Showing papers in "Psychotherapy Research in 2006"

Development and validation of a revised short version of the working alliance inventory

Abstract: The Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) and the Working Alliance Inventory–Short (WAI-S; Tracey & Kokotovic, 1989) are widely used measures of alliance in therapy. This study evaluated the factor structure of the WAI and WAI-S with confirmatory factor analysis in two relatively large samples (Ns = 231 and 235). The hypothesized structures were not confirmed. An alternative 12-item WAI (WAI-SR), consistent with Bordin's (1979) model of alliance, was developed in one sample and cross-validated in the other. The WAI-SR better differentiated Goal, Task, and Bond alliance dimensions and correlated well with other alliance measures. The Task dimension was particularly salient, as expected based on Bordin's original theory. Additional psychometric properties and item response theory analysis of the WAI-SR are presented. Zusammenfassung Eine Revision der Kurzform des Working Alliance Inventars (WAI-SR) Das Arbeitsbeziehungsinventar (Working Alliance Inventory, WAI; Horvath & Green...

Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data

Abstract: Data for completer and intent-to-treat samples from the two psychotherapy conditions of the National Institute of Mental Health Treatment of Depression Collaborative Research Program were analyzed to estimate the proportion of variability in outcomes resulting from therapists. Therapists, who were nested within treatments, were considered a random factor in multilevel analyses. These analyses, which modeled therapist variability in several different ways, indicated that about 8% of the variance in outcomes was attributable to therapists, whereas 0% was due to the particular treatment delivered. When therapist effects were appropriately modeled, previously detected differences in efficacy between the two psychotherapy conditions for more severely depressed patients disappeared, as predicted by methodological considerations. Daten von vollstandigen Stichproben mit einer Behandlungsabsicht, von den beiden Psychotherapiebedingungen des gemeinsamen Forschungsprogramms des Nationalen Instituts fur psyc...

Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies

Abstract: The open dialogue (OD) family and network approach aims at treating psychotic patients in their homes. The treatment involves the patient’s social network and starts within 24 hr after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue with the family to construct words for the experiences that occur when psychotic symptoms exist. In the Finnish Western Lapland a historical comparison of 5-year follow-ups of two groups of first-episode nonaffective psychotic patients were compared, one before (API group; n! /33) and the other during (ODAP group; n! /42) the fully developed phase of using OD approach in all cases. In the ODAP group, the mean duration of untreated psychosis had declined to 3.3 months (p! /.069). The ODAP group had both fewer hospital days and fewer family meetings (p B/.001). Nonetheless, no significant differences emerged in the 5-year treatment outcomes. In the ODAP group, 82% did not have any residual psychotic symptoms, 86% had returned to their studies or a full-time job, and 14% were on disability allowance. Seventeen percent had relapsed during the first 2 years and 19% during the next 3 years. Twenty nine percent had used neuroleptic medication in some phase of the treatment. Two cases from both periods are presented to illustrate the approach.

Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression

Abstract: Supervision of psychotherapists and counselors, especially in the early years of practice, is widely accepted as being important for professional development and to ensure optimal client outcomes. Although the process of clinical supervision has been extensively studied, less is known about the impact of supervision on psychotherapy practice and client symptom outcome. This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. The authors randomly assigned 127 clients with a diagnosis of major depression to 127 supervised or unsupervised therapists to receive eight sessions of problems-solving treatment. Supervised therapists were randomly assigned to either alliance skill– or alliance process–focused supervision and received eight supervision sessions. Before beginning treatment, therapists received one supervision session for brief training in the working alliance supervision approach and in specific chara...

The role of therapist adherence, therapist competence, and alliance in predicting outcome of individual drug counseling: Results from the National Institute Drug Abuse Collaborative Cocaine Treatment Study

Abstract: This study tested hypotheses related to linear and curvilinear relations among adherence, competence, and outcome and interactions of these effects with the quality of the therapeutic alliance among patients (N=95) who received individual drug counseling as part of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Results support a hypothesized curvilinear relation between adherence and outcome as well as an interaction between this curvilinear effect and alliance early in treatment. For patients with a strong therapeutic alliance, counselor adherence to the treatment model was essentially irrelevant to treatment outcome. When the alliance was weaker, by contrast, a moderate (vs. high or low) level of counselor adherence was associated with the best outcome. The current results suggest that studies of the relation between therapist's adherence to models of treatment and outcome may need to take into account the complex moderating effect of therapeutic alliance. Diese Stu...

