists experience in relation to client and therapist
working alliance ratings and clients‘ ratings of therapeutic empathy.




                                              401
Panel Session 56 - Paper in Panel

Title:                 Comparing Changes in Clients‘ Levels of Depression, Self Esteem and
                       Interpersonal Problems in Cognitive-Behavioural and
                       Process-Experiential Therapy

Authors:               Jeanne C. Watson & Lana Stermac

Address for Correspondence:

                       Jeanne C. Watson
                       OISE / University of Toronto
                       Department of Adult Education, Community
                       Development & Counselling Psychology
                       252 Bloor Street West
                       Toronto, Ontario,
                       Canada, M5S 1V6


                                          ABSTRACT


     Recently Greenberg & Watson (1997) reported that humanistic approaches including
client-centered and process-experiential were effective in treating depression. It is important to
replicate these findings to determine the efficacy of emotionally-focussed and humanistic
approaches in treating major DSM IV disorders and to determine whether these approaches are as
effective as other treatments with depression.

     This paper will present preliminary data from the University of Toronto Depression Project.
This is a randomized controlled outcome study in which clients diagnosed with major depression
in terms of SCID IV (Spitzer, Williams, Gibbon & First, 1990) were randomly assigned to
process-experiential or cognitive-behavioral therapy. Preliminary outcome data from 40 clients
will be presented in terms of their self-reported change on the Beck Depression Inventory
(Beck, ward, Mendelson, Mock & Erbaugh, 1961), the SCL-90-R (Derogatis, 1983); The
Rosenberg Self Esteem Scale (Rosenberg, 1965), and the Inventory for Interpersonal Problems
(Horowitz,, Rosenberg, Baer, Ureno & Villasenor, 1988).




                                             402
Panel Session 56 - Paper in Panel

Title:                 A Comparative Analysis of Change in Clients‘ Styles of Coping and
                       Dysfunctional Attitudes in Cognitive-Behavioural and
                       Process-Experiential Therapy

Authors:               Laurel Gordon, Jeanne C. Watson & Lana Stermac

Address for Correspondence:

                       Laurel Gordon & Jeanne C. Watson
                       OISE / University of Toronto
                       Department of Adult Education, Community
                       Development & Counselling Psychology
                       252 Bloor Street West
                       Toronto, Ontario,
                       Canada, M5S 1V6

                                           ABSTRACT

      This paper will compare changes in clients‘ coping styles using the Problem-Focused Styles
of Coping Inventory (Heppner, Cook, Wright & Johnson, 1995), and clients‘ dysfunctional
attitudes (DAS, Weissman & Beck, 1978) in cognitive-behavioural and process-experiential
therapy for depression. Preliminary data for forty clients, diagnosed with major depression on
the SCID-IV, will be examined pre and post treatment. The goal of the study is to determine
whether there are differences in the types of coping styles clients use after treatment. It is
hypothesised that good outcome clients will show more reflective styles of coping at the
termination of therapy and less suppression. It is expected that these changes will be related to
changes in their dysfunctional attitudes. Clients‘ change scores on DAS and coping styles will
be related to their levels of depression, self-esteem and interpersonal problems at the termination
of therapy.




                                              403
Panel Session 56 - Paper in Panel

Title:                 A Comparative Analysis of the Therapeutic Alliance as it Relates to
                       Therapy Outcome in Process-Experiential and Cognitive-Behavioural
                       Therapy

Authors:               Freda Kalogerakos, Jeanne C. Watson & Lana Stermac

Address for Correspondence:

                       Fred Kalogerakos & Jeanne C. Watson
                       OISE / University of Toronto
                       Department of Adult Education, Community
                       Development & Counselling Psychology
                       252 Bloor Street West
                       Toronto, Ontario,
                       Canada, M5S 1V6

                                           ABSTRACT

     Psychotherapy process research continues to flourish in it‘s quest to discover how it is that
psychotherapy is effective. One major factor that has been the focus of attention is the
therapeutic alliance. A positive, or affiliative client-therapist relationship has been found to be
consistently related to therapeutic outcome (Orlinsky and Howard, 1978; Horvath & Symonds,
1991). Significant associations between the quality of the therapeutic relationship and outcome
have been found across a diversity of psychotherapy approaches, a variety of outcome measures,
and a variety of sources including client, therapist, and clinical judges (Gaston, 1990). This
paper will examine differences in clients‘ reports of the quality of the working alliance (WAI -
Horvath & Grenberg, 1989) between process-experiential and cognitive-behavioural therapy
using preliminary data from a psychotherapy study investigating the treatment of depression at
the University of Toronto. The relationship between the working alliances and post treatment
outcome in the two therapies will also be explored.




