CC-BY Nature is considered to have restorative qualities that can potentially improve psychotherapy success. However, little is known about how clients experience nature during psychotherapy. The research aim of this phenomenological qualitative study was to study how clients experience nature during individual outpatient psychotherapy that took place while walking in nature. More specifically we were interested in clients’ inner world experiences. All participants (N = 12) received treatment through licensed therapists for a DSM-5 classified disorder. Semi-structured interviews were conducted. To uncover true lived experiences during these interviews, participants were asked to close their eyes and envision themselves during a psychotherapy session in nature. The verbatim transcripts were coded by means of inductive thematic analysis and the results were member checked. Results showed that nature brings clients closer to their inner worlds. How nature brings this about is unfolded in a conceptual model of lived experience. We argue that psychotherapy can be enriched by considering nature as a supportive environment because bringing clients closer to their inner worlds is of essential value in facilitating successful treatment interventions.
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Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment.
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Background. Violent criminal offenders with personality disorders (PD’s) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods. We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results. Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*- time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*- time: t(1387) = −2.85, p = 0.005). Conclusions. These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community
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Most of the scientific literature on computer games aimed at offering or aiding in psychotherapy provides little information on the relationship between the game's design and the player's cognitive processes. This article investigates the use of Bloom's taxonomy in describing a psychotherapeutic game in terms of knowledge level and cognitive processing. It introduces the Revised Bloom Taxonomy and applies this to five psychotherapeutic games (Personal Investigator, Treasure Hunt, Ricky and the Spider, Moodbot, and SuperBetter) in a two-round procedure. In the first round consensus was reached on the Player Actions with Learning Objectives (PALOs) in each game. The second round sought to determine what level of knowledge and cognitive processing can be attributed to the PALOs by placing them in the taxonomy. Our low intercoder reliability in the second round indicates that Bloom's Revised Taxonomy is not suitable to compare and contrast content between games.
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Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders’ emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.
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Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders’ emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.
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Research on psychological treatment of depression in inpatients is not conclusive,with some studies finding clear positive effects and other studies finding no significant benefit compared to usual care or structured pharmacotherapy. The results of a meta-analysis investigating how effective psychological treatment is for depressed inpatients are presented. A systematic search in bibliographical databases resulted in 12 studieswith a total of 570 respondents. This set of studies had sufficient statistical power to detect small effect sizes. Psychological treatments had a small (g=0.29), but statistically significant additional effect on depression compared to usual care and structured pharmacological treatments only. This corresponded with a numbersneeded- to-be-treated of 6.17. Heterogeneity was zero inmost analyses, and not significant in all analyses. There wasno indication for significant publication bias. Effectswere not associatedwith characteristics of the population, the interventions and the design of the studies. Although the number of studieswas small, and the quality ofmany studieswas not optimal, it seems safe to conclude that psychological treatments have a small but robust effect on depression in depressed inpatients. More high-quality research is needed to verify these results.
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Many affective experiences and learning processes including attachment patterns from early developmental phases manifest during psychotherapy. The first 15 min in art therapy can potentially reveal clients’ preferred ways of processing information or Expressive Therapies Continuum components, attachment patterns in the material handling process, and emotion regulation strategies during art making. This article discusses how, through clients’ choice of materials and manner of interaction with those materials, information about attachment patterns and preferred emotion regulation is available in art therapy. Paying close attention to the first image and material interaction provides crucial information that will guide the goals and course of art therapy. Two case vignettes demonstrate that within the first 15 min of art therapy information is readily gathered about attachment styles, Expressive Therapies Continuum components, emotion regulation, and the course of art therapy.
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The concept of a working alliance is rooted in psychotherapy and has been studied extensively in that field. Much less research has been conducted into working alliances between chronic psychiatric patients and their case managers. The aim of this review was to identify what is known about the working alliance between chronic psychiatric patients and their case managers. An extensive survey of the literature produced 14 articles for this review. The results of studies conducted show that a good working alliance has positive effects on the functioning of patients, and that the quality of the alliance depends on both patient characteristics and the behaviour of the case managers. The results also indicate that the working alliance is largely determined in the first 3 months of the contact. Further research into the development of working alliances is necessary.
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Background: Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP’s as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design: Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the ‘black box’ of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion: The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients.
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