Biomedical subjects

William E Piper

Publications and source records attributed to William E Piper.

25 records · Page 2Linked to original sources

PubMed2002

A test of the phase model of psychotherapy change.

OBJECTIVE: A comparative trial of 2 forms (interpretive and supportive) of short-term, time-limited individual (STI) therapy provided data that were used to test the propositions of the Howard and others phase model of psychotherapy change. METHOD: Patients completed the Integra Outpatient Tracking Assessment Form on 5 occasions during the 20-session treatments. The measure assesses 3 dimensions: subjective well-being, current symptoms, and current life dysfunction. Howard and others regard these as dimensions that represent successive phases in the therapy change process (that is, well-being improves first, followed by resolution of symptoms, and finally by change in long-standing life dysfunction). We conducted a test of their model, using their approach to data analysis. RESULTS: The comparative trial data provided no support for the phase model. CONCLUSIONS: Possible explanations for the absence of confirmatory findings are considered.

Adaptation, Psychological↗

PubMed2002

Cohesion and outcome in short-term psychodynamic groups for complicated grief.

This study used two measures of cohesion for the process analysis of 12 short-term, time-limited groups for complicated grief. The measures had similar theoretical definitions but differed in terms of rater source (member vs. observer), measurement score (mean of items vs. global rating), and rating unit (individual vs. group). We examined the relationship between the measures, assessed the development of cohesion over the life of the group, and evaluated each measure's relationship to outcome. A principal components analysis with each measure yielded one cohesion component, which supported a unidimensional model; however, the two cohesion components were independent of each other, which supported a multidimensional model. Repeated measures analyses indicated that observer-rated cohesion developed in a quadratic manner (v pattern) across sessions, while member-rated cohesion developed in a linear manner. The object focus (the group, other members, the therapist) of the members' ratings determined whether cohesion increased or decreased across sessions. No significant relationships between cohesion and outcome were identified. Implications of the findings for the understanding of group cohesion are considered.

Adjustment Disorders↗

PubMed2002

Interpersonal predictors of group therapy outcome for complicated grief.

This study investigated three aspects of patients' interpersonal functioning as predictors of outcome for two forms of group psychotherapy for complicated grief. Patients presented with a variety of death losses and met criteria for complicated grief. The three aspects of interpersonal functioning were the patient's (1) attachment to the lost person, (2) quality of object relations (QOR), and (3) level of recent social role functioning. A more secure attachment to the lost person and better social role functioning were associated with more favorable outcome in both forms of therapy. In addition, patients with higher QOR had more favorable outcome in interpretive therapy while lower QOR patients had more favorable outcome in supportive therapy. The results suggest that each aspect of interpersonal functioning is important to consider when treating patients for complicated grief.

Adjustment Disorders↗

PubMed2002

Social support as a predictor of response to group therapy for complicated grief.

This study investigated the effect of perceived social support on the outcome of group therapy for patients who experienced complicated grief following a variety of death losses. One hundred and seven psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from three sources (family, friends, and a special person) prior to treatment onset. For patients in both forms of therapy, perceived social support from friends was directly associated with favorable treatment outcome. In contrast, perceived social support from family was inversely related to outcome for patients in both forms of therapy. Perceived social support from a special person was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but unrelated for those in supportive therapy. The results highlight the importance of assessing the level of support patients perceive from their social networks. The findings also suggest that the effect of perceived social support may also depend on the source of the support. Possible explanations and clinical implications of these findings are discussed.

Adjustment Disorders↗

PubMedDate not supplied

The negative effect of alexithymia on the outcome of group therapy for complicated grief: what role might the therapist play?

Alexithymia is a patient characteristic that reflects deficits in the cognitive processing and regulation of emotions. It is generally considered to have an adverse effect on the outcome of psychotherapy. Little is known about the processes through which alexithymia exerts this effect. One proposed mechanism suggests that patients with alexithymia trigger negative therapist reactions that contribute to poor outcome for such patients. This study examined whether therapist reactions to a patient mediate the relationship between alexithymia and outcome in group psychotherapy for complicated grief. Alexithymia was assessed with the Toronto Alexithymia Scale-20. Therapist reactions to a patient, reflecting the therapist's perceptions of a patient's positive qualities, personal compatibility, and significance as a group member, were assessed with a cohesion questionnaire. Outcome in several areas of functioning was measured. We found that alexithymia (specifically, greater difficulty in communicating feelings and greater tendency to engage in externally oriented thinking) was associated with less favorable outcome and that this relationship was mediated by therapist reactions to a patient. The mediation provided by therapist reactions to a patient accounted for approximately one third to one half of the direct effect of alexithymia on psychotherapy outcome. This suggests that therapist reactions to a patient represent a major mechanism through which alexithymia exerts its effect.

Adult↗

PubMedDate not supplied

Strategies for reducing patient-initiated premature termination of psychotherapy.

Rates of patient-initiated premature termination in different forms of psychotherapy are consistently high. Patient-initiated premature termination is recognized as a significant obstacle to the effective and efficient use of psychotherapy. The literature describes many strategies for preventing premature termination, but lacks integration. This review attempts to provide a concise and comprehensive summary of the strategies that research or clinical experience have suggested may be useful for minimizing patient-initiated premature termination. A search was conducted on the MEDLINE, PsycINFO, and EMBASE databases for literature published between January 1970 and March 2004. Retrieved articles were published in English in peer-reviewed journals and focused on psychotherapy for adults. Thirty-nine publications that discussed strategies for preventing or reducing patient-initiated premature termination of psychotherapy were identified. Surprisingly, only 15 of these were research studies. Most of the retrieved literature consisted of clinical descriptions. The strategies can be assigned to nine categories: pretherapy preparation, patient selection, time-limited or short-term contracts, treatment negotiation, case management, appointment reminders, motivation enhancement, facilitation of a therapeutic alliance, and facilitation of affect expression. Research supports some of the strategies for reducing premature termination. However, methodologically sound studies of prevention strategies remain few in number.

Humans↗

PubMedDate not supplied

Preventing postnatal depression: a review of research findings.

Postnatal depression is a major source of morbidity among women who have recently delivered a child. Considering its high prevalence and serious negative consequences, prevention should be a high priority. A comprehensive synthesis of current knowledge of prevention strategies is important for clinical practice and future research. Searches of MEDLINE and PsychINFO were performed to identify English-language articles of randomized, controlled trials published from 1990 to 2003 focusing on primary prevention of postnatal depression in both the general and high-risk populations. Nineteen studies meeting these criteria were identified. The main findings and limitations of each study are documented. While the results are mixed, several of the studies provide support for the role of midwife intervention for pregnant and postnatal women. There are also some data that support the efficacy of brief psychotherapy in primary prevention. Unfortunately, many of the studies suffer from shortcomings that may limit their generalizability. Data is also lacking on biological interventions. Directions for future research are discussed, and general recommendations for prevention of postnatal depression in clinical practice are made. The findings of this review indicate that despite the relatively brief history of work in this area, progress is being made in identifying possible prevention interventions.

Adult↗