A randomised controlled feasibility study of interpersonal art psychotherapy for the treatment of aggression in people with intellectual disabilities in secure care

Background: Rates of aggression in inpatient secure care are higher than in other psychiatric inpatient settings. People with intellectual disabilities in secure care require adapted psychological treatments. Interpersonal art psychotherapy incorporates the use of creative art making approaches by participants, thus reducing sole reliance upon verbal interactions during psychotherapy for people who may have communication difficulties. During interpersonal art psychotherapy, participants are individually supported by their therapist to consider how they conduct relationships. This includes the influence and impact of interpersonal issues resulting in repeated patterns of conflict. The key feasibility objectives were to assess recruitment and retention rates, follow-up rates and trial procedures such as randomisation, allocation and identifying any practical or ethical problems. In addition, a preliminary ‘signal’ for the intervention was considered and an indicative sample size calculation completed. The acceptability of a potential third trial arm attentional control condition, mindful colouring-in, was assessed using four single-case design studies and a UK trial capacity survey was conducted. Methods: Adult patients with intellectual disabilities in secure care were recruited and randomised to either interpersonal art psychotherapy or delayed treatment in this multi-site study. Outcomes were assessed using weekly observations via the Modified Overt Aggression Scale and a range of self-report measures. Within study reporting processes, qualitative interviews and a survey were completed to inform trial feasibility. Results: Recruitment procedures were successful. The target of recruiting 20 participants to the trial from multiple sites was achieved within 8 months of the study opening. All participants recruited to the treatment arm completed interpersonal art psychotherapy. Between-group differences of interpersonal art psychotherapy versus the delayed treatment control showed a ‘signal’ effect-size of.65 for total scores and.93 in the verbal aggression sub-scale. There were no amendments to the published protocol. The assessment of key feasibility objectives were met and the trial procedures were acceptable to all involved in the research. Conclusion: This study suggested that a randomised controlled trial of interpersonal art psychotherapy is acceptable and feasible. Trial registration: ISRCTN14326119 (Retrospectively Registered)

Therapist’s defense mechanisms and their relationship with change in patient’s defensive functioning during psychoanalysis

Aim: Research largely study the role of defense mechanisms in psychotherapy. The relationships between defense mechanisms and mental health have been widely demonstrated, but less is known about the role of therapist’s defenses in promoting changes in patient’s defensive functioning. The present study focused for the first time on therapist’s defense mechanisms activated throughout the course of a psychoanalytic treatment and analyzed their relationships with changes in patient’s defensive functioning assessed at different time of the treatment. Methods: Three trained raters coded defense mechanisms using the Defense Mechanisms Rating Scales (DMRS) on transcripts of 20 psychoanalytic sessions collected in five times of the treatment. For each session we coded both therapist’s and patient’s defense mechanisms, with particular attention to the qualitative sequence of defenses consecutively activated within the therapeutic pair. Results: Patient’s defensive functioning tend to gradually improve over the course of psychoanalysis, with a slight decrease at the end of the treatment. As expected, therapist’s overall defensive functioning (ODF) remains stable throughout the treatment with values in the range of highly adaptive defensive functioning. Qualitative analyses showed that the patient tends to activate the same defense mechanisms activated by the therapist more in the initial phases of the treatment. Through the end of the psychoanalysis, patient-therapist defense match decreased while the patient’s ODF becomes more adaptive and individualized. Conclusion: The qualitative and quantitative assessment of defenses in use in the present single case of analytic treatment showed that there is an interaction between therapist-patient in-session defense use. Results says that patient imitates the therapist's ways of defending initially, whereas later there is "individualization" in that patient starts to use their own defenses as a function of development of subjectivity. Further research is needed to confirm the attachment-individuation hypothesis that will be tested in a bigger sample of analytic treatments

Psychotherapy for personal growth? A multicultural and multitheoretical exploration

Objective: This paper reports on a focus-group discussion of four expert psychotherapy researchers facilitated at an international conference from the Society of Psychotherapy Research. A discussion was facilitated to explore their perspectives on psychotherapy practices of personal growth (intentionally working towards a strengthened sense of autonomy, mastery, and self-acceptance) in different countries (United States, Canada, Argentina, and Chile) and different modalities (psychoanalysis, humanistic therapy, and cognitive behavioral therapy). Methods: Following the conference, the audio recording of this discussion was transcribed and analyzed using consensual qualitative research methods. Results. Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma. Results: Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma. Conclusion: Future research examining the cost-effectiveness and benefits of psychotherapy for personal growth is warranted. Building on the six domains, specific future research projects on the evidence-based practice of psychotherapy for personal growth are suggested.Fil: Aafjes-van Doorn, Katie. Yeshiva University; Estados UnidosFil: Garay, Cristian Javier. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Etchebarne, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Belgrano; ArgentinaFil: Kamsteeg, Céline. Utrecht University; Países BajosFil: Roussos, Andres Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Belgrano; Argentin

The Development of a Self-Report Scale to Assess Therapists’ Acceptance of Online Psychotherapy via Video Conferencing

Objective: We aimed to develop a self-report measure of therapist acceptance of online therapy via videoconferencing based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. Method: Using a cross-sectional survey design, 1,265 therapists completed the UTAUT-T, as well as additional questions. Results: Confirmatory analysis indicated that the original UTAUT model did not fit the therapist context well. Exploratory factor analysis specified a better-fitting five-factor model (Therapy Quality Expectation, Pressure from Others, Ease of Use, Professional Support, Convenience), which showed good internal validity. Of the five factors, four predicted intention to use online therapy in the future. Conclusion: The 21-item UTAUT-T offers a promising self-report measure of therapist acceptance of online therapy and intention towards using it in the future, which, in turn are likely to predict actual future use outside the pandemic context. Future studies on the convergent and predictive validity of the UTAUT-T are warranted

The Effect of Hopelessness and Perceived Group Compatibility on Treatment Outcome for Patients With Personality Dysfunction

Improvement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N= 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction

THE RELATIONSHIP BETWEEN PATIENTS' PERSONALITY TRAITS, THE ALLIANCE, AND CHANGE IN INTERPERSONAL DISTRESS IN INTENSIVE GROUP TREATMENT FOR PERSONALITY DYSFUNCTION

This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame

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

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