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Biomedical subjects

William E Piper

Publications and source records attributed to William E Piper.

At least 19 recordsLinked to original sources
PubMed2006

Treatment compliance in different types of group psychotherapy: exploring the effect of age.

This study examined the effect of age on attending and completing different types of group therapy among psychiatric outpatients, and whether cohesion among group members mediates the effect of age on attendance. The sample consisted of 139 outpatients who began short-term interpretive or supportive group psychotherapy. Hierarchical regression analysis and Kaplan-Meier survival analysis were used to test the effect of age on attending and completing therapy. Mediation analysis was used to examine whether cohesion mediated the effect of age. Significant associations between age, session attendance, and termination status were found for patients receiving supportive group therapy. Age was directly related to attending and completing therapy. Quality of the relationships among patients (i.e., cohesion) was found to mediate the effect of age on attendance. Depending of the type of group therapy offered, younger patients may be at risk for poor treatment adherence. Difficulty forming positive relationships with other group members may contribute to this risk.

Adult↗
PubMed2006

Use of the social relations model by group therapists: application and commentary.

This article presents research findings concerning the relationship of patient positive regard to the outcome of time-limited, short-term group therapy for psychiatric outpatients with complicated grief. The Social Relations Model (SOREMO) of David Kenny was used to investigate this relationship. While the patient's ratings of positive regard of others in the group, known as the Perceiver Effect, accounted for the most variation of the patients' ratings, the other patients' rating of the patient's positive regard, known as the Target Effect, was directly related to favorable change. In addition, a simpler method was used to calculate variables that were analogous to the Perceiver Effect and Target Effect variables of the SOREMO. These variables yielded similar outcome findings. Because of limitations and difficulties associated with learning and using the SOREMO, the simpler method represents a more feasible choice for group therapists who are primarily clinicians or group therapists who wish to collect a small amount of data on an ongoing basis. Even experienced group therapy researchers are likely to find the SOREMO program challenging to use.

Adult↗
PubMed2006

Treatment compliance among patients with personality disorders receiving group psychotherapy: what are the roles of interpersonal distress and cohesion?

It is often assumed that patients with personality disorders have worse compliance in psychotherapy (i.e., attend fewer sessions) than patients without personality disorders. Such an assumption can have negative consequences for the treatment of patients with personality disorders. It also denies the presence of variability in session attendance among patients with personality disorders. Research that attempts to identify the factors that are associated with variability in session attendance among patients with personality disorders is needed. The present study examined the role of interpersonal distress as a predictor of session attendance for patients with personality disorders (n = 72) in two different forms of group psychotherapy (interpretive, supportive). The study also investigated whether patients' cohesion to their group mediated the effect of interpersonal distress on attendance. Findings indicated that interpersonal distress had a strong, direct association with attendance in supportive group therapy, but minimal association in interpretive group therapy. High levels of interpersonal distress were associated with higher attendance in supportive therapy. Furthermore, cohesion to the group accounted for about two-thirds of the effect of interpersonal distress on attendance in supportive group therapy, thus providing compelling evidence for its role as a mediator. Possible explanations and clinical implications of these findings are discussed.

Adult↗
PubMed2005

Screening for complicated grief: when less may provide more.

OBJECTIVE: This study aimed to discover screening questions for initial assessments of psychiatric outpatients to identify which patients are likely experiencing complicated grief (CG). METHOD: We examined the responses of 235 outpatients to questionnaire items. One set came from the Texas Revised Inventory of Grief (TRIG). This set represented events cited in clinical literature as indicators or risk factors for CG. Another set came from a factor analysis of items that define CG. We determined relations between items and CG, analyzed sensitivity and specificity, and compared the 2 sets of items. RESULTS: The factor analysis items were superior. The 2 best items correctly identified nearly 90% of patients with and without CG. CONCLUSION: The items can be transformed into screening questions to be used in initial interviews.

Adult↗
PubMed2005

Level of alliance, pattern of alliance, and outcome in short-term group therapy.

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short-term group therapy for complicated grief. Both patient-rated alliance and therapist-rated alliance were studied. For patient-rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist-rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.

Adult↗
PubMed2004

Residual symptoms in depressed patients who successfully respond to short-term psychotherapy.