Can therapists be trained to improve their alliances? A preliminary study of alliance-fostering psychotherapy

Abstract: Research has consistently documented that the quality of the therapeutic alliance is related to the outcome of diverse psychotherapies. In this preliminary study, the authors examined whether therapists could learn to improve their alliances with patients. Therapists were trained in alliance-fostering therapy, a 16-session treatment for major depressive disorder that combines interpersonal–psychodynamic interventions with techniques for enhancing the alliance based on Bordin's model of the alliance. Five therapists with 1 to 3 years of postdoctoral clinical experience treated three patients in each of three study phases: before, during, and after training. From pre- to posttraining, moderate to large increases in the alliance were apparent, although these effects were not statistically significant. Variability between therapists was also apparent. The training produced small improvements in depressive symptoms but larger improvements in quality of life, particularly at follow-up and for cases tha...

Attachment scales predict outcome in a randomized controlled trial of two group therapies for binge eating disorder: An aptitude by treatment interaction

Abstract: Resume Resumen Patients (N=135) with binge eating disorder (BED) were randomized to a control condition or to one of two 16-session group treatments: group cognitive–behavioral therapy (GCBT) or group psychodynamic interpersonal psychotherapy (GPIP). The two treatments performed equally well, and each resulted in reduced days binged compared with the wait-list control condition. Twelve-month follow-up indicated that improvements were maintained in days binged and in other outcome variables. For women who completed GPIP, higher attachment anxiety was related to improvements in days binged by posttreatment. On the other hand, for women who completed GCBT, lower attachment anxiety was associated with improvements in days binged by posttreatment. Higher attachment avoidance was related to dropping out of GCBT. Although both GPIP and GCBT reduced binge eating, the results indicated that individual outcomes differ across treatments based on level of attachment anxiety and avoidance. Zusammenfassung Bin...

The effects of adding emotion-focused interventions to the client-centered relationship conditions in the treatment of depression

Abstract: A study was conducted to test the effects of adding emotion-focused interventions to the empathic relationship. The authors compared client-centered therapy, which provides an empathic relationship based on the relational attitudes of empathy, positive regard, and congruence, and emotion-focused therapy (EFT), which integrates process-guiding emotion-focused interventions that focus on depressogenic affective–cognitive problems with a client-centered supportive relationship. Thirty-eight patients meeting DSM–IV criteria for major depressive disorder were randomly assigned to 16 to 20 sessions of 1 of the 2 treatments. Clients’ level of depressive symptoms, general symptom distress, interpersonal distress, and self-esteem improved in each condition, but improvement on symptomatology was superior in the EFT condition. An empathic relationship appears to be enhanced by the addition of specific emotion-focused interventions. Zusammenfassung Die Effekte zusatzlicher emotions-fokussierter Interventione...

Therapist effects in the National Institute of Mental Health Treatment of Depression Collaborative Research Program

Abstract: Recent psychotherapy research literature has stressed the importance of therapist effects (i.e., the impact of the individual therapist on treatment outcome). The authors report an analysis of therapist effects in the National Institute of Mental Health Treatment of Depression Collaborative Research Program using hierarchical linear modeling. In addition to studying overall therapist effects, they investigate the possible interaction of therapists with initial patient severity and difficulty levels. There were virtually no significant findings in regard to either overall effects of therapists or the interaction with patient severity and difficulty. There was some suggestion of outliers (i.e., therapists who had especially good [or poor] rates of patient retention and recovery). Recommendations are made regarding different methodological approaches for studying outcome differences due to therapists. In der Psychotherapieliteratur wird die Wichtigkeit von Therapeuteneffekten (d. h. der Einfluss der...

Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression; a meta-analysis,

Abstract: We investigated the efficacy of pharmacotherapy and psychotherapy for depression by searching for RCT's. Studies were classified according to chronicity and severity and a meta-analysis was applied. Ten studies were included. Remission did not differ between psychotherapy (38%) and pharmacotherapy (35%). No differences were found in chronic, or in non-chronic depression, and in mild or in moderate depression. Both treatments performed better in mild than in moderate depression. Dropout was larger in pharmacotherapy (28%) than in psychotherapy (24%). At follow-up relapse in pharmacotherapy (57%) was higher than in psychotherapy (27%). Psychotherapy and pharmacotherapy appear equally efficacious in depression. Both treatments have larger effects in mild than in moderate depression, but similar effects in chronic and non-chronic depression and at follow-up psychotherapy outperforms pharmacotherapy. Zusammenfassung Die relative Effizienz von Psychotherapie und Pharmakotherapie bei der Behandlung von ...

