Rayna D. Markin

Transference, countertransference, emotional expression, and session quality over the course of supportive expressive therapy: the raters' perspective.

Abstract Independent judges rated transference, countertransference, therapist emotional expression, and session quality, in videotaped sessions of Supportive Expressive Psychotherapy for Depression over time. Based on 44 patients and four therapists, HLM analyses suggested that negative transference predicted therapist expression of negative affect. While negative transference predicted a rough session, positive transference predicted a deep session. Positive countertransference and positive affect predicted a smooth but superficial session, with positive transference sometimes acting as a moderator. Sessions became less deep and smoother over time, with therapist emotional expression moderating the relationship between treatment phase and depth. The results suggest that positive countertransference behaviors and feelings have a particularly negative impact on a session and that transference contributes to a deep and rough session.

The Therapist, the Client, and the Real Relationship: An Actor-Partner Interdependence Analysis of Treatment Outcome

The relationship between treatment progress (as rated by both clients and therapists) and real relationship (also rated by both clients and therapists) was decomposed into between-therapist and within-therapist (between-client) effects and analyzed using the actor-partner interdependence model. We reanalyzed a subset of the data, 12 therapists and 32 clients, from Gelso et al.s (2012) study of brief, theoretically diverse outpatient treatment. Consistent with and extending previous research, clients whose therapists provided higher average levels of client-perceived real relationship across the clients treated by a given therapist had better progress ratings from both themselves and their therapists. Within each therapists caseload, differences between clients in client- or therapist-rated real relationship were unrelated to either client- or therapist-rated outcome. Clients whose therapists provided higher average levels of therapist-perceived real relationship, across the clients treated by the therapist, had worse progress ratings from the therapists. The results provide additional evidence for the importance of between-therapist differences in therapeutic relationship qualities, both client and therapist rated.

Mentalization-based psychotherapy interventions with mothers-to-be.

In recent years, the theory of mentalization has been applied to a number of clinically relevant areas including psychotherapy for patients with borderline personality disorder, therapy with adolescents and children, treatment of self-harm in young people, parent-infant early interventions, and even community outreach (see Midgley & Vrouvam, 2012. Minding the child: Mentalizing interventions with children, young people, and their families. London and New York: Routledge). Extending on this body of work, the present article applies the theory of mentalization to psychotherapies that aim to help first time expecting mothers psychologically adjust to and prepare for motherhood. Theory and research suggest that pregnancy represents an intermediate space in which, under ideal circumstances, the woman comes to represent herself as a mother, her unborn child as a separate and intentional being, and her emotional bond or attachment to the fetus. However, the expecting mothers own conflictual experiences being mothered are likely to influence her ability to mentalize her pregnancy, setting the stage for problems in the mother-infant dyad postpartum. This article explores how mentalizing techniques may be used in psychotherapy to help mothers-to-be to mentalize their emerging identity as a mother, their unborn child, and their developing relationship to the fetus.

Toward a common identity for relationally oriented clinicians: a place to hang one's hat.

The goal of this special section is to work toward establishing a common identity for relationally inclined clinicians across proscribed theoretical orientations, facilitating a shared identity among diverse psychotherapists while placing a spotlight on relationship research. This article discusses the need for a more coherent and less polarizing professional identity for psychotherapists and why a more universal relational orientation to psychotherapy is timely given the current state of psychotherapy practice and research. Lastly, common relational themes that run throughout the diverse treatment paradigms presented in this special section are discussed, framing what it means to be a relational psychotherapist while hopefully providing some direction for future research and clinical training.

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents’ ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent’s loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent’s response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent’s experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent’s feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed.

What clinicians miss about miscarriages: Clinical errors in the treatment of early term perinatal loss.

In this article, clinical errors in the treatment of perinatal grief after a miscarriage are discussed, including (a) minimizing or avoiding painful affects related to the miscarriage, (b) assuming grief is resolved upon a subsequent healthy pregnancy, and (c) neglecting early unresolved losses that are reawakened by the loss of the pregnancy. It is argued that these unintentional errors, frequently committed by significant others in the patients life, are similarly made by well-intentioned clinicians due to a lack of knowledge about the psychological impact of miscarriage and, moreover, an unconscious avoidance of such a common yet distressing loss. Background information relevant to each clinical error is briefly reviewed, followed by recommendations for a better approach to the situation and verbatim clinical exchanges. The author suggests that, in general, a better approach to treatment is based on the assumptions that: (a) miscarriage is often a traumatic loss in a womans life, and (b) the traumatic affect associated with the event should be approached, rather than avoided, within a safe affect regulating relationship with the therapist. (PsycINFO Database Record

An introduction to the special section on psychotherapy for pregnancy loss: Review of issues, clinical applications, and future research direction.

This introduction article to the special section on psychotherapy for pregnancy loss reviews important societal and psychological issues, key clinical processes and recommendations, and future research directions. Differences and similarities among the articles in the special section are discussed along with each article’s contribution to the higher order goal of viewing pregnancy loss through a psychological rather than solely medical lens. Each article in this section reviews different therapeutic modalities, interventions, and key clinical process issues when working with patients who have suffered the loss of a pregnancy. The important role that psychotherapy can play in helping parents to mourn the loss of a pregnancy is explored in this introductory article and throughout the special section.