                                              404
Panel Session 56 - Paper in Panel

Title:                 Being in the Here and Now: A Comparison of Therapists'
                       Experience of Presence in Cognitive-Behavioural and Process-
            Experiential Therapy

Authors:               Shari M. Geller, Leslie Greenberg & Jeanne C. Watson

Address for Correspondence:

                       Department of Psychology
                       York University
                       4700 Keele Street
                       Downsview, Ontario
                       Canada, M3J 1P3


                                          ABSTRACT

     The purpose of this paper is to compare therapists' experience of presence in
cognitive-behavioral and process-experiential therapy. Presence is seen as a precondition for
clients to experience the Rogerian relationship conditions, of empathy, prizing and congruence in
the session. A presence scale was developed from a qualitative analysis of interviews with
experienced therapists, and then integrated with the relevant clinical literature. The measures
reliability and validity will be discussed. Therapists' experience of presence will be related to
client ratings of the relationship (the Relationship Inventory - Barrett-Lennard, 1962, 1978), the
working alliance (WAI - Horvath & Greenberg, 1989) and session outcome on the Clients Task
Specific Change Measure - Revised (Greenberg & Watson, 1996), and to clients' perceptions of
therapists' presence during the session.




                                              405
Panel Session 57 - Overall Summary

Title:                 Quantitative and Qualitative Methods of Transcript Analysis: Comparing
                       SASB, PPQS, FRAMES, CRA, and EAP

Participants:          Katja Kalmykova, Irina Tschesnova, Erhard Mergenthaler, Janine
                       Vidal-Didier, Alejandro Ávila-Espada, Paul Siegel, Mark Sammons,
                       Hartvig Dahl

Moderator:             Erhard Mergenthaler

Discussant:            Hartvig Dahl

Address for Correspondence:

                       Erhard Mergenthaler
                       Sektion Informatik in der Psychotherapie
                       Universität Ulm - Medizinische Fakultät
                       Am Hochsträß 8
                       89081 Ulm, Germany
                       Fax: (0049) 731 502 5662
                       merg@sip.medizin.uni-ulm.de

                                           ABSTRACT

    This panel focuses on the integration of qualitative and qualitative approaches for transcript
analysis.

    In the first presentation Katja Kalmykova will present a single case study where a rating for
SASB categories was applied to the same session material as the computer assisted measures for
Emotion-Abstraction patterns and Referential Activity. It will be shown that all three measures
substitute each other in a meaningful way.

    In the second paper Janine Vidal-Didier will present a pilot study where the Psychotherapy
Process Q-Sort was applied in different ways to transcript material from a single case and
compared to findings given from computer assisted text analyses for Referential Activity and
Emotion-Abstraction patterns. The results will be discussed in an integrative manner.

    The third presentation by Paul Sigel will focus on the application of Hartvig Dahl‗s
FRAMES approach to transcript analysis. Special attention will be given to the phenomenon of
change and how FRAMES are capable to represent such.




                                              406
Panel Session 57 - Paper in Panel

Title:                   The Therapeutic Cycle Model and SASB: Cognitive and Interactional
                         Aspects of Psychotherapeutic Processes

Authors:                 Katja Kalmykova, Irina Tschesnova, Erhard Mergenthaler

Address for Correspondence:
                    Katja Kalmykova
                    Psychology Department Russian Academy of Science
                    Yaroslavskaja 13, 129 366 Moskau, Russia
                    Fax: (007) 095 282 9201, e-mail: katya@rinet.ru