The impact of psychotherapy training: Introduction to the special section

Abstract: Does psychotherapy training positively, negatively, or negligibly impact process and outcome of clinical practice? This fundamental question touches a deep core of meaning not only for students of ...

Assimilation in good- and poor-outcome cases of very brief psychotherapy for mild depression: An initial comparison

Abstract: This study compared the assimilation of problematic experiences in four good-outcome cases versus four poor-outcome cases of very brief psychotherapy (two sessions plus a follow-up) for mild depression. Clients’ central problems were consensually formulated, and transcribed passages concerning these problems were rated on the Assimilation of Problematic Experiences Scale by trained raters. Results supported the theoretical expectation that reductions in the intensity of depressive symptoms were associated with higher levels of assimilation. All of the good outcome cases reached Assimilation Level 4 (understanding/insight), whereas none of the poor outcome cases did so. Despite methodological limitations, it is suggested that this study represents an empirical endorsement of the assimilation model. Zusammenfassung Assimilation in Fallen mit gutem und schlechten Ergebnis sehr kurzer Psychotherapie fur leichte Depression: ein erster Vergleich Diese Untersuchung vergleicht die Assimilation problemati...

Therapist effects: Clever ways to make them (and everything else) disappear

Abstract: The purpose of Kim, Wampold, and Bolt's (2005) analysis of the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) data was to estimate the pro...

Attachment characteristics and treatment outcome following inpatient psychotherapy: Results of a multisite study

Abstract: The authors evaluated 617 patients at hospital admission using an interpersonal interview analyzed with the Adult Attachment Prototype Rating (Strauss, Lobo-Drost, & Pilkonis, 1999) in nine different psychotherapeutic hospitals. Attachment characteristics derived from this method served as predictors of treatment outcome. Outcome was quantified in all sites using the Symptom Checklist-90-Revised, Inventory of Interpersonal Problems, and, in a subsample, the Impairment Score (Schepank, 2003) as an observer rating. All measures were administered at patient admission and discharge. Additionally, patients completed the Bielefeld Questionnaire of Client Expectations (BQCE) at admission to assess self-reported attachment expectations toward the therapist. The study combined patients with a variety of clinical disorders (predominantly depressive and anxiety disorders, personality disorders, eating disorders) and confirmed the expected correlations of attachment characteristics with diagnoses and other c...

Reliability and validity of the Social Cognition and Object Relations Scale in clinical use

Abstract: The authors examined the reliability and convergent validity of the Social Cognition and Object Relations Scale (SCORS) when used to measure relational narratives and self-statements expressed to clinicians during clinicians sessions. Ninety patients admitted to short-term psychodynamic psychotherapy were rated by clinicians on the SCORS, DSM-IV Axis V Global Assessment of Functioning Scale, Global Assessment of Relational Functioning Scale, and Social and Occupational Functioning Assessment Scale; patients were also rated on Axis II. The SCORS exhibited good to excellent interrater reliability and a pattern of significant convergent validity with all scales. Convergent validity indicates the SCORS has utility as a measure of psychiatric, social–occupational and interpersonal functioning, and personality dysfunction in applied clinical use. Zusammenfassung Zuverlassigkeit und Gultigkeit der sozialen Kognitions- und Objektbeziehungsskala in der klinischen Anwendung Die Autoren haben die Zuverlassi...

Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique

Abstract: This study investigates the effects of graduate clinician training in short-term psychodynamic psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) on the acquisition of techniques within and across two training cases. Sessions 3 and 9 from the first and second treatment cases of 15 graduate clinicians receiving structured training in STPP were examined for the frequency of psychodynamic–interpersonal (PI) therapeutic techniques. Results demonstrated that structured training in STPP led to a significantly increased use of PI therapeutic techniques both within and across cases. The authors also examined the frequency of cognitive–behavioral (CB) therapeutic techniques used by the graduate clinicians. No changes in the number of CB interventions were observed over the same set of sessions. Practical implications for the use of structured clinical training and issues pertinent to supervision in graduate education are reviewed. Finally, the impact of structured train...

