Shift in representation and symbolisation of affective experience:a paradoxical outcome in therapy

Defining outcome represents a key challenge for psychotherapy theory, research and practice. The present paper uses a case study of a client with anorexia nervosa to contribute to the development of conceptual understanding of the nature of paradoxical outcome. In this case, different sources of outcome data offered different answers to the question of whether or not the therapy had been successful. Qualitative thematic analysis of therapy transcriptions was carried out, using Interpretative Phenomenological Analysis (IPA). Both the process of change that occurred in this case, and the conflicting outcome indicators, could be explained in terms of a model of affect elaboration. These findings are discussed in terms of the need for caution when interpreting results from outcome measures in psychotherapy research and practice

The cultural change narrative as a core component of therapeutic change

IntroductionResearch indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment.MethodsThe study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD.ResultsThe main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead.DiscussionThe participants’ stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT

Paradoxical outcomes in psychotherapy: Theoretical perspectives, research agenda and practice implications

Client self-report symptom measures are widely used in counselling and psychotherapy research and practice to track client progress and evaluate outcome. A growing body of evidence indicates differences between self-report assessments and information collected through other sources. This paper considers a range of theoretical and empirical perspectives on this issue, including the concept of illusory mental health. Particular emphasis is given to the relevance of single-case research as a means of identifying different patterns of paradoxical outcome. Implications for practice and research are discussed

Navigating in the dark: Meta-synthesis of subjective experiences of gender dysphoria amongst transgender and gender non-conforming youth

Objective We conducted a meta-synthesis of qualitative research on subjective experiences of gender dysphoria (GD) amongst transgender and gender non-conforming (TGNC) youth in order to improve clinical encounters, complement existing knowledge and potentially influence future research. Methods We systematically searched for qualitative studies on GD in English, German, Spanish and Scandinavian languages in seven databases. Starting with 2000 articles, we finally included 12 papers in the meta-synthesis, following Noblit and Hare's (1988) seven steps for qualitative meta-synthesis research. Results Through the consistent comparison of key concepts, we were able to cluster the findings from the 12 included studies into four meta-themes: (1) the emerging understanding and awareness of GD was described as navigation in the dark, (2) the importance of relationships and societal norms, (3) the role of the body and the exploration of one's own body and (4) sexuality and sexual impulses. The young person's relation with his or her own body and sexuality influences subjective experiences of GD. The experiences are always mediated in relation with other people and societal norms, and they are both long-lasting and changing. Conclusion The phenomenological analysis indicated that GD is a complex phenomenon involving manifold factors that changes across time and place for each individual. GD is not a static phenomenon but an expression of continuous negotiation amongst the body, its impulses, sexual desire and the relationships in which each person participates. Therefore, clinicians who treat TGNC youth should help them to reflect on this developmental process over time as a complement to medical approaches

How Usual is Treatment as Usual? Experienced Therapists’ Reflections on Participation in Practice-based Research.

Studies have shown that many clinicians are skeptical about research and hesitant about participating in research. In the present study, we explored this issue by studying experienced therapists’ reflections on their participation in practice-based research. Data were drawn from a practice-based research study at the University of Oslo, Norway. Twelve highly experienced therapists who had contributed to the study were invited to complete an open-ended questionnaire regarding their participation, and the text material was analyzed using a thematic analytic approach. Results indicated that research participation was experienced both as beneficial and demanding, and that being observed by others and following research procedures was experienced as affecting therapists’ clinical work. We discuss these findings in relation to the distinction between “treatment as usual” versus “treatment in a research context”, and offer suggestions for steps to increase the clinical relevance and the ecological validity of psychotherapy research. This is an Accepted Manuscript of an article published by Taylor & Francis in Counselling Psychology Quarterly on 10 Nov 2017, available online: http://www.tandfonline.com/10.1080/09515070.2017.139750

Antecedents of fathers’ perception of child behavior at child age 12 months

This study investigates whether fathers’ adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers’ perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N = 835) were recruited to “The Little in Norway (LiN) study” (Moe & Smith) at nine well‐baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path‐analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers’ ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers’ mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers’ perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers’ early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress

Pedagogical stance in mentalization-based treatment

Background A common aspect of evidence-based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization-based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined. Methods Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA). Results The dominating intervention type was MBT Item 16—therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies. Conclusion Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions

Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder

Objective: Mentalization-based treatment (MBT) is an evidence-based long-term treatment for borderline personality disorder (BPD). Alliance is central for effective psychotherapies. Few studies have addressed aspects of working alliance in BPD evidence-based treatments. This study aimed to investigate alliance development in MBT therapies with different clinical outcomes. Method: The sample included 155 patients in an MBT programme. Clinical outcomes were based on Global Assessment of Functioning (GAF). The sample was divided in two subgroups according to GAF levels at the end of treatment (cut-off = 60). Working alliance was assessed by patient report (Working Alliance Inventory, subscales, Goals, Bonds and Tasks) and assessed repeatedly over 36 months. The method for statistical analyses was linear mixed models. Results: Initial levels of Goals, Bonds, and Tasks did not differ by subgroup, but change over time differed significantly by subgroup. In the good outcome subgroup, ratings of Goals, Bonds, and especially Tasks increased significantly over time. In the poor outcome subgroup, paranoid PD was associated with poorer alliance development over time. Conclusions: Good outcome therapies were characterized by a process where the working alliance grew over time. Results encourage an explicit focus on tasks in therapy particularly for patients with high levels of mistrust

Table_1_The cultural change narrative as a core component of therapeutic change.docx

IntroductionResearch indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment.MethodsThe study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD.ResultsThe main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead.DiscussionThe participants’ stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.</p