Brief Psychotherapy

In accordance with Freud's hypothesis about the nature of primary process thinking we analysed metaphors as possible tools for the integration of unconscious affective und cognitive representational processes which, besides being complementary to affective interactive dyadic behaviour, may be of curative value. Using videotapes of 10 fifteen-hour short-term therapies by very experienced therapists treating an unselected group of patients, facial affect and metaphoric language of the therapist and the patient as well as the temporal distance between the two was recorded. The density of metaphors was not significantly correlated with symptom reduction but with treatment satisfaction. However, symptom reduction correlated significantly with the frequency of interactive metaphors used by both the therapist and the patient. It could be shown that there is an optimal time window between facial affect and metaphor production beyond the here and now, but not as a long term memory.

Background: Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a twoyear follow-up. Methods: Thirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions. Results: All patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group. Conclusions: Although STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone. Trial Registration: ClinicalTrials.gov: NCT1356069

Background. Insufficient evidence exists for a viable choice between long-and short-term psychotherapies in the treatment of psychiatric disorders. The present trial compares the effectiveness of one long-term therapy and two shortterm therapies in the treatment of mood and anxiety disorders.

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for selfand group-evaluation and practice tasks completed ou1.side the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that shortterm group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.

Background/Objective: Guided by ACGME's requirements, psychiatric residency training in psychotherapy currently focuses on teaching school-specific forms of psychotherapy (i.e., cognitive-behavioral, supportive, and psychodynamic psychotherapy). On the basis of a literature review of common factors affecting psychotherapy outcomes and experience with empirically supported and traditional psychotherapies, the authors aimed to develop an advanced contemporary and pragmatic approach to psychotherapy training for eight residents (two per PGY year) enrolled in a specialized Psychotherapy Scholars' Track within an adult general-residency program.

Responds to the comment by M. F. Hoyt (see record 2001-18061-014) on the article by P. Gilford and P. Cushman (see record 2000-05933-002). It is argued that Hoyt did not grasp the synchronistic connection between managed care's practices and its implications for current understandings of human being. The authors believe that either Hoyt did not fully understand their concerns or he is unable to apply them to his own theory. It is maintained that Hoyt's comments demonstrate how difficult it is for psychologists to think historically and critically about their practice. (PsycINFO Database Record (c) 2012 APA, all right Although Hoyt begins his comment with a lengthy quote from the conclusion of our article, it is puzzling that he does not then discuss it. We wonder if his silence about the quote and the overall direction of his comment indicates that either he does not fully understand our larger concerns, or he is not able to apply them to his own theory. The comment demonstrates how difficult it is for all of us to think historically and critically about psychological practices.

Interpreting or addressing defenses is an important aspect of psychoanalytic technique. Previous research has shown that therapist addressing defenses (TADs) can produce a positive effect on alliance. The potential value of TADs during the process of alliance rupture and resolution has not yet been documented. We selected patients (n = 17) undertaking a short-term dynamic psychotherapy in which the therapeutic alliance, measured with the Helping Alliance Questionnaire and monitored after each session, showed a pattern of rupture and resolution. Two control sessions (5 and 15) were also selected. Presence of TADs was examined in each therapist interpretation. Compared with control sessions, rupture sessions were characterized by fewer TADs and especially fewer TADs addressing specifically intermediateVessentially neuroticVdefenses. Resolution sessions were characterized by more TADs addressing specifically intermediate defenses. This confirms the link between therapist technique and alliance process in psychodynamic psychotherapy.