Orya Tishby

Client attachment, attachment to the therapist and client-therapist attachment match: How do they relate to change in psychodynamic psychotherapy?

Abstract Objective: We examined the associations between client attachment, client attachment to the therapist, and symptom change, as well as the effects of client-therapist attachment match on outcome. Clients (n = 67) and their therapists (n = 27) completed the ECR to assess attachment. Method: Clients completed also the Client Attachment to Therapist scale three times (early, middle, and late sessions) and the OQ-45 at intake and four times over the course of a year of psychodynamic psychotherapy. Results: Clients characterized by avoidant attachment and by avoidant attachment to their therapist showed the least improvement. A low-avoidant client-therapist attachment match led to a greater decrease in symptom distress than when a low-avoidant therapist treated a high-avoidant client. Conclusions: These findings suggest the importance of considering client-therapist attachment matching and the need to pay attention to the special challenges involved in treating avoidant clients in order to facilitate progress in psychotherapy.

Changes in rigidity and symptoms among adolescents in psychodynamic psychotherapy

Abstract The present study examined changes in the rigidity of interpersonal patterns and symptoms in adolescents (ages 15–18) in a year-long psychodynamic psychotherapy. Seventy-two adolescents (30 in treatment and 42 in a non-treatment “community group”) underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998), and completed outcome measures at two time points. Results: Adolescents in the treatment group became less rigid in their interpersonal patterns and improved significantly in their symptoms, whereas no such changes were observed in the community group. Levels of rigidity were not related to initial symptom distress; however, changes in rigidity were related to improvement in symptoms within the treatment group.

Collaboration in Psychodynamic Psychotherapy

The concept of the collaborative relationship between patient and therapist has its roots in the psychodynamic literature. We trace the concept of collaboration in psychodynamic psychotherapy from classical psychoanalysis to contemporary psychoanalysis and psychodynamic therapies. The active collaboration between the participants central to Bordins pan-theoretical perspective on the alliance is highlighted. Developments in alliance-fostering techniques and in relational therapy offer the clinician innovative ways to enhance the collaboration and to repair strained or ruptured collaboration. A case study illustrates how the collaborative work in psychodynamic therapy serves as both a means of productive work and as an arena for exploring the evolving here-and-now matrix of the relationship.

Changes in interpersonal conflicts among adolescents during psychodynamic therapy

Abstract The core conflictual relationship theme (CCRT) method was used in psychodynamic therapy with 10 adolescents to study change in interpersonal conflicts in the course of treatment. Relationship anecdote paradigm interviews were conducted at the beginning of therapy and before termination 8 to 9 months later. Adolescents were asked to describe 4 relationship episodes for each of the following significant others: parents, peers, and therapist. The CCRTs for the 3 relationships were different: The main wishes toward the parents were to be close and to be given independence; toward friends, to be close and to be open; and toward the therapist, to be helped and to be understood. The responses of other and self toward parents were significantly more negative than responses in other relationships. Responses of self and other in the therapeutic relationship were significantly more positive. At the end of therapy the interactions with parents were more positive, whereas those with the therapist grew more ambivalent.

Posttraumatic Stress Disorder Among Sri Lankan University Students as a Consequence of Their Exposure to Family Violence

The article presents the results of a study on the association between exposure to family violence (i.e., witnessing interparental violence and experiencing parental violence) during childhood and adolescence and adult posttraumatic stress disorder (PTSD). The study was conducted among a self-selected convenience sample of 476 students from Sri Lanka, using a self-administered questionnaire. The findings indicate that the more participants witnessed interparental violence and the more they experienced parental violence, the more they exhibited PTSD symptoms. Moreover, the findings reveal that participants’ exposure to family violence explains a significant amount of the variance in their PTSD over and above the variance that can be attributed to their sociodemographic characteristics (age, gender, number of siblings, and family’s socioeconomic status) and to their perceptions of the environment and functioning of their families. The limitations of the study and recommendations for future research are discussed.

The Relationship between Plan Compatibility of Therapist Interventions and Patient Progress: A Comparison of Two Plan Formulations

This study tested the reliability of the Plan Compatibility of Intervention Scale (PCIS) and its ability to predict patient progress within two different psychodynamic Plans or formulations: Cognitive-dynamic and object relations. High PCIS interrater reliabilities were achieved based on both theory-based Plans, suggesting that the Plan and the PCIS can be used within different psychodynamic theoretical orientations. The study also compared the relationship between therapist interventions which were compatible with either the cognitive-dynamic or object relations based Plans, and patient progress. Therapist interventions that were compatible with the object relations Plan predicted in-session patient progress in the middle phase of therapy for the two patients studied, and in the early phase for one of them.

Countertransference in the treatment of adolescents and its manifestation in the therapist-patient relationship.