Differential effects of two forms of psychoanalytic therapy: Results of the Heidelberg-Berlin study

Abstract: This prospective naturalistic quasi-experimental study compares 2 psychodynamic therapy approaches that make up about 65% of all forms of psychotherapy currently financed by the health insurance system in Germany. Psychodynamic therapy (PD) is a focal therapy approach involving supportive elements, whereas psychoanalytic therapy (PA) encourages regressive processes, works with transference, and aims at more extensive changes to the personality (structural changes). PAs take longer and involve more sessions per week. By international standards, both approaches are regarded as long-term forms of therapy. This study investigates 2 groups of diagnostically heterogeneous patients, one PA and the other PD, matched with regard to several important parameters. The success of this matching was tested and comparability checked and substantiated on a wide range of features and scales. Treatment effects measured at end of therapy and at 1-year follow-up were analyzed with reference to the Global Severity Ind...

Negative mood regulation expectancies, self-efficacy beliefs, and locus of control orientation: moderators or mediators of change in the treatment of depression?

Abstract: Since the efficacy of cognitive–behavioral therapy for depression has been shown, questions arise concerning possible factors that moderate and mediate therapy outcome. For cognitive variables such...

The Mechanisms of Sudden Gains in Supportive–Expressive Therapy for Depression

Abstract: A sudden gain is a large symptom improvement in one between-session interval. Studies of cognitive–behavioral therapy (CBT) reported that many more cognitive changes occurred in pregain sessions (sessions immediately preceding sudden gains) than in control sessions. This study investigated sudden gains in supportive–expressive therapy (SE) for depression. Compared with control sessions, in these SE pregain sessions the authors found significantly greater therapist interpretation accuracy, better therapeutic alliance at a trend level, but an almost identical number of cognitive changes. Results from this SE study and past CBT studies suggest that sudden gains in different treatments may be associated with different mechanism factors: cognitive changes in CBT and accurate interpretations and possibly therapeutic alliance in SE. Zusammenfassung Die Mechanismen plotzlicher Gewinne in unterstutzend-expressiver Therapie bei Depression Ein plotzlicher Gewinn ist eine Symptomverbesserung in einem Interva...

What does the first exchange tell? Dialogical sequence analysis and assimilation in very brief therapy

Abstract: The authors applied dialogical sequence analysis, a microanalytic method for tracing recurring maladaptive patterns, to study assimilation in the psychotherapy of a woman treated for mild depression in two weekly sessions plus a 3-month follow-up session The very first exchange (four speaking turns each by client and therapist) enacted a pattern in which the client responded to her own potential vulnerability by adopting a controlling caretaker position Subsequent therapeutic work delineated component positions in this pattern, which was recurrent and maladaptive, leading to an insight reached midway through the second session From the client's reports, it appeared that she used her new understanding to assimilate her problematic controlling side, giving her greater flexibility in her relationships and greater scope for meeting her own needs for care She seemed to progress across three of the eight developmental stages postulated by the assimilation model: problem statement–clarification, und

Therapist effects in the National Institute of Mental Health Treatment of Depression Collaborative Research Program and other psychotherapy studies

Abstract: We appreciate this opportunity to react to the two studies in this issue of Psychotherapy Research (Elkin, Falconnier, Martinovich, & Mahoney; Wampold) that address therapist effects on outcome in ...

One-session virtual reality exposure treatment for fear of flying: 1-Year follow-up and graduation flight accompaniment effects

Abstract: The efficacy of a brief 1-session virtual reality (VR) exposure treatment of fear of flying (FOF) was demonstrated in a prior study (Muhlberger, Wiedemann, & Pauli, 2003). The current study further evaluated the exposure's effects on a posttreatment graduation flight, with patients accompanied or not by their therapist, and its long-term efficacy (1-year follow-up). Flight-phobic participants completed a brief cognitive preparation and four VR exposure flights conducted in one individual session. Patients were randomly assigned to a graduation flight either alone or with the therapist and other patients. FOF was assessed before and after the treatment session, after the graduation flight, and 12 months later. Fear responses were assessed during VR and graduation flights. Treatment efficacy was reflected in significant FOF reductions, which were maintained over the 12-month follow-up period. Eighty-seven percent and 67% of the assigned patients completed graduation flights accompanied and alone, r...

