Biomedical subjects

A S Joyce

Publications and source records attributed to A S Joyce.

29 records · Page 2Linked to original sources

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

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

Quality of object relations versus interpersonal functioning as predictors of therapeutic alliance and psychotherapy outcome.

The purpose of the study was to compare an interview measure of quality of object relations to questionnaire and interview measures of recent interpersonal functioning with respect to the prediction of therapeutic alliance and psychotherapy outcome. The sample consisted of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical-trial investigation. Ratings of therapeutic alliance were provided independently by the patient and the therapist after each session. Outcome measures, which were provided by three sources (patient, therapist, and independent assessor), covered the areas of interpersonal functioning, psychiatric symptomatology, self-esteem, and life satisfaction. Quality of object relations, which characterizes the patient's lifelong pattern of relationships, was the best predictor. It was significantly related to patient-rated and therapist-rated therapeutic alliance and to patient improvement of both general symptomatology and specific target problems. The study also replicated previous studies that have reported significant relationships between therapeutic alliance and therapy outcome. The advantages of pretherapy predictors of therapy outcome, such as quality of object relations, are discussed.

Adjustment Disorders↗

PubMed1990

Patient suitability and outcome in short-term individual psychotherapy.

The effects of short-term (time-limited), dynamically oriented individual therapy and the patient characteristic quality of object relations (QOR) were studied in a controlled clinical trial involving 8 experienced therapists and 144 psychiatric outpatients. A comprehensive set of outcome scores was monitored at 5-month intervals including a follow-up assessment. A strong treatment effect that was maintained at follow-up was found. The effect was evident in terms of statistical significance, effect size, and clinical significance. Evidence for an additive effect of the combination of treatment and QOR was also found. The best results were attained by high QOR therapy patients, and the worst results were attained by low QOR control patients. The results were suggestive of an optimal match between type of patient and type of therapy.

Adolescent↗

PubMed1990

An examination of Mann's model of time-limited individual psychotherapy.

The present study attempted a sensitive test of the dynamic sequence proposed by Mann for time-limited individual psychotherapy (TLP). Session evaluation ratings were collected from both patient and therapist. Indices were constructed that reflected the consistency of patient ratings, the consistency of therapist ratings, and the congruence between patient and therapist ratings, in each third of TLP. Measures of symptoms and social functioning were employed to differentiate cases of "good" versus "poor" treatment outcome. Therapists' adherence to the TLP technique was assessed by categorizing all interventions in each session. Fourteen patients were treated according to the TLP model. Measures of therapist behaviour indicated that treatments had been conducted in general accordance with Mann's technical recommendations. Measures of consistency and congruence failed to support the proposed TLP dynamic sequence. Analyses of mean evaluation ratings indicated a trend towards more positive evaluations as therapy progressed; "good" outcome cases were significantly more likely to evidence this pattern. Results are discussed in terms of interplay between inductive hypothesis building and empirical verification in the development of theories of psychotherapy.

Adaptation, Psychological↗

PubMed1986

The impact of data-based program modifications on the satisfaction of outpatients in group psychotherapy.

A previous assessment of patient satisfaction in our outpatient clinic indicated that patients in group psychotherapy were relatively dissatisfied with services in contrast to patients receiving other forms of therapy. A rational analysis on the part of program staff identified areas where modifications of the group therapy program could be implemented. These program changes are described. Satisfaction ratings of group therapy patients from a subsequent assessment project were compared to ratings from the initial study. Comparisons indicated that an improvement in the level of satisfaction of group patients was evident, providing support for the view that our program changes had had the desired beneficial impact. Results are discussed with regard to the value of ongoing evaluation and data-based modification of delivery services for the continuing improvement of patient care.

Consumer Behavior↗

PubMed1984

Treatment noncompliance as a function of therapist attributes and social support.

Premature termination of short-term psychotherapy was examined as a function of therapist and social support variables. Patient perceived therapist competence, knowledge, relaxed manner, understanding of the help wanted, attitude, acceptance, listening ability, and sensitivity differentiated Continuers from Terminators. Although few of the social support variables were related to the mode of treatment termination, Continuers were found to be more likely than Terminators to have discussed attendance at the Clinic with others, especially family members. These findings were discussed in terms of their relevance to treatment of the emotionally ill and to the training of clinicians.

Clinical Competence↗