Social Work News Headlines

Updated on: Fri, 21 Sep 2018 06:00:34 GMT

Attachment styles and interpersonal motives of psychotherapy trainees.
Interpersonal characteristics contribute to therapists’ ability to form helpful working alliances with their patients. But how are attachment styles and interpersonal motives distributed among therapist trainees? This study examines attachment styles and interpersonal motives of therapist trainees by comparing them with matched reference samples from representative surveys. A total sample of 285 trainees, who were enrolled in either cognitive–behavioral or psychodynamic therapy training programs, was recruited via their training institutes. Participants answered questionnaires on attachment (Experiences in Close Relationships–Revised, 36-item version, and Experiences in Close Relationships–Revised, 8-item version) and interpersonal motives (Circumplex Scales of Interpersonal Values). Compared with 2 matched nonclinical reference samples from representative surveys, therapist trainees reported lower scores on attachment-related avoidance and higher scores on harmonious interpersonal motives. Therapist trainees are characterized by a wish for warm proximity with others and feel comfortable in close relationships. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Trainee attachment to supervisor and perceptions of novice psychotherapist counseling self-efficacy: The moderating role of level of experience.
Clinical supervision is often considered to be one of the important tasks in training psychotherapists. The present study investigated the relation between trainees’ attachment to their supervisors and trainees’ perceptions of their own counseling self-efficacy (CSE), as potentially moderated by trainee level of experience. Results indicated that trainees with greater avoidant attachment to their supervisors demonstrated lower levels of CSE. Although the results of the moderator analyses were not statistically significant, levels of avoidance significantly predicted levels of CSE even when controlling for level of experience, whereas levels of anxiety were not found to significantly predict levels of CSE. The study also found that individuals who reported greater levels of experience were more likely to report greater levels of CSE. The implications of the study are discussed, and recommendations for clinical supervision process are offered. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Origins of countertransference and core conflictual relationship theme of a psychotherapist in training as emerging in clinical supervision.
Therapists’ unresolved conflicts might be the source of countertransference phenomena. To investigate the origins of countertransference, the aim of this supervision single-case study was to identify conflictual areas that characterize private life relationships and therapeutic relationships of one therapist in training. With this aim, we applied the core conflictual relationship theme method to the analysis of the therapist’s relationship episodes with patients, as emerged spontaneously during clinical supervision sessions, and to the analysis of relationship episodes concerning his personal life, collected using the relationship anecdotes paradigm interview. Quantitative data showed that core conflictual relationship theme pervasiveness scores concerning private life relationships and therapeutic relationships were significantly interrelated. Qualitative examples of these associations are provided in the paper, and the implications for supervision and training are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

