Marc Diener

Long Island University, Clinical Psychology, Faculty Member

Followers

Following

Co-authors

Public Views

InterestsView All (6)

Uploads

Papers by Marc Diener

Affect-Focused Techniques in Psychodynamic Psychotherapy

In a review of the research literature contrasting psychodynamic–interpersonal (PI) and cognitive... more In a review of the research literature contrasting psychodynamic–interpersonal (PI) and cognitive–behavioral (CB) treatment, Blagys and Hilsenroth [1, 2] identified seven techniques/processes that distinguished PI from CB therapies. In particular, PI treatments contained greater frequency of emotion focus and encouraged patients to express their feelings. This affect-focused process garnered the most evidence for distinguishing PI from CB [1, 2], suggesting

A primer on meta-analysis of correlation coefficients: The relationship between patient-reported therapeutic alliance and adult attachment style as an illustration

Psychotherapy Research, 2009

Multimethod Validity Assessment of the SWAP200 Dysphoric Q-Factor

Journal of Nervous and Mental Disease, 2004

The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment... more The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.

Therapist Affect Focus and Patient Outcomes in Psychodynamic Psychotherapy: A Meta-Analysis

American Journal of Psychiatry, 2007

Objective: The authors systematically examined the relationship between therapist facilitation of... more

Download

Patient Participation in Psychodynamic Psychotherapy: Contributions of Alliance and Therapist Technique

American journal of psychotherapy

The aim of this research is to investigate the relationship among patient participation, techniqu... more The aim of this research is to investigate the relationship among patient participation, technique, and the working alliance during early sessions of psychodynamic psychotherapy. Participants in this study (N=88) were representative of those actually seeking outpatient treatment at a university-based community clinic. Results demonstrated that greater use of psychodynamic techniques is related to greater patient participation in early session process during psychodynamic psychotherapy (r=.23, p=.03). Moreover, greater use of two specific psychodynamic interventions was found to be significantly related to patient participation: “The therapist encourages the exploration of feelings regarded by the patient as uncomfortable” (r=.24, p=.03),” and “The therapist focuses attention on similarities among the patient's relationships repeated over time, settings or people” (r=.33, p=.001). The relationship between overall working alliance and patient participation was also found to be sig...

Affect-Focused Techniques in Psychodynamic Psychotherapy

Handbook of Evidence-Based Psychodynamic Psychotherapy, 2009

ABSTRACT In a review of the research literature contrasting psychodynamic–interpersonal (PI) and ... more ABSTRACT In a review of the research literature contrasting psychodynamic–interpersonal (PI) and cognitive–behavioral (CB) treatment, Blagys and Hilsenroth [1, 2] identified seven techniques/processes that distinguished PI from CB therapies. In particular, PI treatments contained greater frequency of emotion focus and encouraged patients to express their feelings. This affect-focused process garnered the most evidence for distinguishing PI from CB [1, 2], suggesting a heightened attention in psychodynamic treatments to patient emotions.

Dropout and therapeutic alliance: a meta-analysis of adult individual psychotherapy

Psychotherapy Theory Research Practice Training

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout a... more This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between...

Supervisory Process From a Supportive-Expressive Relational Psychodynamic Approach

by Vicky Mesrie and Marc Diener

Psychotherapy (Chicago, Ill.), Jan 3, 2014

Substantial theoretical and empirical focus has been placed on detailing the processes that thera... more Substantial theoretical and empirical focus has been placed on detailing the processes that therapists use in psychotherapy. Relatively limited investigation, however, has been conducted into the utility of the various techniques and processes that supervisors use in facilitating the development of trainee competence to conduct psychotherapy. The present article explores 2 sets of supervisory techniques/processes that can be used to assist novice therapists in the development of clinical skills from a supportive-expressive (Luborsky, 1984) relational (Greenberg & Mitchell, 1983) psychodynamic approach: (a) providing systematic and structured training in interpretation, and (b) facilitating trainee use of countertransference. We detail the theoretical underpinnings and research findings for each supervisory process, followed by presentation of vignettes illustrating supervisor-supervisee interactions that demonstrate the use of these processes. (PsycINFO Database Record (c) 2014 APA,...

Technique and therapeutic process from a supportive-expressive relational psychodynamic approach

Psychotherapy, 2013

In the present article, the authors identify three sets of clinical techniques central to the mec... more In the present article, the authors identify three sets of clinical techniques central to the mechanisms of change in a supportive-expressive relational psychodynamic approach: (a) emphasis on patient affective experience, (b) identifying and understanding patient interpersonal patterns, and (c) therapeutic immediacy. Theoretical foundations and research findings supporting the utility of each intervention are outlined and briefly discussed. Clinical exchanges demonstrating the application of these techniques are also provided.

Effectiveness of combined individual and group dialectical behavior therapy compared to only individual dialectical behavior therapy: A preliminary study

Psychotherapy, 2012

Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personal... more Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to confirm the results.

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy

Psychotherapy: Theory, Research, Practice, Training, 2010

A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures

by Allan Abbass, Marc Diener, and Falk Leichsenring

Psychotherapy, 2012

The aim of this research was to examine the extent to which the use of research-specific procedur... more The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d ϭ 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d ϭ 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychodynamic psychotherapy to enable further elucidation of principles that evidently work.

