Anna Louise von der Lippe

Treatment failure in psychotherapy: The pull of hostility

Abstract Client–therapist interactions were studied in 14 positive-change (PC) and 14 negative-change or nonchange (NC) therapies with the same therapists and similar clients. Aggregated structural analysis of social behavior (SASB) scores showed increasingly dissimilar interaction styles between client and therapist in NC therapies. First-lag transition analyses of SASB codings of Sessions 3, 12, and 20 showed the following differences: Stable hostile complementarity characterized NC within and across sessions. Hostile complementarity was nevertheless relatively rare. Therapists met clients’ invitations to hostile responses most frequently in nonhostile ways, yet they initiated more belittling and ignoring interactions with NC clients, pointing to the subtly hostile therapeutic climate created. Rejection of therapists’ interventions predicted negative outcome most strongly and escalated with time. Clients’ skepticism may make therapists vulnerable to feelings of inadequacy and, if not dealt with therapeutically, may easily release the therapists’ own hostility.

Pretreatment patient characteristics related to the level and development of working alliance in long-term psychotherapy

Abstract This study explored pretreatment patient characteristics associated with the level and growth of working alliance in therapies lasting up to 120 therapy sessions. The quality of working alliance was rated by both patients (N=201) and therapists (N=61) at Sessions 3, 12, and 20 and then at every 20th successive session. Patients reported that experience with good maternal care up to adolescence and better current interpersonal relationships were associated with positive ratings of working alliance throughout therapy. Higher global functioning was associated with growth of alliance over time. Higher levels of interpersonal problems of the cold/detached kind were associated with poorer early working alliance. On the other hand, this type of interpersonal problems was also associated with improvement of working alliance over time. Therapists’ ratings of alliance were associated with patients’ intrapsychic functioning. Implications for treatment and research are discussed.

Ego Development and the Ethics of Care and Justice: The Relations Among Them Revisited

This study examined the links among ego development and the ethics of care and justice in 144 Norwegian men and women, 15 to 48 years old, taking into consideration age, sex, education, and verbal intelligence. As expected, the relationship between Loevingers model of ego development and care-based moral reasoning as measured with Skoes Ethic of Care Interview (ECI) was significantly stronger than the one between ego development and justice as measured with Rests Defining Issues Test (DIT). Both ethics correlated significantly with verbal ability. Analyses showed that beyond its overlap with verbal intelligence, the variance shared between the ECI and ego development was substantial. By contrast, when verbal intelligence was controlled, the DIT was not significantly related to ego development or to the care ethic.

The role of maternal attachment in children's attachment and cognitive executive functioning: A preliminary study

The influence of maternal attachment on childrens attachment and executive functioning skills through maternal sensitivity and decentered tutoring were studied in 40 middle-class mother–child dyads. Infant attachment security in the Strange Situation Procedure was related to maternal attachment security, evaluated with the Adult Attachment Interview. When the children were six–seven months of age, maternal sensitivity was evaluated. When the child was six years old, maternal decentered tutoring and the childrens executive functioning were evaluated. Regression analyses indicated that maternal tutoring accounted for the association between maternal attachment and child cognitive functioning, whereas maternal sensitivity accounted for the association between maternal and child attachment.

The impact of maternal schooling and occupation on child-rearing attitudes and behaviours in low income neighbourhoods in Cairo, Egypt

As a developing country, Egypt and especially Cairo, is in a transitional phase between a traditional and a modern, education-based society and between traditional child-rearing values of passivity and obedience and new demands for academic competence. Education is seen by present day parents as the major vehicle for the future success and happiness of children and much effort is expended toward this goal. Thirty Cairene mothers from low income neighbourhoods with similar housing standards and crowding, but with different levels of education and occupational status were interviewed (1994-95) about socialisation values and practices and observed with their children in order to evaluate how mothers prepare preschoolers for the cognitive demands of school. It was anticipated that educated working mothers would be less traditional and engage their children in more active competence training (mediation of learning experience, MLE, and authoritative child-raising style, AC-R) as a mediator to children’s cognitive competence. These expectations were supported. The 30 mothers were generally found to emphasise a controlling, restricting, and protecting style of child rearing, with moral education, compliance, agreeableness, passivity, and loyalty as ideals. Observation revealed little verbal interaction or stimulation of children. Educated working mothers, however, expressed belief in earlier developmental timetables and endorsed the less traditional values of stimulating and interacting rather than controlling and expecting obedience of the child more than the remaining mothers. Educated working mothers were also more positively verbally interacting with their children during the interview than nonworking low-educated mothers. They scored higher on AC-R and on the MLE categories guiding and expanding in interactive play and these variables were related to the children’s cognitive competence (intelligence scores), also when the mothers’ intelligence was accounted for. Mothers’ educational and occupational levels did not predict children’s cognitive competence directly, suggesting that mothers’ child-rearing behaviours acted as mediators. Fathers’ educational level was not related to the children’s cognitive competence. The results point to the potential benefit of investing in girls’ (and future mothers’) education for the future of their children.As a developing country, Egypt and especially Cairo, is in a transitional phase between a traditional and a modern, education-based society and between traditional child-rearing values of passivity...

