What to Expect in the Intake Interview? Impression Management Tactics of Psychotherapy Patients

The therapeutic alliance consists of a mutual dependency between patient and therapist. Whereas earlier studies have focused on the therapists' behavioral influence, the present study examined patients' impression management tactics. The motivation to manage the impressions one has on others is particularly strong during first contact. Patients' behavioral influence was thus examined in the intake interview. Twelve possible impression management tactics were defined on the basis of theoretical conceptions of the therapeutic alliance and discussions with practicing psychotherapists. After a comprehensive training, judges rated 60 videotaped interviews. Interjudge agreement was fair to good. Influence attempts could be observed in roughly 30% of all patients' utterances. The most frequent tactics were Supplication, Provoking a response from the therapist, and Self-promotion. Patients could be grouped into three different clusters of tactic employers: Negative self-presenters, positive self-presenters, and response provokers. Male and female patients did not differ with respect to the total amount of tactics used and to the choice of specific tactics. However, when the therapist was female, male patients used significantly more tactics overall and significantly more often the tactic Negative reports about third persons. Being sensitive to patients' behavioral influence can help therapists to better understand their interactional goals and to better tailor the therapeutic alliance.

Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.

BACKGROUND AND PURPOSE Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed. METHODS Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake. RESULTS Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex. CONCLUSIONS Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.