... of emo-tions, humans have limited ability to describe their emotional world; (3) emotional an... more ... of emo-tions, humans have limited ability to describe their emotional world; (3) emotional and memory systems are dynamic ... context-sensitive method for determining a biologically based moment-to-moment measure of emotional engagement in an audience in response to a ...
As Westen et al (2003) elucidate, the empirical validation of treatment models tends to remain ri... more As Westen et al (2003) elucidate, the empirical validation of treatment models tends to remain rigidly focused on treatment outcomes,and misses important information about what is efficacious about a given treatment. In this response to Weston et al., we argue that focusing on treatment packages as a whole represents too high a level of abstraction, far removed from the
In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manu... more In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manualized treatment packages misses important information about what is efficacious about a given treatment. Psychotherapy process has demonstrated that treatments may promote change in ways other than their underlying theories claim. Manualized therapies may appear distinct despite important similarities in dyadic interaction. These functional similarities in the emergent transactional process between therapist and patient may help explain the difficulty demonstrating differential outcomes across brands of brief therapy. Rather than focus on treatment packages targeting patient symptomatology, the authors recommend a shift in focus to the empirical validation of change processes coconstructed by therapist and patient in naturalistic settings.
To determine whether placebo responses can be explained by characteristics of the patient, the pr... more To determine whether placebo responses can be explained by characteristics of the patient, the practitioner, or their interpersonal interaction. We performed an analysis of videotape and psychometric data from a clinical trial of patients with irritable bowel syndrome who were treated with placebo acupuncture in either a warm empathic interaction (Augmented, n = 96), a neutral interaction (Limited, n = 97), or a waitlist control (Waitlist, n = 96). We examined the relationships between the placebo response and a) patient personality and demographics; b) treating practitioner; and c) the patient-practitioner interaction as captured on videotape and rated by the Psychotherapy Process Q-Set. Patient extraversion, agreeableness, openness to experience, and female gender were associated with placebo response, but these effects held only in the augmented group. Regression analyses controlling for all other independent variables suggest that only extraversion is an independent predictor of placebo response. There were significant differences between practitioners in outcomes; this effect was twice as large as the effect attributable to treatment group assignment. Videotape analysis indicated that the augmented group fostered a treatment relationship similar to a prototype of an ideal healthcare interaction. Personality and gender influenced the placebo response, but only in the warm, empathic, augmented group. This suggests that, to the degree a placebo effect is evoked by the patient-practitioner relationship, personality characteristics of the patient will be associated with the placebo response. In addition, practitioners differed markedly in effectiveness, despite standardized interactions. We propose that the quality of the patient-practitioner interaction accounts for the significant difference between the groups in placebo response.
Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psych... more Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psychotherapy process research and clinical practice. We present a case report of a patient and therapist who participated in a process-oriented psychotherapy research protocol using simultaneous measures of skin conductance. Data from the research protocol were used to broaden an empathic understanding of the patient, which facilitated insight and enhanced the exploration of conscious and unconscious processes that originated in the past and have come to dominate the present--the core of psychodynamic theories of change. The case illustrates the clinical relevance of psychophysiology and its use as a potential bridge between psychotherapy research and the theory and practice of psychotherapy. The implications of the case in support of the role of empathy in psychotherapy are discussed.
This article provides a critical review of the assumptions and findings of studies used to establ... more This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.
Http Dx Doi Org 10 1080 17439760902819576, May 1, 2009
... DOI: 10.1080/17439760902819576 Zachary Warren a * , Nancy Etcoff b , Benjamin Wood c , Chris ... more ... DOI: 10.1080/17439760902819576 Zachary Warren a * , Nancy Etcoff b , Benjamin Wood c , Chris Taylor a & Carl D. Marci b pages 234-242. ... 2002. An empirical reflection on the smile , Lewiston, NY: Edwin Mellen Press. View all references). ...
Handbook of Evidence-Based Psychodynamic Psychotherapy, 2009
ABSTRACT There is a rich history of measuring physiologic responses between patient and clinician... more ABSTRACT There is a rich history of measuring physiologic responses between patient and clinician that has infused psychodynamic psychotherapy research for over half a century. The findings complement research outside of psychotherapy that increasingly supports a significant relationship between physiological, emotional, and psychological states [1]. Indeed, investigations into how physiologic parameters change during psychotherapy offer a unique opportunity to inform clinical practice, improve training of clinicians, and illuminate change processes unique to human dyadic relationships [2]. The goal of this chapter is to review the history of physiologic monitoring during psychodynamic psychotherapy and present recent findings that complement neuroimaging results and support recent advances in interpersonal neurobiology and social neuroscience. A clinical case from a research protocol is described that demonstrates the power of insights derived from physiologic measurement and illustrates the challenges of breaking through unconscious defenses in the process of psychodynamic psychotherapy.
The present study examined the relationship among contemplation stage of readiness to change, for... more The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psych... more Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psychotherapy process research and clinical practice. We present a case report of a patient and therapist who participated in a process-oriented psychotherapy research protocol using simultaneous measures of skin conductance. Data from the research protocol were used to broaden an empathic understanding of the patient, which facilitated insight and enhanced the exploration of conscious and unconscious processes that originated in the past and have come to dominate the present--the core of psychodynamic theories of change. The case illustrates the clinical relevance of psychophysiology and its use as a potential bridge between psychotherapy research and the theory and practice of psychotherapy. The implications of the case in support of the role of empathy in psychotherapy are discussed.
... of emo-tions, humans have limited ability to describe their emotional world; (3) emotional an... more ... of emo-tions, humans have limited ability to describe their emotional world; (3) emotional and memory systems are dynamic ... context-sensitive method for determining a biologically based moment-to-moment measure of emotional engagement in an audience in response to a ...
