Isa Sammet

The influence of interpersonal problems and symptom severity on the duration and outcome of short-term psychodynamic psychotherapy

This naturalistic outcome study investigated validity aspects of the Inventory of Interpersonal Problems (IIP [Horowitz, Strauß, & Kordy, 1995]). The sample consisted of 180 patients who received short-term psychodynamic psychotherapy for an average number of 7.8 sessions and an average duration of 3.4 months. Small changes in pre-post-measures imply that the IIP is not to be recommended as an instrument for outcome evaluation in short-term psychotherapy, due to the traitlike character of its items. However, we showed by path analyses that a higher score on the affiliative dimension of the interpersonal circumplex goes along with a better treatment outcome. The influence of the dominance dimension is gender specific: male patients (who generally showed more dismissive and introverted behavior in this sample) received, if dismissive and introverted, a longer introductory therapy, whereafter they - in cases of high symptom load - were often referred to long-term treatment. Dominant male patients and, in general, female patients with high symptom scores, were referred faster, after only a few sessions. Results are discussed under aspects of adaptive therapist behavior.

Change mechanisms in psychotherapy: Multiperspective assessment and relation to outcome

Abstract The study aimed at constructing a reliable and valid post-session questionnaire measuring general change mechanisms of psychotherapy with correspondent versions for patient and therapist perspectives. Therefore, 253 inpatients in early, middle, and late stages of psychotherapy completed the newly developed Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and diverse outcome measures. The psychometric qualities of the SACiP were excellent as shown by (a) exploratory factor analyses on patient and therapist ratings, (b) confirmatory factor analyses on later measuring times, and (c) high internal consistencies. Supporting construct validity, the SACiP predicted outcome, as shown by correlational analyses and mixed effects modeling. Patient evaluations of change mechanisms were better predictors of outcome than the corresponding therapist evaluations.

Is a self-rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the Mentalization Questionnaire (MZQ)

Abstract The purpose of this study was to develop and validate a self-rating scale for a differentiated assessment of mentalization. A pool of 40 items was developed and evaluated on n=434 inpatients with mental disorders at three time points. Symptom severity, self-injuring behavior, suicidal tendency and attachment style were also assessed. A varimax-rotated factor analysis supported the extraction of four factors. The model fit was checked by confirmatory factor analysis. Internal consistency of the Mentalization Questionnaire (MZQ) was .81. The relation between symptom severity and MZQ scores was found to be significant, and significant group differences were found between patients displaying self-injuring behavior and those who did not as well as between patients with and without suicide attempts. The MZQ can be considered as a practicable self-rated instrument with acceptable reliability and sufficient validity to assess at least aspects of mentalization in patients with mental disorders.

Patients With Depression, Somatoform Disorders, and Eating Disorders on the Stages of Change: Validation of a Short Version of the URICA

The study aimed at constructing a time-efficient short version of the University of Rhode Island Change Assessment (URICA), and at exploring differences in the stages of change between patients with depression, somatoform disorders, and eating disorders across the course of therapy. The URICA and diverse outcome measures were administered to 253 patients in early-, middle-, and late stages of inpatient therapy. The factor structure of the short form of the URICA (URICA-S) was excellent as shown by (1) an exploratory factor analysis on a randomized one-half of the sample, (2) a confirmatory factor analysis on the other half of the sample, and (3) a stable factor structure over a 6-week interval. The resulting factors of the URICA-S were called precontemplation, contemplation, action, and maintenance. The internal consistencies of the URICA-S factors were sufficient to excellent. Supporting the criterion-related validity, the URICA-S predicted relevant outcome measures. Analyses of variance showed that the ratings on the action and the maintenance factors were differentially associated with outcome in patients with depression, somatoform disorders, and eating disorders. These findings implicate that a disorder-specific combination of action and relapse-prevention-oriented interventions might optimize outcome in inpatients with different psychiatric disorders.

Associations between Grawe's general mechanisms of change and Young's early maladaptive schemas in psychotherapy research: a comparative study of change processes.

Abstract Objective: The study aimed at analyzing associations between Grawes general mechanisms of change and Youngs early maladaptive schemas (EMS). Method: Therefore, 98 patients completed the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP), the Young Shema Questionnaire-Short Form Revised (YSQ S3R), and diverse outcome measures at the beginning and end of treatment. Results: Our results are important for clinical applications, as we demonstrated strong predictive effects of change mechanisms on schema domains using regression analyses and cross-lagged panel models. Conclusions: Resource activation experiences seem to be especially crucial in fostering alterations in EMS, as this change mechanism demonstrated significant associations with several schema domains. Future research should investigate these aspects in more detail using observer-based micro-process analyses.

Self-ratings of pathogenic beliefs: A study based on the psychodynamic control-mastery theory

Abstract Single-case studies by the San Francisco Psychotherapy Research Group have shown psychotherapy to be successful if pathogenic beliefs are disproved by the therapist. To date, however, no systematic knowledge regarding relevant thematic areas of pathogenic beliefs has been available. The authors examined whether those pathogenic beliefs judged by trained raters to be of regular occurrence also prove symptomatically relevant according to the self-ratings of patients and whether these beliefs can be classified along content-related dimensions. The authors presented 49 items, obtained from expert ratings in the context of diagnostic interviews with 35 differentially diagnosed patients and on the basis of verbal, scenic, and biographical informational levels, were presented to three samples: 74 individuals selected from the normal population, 79 patients with somatoform disorders, and 165 clients with various diagnoses receiving inpatient psychotherapy. Based on these results, the List of Pathogenic Beliefs (LPB) comprising 23 items was developed. Individuals receiving inpatient psychotherapy attained significantly higher scores than those from the normal population on the Self-Doubt, Doubt of Others, Expression of Anger, Fear of Close Relationships, and Guilt of Success subscales. Significant correlations were found between the total LPB scale and the Global Severity Index of the Symptom Checklist (r=.70) as well as the total score of the Inventory of Interpersonal Problems (r=.74). Results thus demonstrate the symptomatic relevance of self-rated pathogenic beliefs. More extensive application of the LPB could help supplement previous case- study research on control–mastery theory.

Fragebogen zum Erleben der Kunsttherapiegruppe in der Psychosomatik aus Patientensicht (FEKTP) : Konstruktion und Validierung eines Messinstruments

Art therapy is a clinically accepted method of therapy, but there are still very few studies that deal with the efficacy, change factors or mode of action of art therapy. In particular, there is a dearth of research instruments and psychometrically verified research tools specially fitted for art therapy which measures the experience dimensions of the art therapy group from the patients point of view. Hence, it provides evidence of its effectiveness, better understands the art therapy group processes and serves quality assurance. The aim of the present study was to develop and validate the questionnaire on the experience of the art therapy group from patient view (FEKTP). This questionnaire is based on Grawes and Yaloms conceptions of change factors in group therapy. 133 patients participated in the study and completed the FEKTP directly after the 6th art therapy session. Patients additionally received established questionnaires concerning clinical symptoms and experience processes at the beginning and end of treatment. Factor analysis demonstrated a clear factor structure of the FEKTP, which corresponded to the theoretically predicted subscales to the greatest extent. The test psychometric main quality criteria of the FEKTP (reliability, validity and objectivity) can be classified as acceptable to good range. The criterion validity appear to be given, but should be examined more exactly in future studies. Thus, a valid instrument for the systemic detection of general change factors for art therapy is now available. The questionnaire can be recommended for research as well as clinical contexts.