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A major challenge in offender therapy is to facilitate clients' emotional engagement, especially with clients who over-regulate their affect. It has been suggested that treatments that focus on improving clients' affect regulation (AR) and deepen client's emotional experience during treatment may enhance treatment outcomes. In this systematic mixed-methods case study the role of Emotion-Focused Therapy (EFT) to change clients' problems with AR during inpatient treatment for individuals who committed sexual offences against children was investigated. It was observed that clients' over-regulation of affect was coupled with a lack of connection to a part of the self that was deemed unacceptable. Over the course of treatment, this hidden part of self that had instigated the misbehaviour became more accepted and integrated. Verbatim clinical vignettes are included to illuminate key interventions, hindrances, and possible mechanisms of change. Quantitative analysis showed significant change in AR based on self-report and observation. The addition of Emotion-Focused Therapy to forensic treatment as usual can increase emotional engagement in clients who are emotionally avoidant. The case study showed transformation of maladaptive shame. Facilitating emotional change led to more acceptance and integration of dissociated parts of self, including needs and desires. [ABSTRACT FROM AUTHOR]

Self-critical perfectionism has been linked to alliance impairments due to patients' distancing attitudes. However, systematic research on therapists' emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients' interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients' superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work. [ABSTRACT FROM AUTHOR]

The Beck Depression Inventory-II (BDI-II) is a frequently used scale for measuring depressive severity. BDI-II data (404 clinical; 695 nonclinical adults) were analyzed by means of confirmatory factor analysis to test whether the factor structure model with a somatic-affective and cognitive component of depression, formulated by Beck and colleagues, has a good fit. We also evaluated 10 alternative models. The fit of Beck's model was not good for all criteria. Three of the alternative models had a better fit in both samples, but none of these met all criteria for good fit. Of the alternatives with a better fit, we selected the only model with unidimensional subscales, which assesses a somatic, affective, and cognitive dimension. For this model, which we recommend, as well as for Beck's original model, a good fitting structure containing 15 and 16 items was developed with an item-deletion algorithm. (Contains 3 tables and 4 figures.)

The most widely used instrument to measure alexithymia is the 20-item Toronto Alexithymia Scale (TAS-20). However, different factor structures have been found in different languages. This study tests six published factor models and metric invariance across clinical and non-clinical samples. It also investigated whether there is a method effect of the negatively keyed items. Second-order models with alexithymia as a higher order factor are tested. Confirmatory factor analyses showed that the original factor model with three factors--difficulty identifying feelings (DIF); difficulty describing feelings (DDF) and externally oriented thinking (EOT)--is the best fitting model. Partial measurement invariance across samples was illustrated but requires further study. A weakness of the model is the low internal consistency of the third factor. Because models with a method factor had a better fit, future reconsideration of the negatively formulated items seems necessary. No evidence was found for the second-order models. (Contains 7 figures and 6 tables.)

In this article, the authors study the factorial structure of 2 versions (64 items and 32 items) of the Dutch translation of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) in both a clinical sample (n = 382) and a student sample (n = 287). First, the authors test whether both inventories are constituted by correlated uni-dimensional subscales, and they conclude that this is true only for the short version. Second, the authors study whether the correlations between the subscales follow a circumplex pattern. This proves to be true for both versions. Coefficients alpha and correlations between the IIP-64 and IIP-32 subscales are discussed.

