Biomedical subjects

W E Piper

Publications and source records attributed to W E Piper.

At least 37 records · Page 2Linked to original sources

PubMed1998

Exercise groups in an insight-oriented, evening treatment program.

Exercise groups form an integral part of an insight-oriented, psychodynamic evening treatment program for a patient population characterized predominantly by mood and personality disorders. Clinical examples illustrate how the exercise groups are integrated with other therapy groups in the program. Therapists, who lead and participate in the exercise groups, attempt to maintain professional boundaries while they facilitate permissive activities where enactment of patient conflicts can occur. Events from the exercise groups frequently provide material for work in the more traditional psychodynamic groups of the program. A number of benefits of exercise groups are highlighted.

Adult↗

PubMed1998

Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy.

Patient and therapist expectancies regarding the "typical session" were measured during a controlled trial of short-term, time-limited individual psychotherapy. Relationships between expectancy ratings and measures of the therapeutic alliance and treatment outcome were examined. Significant relationships were tested in the presence of a competing predictor variable, either pre-therapy disturbance (depression) or the patient's quality of object relations (QOR). Expectancies were associated strongly with the alliance but only moderately with treatment outcome. In most instances, expectancy and QOR combined in an additive fashion to account for variation in alliance or outcome. The patient's capacity for mature relationships and expectancies for therapy appear to be important determinants of treatment process and outcome. The clinical value of establishing accurate, moderate expectancies prior to therapy is considered.

Adult↗

PubMed1997

Predicting patient benefit from a group-oriented, evening treatment program.

Patients with coexisting mood and personality disorders are a challenge to service care providers who offer treatment. The response of 190 patients with one or both disorders to an intensive group-oriented evening treatment program was investigated. Benefit was assessed using factors derived from pre-post outcome measures and from general impressions of program usefulness. A predictive model consisting of patient levels of psychological mindedness and psychodynamic work was applied. Results indicated that psychological mindedness was significantly related to psychodynamic work in the program, and work was related to general impressions of program usefulness. These results cross-validated findings from a previous study of a day-treatment program. Restricted range may have prevented finding significant results for the pre-post outcome factors. Clinical implications of the findings are discussed.

Cognition↗

PubMed1996

Interpretive work in short-term individual psychotherapy: an analysis using hierarchical linear modeling.

"Work" and "resistance" responses to interpretation in short-term individual (STI) psychotherapy were examined using a hierarchical linear modeling (HLM) procedure. The relationships between interpretation characteristics and patient responses within therapy were considered. Process data were drawn from 60 STI therapy cases, 30 patients with low quality of object relations (QOR), and 30 patients with high QOR. In 4 instances, the relationships between technique and response were found to vary significantly across cases. One was identified for low QOR patients, and 3 were identified for high QOR patients. Individual differences in initial disturbance and outcome were used to account for the variation of technique-response relationships. Significant findings were limited to the high QOR sample. Initial disturbance was directly related to work in response to a transference-oriented approach. The transference focus-work relationship was found to be inversely related to outcome. The results extend previous findings regarding transference technique in STI therapy with high QOR patients. Through capitalizing on within-case variation, HLM can be used to illuminate process-outcome relationships in psychotherapy.

Adolescent↗

PubMed1996

A consideration of factors influencing the utilization of time-limited, short-term group therapy.

Previous reviews of the research literature and a new review conducted for this article were examined for evidence of the efficacy, applicability, and efficiency of time-limited, short-term group therapy (TSGT). Strong evidence for all three factors was found. Additional patient and therapist factors influence the effectiveness and utilization of TSGT in clinical settings, however. Some are analogous to criteria routinely considered in the use of medication such as "ease of administration" and "side effects." Others are particularly relevant to therapists, such as lack of training and experience, organizational difficulties, and negative reactions to managed-care initiatives. Optimal matching of patient and treatment also affects treatment decisions. Implications for clinicians and administration are considered.

Controlled Clinical Trials as Topic↗

PubMed1996

Limiting time-unlimited group psychotherapy.

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.

Adult↗

PubMed1996

Psychological mindedness.

THERE is a consensus in the psychotherapy literature that the patient dimension of psychological mindedness is important to working within all forms of psychoanalytically oriented therapy. Silver (1983) offered a comprehensive definition of psychological mindedness stating that the capacity includes: The patient's desire to learn the possible meanings and causes of his internal and external experiences as well as the patient's ability to look inwards to psychical factors rather than only outwards to environmental factors....[and] to potentially conceptualize the relationship between thoughts, feelings, and actions. (p. 516).

