Biomedical subjects

L Mellman

Publications and source records attributed to L Mellman.

4 recordsLinked to original sources

PubMed2001

Assessing the subjective experience of being a participant in psychiatric research.

OBJECTIVE: To address both clinical and ethical concerns in psychiatric research, the study assessed the subjective experience of being a participant in a feasibility study of outcome in long-term psychodynamic psychotherapy and psychoanalysis. METHOD: A questionnaire assessing positive and negative reactions to three typical research methodologies (self-report questionnaires, structured diagnostic interviews, and tape-recording of sessions) was administered to 23 patient-therapist pairs. RESULTS: Patients reported that questionnaires and interviews were slightly to moderately helpful in promoting self-realization and facilitating therapy, and not at all to slightly intrusive and disruptive. Adjustment to audiotaping of sessions was rapid (within two sessions). Therapists significantly overestimated the negative effects and underestimated the positive benefit patients reported from participating in research. CONCLUSIONS: Traditional objections to research in dynamic psychotherapy on the grounds that patients experience research procedures as significantly intrusive and disruptive appear to be unfounded.

Adult↗

PubMed2000

Can we do psychoanalytic outcome research? A feasibility study.

Despite the widespread use of long-term psychodynamic treatments, methodologically rigorous outcome studies have not been conducted. The authors describe the results of a feasibility study designed to (1) investigate whether patients in psychodynamic treatment, including psychoanalysis, could be recruited and retained as research subjects, (2) determine patient and therapist compliance with self-report measures, rater-administered structured interviews and session audiotaping and (3) obtain pilot data on changes in these measures after one year of treatment. Nine patients entering psychoanalysis and fifteen entering psychodynamic psychotherapy were studied at baseline, six months and one year. Major findings were as follows: (1) recruitment rates were 27% (psychoanalysis) and 83% (psychotherapy), (2) all patients who remained in treatment remained in the research protocol, (3) drop-out rates among research participants and non-participants were equivalent, (4) current Axis I (usually affective or anxiety) disorders were found in over 60% of patients, (5) Axis II disorders in the absence of current Axis I disorders were rare, (6) despite a small number (N) of participants, significant positive change was demonstrated on a variety of measures after one year. Results suggest that it is possible to demonstrate a therapeutic effect of psychodynamic treatments, including psychoanalysis, but changing negative clinical perceptions of research is necessary if methodologically rigorous outcome studies are to be possible in the future.

Adult↗

PubMed1998

A match made in heaven? A pilot study of patient-therapist match.

The authors report on a study of patient-therapist match in 50 psychodynamic psychotherapy dyads. Sixty-six percent of patients and therapists agreed about the quality of the match, with 58% of patients and 56% of therapists reporting that the match was positive. Positive match correlated with positive patient and therapist assessments about the progress and process of therapy, but not with perceived similarity of personal characteristics. Patients' and therapists' perceptions about their similarities and differences from one another did not correlate. This study suggests it is both possible and important to gather data from both patient and therapist when studying match.

Adult↗

PubMed1996

Quality and use of trauma histories obtained from psychiatric outpatients through mandated inquiry.

OBJECTIVE: A growing awareness of the sequelae of trauma has prompted clinical and administrative mandates that psychiatric assessments must include inquiry about whether patients have experienced trauma or abuse. This study was designed to assess how a trauma history obtained through mandated inquiry is recorded and how it is used in diagnostic formulation and treatment planning. METHODS: Histories of physical and sexual abuse and other trauma were reviewed in the charts of 180 outpatients receiving psychotherapy at an urban teaching hospital clinic. The extent and variety of traumatic experiences and the quality of clinicians' assessment of trauma histories were measured by a rating instrument developed for the study. RESULTS: Mandated inquiry led to the detection of histories of traumatic experiences for 72 patients (40 percent). The recognition of trauma did not trigger appropriate evaluation. Only 11 percent of clinicians mentioned posttraumatic stress disorder symptoms. Only one in ten charts of patients with histories of trauma contained diagnostic assessments or treatment plans that adequately incorporated the trauma history as a factor in the patient's presentation for treatment. CONCLUSIONS: Although mandated inquiry led to the detection of substantial abuse and trauma, this information was rarely used in assessment and treatment planning. Implementation of mandated inquiry should be accompanied by relevant education and supervision to ensure that clinicians understand the diagnostic and treatment implications of past trauma.

Adolescent↗