American Journal of Psychotherapy

Patients with co-occurring substance use disorders and borderline personality disorder have high rates of morbidity, mortality, and utilization of medical services. Their acute symptoms present complex challenges to clinical staff in the medical emergency department related to both logistics and management of countertransference. This article examines patterns in countertransference and proposes application of psychodynamically informed principles and strategies to facilitate safety and enhance communication during fraught clinical encounters...

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OBJECTIVE: Blended-format interpersonal psychotherapy (IPT) is an integrated approach consisting of alternating face-to-face (in person or videoconferencing) and online sessions, and this format may increase access to care, empower patients, and improve quality and cost-effectiveness of care. This study, conducted in the Netherlands, was one of the first to investigate the feasibility of blended-format IPT in specialized mental health care. METHODS: Participants (ages 18-64, N=21) with a unipolar depressive episode were recruited at an outpatient mood disorder clinic...

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OBJECTIVE: Intensive short-term dynamic therapy (ISTDP) is an evidence-based psychotherapy supported by a growing literature base. "Unlocking" of the unconscious is a central process in ISTDP. This study sought to operationalize the concept of unlocking by adopting a detailed process analysis of the early phase of therapy for four patients by using a structured measure, the Achievement of Therapeutic Objectives Scale (ATOS). METHODS: The ATOS is a measure of psychotherapy processes...

Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to meet the needs of patients with personality pathology. As it became more clearly defined through a series of treatment manuals and empirical research, TFP has also come to be considered a conceptual and technical model of therapy that can be used to introduce therapists in training to the principles of psychodynamic psychotherapy in a systematic way...

Research confirms that although patients experiencing psychosis want to speak about their symptoms with psychiatrists, psychiatrists are often hesitant to engage them directly in such conversations because of their fear of colluding, promoting defensiveness, or rupturing the therapeutic alliance. As a result, patients are often left to contend with confusing psychotic experiences, such as hallucinations and delusions, that they cannot make sense of on their own. In this article, the common barriers that prevent engagement in conversations about psychosis are described, and the conventional wisdom about the futility of talking with patients about delusions is challenged...

OBJECTIVE: Otto F. Kernberg pioneered the description, understanding, and treatment of pathological narcissism. Narcissism has emerged as a clinical construct of considerable interest in clinical psychology, psychiatry, and psychoanalysis and has often been featured in the literature on personality and social psychology. Considerable discussion in recent years has focused on whether levels of narcissism seen among young adults have been increasing. Nearly all of that discussion has been focused on changes in successive cohorts in normative (normal-range) expressions of narcissism...

OBJECTIVE: Interpersonal psychotherapy (IPT) is an evidence-based psychotherapy, developed to treat major depressive disorder. The aim of this study was to conduct a preliminary investigation of the effects of IPT on depressive symptoms and quality of life among women with depression in Iran. METHODS: Adult women ages ≥18 who met DSM-5 criteria for a current major depressive episode (N=30) were randomly assigned to receive 12 weeks of individual IPT or to a waitlist control (WLC) group...

Technological innovations in cognitive-behavioral therapy (CBT) provide excellent opportunities for mental health clinicians to expand access to mental health treatment among culturally diverse and marginalized populations. This brief report highlights challenges that mental health clinicians encounter as they integrate technological innovations in CBT into their work with diverse clients and provides recommendations for addressing them. The authors identify five key challenges of using technology-driven CBT: development of the therapeutic alliance; potential fit for clients from culturally diverse backgrounds and marginalized groups; geographic and economic access; ethical and legal concerns; and competency in CBT practice, training, and supervision...

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OBJECTIVE: As mobile health technologies proliferate, their use during exposure-based therapies has the potential to illuminate treatment mechanisms. The primary purpose of this study was to examine three approaches to using continuously collected physiological data of patients with posttraumatic stress disorder during prolonged exposure (PE) therapy, in an effort to examine physiological markers of treatment response. METHODS: Photoplethysmogram-measured heart rates from three non-Hispanic White male veterans, during clinic-based PE therapy sessions, were analyzed to assess three potential therapeutic mechanisms: emotional engagement (examined via correlation analysis between self-reported peak distress ratings and objectively measured peak heart rate in the minute prior to distress ratings), initial emotion activation (examined through time to peak heart rate and peak self-reported distress), and extinction processes within and between therapy sessions (examined via multilevel modeling of within- and between-person changes in heart rate over time and across imaginal PE therapy sessions)...

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OBJECTIVE: University students with symptoms of attention-deficit hyperactivity disorder (ADHD) often experience depression. This study examined whether interpersonal counseling (IPC) could be an effective treatment for depression among students with ADHD symptoms. METHODS: Participants were assigned to either an IPC (N=5) or control (N=7) group. Depression was assessed by using the Self-Rating Depression Scale (SDS) at baseline, postintervention, and at 4-, 8-, and 12-week follow-ups...

OBJECTIVE: Research on culturally diverse clients has investigated expectations about psychotherapy and intention to seek counseling. However, few studies have investigated how these factors may be linked to specific client expectations, such as advice-seeking (the client expecting the therapist to give advice) and audience-seeking (the client expecting to lead the sessions) behaviors, particularly for U.S. racial-ethnic minority populations. METHODS: This study used a survey to investigate 593 Polynesian Americans' gender and ethnic preferences for therapists, as well as the mediating effects of advice- and audience-seeking behaviors and their associations with intention to seek counseling and expectations about psychotherapy...

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OBJECTIVE: This study aimed to investigate the effect of brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) on suicidal ideation, posttraumatic stress disorder (PTSD) symptoms, and clinical outcomes among youths with PTSD treated in psychiatric emergency rooms. METHODS: This study included youths with PTSD and suicidality who received either RFPP-S (N=50) or treatment as usual (N=150). The Columbia Suicide Severity Rating Scale (C-SSRS), Clinician-Administered PTSD Scale for children and adolescents, University of California, Los Angeles Trauma Reminder Inventory, Patient Health Questionnaire-9, Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment Scale, and positive psychiatry test batteries were administered at baseline, on day 2, and 1 week and 1 month after discharge...

The Mapping Vulnerability and Privilege (MVP) exercise is a clinical intervention based on a structural competency framework that emphasizes societal structures-social determinants of health and of biology, behavior, and culture-and their impact on health outcomes. The exercise comprises the MVP Tool, Visual Guide, and Processing Guide. It was created with the goals of helping clinicians to develop structural humility and introducing a structural lens for viewing the therapeutic milieu and the structural barriers that affect both intrapsychic experiences and interactions with the health care system, while encouraging patients and clinicians to take action to address the systemic and structural issues that affect patients' well-being...

No abstract text is available yet for this article.

No abstract text is available yet for this article.