Men, women, and their outcome in psychotherapy

Abstract: This article presents a discussion of the author's research on differences in psychotherapy outcome between men and women. Two studies are highlighted. The first concerned differential responses of men and women to interpretive and supportive models of short-term individual psychotherapy. This study found that men benefited more in interpretive therapy than supportive therapy. Conversely, women benefited more from supportive therapy than interpretive therapy. The second study concerned differential responses of men and women to interpretive and supportive models of short-term group psychotherapy and also examined possible mediators of differential response. The study found that women, compared with men, had superior responses in both types of group therapy. The generally poor response of men could be attributed, in part, to their lower levels of commitment to the groups and their lower levels of compatibility with the other (primarily female) group members. The article concludes with thoughts abo...

Client accounts of personal change in process-experiential psychotherapy : a methodologically pluralistic approach

Abstract: Client changes in psychotherapy can be studied using a range of qualitative and quantitative research methods. Despite the availability of these various methods, therapy outcomes research is traditionally conducted with only a single-method approach. In the current study, the authors break from this single-genre research and present a pluralistic approach for examining qualitative accounts of personal change for a naturalistic sample of clients who engaged in process-experiential therapy. Open-coding analysis of changes indicated two broad categories: Changes Within the Self and Changes in Life Situation. Content analysis found that changes in experiential processing were more often reported at the end of treatment. Analyses of quantitative outcome measures indicated substantial pre–post therapy change. Brief case studies of two clients with contrasting outcomes illustrated limitations of the other methods and identified range and manner of expression of reported changes as directions for further...

Client critical incidents in the process of early alliance development: A positive emotion–exploration spiral

Abstract: In the present study, 20 clients nominated a critical incident that contributed to the development of the relationship with their therapist early in therapy. Analysis using the consensual qualitative research method indicated that the incidents were critical because of the meanings clients attached to the interventions the therapist made regardless of intervention type. When clients identified positive meanings, they responded by increasing their openness to exploration. Two different approaches to open exploration—productive openness (disclosing) and receptive openness (making use of input)—were linked to positive feelings that inspired either further openness to exploration or more positive feeling. The findings suggest an explanation for the link between alliance, as measured empirically, and outcome. At critical moments in early therapy, positive feelings (liking or bond) and exploration (task–goal) may interact to produce an upward spiral that launches clients in an exploratory process that ...

Developmental changes in group climate in two types of group therapy for binge-eating disorder: A growth curve analysis

Abstract: The development of group climate across 16 sessions of group psychodynamic–interpersonal psychotherapy (GPIP) and group cognitive–behavioral therapy (GCBT) for 65 female treatment completers with binge-eating disorder (BED) was assessed. Engaged scale growth for GPIP patients varied across sessions and was best represented by a cubic growth curve. This suggested that GPIP progressed in definable phases that reflected a rupture and repair sequence of engaged group climate. For patients receiving GCBT, engaged, avoiding, and conflict scale growth was gradual and consistent (i.e., linear), indicating an increase in positive group climate across sessions. This likely reflected patients taking greater responsibility for treatment as suggested by the CBT model. Linear growth in engaged climate mediated the relationship between attachment anxiety and outcome in GPIP. A consistent increase in engaged group climate through the rupture and repair phase may be a necessary condition for successful treatment ...

An investigation into the effectiveness of the arts therapies for adults with continuing mental health problems

Abstract: Arts therapies treatments offer patients therapy through primarily nonverbal means (i.e., art forms such as music, art, drama, and dance movement). They are particularly effective when normal communication is absent or has broken down. This study used a randomized control design and involved a treatment (n=10) and a control (n=15) group. Treatment was one of four arts therapies delivered in group or individual format. The authors used four separate questionnaires, administered over a 6-month period, to measure effectiveness. There was also a qualitative interview at the end of that period for the treatment group patients. The numerical results were not conclusive owing to high variability and small sample size, but the qualitative data reveal interesting facets of the process (e.g., that the therapists’ and patients’ perceptions of the treatment coincided in all treatment cases). Zusammenfassung Eine Untersuchung zur Effektivitat von Kunsttherapie fur Erwachsene mit lange andauernden psychischen ...