A practical clinical suggestion for strengthening the alliance based on a supportive–expressive framework.
Supportive–expressive psychodynamic psychotherapy builds on the core conflictual relationship theme (CCRT) as a framework for case formulation and interpretations. Much has been written on how interpretive techniques should be implemented in the treatment sessions to bring about therapeutic change, but less is known about implementing supportive techniques for strengthening the alliance using this framework. The present article uses CCRT formulations to articulate clear and concrete supportive techniques that clinicians can use in clinical practice. To this end, we offered 4 main steps and used clinical case examples to illustrate them. We described how the CCRT formulation may be used to rise above relational enactments in a supportive way and how it can provide a corrective emotional experience to enhance the emotional bond between the patient and the therapist. Clinical cases from the pilot phase of a randomized clinical trial, together with theoretical conceptualizations and empirical findings, are intertwined to demonstrate the potential of the techniques presented. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Five types of clinical difference to monitor in practice.
A fundamental part of professional practice is to monitor case progress to inform basic clinical decisions about when to discontinue interventions, when to adjust interventions, and when to proceed as planned. When interpreting observed change, there are at least five distinct types of clinical difference that can occur independently, and mistaking one for another can lead to misinformed clinical decisions. We introduce a distinction between observed difference, detected difference, predicted difference, attainment difference, and induced difference, and use these to analyze current systems for routine outcome monitoring (ROM) in clinical practice. Contrary to what supporting evidence of current ROM systems suggests, we find that—by design—these systems fail to detect and predict potentially harmful treatment and fail to detect and predict likely treatment responders. We discuss implications of the presented classification for professional practice and further development of ROM systems. We argue that clinical practice would benefit from monitoring difference instead of change, as these are not equivalent. We further argue that future research and development efforts should focus on the development of a working approach to monitoring induced difference, improving how to monitor predicted difference, exploring statistical models that better discriminate between various types of clinical cases, and better communicate what can and cannot be interpreted from the clinical differences that are actually monitored, as guided by the presented classification of clinical differences to monitor in practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Overcoming a primary barrier to practice-based research: Access to an institutional review board (IRB) for independent ethics review.
Practice-based research is an important means of bridging the gap between the science and practice of psychotherapy. Unfortunately, numerous barriers exist for clinicians who want to conduct research in practice settings. One specific barrier that has received minimal attention in the literature—lack of access to institutional review board (IRB) oversight for independent ethics review—can impede the ability to carry out and disseminate research projects. This article identifies reasons that practice-based researchers may want to seek IRB review even when not required, reviews the pros and cons of a range of strategies that some practice-based researchers have used to try and address lack of access to an IRB, and describes a novel solution for this problem: the creation of the Behavioral Health Research Collective IRB, a nonprofit IRB whose mission is to provide ethical oversight to practice-based researchers. The authors describe their experiences of developing and running the Behavioral Health Research Collective IRB, with the intent of providing a model for other professionals to create similar mechanisms for supporting practice-based research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Emotional processing and therapeutic change in depression: A case study.
The association between clients’ higher capability of emotional processing and good therapeutic outcome has been consistently observed in different therapeutic approaches. Despite previous studies that have reported an association between emotional processing and pre- to posttherapy change in symptoms, the session-by-session relation between emotional processing and therapeutic change needs further research. The current study explored, in a good-outcome case of depression, the session-by-session longitudinal association of the level of emotional processing with (a) clinical symptoms and (b) type of emotions aroused (adaptive or maladaptive). Using a time-series analysis, we observed a strong negative association between the intensity of clinical symptoms and the level of emotional processing in the same session, r = −.71, p < .001, but a nonsignificant association between emotional processing and the symptoms in the preceding session, r = −.37, p = .101, and the next session, r = −.29, p = .180. During the increase in the level of emotional processing, we observed a change in the type of emotions aroused, from maladaptive to more adaptive. The results support that emotional processing is associated with therapeutic change, although not necessarily precedes such change, at least from one session to the next. As it is an exploratory study, the results must be interpreted carefully. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

“Ghosts” in the womb: A mentalizing approach to understanding and treating prenatal attachment disturbances during pregnancies after loss.
Pregnancies after loss are often characterized by feelings of depression, anxiety, trauma-like symptoms, and problems bonding to the fetus. Difficulties bonding to the unborn baby during pregnancy are of clinical importance because they are predictive of problems in the mother–infant attachment relationship, perhaps explaining why some studies show a higher risk of insecure attachment for babies born after loss. O’Leary (2004) has proposed that problems in prenatal bonding during pregnancies after loss are the result of the challenge these mothers face of having to grieve the loss of one baby while bonding to another. This article argues that the theory of mentalization helps to explain why some parents successfully resolve this central challenge during pregnancies after loss and go on to develop a secure attachment to the next infant, whereas others continue to experience long-term attachment problems. Specifically, pregnancies after loss are conceptualized as a potentially traumatic experience in which mentalization may decrease and, at the same time, serve as a protective factor against attachment problems with infants born after loss due to unresolved trauma and grief. Several aspects of mentalization, including the capacity to mentalize: (a) affect associated with trauma and loss, (b) attachment relationships as distinct, (c) multiple and conflicting mental states, and (d) early inadequate attachment experiences related to trauma and loss, are proposed to help mothers pregnant after loss to mourn the loss of one baby while attaching to another, ameliorating potential attachment problems postpartum. Clinical interventions for facilitating these mentalizing capacities are suggested. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger.
A growing body of research suggests that emotional processing is a central and common change mechanism across various types of therapies (Diener & Hilsenroth, 2009; Foa, Huppert, & Cahill, 2006; Greenberg, 2010), including attachment-based family therapy (Diamond, Shahar, Sabo, & Tsvieli, 2016). The purpose of this study was to examine which therapist interventions facilitated productive emotional processing in a sample of 15 young adults receiving attachment-based family therapy (Diamond, Diamond, & Levy, 2014) for unresolved anger toward a parent, and which therapist interventions led to a discontinuation of productive emotional processing once it had begun. Therapist interventions and productive emotional processing were measured during the course of individual, alliance-building sessions with the young adult. Results indicate that young adults’ productive emotional processing occurred at a rate significantly greater than chance following therapists’ focus on vulnerable emotions, focus on attachment needs, and empty-chair interventions. In contrast, therapists’ focus on clients’ rejecting anger preceded the discontinuation of such processing at rates significantly greater than chance. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)