Moments of tension and strain in psychotherapy and how they promote a good alliance and outcome

It is well established that the therapeutic relationship contributes about as much to therapy outcome as ‘technical’ intervention. Furthermore, it follows clear prescriptive concepts in the same manner as technical interventions do. ‘Motive Oriented Therapeutic Relationship’ is such a concept for establishing a solid basis for whatever therapeutic work the patients’ problems require (Grawe, 1980, 1992; Caspar, 1996). Yet, the therapeutic relationship doesn’t explain everything because other factors play a significant role too. Previous studies showed that outcome is clearly better when therapists achieved a generally high quality of a therapeutic relationship when they did not shy away from possibly threatening interventions such as confrontations. This ratio of a fruitful alliance and marginally present confrontations in the same session also showed significant correlations with patient’s assessment of alliance and progress in therapy (Figlioli et al., 2009). The current state of research in the field, however, does not give any answers to questions like how good and bad confrontations can be characterized or what role does the intensity, respectively frequency of confrontations play in the process of psychotherapy. Therefore, we analyzed a sample of 80 therapies of 3 sessions each representing either good or bad outcome. Independent raters judged moment by moment how therapists used confrontative interventions. 20 cases, which showed an excellent or a very poor outcome, as well as an unexpected pattern were analyzed in further quantitative details. We found that confrontations are correlated to good outcome when they are uttered implicitly, related to an important topic of the patient (e.g. one of the defined therapy goals), long but weak, embedded in prior complementarity and not in the first three sessions of a therapy, as well as not an interactional discrepancy between the patient and the therapist.

Völker, Staaten und Zion : ein Brief an Hermann Cohen u. Bemerkungen zu s. Antwort

von Martin Buber

The effects of type of interval, sensory modality, base duration, and psychophysical task on the discrimination of brief time intervals

The present study was designed to investigate the influences of type of psychophysical task (two-alternative forced-choice [2AFC] and reminder tasks), type of interval (filled vs. empty), sensory modality (auditory vs. visual), and base duration (ranging from 100 through 1,000 ms) on performance on duration discrimination. All of these factors were systematically varied in an experiment comprising 192 participants. This approach allowed for obtaining information not only on the general (main) effect of each factor alone, but also on the functional interplay and mutual interactions of some or all of these factors combined. Temporal sensitivity was markedly higher for auditory than for visual intervals, as well as for the reminder relative to the 2AFC task. With regard to base duration, discrimination performance deteriorated with decreasing base durations for intervals below 400 ms, whereas longer intervals were not affected. No indication emerged that overall performance on duration discrimination was influenced by the type of interval, and only two significant interactions were apparent: Base Duration × Type of Interval and Base Duration × Sensory Modality. With filled intervals, the deteriorating effect of base duration was limited to very brief base durations, not exceeding 100 ms, whereas with empty intervals, temporal discriminability was also affected for the 200-ms base duration. Similarly, the performance decrement observed with visual relative to auditory intervals increased with decreasing base durations. These findings suggest that type of task, sensory modality, and base duration represent largely independent sources of variance for performance on duration discrimination that can be accounted for by distinct nontemporal mechanisms.

Unique and shared techniques in cognitive-behavioural and short-term psychodynamic psychotherapy: a content analysis of randomised trials on depression

Randomised controlled trials (RCTs) of psychotherapeutic interventions assume that specific techniques are used in treatments, which are responsible for changes in the client's symptoms. This assumption also holds true for meta-analyses, where evidence for specific interventions and techniques is compiled. However, it has also been argued that different treatments share important techniques and that an upcoming consensus about useful treatment strategies is leading to a greater integration of treatments. This makes assumptions about the effectiveness of specific interventions ingredients questionable if the shared (common) techniques are more often used in interventions than are the unique techniques. This study investigated the unique or shared techniques in RCTs of cognitive-behavioural therapy (CBT) and short-term psychodynamic psychotherapy (STPP). Psychotherapeutic techniques were coded from 42 masked treatment descriptions of RCTs in the field of depression (1979-2010). CBT techniques were often used in studies identified as either CBT or STPP. However, STPP techniques were only used in STPP-identified studies. Empirical clustering of treatment descriptions did not confirm the original distinction of CBT versus STPP, but instead showed substantial heterogeneity within both approaches. Extraction of psychotherapeutic techniques from the treatment descriptions is feasible and could be used as a content-based approach to classify treatments in systematic reviews and meta-analyses.

Predicting Psychotherapy Dropouts: A Multilevel Approach

The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive–behavioural therapy without pre-determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. Copyright © 2014 John Wiley & Sons, Ltd.

The sleeper effect: Artifact or phenomenon—A brief comment on Bell et al. (2013)

OBJECTIVE: Bell, Marcus, and Goodlad (2013) recently conducted a meta-analysis of randomized controlled additive trials and found that adding an additional component to an existing treatment vis-à-vis the existing treatment produced larger effect sizes on targeted outcomes at 6-months follow-up than at termination, an effect they labeled as a sleeper effect. One of the limitations with Bell et al.'s detection of the sleeper effect was that they did not conduct a statistical test of the size of the effect at follow-up versus termination. METHOD: To statistically test if the differences of effect sizes between the additive conditions and the control conditions at follow-up differed from those at termination, we used a restricted maximum-likelihood random-effect model with known variances to conduct a multilevel longitudinal meta-analysis (k = 30). RESULTS: Although the small effects at termination detected by Bell et al. were replicated (ds = 0.17-0.23), none of the analyses of growth from termination to follow-up produced statistically significant effects (ds < 0.08; p > .20), and when asymmetry was considered using trim-and-fill procedure or the studies after 2000 were analyzed, magnitude of the sleeper effect was negligible (d = 0.00). CONCLUSION: There is no empirical evidence to support the sleeper effect.

Psychotherapy Research and Neurobiology: Challenge, Chance, or Enrichment? Are We Wiser 10 Years Later? (Commentary on "Psychotherapy Research and Neurobiology: Challenge, Chance or Enrichment?"(2003))

Presidential Address of the 2003 SPR annual meeting with commentary from the author, Former President of the SPR, Franz Caspar.

Offener Brief an Se. Ehrwürden Herrn Distrikts-Rabbiner S. B. Bamberger in Würzburg

von Samson Raphael Hirsch

Ms.Ff.F.Stoltze 3. 273 - Brief von Ernst Schalck an Friedrich Stoltze

Umzug, Frankfurter Latern

Ms.Ff.F.Stoltze 3. 276 - Brief von Ernst Schalck an Friedrich Stoltze

Frankfurter Latern, Hampelmann

Betrachtungen einer Mücke : Entgegnung auf d. offenen Brief des ... Samson Raphael Hirsch

Hss. auf Titelbl.: Sign. aus Freimann-Kat. Jud. Ff. 630