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The efficacy of psychodynamic psychotherapy
- AMERICAN PSYCHOLOGIST, 65, 98–109
, 2010
"... Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported ” and “evidence based. ” In addition, patients who receive psychodynamic therapy mai ..."
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Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported ” and “evidence based. ” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling
- Journal of Consulting and Clinical Psychology
, 2010
"... Objective: At present, the most frequently investigated psychosocial intervention for borderline person-ality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was u ..."
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Objective: At present, the most frequently investigated psychosocial intervention for borderline person-ality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was undertaken to find relevant literature from online databases (PubMed, PsycINFO, PsychSpider, Medline). We excluded studies in which patients with diagnoses other than BPD were treated, the treatment did not comprise all components specified in the DBT manual or in the suggestions for inpatient DBT programs, patients failed to be diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, and the intervention group comprised fewer than 10 patients. Using a mixed-effect hierarchical modeling approach, we calculated global effect sizes and effect sizes for suicidal and self-injurious behaviors. Results: Calculations of postintervention global effect sizes were based on 16 studies. Of these, 8 were randomized controlled trials (RCTs), and 8 were neither randomized nor controlled (nRCT). The dropout rate was 27.3 % pre- to posttreatment. A moderate global effect and a moderate effect size for suicidal and self-injurious behaviors were found, when including a moderator for RCTs with borderline-specific treatments. There was no evidence for the influence of other moderators (e.g., quality of studies, setting, duration of intervention). A small impairment was shown from posttreatment to follow-up, including 5 RCTs only. Conclusions: Future research should compare DBT with other active borderline-specific treatments that have also demonstrated their efficacy using several long-term follow-up assessment points.
Dialectical behaviour therapy: Description, research and future directions
- International Journal of Behavioral Consultation and Therapy
"... Dialectical Behaviour Therapy (DBT) is a cognitive behavioural treatment initially developed for adult women with a diagnosis of borderline personality disorder (BPD) and a history of chronic suicidal behaviour (Linehan, 1993a; 1993b). DBT was the first treatment for BPD to demonstrate its efficacy ..."
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Dialectical Behaviour Therapy (DBT) is a cognitive behavioural treatment initially developed for adult women with a diagnosis of borderline personality disorder (BPD) and a history of chronic suicidal behaviour (Linehan, 1993a; 1993b). DBT was the first treatment for BPD to demonstrate its efficacy in a randomised controlled trial (Linehan, Armstrong, Suarez, Allmon & Heard, 1991). Adaptations of the treatment (Dimeff & Koerner, 2007) and further randomised trials followed this initial study. This paper provides an overview of the theoretical and philosophical foundations of DBT and how these inform the major treatment strategies. Next, structural aspects of the treatment are described, and how the treatment structure allows for the adaptation of the treatment to different clinical settings. Finally, the paper reviews research evidence for the efficacy and effectiveness of the treatment and considers future research directions.
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"... Emotional states, crime and violence A Schema Therapy approach to the understanding and treatment of forensic patients with personality disorders Emotional states, crime and violence A Schema Therapy approach to the understanding and treatment of forensic patients with personality dis-orders ..."
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Emotional states, crime and violence A Schema Therapy approach to the understanding and treatment of forensic patients with personality disorders Emotional states, crime and violence A Schema Therapy approach to the understanding and treatment of forensic patients with personality dis-orders
DOI: 10.1177/0003065113507746
"... I appreciate the interest and dedicated study of Siegfried Zepf and Alf Gerlach in their commentary (JAPA 61/4, pp. 771–786) on my paper ..."
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I appreciate the interest and dedicated study of Siegfried Zepf and Alf Gerlach in their commentary (JAPA 61/4, pp. 771–786) on my paper
FOCUS ON ETHICS Ethical Considerations in Treatment of Personality Dysfunction: Using Evidence, Principles, and Clinical Judgment When the Evidence Base Is Scant: Some Considerations in the Ethical Treatment of Personality Dysfunction
"... Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clini ..."
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Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clinicians are faced with several challenges in making treatment decisions that are ethically informed and based on available research findings. Because of the relative dearth of evidence-based treatments for these clients, clinicians are encouraged to use a cost-benefit analysis approach when weighing the benefits versus disadvantages of specific interventions and treatment approaches. Recommendations for effective and ethical treatment of clients with personality dysfunction are provided that are based on an empirically grounded framework. Three expert commentators provide insights into the state-of-the-art of clinical work with these clients.
A Meta-Analysis of Psychodynamic Psychotherapy Outcomes: Evaluating the Effects of Research-Specific Procedures
"... The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, an ..."
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The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychody-namic psychotherapy to enable further elucidation of principles that evidently work.
ABSTRACT THE THERAPEUTIC RELATIONSHIP IN DIALECTICAL BEHAVIOR THERAPY: A
, 2011
"... The quality of the therapeutic alliance in psychotherapy has been found to be positively associated with many treatment outcome variables, such as client retention, client satisfaction in treatment, and improvement in symptoms. While some theorists assume that therapeutic alliance is established ear ..."
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The quality of the therapeutic alliance in psychotherapy has been found to be positively associated with many treatment outcome variables, such as client retention, client satisfaction in treatment, and improvement in symptoms. While some theorists assume that therapeutic alliance is established early in therapy and remains fairly stable across time in treatment, others such as Safran et al. (1990) suggest that the alliance quality fluctuates across time and is likely to be marked by frequent patterns of rupture and repair. In particular, individuals with Borderline Personality Disorder (BPD) have clusters of symptoms and interpersonal styles that are likely to present challenges to the formation and maintenance of a therapeutic alliance. The present study examines characteristics of the therapeutic alliance in Dialectical Behavioral Therapy (DBT), which is a comprehensive form of cognitive behavioral therapy that has received empirical support for the treatment of chronically suicidal and self-harming individuals with Borderline Personality Disorder. Clients in an outpatient DBT program at a community mental health center completed monthly self-report measures of therapeutic alliance quality and psychiatric symptoms
treatment outcome of 18-month, day hospItal mentalIzatIon-based treatment (mbt) In patIents wIth severe borderlIne personalIty dIsorder In the netherlands
, 2012
"... Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As ..."
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Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As to yet it has not been shown whether manualized day hospital MBT would yield similar results when conducted by an independent institute outside the UK. We investigated the applicability and treatment outcome of 18-month, manualized day hospital MBT in the Netherlands by means of a prospective cohort study with 45 Dutch patients with severe BPD and a high degree of comorbid Axis I and Axis II disorders. Outcomes were assessed each six months. Symptom distress, social and interpersonal functioning, and personality pathology and functioning all improved significantly, with effect sizes between 0.7 and 1.7. Suicide attempts, acts of self-harm, and care consumption were also significantly reduced. The results indicate that MBT can effectively be implemented in an independent treatment institute outside the UK. This study also supports the clinical effectiveness of manualized day hospital MBT in patients with severe BPD and a high degree of psychiatric comorbidity.