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Biomedical subjects

W E Piper

Publications and source records attributed to W E Piper.

At least 19 recordsLinked to original sources
PubMed2001

Psychotherapy of personality disorders.

This article reviews recent research examining the effectiveness of treating personality disorders with psychotherapy. Despite the prevalence and seriousness of these conditions, and the extensive clinical writings about them, research on the treatment of personality disorders has been limited. Much of the research is hampered by a multitude of difficult issues. Research from the past 3 years is reviewed, with an eye toward what new contributions the studies have made to the psychotherapy literature. Implications of their findings are considered and recommendations for future research are made.

Humans↗
PubMed2001

Ambivalence and other relationship predictors of grief in psychiatric outpatients.

Ambivalence has been viewed as an important causal agent in the development of complicated grief. However, examination of studies commonly cited as supporting this belief reveals basic limitations in their methodology and conclusions. The current study examined associations between several relationship predictors (ambivalence, affiliation, and dependence) and both grief-specific symptoms and depression in two samples of psychiatric outpatients who had experienced loss of significant others. Findings from the first sample (N = 138) were used to test for evidence of cross-validation in the second sample (N = 139). Contrary to traditional belief, ambivalence was inversely related to severity of grief symptoms. In contrast, affiliation and dependence were directly related to severity of grief symptoms. None of the predictors provided evidence of cross-validation in the case of depression. Explanations for the findings and clinical implications are considered.

Adult↗
PubMed2001

Prevalence of loss and complicated grief among psychiatric outpatients.

OBJECTIVE: This study examined the prevalence of significant loss through the death of another person as well as complicated grief among patients at two psychiatric outpatient clinics for one year. METHODS: A total of 729 patients were interviewed about significant losses through death during their lives. Standard questionnaires were used to classify 235 patients who had experienced such losses into three groups: those who had minimal disturbance, those who had moderate complicated grief, and those who had severe complicated grief. Multivariate and univariate analyses of variance were used to test for differences in loss-specific variables (for example, pathological grief) and variables that were not specific to loss (for example, depression) among the three groups. RESULTS: More than half of the 729 patients reported that they had experienced one or more significant losses through death. About a third of all patients who came to the clinics met the criteria for either moderate or severe complicated grief. The average time since the loss was about ten years, indicating that these patients had long-term complicated grief. Significant differences in loss-specific variables and variables that were not specific to loss were detected among the three groups. Patients who had severe complicated grief scored higher than patients in the other two groups on both types of variables. Patients with moderate complicated grief had higher scores than those with minimal disturbance. CONCLUSIONS: Clinicians should routinely assess outpatients for loss and complicated grief and should consider addressing loss and complicated grief in treatment. Rather than a single classification of complicated grief, different levels should be considered.

Adolescent↗
PubMed2001

Patient personality and time-limited group psychotherapy for complicated grief.

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.

Adjustment Disorders↗
PubMed2001

Using DSM axis II information to predict outcome in short-term individual psychotherapy.

The present study considered three methods of using DSM Axis II information to examine the effect of personality disorder on outcome in two forms of short-term, individual psychotherapy (interpretive and supportive). The first method involved examining whether the presence of any personality disorder influenced treatment outcome. The second method involved examining the effect of the number of personality disorders on outcome. The third involved examining outcome for specific personality disorders. The study found that a diagnosis of any personality disorder did not influence the outcome of therapy. In contrast, the number of personality disorders was significantly related to outcome at post-therapy and at 12-month follow-up. The findings indicated that a greater number of personality disorders was associated with less favorable outcome across both forms of therapy. This supports the notion that personality pathology is more severe when it involves a greater number of personality disorders. In an exploratory set of analyses, the study also found some evidence of differences in outcome for specific personality disorders.

Adolescent↗
PubMed2001

Effect of patient gender on outcome in two forms of short-term individual psychotherapy.

