Enrico E. Jones

Comparing the process in psychodynamic and cognitive-behavioral therapies.

Archival records were used to compare the therapy process in 30 brief psychodynamic and 32 cognitive-behavioral therapies. Verbatim transcripts of 186 treatment sessions were rated with the Psychotherapy Process Q-set, designed to provide a standard language for the description of process. Results demonstrated that although some features were common to both treatments, there were important differences. Cognitive-behavioral therapy promoted control of negative affect through the use of intellect and rationality combined with vigorous encouragement, support, and reassurance from therapists. In psychodynamic psychotherapies, there was an emphasis on the evocation of affect, on bringing troublesome feelings into awareness, and on integrating current difficulties with previous life experience, using the therapist-patient relationship as a change agent. The clinical theoretical precepts underlying psychodynamic treatments received considerable support. In cognitive-behavioral therapies, there was evidence for the importance of developmental, as opposed to rationalist, intervention strategies for treatment outcome.

Psychotherapy Process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program

This study examined psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Transcripts of brief interpersonal and cognitive-behavioral therapies were rated using the Psychotherapy Process Q Set (PQS), an instrument designed to provide a standard language for describing therapy process. Results demonstrated that there were important areas of overlap and key differences in the process of the treatments. There were important differences in therapist stance, activity, and technique that were consistent with theoretical prescription, but patient characteristics within sessions were quite similar. Patient in-session characteristics as measured by the PQS were related to outcome across the treatment samples. These findings are linked to theoretical models, which may help explain the role of nonspecific factors associated with nondifferential treatment outcome in brief therapy.

The Psychoanalytic Case Study: Toward a Method for Systematic Inquiry

This study represents a contribution toward the systematic and empirical investigation of psychoanalytic treatments. The method used, the Q-technique, allows the transformation of clinical data into a form amenable to quantitative analysis, thereby providing an empirical means to test theoretically and clinically derived understandings of psychoanalytic process. The treatment hours of a six-year analysis were audio-recorded and transcribed, and blocks of ten sessions were selected at regular intervals throughout the course of the analysis. Transcripts of these hours were then rated in random fashion by clinical judges with a Q-set designed to provide a standard language for the description and classification of analytic process. These descriptions of analytic hours, as structured by the Q-set, proved highly reliable, demonstrating the methods promise for addressing the long-standing problem of achieving reliable clinical judgments. Results suggest that subjecting the traditional psychoanalytic case study to systematic inquiry can contribute to establishing an empirical science base for some psychoanalytic propositions.

On analytic process.

An innovative methodology is presented for identifying and assessing change process in psychoanalytic treatments. Using the Psychotherapy Process Q-set (PQS), a panel of experienced psychoanalysts developed a prototype of an ideal psychoanalytic hour. This prototype was then applied to verbatim transcripts of three archived treatment samples: psychoanalyses, long-term analytic therapies, and brief psychodynamic therapies. The degree to which these treatments fostered an analytic process as represented by the prototype was measured quantitatively. Analytic process was significantly more present in psychoanalyses than in the long-term analytic therapies, which, in turn fostered significantly more analytic process than did brief psychodynamic therapies. The study demonstrates that, given descriptive language that does not represent a particular theoretical perspective, analysts can agree on a definition of analytic process, and that analytic process can be operationalized and quantitatively assessed. A second study demonstrates that despite consensus on its definition, there is not just one proper analytic process; rather, there are change processes unique to each dyad. Two quantitative case studies illustrate how each analytic pair has a unique interaction pattern linked to treatment progress. These dyad-unique “interaction structures” are recurrent, mutually influencing patterns of interaction, the experience, recognition, and comprehension of which appear to be a fundamental component of therapeutic action. A bipersonal model is described that attempts to bridge theories of therapeutic action that focus on insight and self-understanding and those that emphasize the patients experience of the therapist.

A Paradigm for Single-Case Research: The Time Series Study of a Long-Term Psychotherapy for Depression.