                                               ABSTRACT
         The Therapeutic Cycle Model (Mergenthaler 1996) measured as Emotion-Abstraction Patterns
(EAP) concentrates on cognitive aspects of psychotherapy without explicitly paying attention to
interpersonal aspects. Within the context of psychotherapeutic processes, however, the therapeutic
relationship aspect plays a significant role as well, contributing to the successful development of cognitive
self-exploratory processes. The presentation given here stems from a pilot study and contributes to the
integration of interactional aspects into the above model. The interpersonal process roughly can be
described as two recurrent phases in the therapeutic dyad: (1) Maintaining the relationship between patient
and therapist marked by interactions that are highly conform to role expectations, and (2) „Negotiating―
the role positions of both participants anew. The most productive development of cognitive processes and
the development of cognitive cycles is expected to be observed in phase (1), while the in phase (2)
break-downs in the unfolding of cognitive cycles are considered to be more likely.
         In the present study the two phases were examined in terms of their reciprocal relations and
contribution to the general therapy process as conceptualized in the Therapeutic Cycle Model. The cluster
version of the SASB method was used to assess the interactional aspects.
         Two hypotheses were tested: A. The distribution of SASB clusters varies within a single
therapeutic hour; during the phase of cognitive productive development the variability of SASB clusters is
expected to be significantly lower compared to the phases where no cognitive cycle is to be identified; B.
The variability of interactions measured with SASB clusters for the patterns Relaxing (little emotion tone
and little abstraction) and Reflecting (little emotion tone but high abstraction) is significantly higher than
for Experiencing (high emotion tone but little abstraction), Connecting (high emotion tone and high
abstraction) and Narrative Style (high Computer Referential Activity). The pattern Relaxing represents a
non-explorative state of mind and the pattern Reflecting very often denotes defensive processes. In
contrast the pattern Experiencing signifies from emotional self exploratory processes and the pattern
Connecting often has been identified as emotional insight.
         A sample of verbatim protocols from 8 sessions of a short-term psychodynamic psychotherapy
(total of 45 sessions) was analysed for the distribution of EAP. Using video tapes the very same sessions
were entirely rated according to the SASB coding procedure. The results supported both hypotheses and
give raise to plan for a more comprehensive confirmatory study.




                                                   407
Panel Session 57 - Paper in Panel

Title:                The Therapeutic Cycle Model and the Psychotherapy Process Q-Sort
                      PPQS: An Exploratory Comparative Study

Authors:              Janine Vidal-Didier, Alejandro Ávila-Espada, Erhard Mergenthaler.

Address for Correspondence:

                      Research Unit on Clinical Psychology and Psychotherapy
                      Department of Personality, Psychological Assessment and Treatment
                      University of Salamanca
                      Avenida de la Merced, 109-131
                      37005-Salamanca (Spain)
                      Fax 34-23-294607, Phone 34-23-294400 ext. 3319
                      E-Mail:jjvidal@gugu.usal.es

                                          ABSTRACT

        This paper will present a single case study exploring the relationship between three
language based process measures: The Therapeutic Cycle Model based on patterns of the
computer measured variables Emotional Tone and Abstraction (Mergenthaler, 1996), the
Computer Referential Activity (Mergenthaler & Bucci, in print), and the Psychotherapy Process
Q-Sort (PPQS) done by human raters (Jones, 1985). The subject is a female patient in a
psychoanalytically oriented psychotherapy which is still ongoing. For the pilot study presented
here we choose a sample of 13 sessions randomly selected from the first 45 session. The
transcription has been done using the Standards by Mergenthaler and Gril (1996) for Spanish
language. The use of transcription standards not only allows for an economic transcript
production, but also provides textual data that allow to compare the findings to other studies
using different textual material but the same transcription standard.

         On a macro analytic level for each session the PPQS will be applied. The results will be
compared to the distribution of the Emotion-Abstraction patterns across the sample. In a micro
analytic approach the sessions will be analyzed by use of the CM program (download from:
http://inf.medizin.uni-ulm.de). The resulting graph for each session showing the flow of the
computer measures over time will be used to segment the sessions into subtexts characteristic for
each language pattern. For these subtexts the PPQS will be thrown separately. It is expected to
find a set of Q-items that is highly representative for each pattern. The results also will be
compared to the PPQS factorial dimensions found elsewhere (Jones, Parke, & Pulos, 1992; Jones
& Windholz, 1990).




