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Biomedical subjects

A S Joyce

Publications and source records attributed to A S Joyce.

At least 19 recordsLinked to original sources
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

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

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↗
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↗
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↗
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

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↗