Mathematical model of the dynamics of psychotherapy

The success of psychotherapy depends on the nature of the therapeutic relationship between a therapist and a client. We use dynamical systems theory to model the dynamics of the emotional interaction between a therapist and client. We determine how the therapeutic endpoint and the dynamics of getting there depend on the parameters of the model. Previously Gottman et al. used a very similar approach (physical-sciences paradigm) for modeling and making predictions about husband–wife relationships. Given that this novel approach shed light on the dyadic interaction between couples, we have applied it to the study of the relationship between therapist and client. The results of our computations provide a new perspective on the therapeutic relationship and a number of useful insights. Our goal is to create a model that is capable of making solid predictions about the dynamics of psychotherapy with the ultimate intention of using it to better train therapists

Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: The POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial

Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. Methods: The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. Discussion: This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders. Trial Registration Current Controlled Trials ISRCTN2924287

Exploring how Chinese primary school psychological counsellors understand and use therapeutic stories

Psychological counsellors in western countries have used stories and storytelling for therapeutic purposes for decades. However, the development of the profession of school counselling in China is at an early stage and little research has been done on using therapeutic stories in Chinese primary school settings. This exploratory study presents qualitative data on using therapeutic stories collected from interviews with Chinese psychological counsellors who work with primary school students. Findings from a grounded theory analysis revealed that therapeutic stories were used by the participants in various therapeutic approaches. A spectrum of therapist directiveness was developed to integrate different ways of using therapeutic stories

Early and Later Predictors of Outcome in Brief Therapy: The Role of Real Relationship

Objectives: The study examined whether clients who continued longer in brief therapy reported stronger associations of real relationship and working alliance with therapy outcome than clients who received very brief treatment. It also examined whether real relationship and working alliance assessed early in treatment predicted outcome differently from that assessed later in therapy. Method: Fifty clients (32 women; Mage = 22.3 years) were recruited from a university counseling center. Thirty- two clients (very brief therapy) completed the post-third session assessment of real relationship and working alliance, and 18 (brief therapy) had both the third and eighth assessment. Results: The real relationship scores (both client and therapist rating) were significantly correlated with outcome in the 18 brief therapy clients, but not in the 32 very brief therapy clients. We found significant correlations between outcome and Bond element of the working alliance in the 18 brief therapy clients, and between outcome and working alliance-Task in the 32 very brief therapy clients. Conclusions: These findings suggested that the strength of the early real relationship, as well as later real relationship, are highly associated with outcome for clients who continue brief therapy past its earliest stages

Relation of the Real Relationship and the Working Alliance to the Outcome of Brief Psychotherapy

The (a) association of the client and therapist-rated strength of the real relationship to the outcome of brief psychotherapy and (b) extent to which the real relationship predicted outcome above and beyond the predictive power of the working alliance were examined. Fifty clients at the counseling center of a university in Italy received brief therapy and completed measures before treatment, after the third session, and at the end of treatment. From clients’ perspective, both the Genuineness element of the real relationship and the Bond scale of the working alliance were found to relate significantly to treatment outcome. When we examined the real relationship and working alliance as predictors in a hierarchical regression format, the client-rated real relationship, especially the Genuineness element, did predict outcome and, furthermore, added significantly and substantially to the working alliance in predicting outcome. Neither the strength of the real relationship from the therapist’s perspective nor the therapist-rated working alliance was found to relate to outcome. The findings are discussed in the context of methodological differences with other investigations of the real relationship

Ethical Issues in Providing Online Psychotherapeutic Interventions

The Internet offers psychotherapists a new communication medium through which they can deliver psychotherapeutic interventions that are appropriate to the medium. Yet online psychotherapy also offers new ethical challenges for therapists interested in providing online psychotherapeutic services. The differences between interactive text-based communication and in-person verbal communication create new ethical challenges not previously encountered in face-to-face therapy. This article will examine the Internet's potential for providing online psychotherapeutic interventions and will review the ethical issues involved with providing interactive text-based psychotherapy