                                             408
Panel Session 57 - Paper in Panel

Title:                 FRAMES as a Measure of the Process of Change

Authors:               Paul Siegel, Mark Sammons, Hartvig Dahl

Address for Correspondence:
                    The Glass Institute
                    75 Varick Street, 2nd Floor
                    New York, NY 10013
                    USA

                                           ABSTRACT

     In their statement of the P-T-O congruence principle, Strupp, Schacht and Henry (1988)
proposed that the most convincing measures of the psychotherapeutic process would be those that
effectively represent (1) a patient's problem, (2) the therapeutic process, and (3) the therapeutic
outcome, in the same terms. The central claim (Holzer & Dahl, 1996) regarding the FRAMES
method of thematic structure and content analysis has been that it is a strong candidate to meet
this guiding principle. It has been demonstrated that FRAMES can meet the first and third criteria
of this principle, and preliminary findings suggest that FRAMES can potentially meet the second
(Dahl, 1988; Siegel & Sammons, 1997). This presentation will build on these preliminary
findings and illustrate the capacity of FRAMES to meet the more challenging second criterion,
the process of therapeutic change, by chronicling the sequence of key therapist interventions and
evolving FRAME structures in a more extended block of contiguous sessions.

      An episode of change during 3 sessions (hours 726-728) in the case of Mrs. C. was identified
by a previous FRAMES analysis and has been described in detail (Dahl, 1998). In these hours
Mrs. C repeats a 3-event FRAME structure we now call Provocation: she provokes someone to
fight or attack her and feels satisfied after the person retaliates in fact or in fantasy. After two
such episodes with her husband, it is enacted with the analyst in the next session, followed by an
instantation in an association to a novel. In the third session it occurs again with her husband, but
now the patient no longer feels satisfied and instead regards the incident as very unpleasant. It is
as if she is beginning to gain insight into her repetitive pattern. At this point, there are two
questions: When did the FRAME structure first appear? And, did the change persist? After a
brief introduction to FRAMES, the FRAME structures that represent the change that occurred in
these three sessions will be presented. Then the results of a similar analysis of two blocks of five
sessions before and after the 'change' event will be presented, including any alterations in
FRAMES and the attending analyst interventions, in order to shed further light on the prehistory
and the fate of the Provocation FRAMES.




                                               409
Panel Session 58 - Overall Summary

Title:                 Time Matters - Longitudinal Research and Its Implications for Etiology
                       and Diagnosis, Treatment Planning, and Health Service Provision

Participants:          Hans Kordy, Tracie Shea, Ulrike Schmidt

Moderator:             Hans Kordy

Discussant:             John Clarkin

Address for Correspondence:

                       Hans Kordy
                       Center for Psychotherapy Research Stuttgart
                       Christian-Belser-Str. 79a
                       D-70597 Stuttgart
                       Germany

                                           ABSTRACT

     It is well known from clinical observation that for some people a psychological illness is just
a brief episode in their life, from which they fully recover with or without any treatment.
However, for many people such an illness is a varyingly troublesome part of their life over many
years. Their symptoms may come and go, and also change in kind over the years. For some it can
be a truly lifelong affliction.

    Psychotherapy research has rarely taken full account of this heterogeneity of courses,
especially its traditional cross-sectional designs. Disorders develop, decay and vary over time.
The study of the sequence and time course of such changes may give important clues about the
nature of the disorders in general and make prognosis and treatment planning better informed.

    Recently started longterm observational studies provide rich longitudinal data and newly
developed powerful statistical tools draw attention on the longitudinal perspectives. In this panel
we discuss which new possibilities the longitudinal approach offers. We do this by hand of three
examples:

     (1) Refining of etiology and diagnosis of personality disorders, (2) designing treatment
strategies like step-wise treatment for eating disorders, and (3) extending outcome research by
taking time into account.




                                               410
Panel Session 58 - Paper in Panel

Title:                How Long Does It Take to Change - and For How Long?

Authors:              Hans Kordy, Matthias Richard, Horst Kächele & Project TR-EAT

Address for Correspondence:

                       Hans Kordy
                       Center for Psychotherapy Research
                       Christian-Belser-Str. 79a
                       70597 Stuttgart
                       Germany
                                          ABSTRACT

     It takes time to change! How much time it takes depends on the individual conditions of the
patients, the aimed for amount (―distance‖) of change, the speed of change, and the means which
push the change. While traditional cross-sectional outcome studies allow answers on the question
whether patients changed, usually by comparing patient‘s status at two more or less arbitrarily
chosen timepoints, longitudinal outcome studies investigate how patients change over a certain
period of time.

     Project TR-EAT, a German multisite study on the efficiency of psychodynamic treatment of
eating disorders, is conducted as an longitudinal oberservational study. Monthly assessments of
1171 patients over an observation period of 2.5 years allow the investigation of the course of
change. For this purpose we adapted the longitudinal terms recovery, partial and full remission,
relapse and recurrence for eating disorders and address questions like: How is the chance for
improvement - recovery, full or partial remission - distributed over time? How is the risk for
relapse distributed over time? And how do treatment length and intensity influence the
distributions of chances and risks?




