Hassan F. A. Azim

Quality of object relations versus interpersonal functioning as predictors of therapeutic alliance and psychotherapy outcome.

The purpose of the study was to compare an interview measure of quality of object relations to questionnaire and interview measures of recent interpersonal functioning with respect to the prediction of therapeutic alliance and psychotherapy outcome. The sample consisted of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical-trial investigation. Ratings of therapeutic alliance were provided independently by the patient and the therapist after each session. Outcome measures, which were provided by three sources (patient, therapist, and independent assessor), covered the areas of interpersonal functioning, psychiatric symptomatology, self-esteem, and life satisfaction. Quality of object relations, which characterizes the patients lifelong pattern of relationships, was the best predictor. It was significantly related to patient-rated and therapist-rated therapeutic alliance and to patient improvement of both general symptomatology and specific target problems. The study also replicated previous studies that have reported significant relationships between therapeutic alliance and therapy outcome. The advantages of pretherapy predictors of therapy outcome, such as quality of object relations, are discussed.

Time-limited day treatment for personality disorders: Integration of research and practice in a group program.

Historical Evolution of Day Treatment Psychiatric Partial Hospitalisation A Review of the Research Utilization of Partial Hospitalisation Alternative Psychosocial Treatments for Affective Disorders and Personality Disorders The Edmonton Day Treatment Programme Two Weeks in the Life of the Day Treament Programme Clinical Trial Evaluation of Treatment Efficacy Prediction of Success in the Day Treatment Programme Relationships Among Psychological Mindedness, Patient Work, and Favourable Outcome in the Day Treatment Programme The Psychosocial Environment as a Predictor of Outcome in the Day Treatment Programme Case Illustrations from the Day Treatment Programme Themes and Future Directions.

Patient characteristics and success in day treatment.

This study examined the ability of seven patient characteristics to predict success (remaining, benefiting) in a day treatment program for psychiatric outpatients. The sample consisted of 165 patients, most with affective and personality disorders, who participated in an intensive psychodynamically and group-oriented program within a controlled clinical trial. Two patient personality characteristics (psychological mindedness, quality of object relations) emerged as the strongest predictors. Other variables that contributed to the predictions, either singly or in an interaction with quality of object relations, were age, marriage, presence of a personality disorder, and previous psychiatric hospitalization. The patients initial level of symptomatic disturbance was not a significant predictor. The advantage of using predictors that are relevant to the theoretical and technical orientation of a program is emphasized.

Interpretive and supportive psychotherapies : matching therapy and patient personality

What is Short-Term, Interpretive Therapy, and Who is a Good Candidate? What is Short-Term Supportive Therapy, and Who is a Good Candidate? Interpretive and Supportive Dimensions of Psychotherapy Optimal Matching of Parents and Short-Term Psychotherapies Quality of Objective Relations and Psychological Mindedness - Predictive Patient Characteristics Interaction of Interpretive and Supportive Forms of Psychotherapy and Patient Personality Variables What Role Does Gender Play as a Patient Aptitude for Therapy? Relationships Among Therapy Process, Outcome, and Dropping Out Clinical Illustrations of Dropping Out From Interpretive Therapy - Importance of Flexibility Relationships Between Patient Personality (QOR, PM) and the Process of Psychotherapy - Clinical Illustrations of Successful and Unsuccessful Cases Therapy Manuals for Interpretive and Supportive Forms of Psychotherapy Themes and Future Directions.