Abstract Countertransference is a central construct in the clinical literature (Freud, 1910; Gabbard, 2001), yet it has generated very little research to date. The present study used the CCRT method (Luborsky & Crits- Cristoph, 1998) to measure countertransference themes in a sample of 12 therapists, who described relationship episodes with their parents and with two clients. Results showed high repetitiveness of the parent themes in the narratives about the patients for all three components of the CCRT: Wish, Response of Other and Response of Self. A qualitative analysis of the narratives generated four countertransference dynamics: Repeating the parent RO, repairing the parent RO, identification with the patient, and withdrawing. It is suggested that these four dynamics constitute the process which links the origins and triggers with the manifestations and effects in Hayess (2004) operational model of countertranference.

The therapeutic relationship: Multiple lenses and innovations Introduction to the Special Section

In 2005, Psychotherapy Research marked 15 years of publication with a special issue, “The Therapeutic Relationship” (Volume 15, Issues 1–2). The challenges lying ahead were outlined in Horvath’s (2005) introduction to the issue, and these and other challenges have been put forward during the last decade in other joint efforts published in special sections of other journals and in edited books devoted to the therapeutic relationship. They include prominent publications such as the special section of Psychotherapy: Research, Theory, Practice, Training that was devoted to the working alliance (Samstag, 2006), Muran and Barber’s (2010) The Therapeutic Alliance: An Evidence-Based Guide to Practice, and Norcross’s (2002, 2011) Psychotherapy Relationships that Work (which appeared both in book form and in a special issue of Psychotherapy). The latter presents the work of the contributors of the APA Interdivision Task Force on Evidence-Based Relationships and their conclusions and recommendations for research and practice (Norcross & Lambert, 2011; Norcross & Wampold, 2011). Research on the therapeutic relationship continues to develop and this special section is devoted to providing “multiple lenses” on some of the important and exciting new directions in research on the therapeutic relationship. The articles present an array of empirical studies in which the contributors offer innovative ways of studying various relationship mechanisms as they relate to change processes and outcomes. The joint initiative for this special section originated during the course of a research workshop held in Jerusalem in the summer of 2010. As an extension of our collaboration in a psychotherapy research project (University of Haifa and the Hebrew University of Jerusalem), we had received support to gather leading psychotherapy researchers and clinicians to take part in a research workshop on a topic related to our ongoing research project (Wiseman & Tishby, 2011). We entitled the workshop Multiple Lenses on the Therapeutic Relationship. Its aims were to focus on research and clinical practice on the therapeutic relationship—past, present, and future—to paraphrase Castonguay, Constantino, and Holtforth (2006), where we were, where we are, and where should we go. The key speakers addressed theoretical underpinnings, clienttherapist relationship processes and experiences, client and therapist variables, techniques versus the relationship and outcome, and implications for training therapists. The original work presented at this workshop by the key speakers formed the basis for the papers in this special section. Given our intention to bring together researchers from a variety of psychotherapy orientations and research methodologies, we have added two additional research groups to the contributors of the special section. Thus, we set out to provide a panorama of cutting-edge studies on the therapeutic relationship that are intended to demonstrate and suggest promising pathways for future research. Going back to the challenges for the next generation of research on the therapeutic relationship, we wish to highlight five: First, the theoretical-conceptual challenge of clarifying the construct of the therapeutic relationship and defining and refining new constructs and various specific components of the relationship; second, the methodological challenge of how best to measure the relationship and study process-outcome questions such as whether the therapeutic relationship is curative in itself; third, the change process challenge, entailing understanding the function of the relationship in the change process and its development over time at different phases of therapy; four, the client and therapist contributions challenge, concerning how the participants influence the kind of relationship that is formed between them; and five, the training challenge, consisting of the development of successful training programs for therapists regarding the development and management of their relationships with their clients (Castonguay et al., 2006; Crits-Christoph, CritsChristoph, & Connolly, 2010; Horvath, 2006; Sharpless, Muran, & Barber, 2010).

Relationship representations and change in adolescents and emerging adults during psychodynamic psychotherapy

Abstract Objective: Two groups of clients at sequential developmental stages, adolescents and emerging adults, were compared regarding their presenting problems, psychological distress, and relationship representations over one year of psychotherapy. Method: Thirty adolescents aged 14–18 years and 30 emerging adults aged 22–28 years, with similar demographic background, completed outcome measures and interviews according to the Core Conflictual Relationship Theme (CCRT) method. Results: The groups differed significantly in the presenting problems but did not differ in their initial levels of distress; their symptoms improved to a similar extent after one year of psychotherapy; differences between the groups in the representations of others were consistent with age-specific developmental challenges; levels of representations were associated with levels of symptoms at the end-point of treatment. Conclusion: Clinicians need to be attuned to the specific difficulties and challenges of these continuous yet distinct developmental stages.

Therapists’ honesty, humor styles, playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect

Abstract Objective: This study examined whether therapists’ honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. Method: In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. Results: Therapists’ Aggressive Humor Style (AHS) was a significant negative predictor of clients’ symptom change over time. The therapists’ honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. Conclusions: Therapists’ inferred traits of Honesty–Humility and AHS may influence the effectiveness of their treatments.