Exploring a Method for Transference Assessment in Group Therapy Using the Social Relations Model: Suggestions for Future Research

This article discusses how group clinicians and researchers might use a methodological and statistical model called the Social Relations Model (SRM) to circumvent common challenges to studying transference in groups. In particular, it examines how this method of transference assessment deals with the distortion aspect of transference and explains how the SRM can be used to better define transference and examine its relationship to the process and outcome of group therapy. Strengths and limitations of the model are examined and future directions for research are suggested.

The real relationship and its role in psychotherapy outcome: A meta-analysis.

Although writing about the real relationship has existed from the beginnings of the “talking cure,” it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this article, a meta-analysis is presented on the association between the strength of the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r = .38, 95% confidence interval [.30, .44], p < .001, d = 0.80, N = 1.502). This real relationship−outcome association was independent of the type of outcome studied (treatment outcome, treatment progress, and session outcome) and of the source of the measure (whether the client or the therapist rated the real relationship and/or treatment outcome). We also present commonly used measures of the real relationship, limitations of the research, and patient contributions. The article concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship.

The Process of Change in Accelerated Experiential Dynamic Psychotherapy (AEDP): A Case Study Analysis.

Accelerated experiential dynamic psychotherapy (AEDP) is a highly integrative treatment that incorporates elements of short-term psychodynamic and emotion-focused, process-experiential, psychotherapies, as well as attachment theory. The current study employed a mixed-methods multicase study design to describe how the process of change unfolds in a “successful” and an “unsuccessful” case of AEDP, as defined by reliable change (RC) on the Outcome Questionnaire-30.2 (OQ-30; Lambert, Vermeersch, Brown, & Burligame, 2004). Concurrently, several additional outcomes (affect experience and adult attachment), therapy relationship variables (working alliance [WA], real relationship [RR], and patient attachment to the therapist), and a qualitative description of the therapy process (Important Events Questionnaire [IEQ]; Cummings, Martin, Hallberg, & Slemon, 1992) were assessed at 3 time points during the course of therapy. Overall, the clinical observations in this study are consistent with AEDP’s theory of change, which predicts that symptom relief is accompanied by changes in affect and insecure attachment, and that these changes occur within a strong therapeutic relationship that is real, collaborative, and secure. Furthermore, qualitative analyses suggest that the advent of a corrective emotional experience (CEE) may have served as a catalyst for change in the “successful” therapy dyad. On the contrary, a reliable decline in agreement over the tasks of therapy and decreasing positive affect (PA) and negative affect (NA) may have hindered early change in the “unsuccessful” case. El proceso de cambio en la psicoterapia dinámica experiencial acelerada (AEDP por su sgla en inglés): un análisis de estudio de caso La psicoterapia dinámica experiencial acelerada (AEDP, por sus siglas en inglés) es un tratamiento altamente integrador que incorpora elementos psicoterapéuticos psicodinámicos a corto plazo y centrados en la emoción, experimentales en el proceso, así como la teoría del apego. El estudio actual empleó un diseño de estudio multicaso de métodos mixtos para describir cómo se desarrolla el proceso de cambio en un caso “exitoso” y “no exitoso” de AEDP, según lo definido por el cambio confiable (RC) en el Cuestionario de Resultados-30.2 (OQ- 30; Lambert, Vermeersch, Brown y Burligame, 2004). Simultáneamente, varios resultados adicionales (afectan la experiencia y el apego adulto), variables de relación terapéutica (alianza de trabajo [WA], relación real [RR] y apego del paciente al terapeuta) y una descripción cualitativa del proceso de terapia (Cuestionario de eventos importantes [IEQ]; Cummings, Martin, Hallberg y Slemon, 1992) se evaluaron en 3 puntos de tiempo durante el curso de la terapia. En general, las observaciones clínicas en este estudio son consistentes con la teoría de cambio de AEDP, que predice que el alivio de los síntomas va acompañado de cambios en el afecto y el apego inseguro, y que estos cambios ocurren dentro de una fuerte relación terapéutica que es real, colaborativa y segura. Además, los análisis cualitativos sugieren que el advenimiento de una experiencia emocional correctiva (PEC) puede haber servido como un catalizador para el cambio en la díada de terapia “exitosa”. Por el contrario, una disminución confiable en el acuerdo sobre las tareas de la terapia y la disminución del afecto positivo (PA) y el afecto negativo (NA) pueden haber obstaculizado el cambio temprano en el caso “sin éxito”. ??????????????(AEDP)??????:?????? ?????????????????????????,?????????????????????????????????????? ??????????????????????????AEDP“??”?“???”?????????????????????????????-30.2 ??????(RC)????(OQ-30; Lambert, Vermeersch, Brown, & Burligame, 2004)? ??,????????????,???????:???????(????????????),???????(???????WA?,??????RR?,?????????????),????????? (???????IEQ?;Cummings, Martin, Hallberg, & Slemon, 1992)? ????,????????????AEDP?????????????????????????????,??????????????????????????????????????????????? ??,?????????????(CEE)????“??”?????????? ??,?“???”???,????????,???????(PA),?????(NA)????????