Adolescent↗

PubMed1996

Dimensions and predictors of patient response to interpretation.

THE technique of interpretation is central to psychodynamic psychotherapy. Empirical information about effective interpretive technique would be of practical value to clinicians. The objectives of this exploratory study were to describe the immediate response to interpretation and identify the features of interpretation that are predictive of the response.

Adolescent↗

PubMed1995

Effective psychiatric day treatment: historical lessons.

This paper describes a successful day treatment program that provides four months of intensive psychodynamic group-oriented milieu treatment for patients with long-standing personality disorders, who commonly experience recurrent major depression, dysthymia, and excessive anxiety. The authors outline three factors that have contributed to the success of the program--optimal treatment-patientmatching, judicious use of authority in milieu therapy, and careful attention to maintaining close working relationships with referral sources. They provide an overview of the historical evolution of day treatment programs from earlier day hospital model to show day programs' neglect of these factors may have led to treatment failures. Such failures may have spurred recent suggestions that psychiatric day treatment programs should be replaced entirely by assertive community treatment. The authors argue that such a move could amount to abdication of psychiatry's responsibility to provide intensive milieu treatment that can be effectively offered only on a day treatment basis.

Adult↗

PubMed1994

Psychological mindedness, work, and outcome in day treatment.

A recently completed clinical trial that investigated the effectiveness of a group-oriented, day treatment program provided an opportunity to pursue a multidimensional approach to the prediction of treatment outcome. The sample consisted of 99 psychiatric outpatients, most of whom had received diagnoses of affective and personality disorders. The predictor variables included a patient personality characteristic (psychological mindedness), a group process variable (patient work), and their interaction. Univariate analyses revealed significant direct relationships between psychological mindedness and both work and favorable outcome, and between work and favorable outcome. Multivariate analyses indicated that psychological mindedness and work had independent significant relationships (additive or interactive) with several of the outcome variables. In combination they accounted for up to a quarter of the outcome variance. The results demonstrate the benefit of using a theoretically consistent multidimensional approach. The time-efficient nature of the predictor measures used in the study make them particularly amenable for use by clinicians and researchers.

Ambulatory Care↗

PubMed1994

Patient characteristics and success in day treatment.

This study examined the ability of seven patient characteristics to predict success (remaining, benefiting) in a day treatment program for psychiatric outpatients. The sample consisted of 165 patients, most with affective and personality disorders, who participated in an intensive psychodynamically and group-oriented program within a controlled clinical trial. Two patient personality characteristics (psychological mindedness, quality of object relations) emerged as the strongest predictors. Other variables that contributed to the predictions, either singly or in an interaction with quality of object relations, were age, marriage, presence of a personality disorder, and previous psychiatric hospitalization. The patient's initial level of symptomatic disturbance was not a significant predictor. The advantage of using predictors that are relevant to the theoretical and technical orientation of a program is emphasized.

Adolescent↗

PubMed1993

Concentration and correspondence of transference interpretations in short-term psychotherapy.

This article provides a review of research on the relationship between aspects of transference interpretation and outcome in dynamic psychotherapy. It also presents the results of a recently completed study that focused on 2 aspects of transference interpretations, concentration and correspondence. Significant relationships between each of these 2 aspects and both therapeutic alliance and outcome were found, as well as an interaction effect for outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations. The results concerning correspondence were consistent with those of previous studies that investigated the correctness of interpretations. The overall findings suggest that (a) variation in technique may make a difference in brief dynamic therapy and (b) variation and impact of technique may have been masked in some previous studies and reviews.

Adult↗

PubMed1993

Affect and outcome in short-term group therapy for loss.

Affect and work variables were monitored for 12 of 16 groups involved in a controlled outcome study of psychoanalytically oriented short-term group therapy. Groups were conducted by experienced therapists for outpatients who experienced difficulties adapting to personal losses through death, separation, or both. Postsessional ratings of positive and negative affect were provided by individual patients, therapists, and other patients. Psychodynamic work was rated independently using a content analysis system. Patients who had experienced separation were more inhibited in their affective expression. Rating sources agreed that positive affect increased over time. Direct relationships were found between positive affect and favorable outcome. Concerning negative affect, the strongest predictors of favorable outcome involved the interaction of affect and work. Implications of these findings are discussed in terms of the cathartic hypothesis.

Adult↗

PubMed1993

Understanding the relationship between transference interpretation and outcome in the context of other variables.