                                             411
Panel Session 58 - Paper in Panel

Title:                 Short Term Stability of Personality Disorder Diagnoses

Authors:               Tracie Shea, Robert Stout, Regina Dolan, Andrew Skodal, Leslie Morey,
                       Mary Zanarini, and Charles Sanislow

Address for Correspondence:

                       Tracie Shea
                       Brown University
                       700 Butler Drive
                       Providence, RI 02906
                       USA

                                           ABSTRACT

     An important indicator of the validity of personality disorders is their diagnostic stability.
The degree to which the personality disorders under study in the CLPS (Schizotypal, Borderline,
Avoidant and Obsessive-Compulsive) are stable is a central question of the study. Our follow-up
assessments include the Diagnostic Interview for Personality Disorders - Follow Along Version,
which provides ratings of the presence or absence of individual PD criteria on a monthly basis.
Preliminary data from the six month follow-up assessment of the first 210 subjects in the study
has shown only moderate diagnostic stability for the four Pds. Of subjects cell-assigned at
baseline to each of the four disorder categories, 68% of 22 schizotypal subjects, 70% of 53
avoidant subjects, 69% of 49 obsessive compulsive subjects, and 60% of 77 borderline subjects
continued to meet full criteria throughout the six months of follow-up. This presentation will
report findings on diagnostic stability throughout the first six months of follow-up for the
complete PD sample, including 87 schizotypal, 175 borderline, 156 avoidant, and 152
obsessive-compulsive PD subjects. We will compare the diagnostic stability of the PD groups
with that of our control sample, 98 subjects with major depression without personality disorder.
Factors hypothesized to be associated with the degree of diagnostic persistence will be explored,
including course of co-occurring Axis I disorders, and different indicators of severity of Pds
assessed at baseline.




                                              412
Panel Session 58 - Paper in Panel

Title:                 How Can Longitudinal Research Assist us With Treatment Planning? The
                       Case of Eating Disorders

Author:                Ulrike Schmidt

Address for Correspondence:

                       Ulrike Schmidt
                       Consultant Psychiatrist
                       Maudsley Hospital
                       Denmark Hill
                       London SE5 8AZ
                       Great Britain

                                           ABSTRACT

      Treatment of bulimia nervosa has been extremely well researched despite the recency of its
first description. Randomized controlled trials have helped to delineate a number of effective
psychological treatments (for review see Schmidt, 1998). With the best available treatments, 40
to 60% of patients are symptom free at the end of treatment. Yet many questions important for
rational clinical decision-making, remain unanswered. E.g., how generalizable are these findings
to patients seen in clinical practice whose characteristics are likely to differ considerably from
those included in research populations? Moreover, whilst stepped care approaches to bulimia
nervosa have been thought to be desirable, there is considerable uncertainty as to what type and
how much further treatment ought to be given to those who do not respond to initial treatment.
There is also uncertainty about what are solid predictors of outcome.

    In the case of anorexia nervosa the situation is even more difficult. Very few randomised
controlled trials exist and those that do are either of insufficient power or have been beset with
other problems like poor compliance or drop-out (Crisp et al., 1991; Serfaty, 1998), making any
conclusions drawn from this kind of research extremely tentative.

    Well-conducted naturalistic longitudinal studies can help us to get around many of the
problems described above. The paper will focus on how the results of the COST-B6 action
(Treasure & Kordy, 1998), a European-wide longitudinal study on the treatment of eating
disorders might help clinical and purchaser decision making in matching interventions to patients'
needs.