Validation of the SASB introject surface in a norwegian clinical and nonclinical sample

In this study, we examined the reliability and construct validity of the Structural Analysis of Social Behavior Introject Surface, Intrex long form A (SASB-IS; Benjamin, 1995) in 2 Norwegian samples. The fit of the 8 SASB-IS scales to the structural requirements of a circumplex model with relaxed equal spacing constraints was reasonably good in an outpatient sample, but poor in a normal reference sample. The deviations from the equal spacing based on an ideal circumplex model, however, seem to have minimal implications for the utility of the instrument in clinical assessment. The reliability of the SASB-IS was acceptable on most scales, but two scales had unacceptable low reliability. Correspondence with external criteria supported the validity of the SASB-IS in both samples. Profile patterns related to different segments of the introject circumplex model were systematically related to severity of psychopathology: Hostile and accepting patterns of self-relatedness formed polar opposites; control patterns and intermediate patterns gave intermediate pathology scores.

Negotiation of conflict, communication patterns, and ego development in the family of adolescent daughters

Late-adolescent females (N = 39) and their parents were studied, relating the quality of conflict negotiation in the family to their ego development and their dyadic communication patterns. Family communication was evaluated by the Constraining and Enabling Coding System (CECS; Hauser et al., 1985) from discussions in a revealed difference task. Each statement given by a person directed at another was coded and scores were aggregated. Quality of negotiation for the family as a unit was assessed from the discussions in molar codings guided by Stierlin’s (1974) model of individuated relationships and developed for this study. Ego development was measured by Loevinger’s Washington University Sentence Completion Test. Analyses showed that the adolescents’, but not the parents’, ego level predicted family negotiation scores. The results also suggested that the quality of family negotiations was enhanced by different patterns of dyadic communication between adolescent daughters and their parents. Negotiating skill was high when there was cognitive complementarity between parents and daughters such that the father was cognitively enabling toward the daughter (and she was not) and the daughter was cognitively enabling toward the mother (whereas this was not predictive of the mother), and there was affective symmetry between parents and daughters (both facilitative). Daughters contributed to negotiation skill in the family by being more attentive to the mother than to the father. Regression analyses indicated that affective factors were more predictive of the negotiation climate in the family than cognitive factors.

INDIVIDUATION, EGO DEVELOPMENT AND THE QUALITY OF CONFLICT NEGOTIATION IN THE FAMILY OF ADOLESCENT GIRLS

Individuation, ego development and family negotiation of conflict were studied in 27 Norwegian families with an adolescent daughter, 16-19 years, drawn from a larger sample to represent a rectangular distribution of ego development. Individuality and Connectedness (individuation) as conceptualized and scored by Condon et al. (1984) was modified and adapted to a Norwegian material. Four factors were extracted, one related to individuality (self-assertion and separateness) and two to connectedness (clarification and acceptance). Ego development, measured by the Washington University Sentence Completion Test (Loevinger & Wessler, 1970) was related to connectedness between mother and daughter and between father and daughter, but not to individuality. Maturity of conflict negotiation was positively related to connectedness between mother and daughter and negatively to individuality between father and daughter. It was argued that for women, individuality may not be a singular goal in ego development or in individuation and that self-other differentiation of identity and interests may develop within a close relationship and not only through separation.

Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency

Abstract Objective: Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. Method: The study involves in-depth analyses of therapist–client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Results: Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client’s proactive agentic involvement in change work and discouraging client’s proactive agentic involvement in change work, 8 categories and 22 sub-categories. Conclusion: The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.