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

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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.
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


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.
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

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).
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


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.

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

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.
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
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.
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)

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.
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


Tel/Fax 06/44233878
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.

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

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.

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

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.
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
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.
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
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.
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
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.

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

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.
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


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).

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