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Biomedical subjects

W E Piper

Publications and source records attributed to W E Piper.

At least 19 recordsLinked to original sources
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↗
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↗
PubMed1991

The Quality of Object Relations Scale.

The Quality of Object Relations Scale (QORS) provides a methodological and theoretical framework for personality classification based on relative level and quality of object relations. The authors believe that many available clinical assessment systems have little heuristic value, and propose that the QORS yields more meaningful descriptions of people. They discuss its theoretical basis in psychoanalytic object relations theory, and how its construction and rationale represent an attempt to incorporate recent thought relevant to the classification of personality. They include criteria for its organizational levels, prototypical vignettes, and a case demonstration. They also explore methodological issues relevant to clinical use and present reliability and validity data derived from empirical studies.

Adult↗
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

A controlled study of effectiveness and patient suitability for short-term group psychotherapy.

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient-treatment match.

Adaptation, Psychological↗
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↗
PubMed1989

Pretherapy preparation for group members.

The authors provide a comprehensive survey of the research literature on pretherapy training for group psychotherapy. The twenty studies identified during the twenty-five-year period 1962-1987 were fraught with various methodological and design inadequacies. Despite the widespread positive endorsement found in the clinical literature, the research evidence for the benefit of pretherapy training is not particularly impressive. While there is evidence of certain immediate effects (e.g., improved attendance), results concerning process and outcome effects are, at best, only suggestive. In the face of the disappointing findings, the authors are nonetheless optimistic regarding the potential value of pretherapy training.

Humans↗
PubMed1989

An analysis of pretraining work behavior as a composition variable in group psychotherapy.

Pretraining work behavior was investigated as a composition variable for group psychotherapy. The work behavior of sixty-six outpatients in nine pretraining groups was measured. Six of the pretraining groups were recomposed into either high or low work therapy groups on the basis of the pretraining scores. The other three groups entered therapy intact. Audiotapes from the first six months were analyzed to assess therapy process. Outcome measures were administered before therapy and after six months of therapy. Hypotheses concerned the effects of composition on process and outcome and the relationship between pretraining work behavior and outcome. The results suggest that pretraining work behavior has merit as a composition variable and may have promise as a selection variable. Therapeutic uses of pretraining are discussed.

Adult↗
PubMed1988

Psychotherapy research in the 1980s: defining areas of consensus and controversy.

Psychotherapy research is characterized by slowly accumulated findings, not by dramatic breakthroughs. In this review of psychotherapy research methodology, the author identifies eight areas of relative consensus--such as the use of clinical trials, random assignment to treatment conditions, investigation of interaction effects, high statistical power, and integration of process and outcome--as well as areas of controversy. The latter mainly concern disagreements about the usefulness of meta-analysis, the distinction between specific and nonspecific factors, and the choice of comparison groups. Taken together, the areas of consensus, along with the methodological suggestions the literature offers for future research, signal a shift toward studies that are more relevant to clinicians. However, implementation of such studies depends very much on the collaboration of clinicians and researchers.

Clinical Trials as Topic↗
PubMed1986

Relationships between the object focus of therapist interpretations and outcome in short-term individual psychotherapy.

The relationships between the object (person) focus of therapist interpretations and outcome were examined for 21 patients who received short-term individual psychotherapy. Percentages of single objects and linked objects, e.g. therapist-parent link, were derived from an analysis of the therapy sessions. Patients, therapists and an independent assessor provided pre-therapy, post-therapy and six-month follow-up outcome scores. Contrary to other reports in the literature little evidence was found to support the hypothesis of a direct linear relationship between object focus and favourable outcome. Several explanations for the findings are discussed.

Female↗
PubMed1986

On the concept of psychoanalytic work.

A set of criteria for psychoanalytic work that can be used to define various forms of psychoanalytic therapy is proposed. Four patients who were involved in short-term individual psychotherapy with the same therapist, but who evidenced considerably different therapy process and outcome, are used to illustrate the criteria. Implications for practice and research are cited.

Adult↗
PubMed1985

Patient predictors of process and outcome in short-term individual psychotherapy.

Twenty-one psychiatric outpatients were treated with short-term, psychoanalytically oriented, individual psychotherapy. Outcome ratings were provided by the patient, the therapist, and an independent assessor. Process ratings were provided by the patient and the therapist at the end of therapy. From a series of multiple regression analyses two pretherapy predictor scores (defensive style of the patient, object choice of the patient) emerged as good predictors of several of the process and outcome ratings. The two predictor scores were statistically independent of one another and were not significantly related to initial severity of disturbance. Attention to these two concepts in future research and in clinical assessment of patients for short-term individual psychotherapy is recommended.

Adult↗