William E. Piper

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.

Alliance and Technique for Predicting Outcome in Short-and Long-Term Analytic Psychotherapy

A previous clinical trial provided the opportunity to examine the roles and interaction of alliance and technique in both short- and long-term analytic psychotherapy. Two separate teams of trained clinical judges rates either alliance on the CALPAS or therapist interventions on the ITS. Outcome included symptomatology and interpersonal problems. In short-term therapy, working and therapeutic alliance ratings contributed significantly to the reduction of symptomatology only. In long-term therapy, working alliance ratings contributed significantly to the reduction of interpersonal problems, and the interaction of working alliance ratings with supportive or exploratory intervention rating were found to account for significant amounts of the variance of both symptomatology and interpersonal problems at termination. These findings should be considered with caution, given the restricted sample sizes.

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.

Task Analysis of “Working” Responses to Dynamic Interpretation in Short-Term Individual Psychotherapy

Results of the preliminary stages of a task analysis of “working” interpretation episodes from brief dynamic psychotherapy are described. A database of interpretation episodes (N = 1081) drawn from 60 completed therapy cases was the source for the study sample. Each episode was characterized by a dynamic interpretation, reliably coded according to a therapist intervention rating system. A conceptual model of a “working” response to interpretation was specified. The model was first evaluated against 10 episodes selected to reflect a working response by the patient. The analysis identified additional patient and therapist operations and greatly increased the complexity of the model. The revised model was then refined through the review of another 10 work episodes. The final model was applied to 10 episodes in which the patient had clearly evidenced a “nonwork” response, allowing for a diagnosis of deviations from a working interpretive process. Implications, limitations, and verification research directions...

The psychometric properties of the Readiness and Motivation Questionnaire: a symptom-specific measure of readiness for change in the eating disorders.

Readiness for change, as assessed by the readiness and motivation interview (RMI), predicts a number of clinical outcome variables in eating disorders including enrollment in intensive treatment, symptom change, dropout, and relapse. Although clinically useful, the training and administration of the RMI is time consuming. The purpose of this research was to (a) develop a self-report, symptom-specific version of the RMI, the readiness and motivation questionnaire (RMQ), that can be used to assess readiness for change across all eating disorder diagnoses and (b) establish its psychometric properties. The RMQ provides stage of change, internality, and confidence scores for each of 4 eating disorder symptom domains (restriction, bingeing, and cognitive and compensatory behaviors). Individuals (N = 244) with current eating disorder diagnoses completed the RMQ and measures of convergent, discriminant, and criterion validity. Similar to the RMI scores, readiness scores on the RMQ differed according to symptom domain. Regarding criterion validity, RMQ scores were significantly associated with ratings of anticipated difficulty of recovery activities and completion of recovery activities. The RMQ contributed significant unique variance to anticipated difficulty of recovery activities, beyond those accounted for by the RMI and a questionnaire measure of global readiness. The RMQ is thus an acceptable alternative to the RMI, providing global and domain-specific readiness information when time or cost prohibits use of an interview.

Leader Style, Leader Consistency, and Participant Personality Effects on Learning in Small Groups

Twelve small experiential learning groups were conducted in which leader style and leader consistency were experimentally manipulated. The leaders were predominantly meaning attributive or predominantly caring in style, and either consistent or inconsistent in their behavior from session to session. Each group was composed of two high, two medium, and two low scorers on the change subscale of the PRF-E. Seventy-one participants provided self-report data concerning several aspects of learning. Evaluations of participant learning were also provided by the three leaders. Leader style that was characterized by a predominance of meaning attributive interventions relative to caring interventions was associated with greater learning. Consistent leader behavior as opposed to inconsistent leader behavior was also associated with greater learning. Evidence for the additive effect of meaning attributive style and consistency on participant learning was discussed. Relationships among participant perceptions of leader style and reports of learning were consistent with previous research findings. The personality trait, change, was associated with few significant findings. Contributions and limitations associated with the present investigation were considered.

Psychoanalytically oriented short-term groups for outpatients: Unsettled issues

The psychoanalytic approach to short-term group therapy for outpatients has been less prevalent than other approaches. Unsettled issues associated with this approach concern the feasibility of carrying out psychoanalytic work on an ongoing basis, patient selection, group composition, patient preparation, therapist technique, and cotherapy. Recent literature relevant to a conceptual consideration of these issues is reviewed. A vignette from a recent therapy group is presented as part of a clinical consideration of the issues. In addition, practical suggestions for conducting such groups are provided.

Treatment length and termination contracts in dynamic psychotherapy: A comparison of findings from two independent studies of brief dynamic psychotherapy

The associations between use of specific techniques and treatment outcome were very similar in two independent studies of brief dynamic psychotherapy in Edmonton. Canada, and Oslo. However, the associations between treatment length and outcome were the opposite in the two studies. The Edmonton study used a fixed time limit, while the Oslo study used open-ended treatment, which may have contributed to the difference. Patients with a high quality of object relations (QOR) were able to make optimal use of the expected treatment length in both time-limited and formally open-ended brief therapy, with regard to treatment-specific changes found at follow-up. In contrast, low QOR patients tended to do relatively better with fewer sessions than 20 in time-limited therapy (Edmonton) but more than 35–40 sessions in formally open-ended therapy (Oslo). These findings elucidate the complex interaction among patient characteristics, treatment length, type of outcome, and contractual factors in psychotherapy.