The evaluation and assessment of outcome is an important issue in psychotherapy research and practice. Since the beginning of empirical research, the effectiveness of treatments has been in the focus of interest to optimise mental health care. Despite this importance, the assessment of outcome by pre‐to‐post comparisons of point measures is hampered by some limitations. These include, amongst others, the predominant use of standard questionnaires neglecting personalised outcome criteria, the focus on point measures that ignore dynamic patterns representing the volatility of mental functioning, memory biases that become important if a recall of longer time periods is urged, and the non‐ergodicity of trajectories of change. Based on new methods of digitalised data collection in the real‐life setting of patients, some conclusions for process and outcome monitoring can be drawn: first, most mental diseases are characterised by specific dynamic patterns (dynamic diseases) whose changes can be assessed by high‐frequency time sampling, for example daily assessments of patients. Second, personal criteria for self‐assessments can be identified by multiperspective case formulations. Third, electronic devices such as smartphones allow for data collection in the real‐world settings of patients, which gives access to experiences in their ecosystems. [ABSTRACT FROM AUTHOR]

Quantified symptom measurement by self-report questionnaires is part of the 'gold standard' of assessing psychotherapeutic efficacy. In this paper, we report a qualitative case comparison to explore how June and Amy, two patient-participants in a gold standard psychotherapy study, experienced the process of quantitative data collection. The study resembles cognitive interviewing studies conducted in the development of measures, yet advances them by investigating patients' experiences of questionnaire administration in actual psychotherapy. Both cases reported known issues in interpretation of pre-structured item- and response formats, communicative administrator-respondent dynamics, and response shifts. Beyond known scoring problems, the act of questionnaire administration changed their interpretation of experienced symptoms, which facilitated clinical change beyond therapeutic effects. For Amy, this change was associated with improvement, but for June, questionnaire administration facilitated deterioration in experienced symptoms. These findings emphasize that it is both epistemically and ethically vital to consider measurement effects in clinical practice. This study demonstrates the importance of taking a qualitative stance in psychotherapy research, as qualitative research can elaborate the contextual and idiosyncratic nature of questionnaire scores, and highlights that both researchers and clinicians have to be attentive to the meaning of scores as words in participants' clinical stories. [ABSTRACT FROM AUTHOR]

The Personal Style Inventory-II (Robins, Ladd, Welkowitz, Blaney, Diaz, & Kutcher, 1994) was constructed to assess sociotropy and autonomy; two personality dimensions associated with increased susceptibility to depression. In the present study, the authors used a confirmatory factor analysis to evaluate the fit of the theoretical model of the Personal Style Inventory-II in a heterogeneous clinical sample (N=266) and in a student sample (N=799); construct validity was evaluated by correlating the Personal Style Inventory-II scales with the scales of the Inventory of Interpersonal Problems-64 and the Symptom Checklist-90-R. Poor fit of the original Personal Style Inventory-II model was observed in both samples. Yet, after progressive elimination of 18 items, a good fit was obtained in the clinical sample and replicated in the student sample. This brief version demonstrated better construct validity than the long version, especially in a depressed clinical sample: sociotropy was associated with nonassertive, overly accommodating, and self-sacrificing interpersonal behaviour, depressive symptoms, phobic complaints, and anxiety and somatic symptoms; autonomy was associated with cold and vindictive interpersonal behaviour, obsessive-compulsive symptoms, and aggressive urges. In contrast to the long version, scores on the shortened version showed the predicted sex differences. DOI 10.2466/PR0.106.2.394-404

Construct validity of the 20-item Toronto Alexithymia Scale (TAS--20) was investigated by analyzing natural language use. It was hypothesized that the TAS--20 should be related to a lower use of emotion words and fewer references to social processes. 32 clinical interviews with mental health outpatients were analyzed with four categories of the computerized Linguistic Inquiry and Word Count dictionary: positive emotions, negative emotions, references to others, and communication words. The Difficulty Identifying Feelings subscale was positively related to negative emotion words, the Difficulty Describing Feelings subscale showed no relevant associations, and the Externally Oriented Thinking subscale was related to reduced use of positive emotion words and social process words. It is concluded that in this sample, the Externally Oriented Thinking subscale provides the best operationalization of the alexithymia construct. DOI 10.2466/PR0.105.3.945-956