Download

A primer on meta-analysis of correlation coefficients: The relationship between patient-reported therapeutic alliance and adult attachment style as an illustration

Psychotherapy Research, 2009

The aim of this article is twofold: to offer an introduction to meta-analysis using correlation c... more The aim of this article is twofold: to offer an introduction to meta-analysis using correlation coefficients to facilitate greater understanding of meta-analytic findings and to guide those interested in conducting meta-analyses. The authors review calculations for a weighted average effect size, the statistical significance of this effect, a test of homogeneity, confidence intervals, and file drawer analysis. They provide a running example of the relationship between patient-reported therapeutic alliance and adult attachment style. Results (k = 12, N = 581.17, weighted average r = .17, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, 95% confidence interval=.13-.21) indicated a positive, statistically significant relationship, suggesting that greater attachment security is associated with stronger therapeutic alliances, whereas greater attachment insecurity is associated with weaker therapeutic alliances. File drawer results suggested that some caution is warranted in terms of the size of the effect.

Criterion validity of the Rorschach Mutuality of Autonomy (MOA) scale: A meta-analytic review

Psychoanalytic Psychology, 2013

The present study consisted of a meta-analytic review of the criterion validity of the Rorschach ... more The present study consisted of a meta-analytic review of the criterion validity of the Rorschach Mutuality of Autonomy (MOA; Urist, 1977) scale. Search procedures yielded 27 independent samples (total N = 1,803, average n = 67, SD = 31) for inclusion in the metaanalysis. Results support the criterion validity of the MOA with an average overall weighted effect size of r = .24, p < .001 (95% confidence interval = .17-.30). Publication bias analyses indicate the potential for bias and demonstrate that the likely impact of such bias would bring the average overall weighted effect size down to r = .18, p < .001 (95% confidence interval for adjusted effect size = .11-.24). The data were not demonstrably heterogeneous (Q = 37.29, df = 26, p = .07), and all between-study moderator analyses were nonsignificant (ps > .20) with the exception of the specific type of criterion variable. Implications for future research and clinical practice are discussed.

Download

Processes of therapeutic change in psychodynamic therapy of two inpatients with borderline personality disorder

Journal of Psychotherapy Integration, 2014

ABSTRACT Two psychiatric inpatients with borderline personality disorder (BPD) participated in 5 ... more ABSTRACT Two psychiatric inpatients with borderline personality disorder (BPD) participated in 5 months of three-times-per-week psychodynamic therapy (PDT). Patients completed a measure of psychological distress every week. Forty-four sessions were audiotaped and coded using the Psychotherapy Process Q-Set (PQS) and correlated with PQS prototypes of five treatment models—PDT, cognitive-behavior therapy (CBT), interpersonal therapy (IPT), transference-focused psychotherapy (TFP), and dialectical behavior therapy (DBT). Prototypical CBT process was significantly more prevalent in Patient 1’s than in Patient 2’s treatment. In both treatments combined, prototypical PDT process significantly decreased over time, prototypical CBT process was negatively correlated with distress, and prototypical TFP process was positively correlated with distress. Two PQS items—therapist aloofness and patient feeling inadequate and inferior—were positively correlated with distress for Patient 2. An effective PDT treatment model for severely disturbed BPD inpatients requires technical flexibility to make temporary use of more structured interventions that serve the treatment goal of stabilization. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Multimethod Validity Assessment of the SWAP-200 Dysphoric Q-Factor

The Journal of Nervous and Mental Disease, 2004

A Meta-Analysis of the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity

Clinical Psychology & Psychotherapy, 2011

The present study examined the relationship between the Rorschach Ego Impairment Index (EII) and ... more The present study examined the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity. Search procedures yielded 13 independent samples (total N = 1402, average n = 108, standard deviation = 90) for inclusion in the meta-analysis. Inter-rater reliability analyses demonstrated that coding of effect sizes and moderator variables was completed with good to excellent reliability. Results indicated that higher EII scores were associated with greater psychiatric severity, with an overall weighted effect size of r = 0.29, p = 0.000002 (95% confidence interval = 0.17-0.40), supporting the EII&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity as a measure of psychological impairment. Publication bias analyses did not indicate any significant cause for concern regarding the results. The data were demonstrably heterogeneous (Q = 56.82, p = 0.0000001), and results of post-hoc tests indicated that effect sizes with dependent variables obtained via researcher ratings were significantly larger than any of the following: effect sizes with dependent variables obtained via clinician ratings, informant ratings, information about level of treatment or placement status or self-report ratings (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s = 0.0005, 0.003, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, respectively). In addition, there was a trend for effect sizes based on performance-based measures to be larger than those based on information about level of treatment or placement status (p = 0.098) as well as those based on self-report measures (p = 0.076). Other moderator analyses were non-significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.10). Copyright © 2010 John Wiley &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sons, Ltd. Key Practitioner Message: • The Rorschach Ego Impairment Index (EII) demonstrated validity in measuring psychiatric severity across a range of normative, outpatient, residential, and inpatient samples. • The degree of the EII&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity in assessing psychiatric severity compared favorably to the overall validity of the Rorschach and the MMPI. • The EII appears to be most valid in capturing psychiatric severity as measured by researcher ratings of social competency or estimated ego impairment.