Transference interpretation has traditionally been regarded as a powerful distinguishing feature of dynamically oriented psychotherapy. The failure of early studies to demonstrate its impact on outcome may, in part, have been due to limitations in methodology and conceptual models. A recently completed clinical trial of short-term individual psychotherapy has provided evidence of associations between two aspects of transference interpretation and outcome. The two aspects were concentration (frequency expressed as a proportion of interventions) and correspondence (congruence with a patient formulation). The nature of the associations varied as a function of the patient characteristic known as quality of object relations. Also important was the therapeutic alliance. When the variables were considered together in a multivariate model and their relationships examined by means of multiple regression, substantial amounts of outcome variance were accounted for. The evidence from previous and recent studies suggests that technique can have an important impact on outcome in short-term individual psychotherapy. It also indicates that the impact of technique should be viewed in relation to patient and relationship variables.

Humans↗

PubMed1993

The immediate impact of transference interpretation in short-term individual psychotherapy.

Interpretation of transference is a hallmark of psychoanalytically-oriented psychotherapy. Proponents of short-term individual (STI) approaches have been divided on the use of the technique, some stating that the time-limited format does not allow for exploration of transference while others advocate a more active and rigorous observation of transference manifestations. Recent theoretical formulations regarding transference, based on a cognitive-affective view of how individuals structure their experience, are summarized. A rationale for the technique of transference interpretation (TI) in the time-limited format is presented. A process analysis of the immediate impact of interpretation is described, and findings and examples of relationships involving the accuracy of TI are reviewed. The findings demonstrate that TIs can have a potent impact on the STI therapy process if employed judiciously and based on a careful formulation of the psychodynamics of the patient's presenting complaint.

Adaptation, Psychological↗

PubMed1993

A randomized trial of psychiatric day treatment for patients with affective and personality disorders.

OBJECTIVE: The outcome of a day treatment program for psychiatric outpatients with affective and personality disorders was evaluated. The program was dynamically oriented, intensive, group focused, and time limited (18 weeks). METHODS: The prospective trial used a randomized treatment-versus-control (delayed-treatment) design to examine 17 outcome variables covering five areas: interpersonal functioning, symptomatology, self-esteem, life satisfaction, and defensive functioning. Those variables, plus individualized treatment objectives, were monitored before and after the treatment and control periods and at follow-up an average of eight months later. RESULTS: Treated patients showed significantly better outcome than control patients for seven of the 17 outcome variables: social dysfunction, family dysfunction, interpersonal behavior, mood level, life satisfaction, self-esteem, and severity of disturbance associated with individual goals of treatment as rated by an independent assessor. The findings could not be accounted for by diagnosis or use of medication. Benefits were maintained over the follow-up period. The average treatment-versus-control effect size for all 17 variables was .71. CONCLUSIONS: The study supports the efficacy of an intensive day treatment program for patients who manifest significant difficulties associated with affective and personality disorders.

Adolescent↗

PubMed1991

Transference interpretations, therapeutic alliance, and outcome in short-term individual psychotherapy.

Relationships between the proportion of transference interpretations provided by therapists and both therapeutic alliance and therapy outcome were investigated for a sample of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical trial investigation. Inverse relationships were found between the proportion of transference interpretations and both therapeutic alliance and favorable therapy outcome for patients with a history of high quality of object relations. An examination of individual sessions revealed evidence that was consistent with two different, but not mutually exclusive, causal explanations. The first concerned the negative effects of high proportions of transference interpretations; the second concerned the reaction of the therapist to the presence of a weak therapeutic alliance. While the evidence from our study was correlational, it was sufficiently strong to warrant alerting clinicians to the possibility of negative treatment effects when high levels of transference interpretations are used with certain types of patients receiving short-term individual psychotherapy.

Adult↗

PubMed1991

Emergent themes and roles in short-term loss groups.

Clinical observations regarding themes and roles that are characteristic of short-term, psychoanalytically oriented therapy groups for loss patients are presented. They reflect aspects of both the therapy and the patients. Themes refer to the content of a recurrent conflict in the group. They include trust, survivor guilt, mortality, and termination. Roles refer to a set of patient behaviors that represent a shared conflict. They include the apparition, monk, professor, professional nurturer, emotional conductor, and cruise director. Challenges that the themes and roles present to the therapist and clinical guidelines for addressing them are offered. Awareness of characteristic themes and roles and possible therapist responses are regarded as important parts of the preparation and training of therapists who plan to conduct short-term loss groups.

Ambulatory Care↗