This study presents an empirical test of Coyne, Thompson, and Whiffen's statement that the Depressive Experiences Questionnaire does not measure the psychoanalytic constructs it is supposed to measure. Convergence was evaluated between the Depressive Experiences Questionnaire's Dependency and Self-criticism scales and clinicians' ratings on hysterical/anaclitic and obsessional/ introjective personality styles in a sex-balanced sample of 56 Flemish outpatients. In line with expectations from Blatt's research paradigm, convergence was observed between the Dependency scale and ratings on hysterical/anaclitic style in the full sample as well as female and male samples separately; convergence between the Self-criticism scale and ratings on obsessional/introjective style was only observed for men. This study yielded no evidence for divergence of the Depressive Experiences Questionnaire and Blatt's psychoanalytic theory. Research is needed to evaluate the sex-specific validity of these subscales. DOI 10.2466/PR0.105.3.714-720

The present study examined symptom-specificity in depression, testing the hypothesis that affective, cognitive, and somatic dimensions in depressive symptoms, as measured with the Beck Depression Inventory-II, cohere, respectively, with the use of affective-, cognitive-, and somatic-related words in natural language, as measured with the Linguistic Inquiry and Word Count. Based on questionnaire and interview data from 32 mental health outpatients, analyses indicate scores for affective depressive symptoms correlate significantly with affective word use, cognitive depressive symptoms are related to cognitively oriented word use combined with affective word use, and the presence of somatic depressive symptoms correlates significantly with words referring to physical states and functions. These results indicate that different facets of depression have specific correlates and that natural word use serves as a psychological marker. From a psychometric point of view, this study substantiates the concurrent validity of the Linguistic Inquiry and Word Count (LIWC2001) categories under study and the Beck Depression Inventory--II subscales for affective, cognitive, and somatic symptoms.

In both clinical and nonclinical samples, the Depressive Experiences Questionnaire is scored with a program that computes factor scores by using means, standard deviations, and item-loadings of a student sample. The underlying assumption of the use of this program in clinical samples is that factor scores computed on the basis of the student factor solution are similar to factor scores computed on the basis of a clinical factor solution. Consequently, both series of scores should lead up to the same conclusions when studying associations with theoretically related variables. This assumption has not been tested although the questionnaire has been used in research for almost 30 years. In the present paper an alternative scoring program was constructed, based on the factor solution of a clinical sample (N=400) to assess whether scores of this clinical scoring program are associated in the same way with different types of depressive symptoms and interpersonal problems as the scores of the original (student-based) program. Analysis gave results inconsistent with the assumption and did not support the use of the student-based scoring program in the clinical sample. Further, results suggest that standards for assessing factorial similarity used in confirmatory factor analysis might be too lenient.

This study examines whether alexithymia relates to specific interpersonal problems, based on data collected in a sample of mental health outpatients (N = 404) and a student sample (N = 157). Linear regression analysis, in which the effects of group, gender, and age were controlled. indicated that two interpersonal problems were significantly and reliably related to alexithymia: cold/distant and nonassertive social functioning. The theoretical relevance of the results for attachment and psychoanalytic theory is indicated, as well as implications of the findings for clinical practice. Keywords: alexithymia; interpersonal; intersubjective; attachment; psychoanalysis; psychotherapy

In psychotherapy research, treatment efficacy is commonly studied by means of self-report questionnaires to gain quantitative data on symptom development. The data serve as input for statistical analyses up to the level of evidence-based treatment. We analyzed how a patient in a psychotherapy study experienced the translation of her story into quantitative data by combining a phenomenological qualitative analysis of her therapeutic narrative and a visual analysis of her extensively annotated paper-and-pencil questionnaires. Our findings provide a practical empirical illustration of the nature and impact of known validity issues. Beyond, we found the act of questionnaire administration affected the primary complaint such that it became performative toward the symptoms under study. We discuss the epistemic consequences for the validity of data, and we argue that valid data collection requires qualitative scrutiny of meaning within data and a concept of validity that allows for consideration of performativity of data collection. [ABSTRACT FROM AUTHOR]