This study articulates a paradigm for single-case research in psychotherapy. A patient diagnosed as having major depressive disorder was seen in an intensive, twice-weekly psychodynamic psychotherapy for 2 1/2 years. Each session was videotaped, and assessment of patient change were obtained at regular intervals. A time-series analysis was used to model fluctuations in the therapy process to take into account time and the effect of previous events on subsequent changes, thereby preserving the context-determined meaning for therapist and patient actions. A bidirectional analysis of casual effects shows that the influence processes between therapist and patient are mutual and reciprocal and suggests that the effect of the patient on the therapist and on the process has not been made sufficiently explicit in previous models of process and change. The potential of intensive single-case designs for uncovering causal effects in psychotherapy is demonstrated.

Psychotherapists' impressions of treatment outcome as a function of race

One hundred sixty-four black and white patients, evenly divided by race, were seen in individual psychotherapy for a mean of more than 31 treatment hours. Half the patients in each group were in racially similar therapist-patient matches and half in racially dissimilar pairings. Assessments of treatment outcomes and personality descriptions of patients were obtained from therapists after termination. White therapists generally rated their clients, and especially their black clients, as psychologically more impaired than did black therapists. Adjective descriptions revealed important differences in the perception of black and white clients by therapists of the two races. In the view of therapists, all patients improved as a result of treatment, and black and white patients, with few exceptions, appeared to benefit about equally. Contrary to expectation, there were no differences in psychotherapy outcome as a function of client-therapist racial match.

How Therapy is Conducted in the Private Consulting Room: A Multidimensional Description of Brief Psychodynamic Treatments

Thirty patients representing a range of neurotic disorders were treated in a brief, 16-session psychodynamic psychotherapy in private practice settings. Verbatim transcripts of therapy hours were rated by judges with the Psychotherapy Process Q-set, designed to provide a standard language for the description and classification of therapy process. The sample demonstrated statistically significant change pre- to posttreatment, and a majority of patients met at least one criterion for clinically significant change. A longitudinal view of the process suggests that these treatments were characterized by what could be described as a gradual shift from an external, reality-oriented construction of personal difficulties to an emphasis on inner experience and the relationship with the therapist. Results are framed within a conceptualization of process as actions that define and give meaning to one another and their context. It is argued that such a conceptualization more adequately captures clinical realities and ...

The Talking Cure Revisited: Content Analyses of a Two-Year Psychodynamic Psychotherapy

A 208-session treatment (previously investigated by Jones, Ghannam, Nigg, & Dyer, 1993) was studied using two computer-assisted content analytic strategies. The first measured the patient’s associative freedom by determining the Co-Occurrence Rate of commonly associated word pairs. The second measured the topics of each session by determining the proportion of topic-related words in each session. Results revealed that the patient’s associative freedom: (a) increased with time (replicating the results of Spence, Dahl, & Jones, 1993), (b) was influenced by the use of psychodynamic techniques, and (c) predicted symptom change. The analyses of the topic of discussion revealed that (a) the therapist displayed a nonneutral attitude (paradoxically shown to be helpful by Jones et al., 1993) while discussing certain key topics, and (b) the patient’s discussion of these topics was related to symptom improvement. Results are discussed in terms of their contribution to an understanding of the case as well as theory of psychotherapy process.

Impact of Interpretation on Associative Freedom.

Seventy hours from the psychoanalytic case of Mrs. C, covering the full course of treatment, were scored for associative freedom, number of interventions, and a variety of clinical phenomena such as clarifications, interpretations, different forms of resistance, transference manifestations, and the like. Associative freedom significantly increased over the course of treatment and was significantly related to the number of analyst interventions per hour. The relationship was particularly strong in the latter stages of treatment. Three specific types of interventions were found to increase associative freedom in the latter stages of treatment. The effect of each type was found to influence both the session containing the interpretation and the next 3 sessions. This carryover effect was specific to the latter stages of the analysis.

Personality Differences among Blacks in Jamaica and the United States

Personality differences among black populations of varying socioeconomic background from Jamaica and the United States were investigated using Rotters Internal-External Locus of Control measure, Goughs Adjective Check List, and Kellys Role Construct Repertory Test. Results demonstrate the differential utility of these personality measures for cultural comparisons, and in particular suggest that the I-E Scale lacks equivalence of meaning cross-culturally as well as for differing sample populations within the United States. Differences in personality traits and social constructs were generally consistent with those that might be predicted between members of a more traditional society and those of a modern nation. The view that studies of racial minorities within a nationality are appropriately conducted in a cross-cultural framework is presented.