Differentiating Symptoms of Complicated Grief and Depression Among Psychiatric Outpatients

Objective: This study examined whether dimensions of complicated grief (CG) could be distinguished from dimensions of depression and whether these dimensions were differentially affected by group psychotherapy for CG. Method: A total of 398 psychiatric outpatients who had experienced one or more significant death losses provided ratings on standard measures of grief and depression. Factor analysis of the 56 items from these measures was used to explore the possibility that grief and depression symptoms would form separate dimensions of distress. Subsamples of the patients also participated in 1 of 2 forms of short-term group therapy for CG. Repeated-measures analysis of variance and calculation of effect sizes were performed to examine changes in the dimensions following treatment. Results: The grief items formed 3 distinct clusters representing different dimensions of CG. None of the depression items loaded highly on these grief dimensions. The depression items formed 2 distinct clusters. Two of the grief dimensions demonstrated the most improvement following group therapy that addressed CG. There was also evidence for differential effectiveness of the 2 forms of group therapy. Conclusions: When assessing psychiatric patients who have death losses, clinicians should consider different types of grief reactions. Different types of grief reactions may be responsive to different treatments. In the absence of depressive symptoms, clinicians should not assume the absence of CG.

Psychological Mindedness, Work, and Outcome in Day Treatment

A recently completed clinical trial that investigated the effectiveness of a group-oriented, day treatment program provided an opportunity to pursue a multidimensional approach to the prediction of treatment outcome. The sample consisted of 99 psychiatric outpatients, most of whom had received diagnoses of affective and personality disorders. The predictor variables included a patient personality characteristic (psychological mindedness), a group process variable (patient work), and their interaction. Univariate analyses revealed significant direct relationships between psychological mindedness and both work and favorable outcome, and between work and favorable outcome. Multivariate analyses indicated that psychological mindedness and work had independent significant relationships (additive or interactive) with several of the outcome variables. In combination they accounted for up to a quarter of the outcome variance. The results demonstrate the benefit of using a theoretically consistent multidimensional approach. The time-efficient nature of the predictor measures used in the study make them particularly amenable for use by clinicians and researchers.

Staff-staff relations group.

This article describes, through the use of clinical examples, how a staff-staff relations group functions in a brief, evening, partial-hospitalization program, and how it differs from other groups within the program. It further illustrates how the appropriate use of this group allows staff to work together harmoniously and treat patients more effectively. This article also compares and contrasts this method of dealing with staff-staff and staff-patient conflict with other approaches.

Ambivalence and Other Relationship Predictors of Grief in Psychiatric Outpatients

Ambivalence has been viewed as an important causal agent in the development of complicated grief. However, examination of studies commonly cited as supporting this belief reveals basic limitations in their methodology and conclusions. The current study examined associations between several relationship predictors (ambivalence, affiliation, and dependence) and both grief-specific symptoms and depression in two samples of psychiatric outpatients who had experienced loss of significant others. Findings from the first sample (N = 138) were used to test for evidence of cross-validation in the second sample (N = 139). Contrary to traditional belief, ambivalence was inversely related to severity of grief symptoms. In contrast, affiliation and dependence were directly related to severity of grief symptoms. None of the predictors provided evidence of cross-validation in the case of depression. Explanations for the findings and clinical implications are considered.

Patient satisfaction in a Psychiatric Walk-In Clinic.

The present study examined consumer satisfaction with services provided in a Psychiatric Walk-In Clinic in order to determine not only general levels of satisfaction but also whether or not differences in satisfaction exist between different user groups. Although levels of reported satisfaction were generally high, group psychotherapy patients reported being significantly less satisfied than patients who had been assessed at the clinic or who were in individual psychotherapy. None of the demographic variables including previous psychiatric experience, diagnosis and patient visits were related to satisfaction. These data were discussed in terms of program development.

Treatment noncompliance as a function of therapist attributes and social support.

Premature termination of short-term psychotherapy was examined as a function of therapist and social support variables. Patient perceived therapist competence, knowledge, relaxed manner, understanding of the help wanted, attitude, acceptance, listening ability, and sensitivity differentiated Continuers from Terminators. Although few of the social support variables were related to the mode of treatment termination, Continuers were found to be more likely than Terminators to have discussed attendance at the Clinic with others, especially family members. These findings were discussed in terms of their relevance to treatment of the emotionally ill and to the training of clinicians.