Workshop 1 Title: Using Code-a-text to Analyse Psychotherapy Texts Authors



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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.



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.
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.
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).


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 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.
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.
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.
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.

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.
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.


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).
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.



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.



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.
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.


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.
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

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