                                              413
Paper Session 17

Title:                 Clinical Trainees' Development of an Understanding of Their Clients

Authors:               Gaiana Germani and David Todd

Address for Correspondence:

                       Gaiana Germani
                       Department of Psychology
                       University of Massachusetts at Amherst
                       Tobin Hall
                       Amherst, Massachusetts 01002
                       USA

                                           ABSTRACT

     While there has been a great deal of research on the concept of empathy in psychotherapy,
there has been very little work focused on the concept of understanding. The nature of
understanding, and the development of the capacity of therapists in training to understand clients
was investigated through in-depth, semi-structured interviews with six supervisees and six
supervisors. These interviews elicited detailed descriptions of the interviewees' thoughts on the
meaning and development of understanding clients during training. A qualitative analysis was
conducted on verbatim interview transcripts. Participants were all able to talk readily about
understanding, largely without explicit reference to the concept of empathy. A comparison of
the interview responses with literature on empathy suggests a great deal of similarity in the issues
and phenomena that are discussed in relation to the terms understanding and empathy. Given the
current controversy surrounding the term empathy (Duan & Hill, 1996), the semantic usefulness
of describing similar phenomena utilizing the term "understanding" is explored. Additionally, a
preliminary stage model of the development of the capacity to understand clients is constructed
and described.




                                              414
Paper Session 17

Title:                Trainee Case Conceptualization Ability: A Cross-Sectional Analysis of
                      Trainee Development

Authors:              Janet L. Muse-Burke, Nicholas Ladany, and Sylvia Marotta

Address for Correspondence:

                      Janet L. Muse-Burke
                      111 Research Drive
                      Counseling Psychology
                      Department of Education and Human Services
                      Lehigh University
                      Bethlehem, PA 18015
                      USA
                      e-mail: jlm5@lehigh.edu

                                          ABSTRACT

     A primary goal of counselor supervision is for the trainee to increase his or her cognitive
understanding of clients and the counseling process (Blocher, 1983; Stoltenberg & McNeill,
1997). The purpose of the present investigation was to determine the relationship between trainee
integrative complexity (i.e., the ability to differentiate and integrate knowledge pertaining to
specific client symptomatology), trainee experience level, and preference for supervisor style.
Data from 100 beginning practicum to intern level psychotherapy trainees revealed that
integrative complexity was related to general trainee experience. However, contrary to
development models of psychotherapy supervision, neither trainee integrative complexity nor
trainee experience significantly predicted preference for supervisor style. Implications for
psychotherapy supervision theory, research, and practice and the limitations of the study are
addressed.




                                             415
Paper Session 17

Title:                 Dedicated Training With Intense Feedback Makes Experts: But is This
                       Too Expensive for Psychotherapy Training?

Authors:               Thomas Berger and Franz Caspar

Address for Correspondence:

                        Thomas Berger
                        Institute of Psychology
                        University of Bern
                        Muesmattstrasse 45
                        CH 3000 Bern 9
                        Switzerland

                                           ABSTRACT

    From research in many other fields it is known that expertise does not develop automatically
from experience: Dedicated, intense training with sufficient feedback is needed. The fact that in
natural settings, psychotherapists hardly ever find satisfactory learning conditions may explain
why the difference between novices and experienced therapists is not as great as we would wish.

     Some time ago we have developed a training program for coherence and related formal
aspects in the view therapists develop of their patients. Computer support made the training
efficient and feedback much quicker and affordable than in traditional forms of training. The
problem was: The computer could not react to the content of what trainees fed in. On the other
hand, it seemed inappropriate to let therapists check multiple choice boxes to give them feedback
on the correctness of their view in terms of content. Based on the Latent Semantic Analysis
(LSA) program by the cognitive scientists Kintsch and Landauer we have developed a program
able to build up a semantic space from texts related to a disorder, a therapy approach, or a patient.
Subsequently, any text formulated in natural language can be projected into this space, and
individual feedback can be given within splits of a second. A trainee can inform him or herself
how experts have, for example, seen a case, what aspects he or she has neglected, etc. Data from
the evaluation of case conceptualizations by 20 trainees related to a depressed patients will be
presented along with a life demonstration of the program.




                                               416
Paper Session 17

Title:                  Developing an Elaborate, Coherent View of Your Patients and Their
                        Problems: Why is it Important and What are the Effects of a Computer
                        Supported Training Program?

Authors:                Franz Caspar and Dieter Benninghoven

Address for Correspondence:

                         Franz Caspar
                         Institute of Psychology
                         University of Bern
                         Muesmattstrasse 45
                         CH 3000 Bern 9
                         Switzerland

                                             ABSTRACT

     To the extent to which the belief in simple, generally effective ingredients of psychotherapy
is vanishing, the ability of a therapist to do the right thing with the right patient at the right time is
more and more seen as the crucial factor in psychotherapy. Not accidentally, last year's
presidential address was dedicated to this issue. The question is: How can we help therapists to
develop the underlying abilities? Research on such abilities and effects of training related to
them is essential, but largely lacking.