BACKGROUND: Most investigations of residual symptoms have focused on partial responders to antidepressant medications. Comparatively few have examined residual symptoms among patients who achieved a more successful response to treatment. In addition, few studies have assessed residual symptoms among patients treated with psychotherapy. The purpose of the present study was to assess residual symptoms of depression among psychiatric outpatients who successfully responded to psychotherapy and determine their association with other important clinical outcomes. METHODS: Sixty patients with major depression who participated in a randomized controlled trial of two forms of short-term, individual psychotherapy were studied. We examined the prevalence of residual symptoms among successful responders, as well as the relationships between residual symptoms, pre-therapy patient characteristics, relapse, and other outcomes. RESULTS: Thirty-three (55%) of the 60 patients responded successfully to psychotherapy. Of those, 82% had residual symptoms. Residual symptoms predicted relapse at 6-month follow-up, and were associated with less favorable psychosocial functioning at post-therapy and at 6-month follow-up. LIMITATIONS: The study consisted of post-hoc analyses of existing data, the number of asymptomatic patients was small, and a proxy measure of relapse was used. CONCLUSIONS: Residual symptoms are prevalent among depressed patients who successfully respond to psychotherapy. Greater residual symptoms appear to increase the risk for relapse and are associated with poorer psychosocial functioning.

Adult↗
PubMed2004

Alexithymia as a predictor of residual symptoms in depressed patients who respond to short-term psychotherapy.

Residual symptoms are increasingly becoming recognized as an important problem in the treatment of major depression. It is unclear which individuals are more likely to suffer from residual symptoms following treatment. This study investigated the role of alexithymia in the prediction of residual symptoms following treatment with psychotherapy. The study utilized data from 33 outpatients with major depression who were positive responders to psychotherapy. Alexithymia was assessed prior to treatment using the 20-item Toronto Alexithymia Scale. Depressive and anxious symptomatology were assessed using the Beck Depression Inventory and the Spielberger State-Trait Anxiety Inventory, respectively. Alexithymia factor 1 (difficulty identifying feelings) was predictive of the severity of residual symptoms, over and above the effect of initial levels of depression and anxiety, form of psychotherapy, and use of antidepressant medication. The findings suggest that difficulty identifying feelings may constrain one's ability to effectively utilize psychotherapy, thereby contributing to the persistence of residual symptoms.

Adult↗
PubMed2004

Implications of psychotherapy research for psychotherapy training.

This review article considers implications of psychotherapy research for psychotherapy training. It considers 8 themes that characterize the research literature. The themes involve outcome findings, common factors, empirically supported therapies, patient treatment matches, therapy manuals and practice guidelines, brief therapies, combinations of medication and psychotherapy, and group therapies. Each theme represents a controversial issue that has implications for the content of contemporary psychotherapy curricula. To assist trainees in becoming well-informed therapists, themes and implications such as these should be covered as part of their introduction to learning about the psychotherapies. To understand the themes and implications, as well as new findings that continually emerge from the research literature, trainees also need to be familiar with basic research methods and evaluative criteria, subjects that can also be covered as part of their introduction to the psychotherapies. As their training proceeds, research findings can be integrated with the development of their clinical skills in a broad range of psychotherapies.

Education↗
PubMed2004

Quality of object relations as a moderator of the relationship between pattern of alliance and outcome in short-term individual psychotherapy.

In this study, we investigated the personality variable quality of object relations (QOR) as a moderator of the relationship between the pattern of the therapeutic alliance and treatment outcome in two forms (interpretive, supportive) of short-term individual psychotherapy. In a sample of 72 psychiatric outpatients who completed interpretive therapy, QOR emerged as a moderator for the outcome factor general symptomatology and dysfunction. For high-QOR patients, an increasing level of alliance was directly related to benefit, whereas for low-QOR patients, a decreasing level of alliance was directly related to benefit. An explanation for these findings emphasized the importance of patients repeating their typical pattern of maladaptive interpersonal behavior in the therapy sessions in the context of the therapist working with the transference. In a sample of 72 psychiatric outpatients who completed supportive therapy, QOR did not emerge as a moderator. These findings in combination with evidence from previous studies suggest that QOR should be investigated as a moderator variable in future studies of short-term psychotherapy.

Adolescent↗
PubMed2004

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history.

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.

Alberta↗
PubMed2003

Expression of affect as a mediator of the relationship between quality of object relations and group therapy outcome for patients with complicated grief.