Assimilation and the process of outcome: Introduction to a special section

Abstract: The four articles in this special section explored the relation of assimilation to psychotherapy outcome conventionally construed as change in symptom intensity and distress. One study used a contrasting groups design (Detert, Llewelyn, Hardy, Barkham, & Stiles, 2006), and the other three used intensive analyses of single cases, including two good-outcome cases, Karen (Stiles et al., 2006) and Marı́a (Caro Gabalda, 2006b), and one poor-outcome case, Ana (Caro Gabalda, 2006a). The assimilation model is a theory of psychological change (Stiles, 2002; Stiles et al., 1990) developed partly in reaction to repeated failures to link psychotherapy processes with outcome using linear model statistics (Stiles & Shapiro, 1989, 1994). Whereas therapy process concerns in-session events assessed on time scales of seconds or minutes, therapy outcome has been assessed on time scales of months or years. Linking events that occurred in minutes with effects that occurred over months would be statistically improbable, even if it were not for the subtle but powerful interference of responsive processes, which defeat linear process outcome relations through recursive influences (Stiles, Honos-Webb, & Surko, 1998). The assimilation model’s approach has been to conceptually subdivide people into parts and examine relations among the parts longitudinally across the course of therapy. Attention has focused on the assimilation of problematic experiences into the person’s normal schemas, a process that can also be described as the assimilation of agentic problematic voices into a community of voices that constitutes the self. After the experiences are assimilated, they are no longer problematic but rather become resources, available as needed to meet life’s challenges and opportunities. For example, voices responsible for problematic uncontrolled verbal outbursts may become assimilated as a capacity for appropriate assertiveness (Stiles, 1999). Theory-building case study research has suggested that assimilation can be described as a series of stages through which problems pass in successful therapy, summarized in the Assimilation of Problematic Experiences Sequence (APES). The APES is continually evolving as investigators gain new understandings of therapeutic progress (see Stiles, 2002, 2003, and 2005 as well as the four articles in this special section). One version of the APES stage names is as follows: Stage 0, warded off dissociated; Stage 1, unwanted thoughts active avoidance; Stage 2, vague awareness emergence; Stage 3, problem statement clarification; Stage 4, understanding insight; Stage 5, application working through; Stage 6, resourcefulness problem solution; and Stage 7, integration mastery. The APES is understood as a continuum, and intermediate substages can be distinguished (e.g., Brinegar, Salvi, Stiles, & Greenberg, 2006). In different studies, the APES has been considered as both a theoretical description and a rating scale. It may be used to describe the rate and degree of therapeutic progress with or without a formal rating procedure. Theoretically, distress and symptom intensity vary systematically across APES stages, but the relation is not linear (Stiles, Osatuke, Glick, & Mackay, 2004). Clients who enter therapy with problematic experiences that are warded off or avoided (APES Stages 0 or 1) are likely to feel worse before they feel better as these experiences emerge and are acknowledged and confronted. The most intense and sustained emotional pain is expected at APES Stage 2 (vague awareness emergence). Progress through APES Stages 2 to 6, however, should be characterized by

The contribution of bibliotherapy to the counseling of aggressive boys

Abstract: This study investigated the contribution of bibliotherapy to the counseling of aggressive boys by novice counselors in Israel. Counseling for all children was provided within an integrative model (Hill, 2005); bibliotherapy was added as adjunct to the counseling process only in 1 group. Boys from 24 classrooms (3 per class) were randomly assigned to 1 of 3 conditions: integrative counseling (IC), integrative counseling plus bibliotherapy (ICB), or no counseling. Results of the comparison among the 3 conditions indicated reduced aggression and increased empathy in both IC and ICB conditions compared with the control condition. A difference between IC and ICB conditions was found for empathy and therapist satisfaction, with higher gains in ICB. In the ICB condition, boys also demonstrated higher stages of change (Prochaska, 1999) and had higher frequencies of insight and therapeutic change (Hill, 2005) compared with boys in the IC condition. Zusammenfassung Der Beitrag von Bibliotherapie zur Beratu...

Conceptualization and treatment of personality disorders

Abstract: Resume There is an emerging consensus that the essence of personality pathology consists of difficulties with self-identity and chronic interpersonal dysfunction. The nature of normal and abnormal attachment to others, attention control, affect regulation, and the autobiographical self are related developmentally to the early caregiving context. Psychotherapeutic intervention for adults with personality disorders across many schools of psychotherapy is focused on changing the individual's dysfunctional internal models of self and others. Future research will examine how cognitive, cognitive–behavioral, interpersonal, and psychodynamic treatments accomplish this task. Advances in neurobiology, laboratory tasks, and interview techniques will assist in the measurement of personality organization and identification of subgroups of patients for more refined treatments. Our future treatment development must be differentiated and multifaceted, respecting subgroups of patients with severe personality dis...