As Westen et al (2003) elucidate, the empirical validation of treatment models tends to remain ri... more As Westen et al (2003) elucidate, the empirical validation of treatment models tends to remain rigidly focused on treatment outcomes,and misses important information about what is efficacious about a given treatment. In this response to Weston et al., we argue that focusing on treatment packages as a whole represents too high a level of abstraction, far removed from the
In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manu... more In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manualized treatment packages misses important information about what is efficacious about a given treatment. Psychotherapy process has demonstrated that treatments may promote change in ways other than their underlying theories claim. Manualized therapies may appear distinct despite important similarities in dyadic interaction. These functional similarities in the emergent transactional process between therapist and patient may help explain the difficulty demonstrating differential outcomes across brands of brief therapy. Rather than focus on treatment packages targeting patient symptomatology, the authors recommend a shift in focus to the empirical validation of change processes coconstructed by therapist and patient in naturalistic settings.
To determine whether placebo responses can be explained by characteristics of the patient, the pr... more To determine whether placebo responses can be explained by characteristics of the patient, the practitioner, or their interpersonal interaction. We performed an analysis of videotape and psychometric data from a clinical trial of patients with irritable bowel syndrome who were treated with placebo acupuncture in either a warm empathic interaction (Augmented, n = 96), a neutral interaction (Limited, n = 97), or a waitlist control (Waitlist, n = 96). We examined the relationships between the placebo response and a) patient personality and demographics; b) treating practitioner; and c) the patient-practitioner interaction as captured on videotape and rated by the Psychotherapy Process Q-Set. Patient extraversion, agreeableness, openness to experience, and female gender were associated with placebo response, but these effects held only in the augmented group. Regression analyses controlling for all other independent variables suggest that only extraversion is an independent predictor of placebo response. There were significant differences between practitioners in outcomes; this effect was twice as large as the effect attributable to treatment group assignment. Videotape analysis indicated that the augmented group fostered a treatment relationship similar to a prototype of an ideal healthcare interaction. Personality and gender influenced the placebo response, but only in the warm, empathic, augmented group. This suggests that, to the degree a placebo effect is evoked by the patient-practitioner relationship, personality characteristics of the patient will be associated with the placebo response. In addition, practitioners differed markedly in effectiveness, despite standardized interactions. We propose that the quality of the patient-practitioner interaction accounts for the significant difference between the groups in placebo response.
Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psych... more Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psychotherapy process research and clinical practice. We present a case report of a patient and therapist who participated in a process-oriented psychotherapy research protocol using simultaneous measures of skin conductance. Data from the research protocol were used to broaden an empathic understanding of the patient, which facilitated insight and enhanced the exploration of conscious and unconscious processes that originated in the past and have come to dominate the present--the core of psychodynamic theories of change. The case illustrates the clinical relevance of psychophysiology and its use as a potential bridge between psychotherapy research and the theory and practice of psychotherapy. The implications of the case in support of the role of empathy in psychotherapy are discussed.
This article provides a critical review of the assumptions and findings of studies used to establ... more This article provides a critical review of the assumptions and findings of studies used to establish psychotherapies as empirically supported. The attempt to identify empirically supported therapies (ESTs) imposes particular assumptions on the use of randomized controlled trial (RCT) methodology that appear to be valid for some disorders and treatments (notably exposure-based treatments of specific anxiety symptoms) but substantially violated for others. Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported. The authors recommend changes in reporting practices to maximize the clinical utility of RCTs, describe alternative methodologies that may be useful when the assumptions underlying EST methodology are violated, and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies.
Http Dx Doi Org 10 1080 17439760902819576, May 1, 2009
... DOI: 10.1080/17439760902819576 Zachary Warren a * , Nancy Etcoff b , Benjamin Wood c , Chris ... more ... DOI: 10.1080/17439760902819576 Zachary Warren a * , Nancy Etcoff b , Benjamin Wood c , Chris Taylor a & Carl D. Marci b pages 234-242. ... 2002. An empirical reflection on the smile , Lewiston, NY: Edwin Mellen Press. View all references). ...
Handbook of Evidence-Based Psychodynamic Psychotherapy, 2009
ABSTRACT There is a rich history of measuring physiologic responses between patient and clinician... more ABSTRACT There is a rich history of measuring physiologic responses between patient and clinician that has infused psychodynamic psychotherapy research for over half a century. The findings complement research outside of psychotherapy that increasingly supports a significant relationship between physiological, emotional, and psychological states [1]. Indeed, investigations into how physiologic parameters change during psychotherapy offer a unique opportunity to inform clinical practice, improve training of clinicians, and illuminate change processes unique to human dyadic relationships [2]. The goal of this chapter is to review the history of physiologic monitoring during psychodynamic psychotherapy and present recent findings that complement neuroimaging results and support recent advances in interpersonal neurobiology and social neuroscience. A clinical case from a research protocol is described that demonstrates the power of insights derived from physiologic measurement and illustrates the challenges of breaking through unconscious defenses in the process of psychodynamic psychotherapy.
The present study examined the relationship among contemplation stage of readiness to change, for... more The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psych... more Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psychotherapy process research and clinical practice. We present a case report of a patient and therapist who participated in a process-oriented psychotherapy research protocol using simultaneous measures of skin conductance. Data from the research protocol were used to broaden an empathic understanding of the patient, which facilitated insight and enhanced the exploration of conscious and unconscious processes that originated in the past and have come to dominate the present--the core of psychodynamic theories of change. The case illustrates the clinical relevance of psychophysiology and its use as a potential bridge between psychotherapy research and the theory and practice of psychotherapy. The implications of the case in support of the role of empathy in psychotherapy are discussed.
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