This study examined the relationship of patient gender and outcome for two forms (interpretive, supportive) of short-term, individual psychotherapy. Female and male patients (N=89) were randomly assigned to either interpretive or supportive therapy. Outcome was measured in the areas of depression, anxiety, and general symptomatic distress. A significant interaction effect between patient gender and form of therapy was found for measures of depression and general symptomatic distress at post-therapy. Male patients had better outcome in interpretive therapy than in supportive therapy. Female patients had better outcome in supportive therapy than in interpretive therapy. The findings suggest that patient gender may be differentially influential with different forms of short-term therapy.

Adult↗
PubMed2000

Different perspectives of the therapeutic alliance and therapist technique in 2 forms of dynamically oriented psychotherapy.

OBJECTIVE: This study addresses several issues concerning patients' and therapists' perceptions of key therapy process variables. This includes examining whether patients and therapists differ in their perceptions of the therapeutic alliance and therapist technique, what the relation is between perceptions of the alliance and technique, and whether these perceptions are predictive of treatment outcome. METHOD: Patient and therapist perceptions of the therapy process were provided in a comparative trial of 2 forms of short-term individual dynamic psychotherapy. Patients (n = 144) were randomly assigned to each condition. Treatment outcome was assessed using a large, comprehensive battery of reliable measures. RESULTS: The findings revealed several differences in the patients' and therapists' ratings of the alliance and technique in the 2 forms of therapy. Patient ratings of the alliance and technique were predictive of treatment outcome. CONCLUSION: The findings contribute to understanding the extent to which therapy participants share views of therapy processes and highlight the importance of the therapist's attending to the patient's perception of therapy.

Adolescent↗
PubMed2000

Role behavior expectancies and alliance change in short-term individual psychotherapy.

Patients and therapists participating in a clinical trial of short-term, time-limited individual (STI) psychotherapy were asked to rate expectancies regarding their own and their counterpart's role behaviors during sessions. Significant relationships differed according to the index of alliance used (patient, therapist) and as a function of scores on a global patient personality measure known as Quality of Object Relations (QOR). Among high-QOR (or mature) cases, the patient's expectancy of being able to contribute to the treatment process was inversely associated with change in the patient-rated alliance. For those with low QOR (more primitive object relations), congruence of expectancies regarding a supportive therapist role was directly associated with change in the therapist-rated alliance. Results are discussed in terms of evaluating and preparing patients for psychotherapy and the appropriate therapeutic strategies for patients of different QOR.

Adult↗
PubMed1999

Object relations theory and short-term dynamic psychotherapy: findings from the Quality of Object Relations Scale.

This review focuses on the relevance of object relations theory to short-term dynamic psychotherapy (STDP). From diverse theoretical and research literatures, a small number of core theoretical concepts and assessment dimensions are identified. Specific assessment methods are also highlighted. Research evidence concerning a particular object relations concept (quality of object relations) and a corresponding interview scale (Quality of Object Relations Scale) that has emerged from a series of psychotherapy clinical trials is presented in support of the relevance of object relations theory to STDP. Clinical implications and future research directions are considered.

Humans↗
PubMed1999

Follow-up findings for interpretive and supportive forms of psychotherapy and patient personality variables.

Follow-up findings at 6 and 12 months are reported for a clinical trial that investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). Patients in both forms maintained their posttherapy improvements at 6- and 12-month follow-up assessments. They did not differ significantly from each other. At 6 and 12 months, there was evidence for a direct relation between QOR and favorable outcome. At 12 months, there was also evidence for an interaction effect, which indicated a direct relation between QOR and favorable outcome for interpretive therapy and almost no relation for supportive therapy. Thus, QOR continued to be an important predictor of outcome at 6 and 12 months, with some evidence for persistence of an interaction effect. In contrast, no follow-up effects were found for PM.

Adult↗
PubMed1999

Borderline functioning, work, and outcome in intensive evening group treatment.

Cluster analysis was used to identify subgroups of a sample of 40 patients with borderline personality disorder (BPD). The BPD patients were part of a larger sample that had participated in an intensive, group-oriented Evening Treatment Program. A set of pretherapy outcome measures was used to represent patient "attributes" for the cluster analysis. Eight clusters were identified. Two, each defined by a single patient with pronounced pathology, were deleted from further analyses. In a discriminant-function analysis, four dimensions emerged that differentiated the six remaining clusters. Significant relationships among the four dimensions and measures of therapeutic work and treatment outcome were identified. The relationships reflected the impact of behavioral characteristics associated with BPD on participation in and benefit from intensive group-oriented evening treatment. Implications of these exploratory findings for the understanding and treatment of BPD are discussed.