In a recent study, the patient characteristic quality of object relations (QOR) was directly related to favorable outcome (reduction of grief symptoms) among a sample of 53 outpatients with complicated grief who completed treatment in 1 of 8 time-limited, interpretive therapy groups. Recent research literature has suggested that patient affect variables may mediate the relationship between QOR and outcome. In the present study, affect variables were investigated as potential mediating variables using the procedure developed by R. M. Baron and K. A. Kenny (1986). The balance of positive and negative affect expressed in therapy as rated by both patients and therapists emerged as a significant mediating variable. Explanations for how this variable works as a mediating variable and why it facilitates favorable outcome were offered. Clinical implications are also considered.

Adult↗
PubMed2003

The alliance as mediator of expectancy effects in short-term individual therapy.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce, M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed.

Adult↗
PubMed2003

Changes in perceived social support after group therapy for complicated grief.

This study investigated changes in perceived social support after group therapy for patients who developed complicated grief reactions subsequent to a variety of death losses. Sixty-one psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from 3 sources (family, friends, a special person) before treatment onset, after treatment completion, and 6 months after treatment. For patients in both forms of therapy, perceived social support from all 3 sources changed significantly during the follow-up period, but not during the treatment period. Changes (pretherapy to 6-month follow-up) in depressive symptomatology were found to be associated with changes in perceived social support. The results suggest that perceived support improves after, but not during, psychiatric treatment of complicated grief, and that a reduction in depression severity is associated with improvement in perceived social support. Possible explanations and implications of these findings are discussed.

Adult↗
PubMed2003

Differentiating symptoms of complicated grief and depression among psychiatric outpatients.

OBJECTIVE: This study examined whether dimensions of complicated grief (CG) could be distinguished from dimensions of depression and whether these dimensions were differentially affected by group psychotherapy for CG. METHOD: A total of 398 psychiatric outpatients who had experienced one or more significant death losses provided ratings on standard measures of grief and depression. Factor analysis of the 56 items from these measures was used to explore the possibility that grief and depression symptoms would form separate dimensions of distress. Subsamples of the patients also participated in 1 of 2 forms of short-term group therapy for CG. Repeated-measures analysis of variance and calculation of effect sizes were performed to examine changes in the dimensions following treatment. RESULTS: The grief items formed 3 distinct clusters representing different dimensions of CG. None of the depression items loaded highly on these grief dimensions. The depression items formed 2 distinct clusters. Two of the grief dimensions demonstrated the most improvement following group therapy that addressed CG. There was also evidence for differential effectiveness of the 2 forms of group therapy. CONCLUSIONS: When assessing psychiatric patients who have death losses, clinicians should consider different types of grief reactions. Different types of grief reactions may be responsive to different treatments. In the absence of depressive symptoms, clinicians should not assume the absence of CG.

Adult↗
PubMed2003

Relationships among psychological mindedness, alexithymia and outcome in four forms of short-term psychotherapy.

This study explored the relative strength of two patient characteristics, psychological mindedness (PM) and alexithymia, as predictors of psychotherapy outcome. Data were provided by two comparative trials of interpretive versus supportive therapy. One involved short-term group therapy for 107 outpatients with complicated grief. The other involved short-term individual therapy for 144 outpatients of mixed diagnoses. Prior to beginning therapy, patients were assessed for PM using the Psychological Mindedness Assessment Procedure and for alexithymia using the 20-item Toronto Alexithymia Scale. For both trials, the association between PM and alexithymia was small and non-significant. The therapy approach (interpretive vs. supportive) did not differentially affect the relationship between either predictor variable and outcome. There were significant direct relationships between PM and favourable outcome, and between alexithymia and favourable outcome in both trials. There was an additive relationship between PM and alexithymia in predicting outcome. Implications of these results are discussed.

Adjustment Disorders↗
PubMed2003

NEO-five factor personality traits as predictors of response to two forms of group psychotherapy.

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.

Adjustment Disorders↗
PubMed2002

Relationships among affect, work, and outcome in group therapy for patients with complicated grief.

This study examined the relationships among patient affect (experienced and expressed), work, and outcome in two forms of time-limited, short-term group therapy for complicated grief. Work was defined as the degree to which the patient pursued the primary objectives of the two forms of therapy. Substantial evidence of direct relationships between the experience and expression of positive affect and favorable outcome was found. A direct relationship between work and favorable outcome was also found. Additive and interaction effects indicated that the combination of these two types of predictor variables (positive affect, work) had a stronger relationship to favorable outcome than either variable alone. Some evidence was found for an inverse relationship between the experience and expression of negative affect and favorable outcome. The findings were consistent with a social-functional theory of the impact of affect on others during bereavement. Clinical implications of the findings are considered.

Adult↗