     The ability of therapists to develop an elaborate, coherent view of their patients and their
problems is conceptualized as one of the crucial abilities. A training program based on
connectionist (neural network) simulations and concepts from Cognitive Science, such as
coherence, has been presented at previous conferences. After a brief description of the program;
the final evaluation of the training with 19 therapists in a training and 15 in a control group is
presented.

     Generally, the program has enjoyed a good acceptance, which is not trivial, as many
therapists see psychotherapy and computer support as largely incompatible. The effects are
significant, but not in all variables: These results as well as the question what we can learn for
future training will be discussed.




                                                 417
Paper Session 18

Title:                 Compliance with a Self-Care Manual in Guided Self-Change For Bulimia
                       Nervosa

Authors:               Cornelia Thieis, Ulrike H. Schmidt, Janet L. Treasure, Roll Garthe, and
                       Nicholas A. Troop

Address for Correspondence:

                       Cornelia Thieis
                       FB 4
                       FH Bielefeld
                       PF 101113
                       D-33511 Bielefeld
                       Germany

                                           ABSTRACT

     Twenty three patients with DSM-III-R bulimia nervosa who had been randomly assigned to
a guided self-change treatment (a self-care manual plus 8 two-weekly sessions of cognitive
behavioral therapy) were questioned about the degree to which they had used their manual.
Questions concerned the amount read, whether it had been shared with a close friend or family
member and the number and nature of exercises completed.

     At the end of treatment, the group of high compliers had not achieved higher abstinence rates
than low compliers regarding any BN symptoms. However, at follow-up, on average 43 weeks
(s.d. 26) after the end of therapy, those who had completed more exercises were more likely than
low compilers to be abstinent from bingeing and vomiting. In terms of predicting compliance,
those with a high frequency of vomiting at the beginning of treatment were less likely to use the
manual while those with a longer duration of illness and higher levels of restraint were more
likely to use the manual.

     While a long duration of illness has often predicted a poor outcome, this study replicates
earlier findings that a long duration of illness predicts greater compliance.




                                              418
Paper Session 18

Title:                 Process and Outcomes Research in a Group of Patients with Eating
                       Disorders: Some Results

Authors:               Francesca Giannone and Girolamo Lo Verso

Address for Correspondence:
                    Dipartimento di Psicologia
                    Universita di Palermo
                    Via Divisi, 81, 90100 Palermo
                    Italy
                    Tel./Fax: 091 - 6164756 - 6171949
                    E-Mail: ITPADPS@MBOX.UNIPA.IT

                                           ABSTRACT
    This study reports on the therapeutic experience of a mono-symptomatic group of patients
with eating disorders, conducted by a therapist with a group-analytic orientation.

     The therapeutic process has been overseen for three years, from the beginning to the end of
therapy. We will present the results of our research and specifically:

Data about the therapeutic process, analysed by:

     - an adaptation to groups of the Q-sort by Jones (1995): the Psychotherapy Process Rating, a
    grid for the monitoring of the therapeutic relationship. It includes items for the analysis of
    important events of therapy and allows a survey of their frequency.

     - the M.R.G. Matrix Representation Grid (G. Alhin, 1988), a grid for the representation of
    the group matrix. This tool allows the observation of the group process by means of a
    diagrammatic approach.

Data about the outcomes of therapy, obtained with the aid of:

    - a P-C Problem checklist, a "thermometric" scale (1-10), to analyse the importance of the
    problems as they are perceived by the patient and the changes occurring during the therapy.

    - a psychometric test: the QAI, a scale for the evaluation of the patient's interpersonal
    adaptation.




                                               419
Paper Session 18

Title:                   The Freiburg Psychotherapy Process Outcome Study: Randomized
                         Controlled Trial of Duration of Psychological Treatment for Bulimia
                         Nervosa

Authors:                 Thomas Herzog and Armin Hartmann

Address for Correspondence:
                    Abt. für Psychosomatik und Psychotherapeutische Medizin, Freiburg
                    University
                    Hauptstr. 8, D-79104 Freiburg, Germany
          FAX: 0761-270-6885
                    E-mail: Herzog@pss1.ukl.Uni-Freiburg.De