Adult↗
PubMed1999

Transference interpretations in short-term dynamic psychotherapy.

Transference interpretations are one of the distinguishing features of dynamically oriented psychotherapy. Previous studies have suggested that too many transference interpretations may be detrimental, in particular for certain kinds of patients. Given the potential for negative effects, attempts to validate (replicate) the previous findings are worthwhile. The relationships between the frequency and proportion of transference interpretations and both the therapeutic alliance and treatment outcome were examined in a sample of 40 patients who received time-limited, 20-session, individual psychotherapy. Inverse relationships were found between the frequency of transference interpretations and both patient-rated therapeutic alliance and favorable outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations (QOR). These results extend previous findings regarding transference technique in short-term dynamic therapy with low-QOR and high-QOR patients.

Adult↗
PubMed1999

Therapy manuals and the dilemma of dynamically oriented therapists and researchers.

The presence of therapy manuals in clinical settings is increasing and the related concepts of adherence and competence are becoming familiar. The benefits of manuals for research and training are evident. However, negative clinical effects have also been reported. Dynamically oriented clinicians and researchers who use manuals face a dilemma. Although there is a need to control aspects of technique for research and training purposes, there is also a need not to control the process of therapy because unpredictability is an intended part of the process. Issues associated with the dilemma are reviewed and a possible solution is provided that has proven helpful in an active clinic and research setting. It involves the use of manuals that emphasize general guidelines rather than detailed technical behaviors.

Clinical Competence↗
PubMed1999

Use of transference interpretations in dynamically oriented individual psychotherapy for patients with personality disorders.

The use of transference interpretations in the individual treatment of patients with personality disorders is a controversial issue. Both expressive approaches that stress the importance of transference interpretations and supportive approaches that avoid interpretation of the transference have been advocated by dynamically oriented therapists. Literature is reviewed regarding recommendations for individual psychotherapy and the different views on interpretation of the transference. Available research that has attempted to illuminate the impact of these interventions is also summarized. Although the findings are limited by a number of methodological shortcomings, three implications have emerged. First, a strong therapeutic alliance is imperative for successful exploration of the transference. Second, transference-focused work should be balanced with supportive interventions. Third, the patient's quality of object relations and his or her ability to work within the transference should be considered. However, without further research to guide clinical decision making, clinicians will be left with a confusing array of recommendations and only their intuition.

Humans↗
PubMed1999

Measuring therapist technique in psychodynamic psychotherapies. Development and use of a new scale.

Treatment manuals are becoming a requirement for conducting quality psychotherapy research. What the field lacks, however, are reliable, valid, and cost-efficient instruments that can be used to measure a wide variety of prescribed therapeutic techniques. This article describes the development and use of a new instrument, the Interpretive and Supportive Technique Scale (ISTS). It is designed to measure interpretive and supportive features of technique for a broad range of dynamically oriented psychotherapies. Data concerning the psychometric properties of the ISTS are presented from two studies. The findings suggest that the ISTS is a potentially useful tool for measuring interventions for different forms of dynamically oriented psychotherapy.

Humans↗
PubMed1998

Interpretive and supportive forms of psychotherapy and patient personality variables.

A randomized clinical trial investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). The psychiatric outpatient sample included 144 therapy completers and 27 dropouts. Eight experienced therapists provided distinct forms of manual-guided therapy. Outcome was assessed by a comprehensive battery. The dropout rate was higher for interpretive therapy than for supportive therapy. Patients in both forms improved, but they did not differ on outcome from each other. A multivariate interaction effect indicated a direct relation between QOR and outcome for interpretive therapy and almost no relation for supportive therapy. A multivariate main effect indicated a direct relation between PM and outcome for both forms. The relevance of patient personality to outcome in different forms of therapy is addressed.

Adolescent↗