                                               ABSTRACT

      Time is a core aspect of any psychotherapeutic treatment. The present study is the first to examine the
independent contribution of therapy duration to psychotherapy process and outcome in a controlled way. It
should support the development of rational criteria for decisions about treatment frequency.
      64 female outpatients with DSM-IV-defined bulimia nervosa recruited from consecutive admissions
to a regional eating disorder clinic were randomly assigned to either high frequency (2 sessions/week) or
low frequency (1 session/2 weeks) disorder-specific, multimodal psychotherapy guided by a treatment
manual (25 sessions). The multidimensional outcome measurement used a battery of standardized
questionnaires and interviews at several time points up to 16 months after first contact and allowed
comparisons for both equivalent number of sessions and equivalent time spans. The multidimensional
process measurement included session-by-session scoring on various instruments by both therapist and
patient.
      Patients, therapists and treatment were typical of everyday clinical reality. Clinically significant and
stable change occurred in different domains, for example eating related behaviors, cognitions and
emotions (Eating Disorder Inventory and the Structured Interview for Anorexia and Bulimia nervosa),
general psychopathology (Hopkins Symptom Checklist revised), depression (Beck Depression Inventory).
Changes were related to treatment dose but not duration and were maintained after the end of treatment (in
the high frequency group). Process measures were quite similar in the two groups. However, it was
noteworthy that - like other process measures - also the helping alliance, while strictly dose-related,
increased during a much shorter period of time in the high frequency group and that patients in treatments
with higher adherence with manual fared better.
      Dose but not frequency/duration of treatment determined outcome, for at least 16 months after intake.
For ethical reasons (speed of recovery), bulimia nervosa patients (and probably those with other well
defined symptomatology) should be treated in a high frequency mode until symptom remission is reached.
This requires significant changes in psychotherapy service delivery, which usually is geared to weekly or
fortnightly sessions. Further, symptom oriented and conflict oriented treatment modalities can be
successfully integrated into a cohesive treatment and their combination possibly contributed both to the
relatively high success and the relatively low relapse rate in the present sample.




                                                   420
Open Discussion 10

Title:                 Alliance Dimensions: The Final Frontier?

Discussion Leaders: W. Henry, A. Horvath, C. Muran, and W. Stiles

Moderator:             A. Horvath

Address for Correspondence:

                       A. Horvath
                       Simon Fraser University
                       Burnaby, BC
                       V5A 1S6
                       Canada
                       E-mail:horvath@sfu.ca

                                          ABSTRACT

     Over the last two decades it has became increasingly evident that the alliance (however it is
defined) represents an important common factor across most, if not all, forms of therapy. When
the concept was first examined alliance has often been broken down into two components the
―working alliance‖ and the ―therapeutic alliance‖. After much effort both theoretical and
empirical, have we moved beyond this bipartite model? The discussion group leaders will offer
their own concepts about an adequate model for the structure of the alliance in therapy and invite
all present to participate in a lively discussion about this topic.




                                              421
Closing Plenary Panel

Title:                 Supportive Psychotherapy: Unique Treatment or Basis for All
                       Psychotherapies?

Moderator:             William E. Piper


Panelists:             Arnold Winston, Mary McCallum, Mary Jane Esplen

Discussant:            Robert M. Weinryb

Address for Correspondence:

             William E. Piper
                       Department of Psychiatry
                       University of British Columbia
             2255 Wesbrook Mall
                       Vancouver, BC V6T 2A1
                       Canada

                                          ABSTRACT

     In recent years, there has been growing recognition of the prevalence and importance of
supportive psychotherapy. Although promoted as a popular and effective treatment for many
disorders, it has tended to be underrated compared to what is known as expressive (or
interpretive) psychotherapy. Part of the problem may be related to the fact that the term
supportive psychotherapy is used to cover a wide range of technical procedures. Thus,
uncertainty about its basic features has persisted. The purpose of the plenary is to address a
number of questions concerning supportive psychotherapy. They include: ―What is it? What is
it not? What evidence exists for its effectiveness? What are its limitations? What are its
active ingredients?‖ Each panelist will attempt to answer some of these questions from his/her
unique perspective. Arnold Winston will approach them from the perspective of providing
supportive individual therapy for patients with personality disorders, Mary McCallum from the
perspective of providing supportive group psychotherapy to patients with pathological
bereavement, and Mary Jane Esplen from the perspective of providing supportive group
psychotherapy to patients with medical illness. After the panelists‘ presentations and before
audience response, Robert Weinryb will provide discussant comments.




                                            422

				
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