Focus is key: Panic-focused interpretations are associated with symptomatic improvement in panic-focused psychodynamic psychotherapy

Abstract

By the middle phase of PFPP, panic-focused interpretations may drive subsequent improvements in panic symptoms, especially among patients with higher interpersonal distress. Interpretations of conflict absent a panic focus may not be especially helpful.

In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy.

“…Process work in psychodynamic therapy indicates that focused confrontation interventions (Town, Hardy, McCullough, & Stride, 2012) or interventions attempting to orient patients to their affects (Ulvenes et al, 2014) tend to be associated with greater emotional experiencing on the part of the patient. Preliminary work in this sample suggests that panic-focused interpretations-found to relate to subsequent outcomes in PFPP (Keefe, Solomonov, et al, 2018)-in one segment of treatment may predict higher emotional expression in the next segment of treatment when patients are discussing an attachment relationship (Keefe, Huque, et al, 2018). This research is ongoing.…”

Is the use of interpretations associated with treatment outcome? A systematic review and meta-analytic answer.

“…Other studies (6.3%) assessed the competence with which the therapists used the interpretations (Barber et al, 1996), or the accuracy and quality of the interpretations (Crits-Christoph et al, 1988) (6.3%). The specific perspective of the assessor also varies, with 68.8% focusing on the perspective of an external observer (Barber et al, 1996;Connolly Gibbons et al, 2012;Crits-Christoph et al, 1988;Goldman & Gregory, 2009;Hill et al, 1988;Keefe et al, 2019; S. R. Levy et al, 2015;McCarthy et al, 2016;Milbrath et al, 1999;Piper et al, 1991;Tschuschke et al, 2015), 18.8% on the therapists' perspective (H. Fisher et al, 2020;Hendriksen et al, 2011;Jacobs & Warner, 1981), and 12.5% on the patients' perspective (Bush & Meehan, 2011;Glock et al, 2018). The potential validity of patients' perspectives depends on the extent to which they are capable of recognizing particular technical processes occurring within their psychotherapy (DeFife et al, 2008) and their internal scaling of the extent to which such interpretations were used.…”

“…The perspective of the outcome assessor also varies, with 62.5% focusing on the patients' perspective (Barber et al, 1996;Bush & Meehan, 2011;H. Fisher et al, 2020;Glock et al, 2018;Goldman & Gregory, 2009;Hill et al, 1988;Jacobs & Warner, 1981; S. R. Levy et al, 2015;Milbrath et al, 1999;Tschuschke et al, 2015) and 18.75% on the external diagnostician's (Hendriksen et al, 2011;Keefe et al, 2019;McCarthy et al, 2016). One study used all three perspectives (Crits-Christoph et al, 1988), another used both patients' and therapists' perspectives (Piper et al, 1991), and yet another study used both external raters' and therapists' perspectives (Connolly Gibbons et al, 2012).…”

Wider, faster, more: Re-envisioning the treatment and research of depression to address its public health burden in the United States

“…Some studies suggest the presence of "late responders" in therapies for depression (e.g.,Keefe et al, 2019), this pattern of late response is usually associated with negative prognostic factors (e.g., personality pathology) and worse outcomes than early response, and it is unclear to what extent late response is attributable to treatment effects.4 This research is not conclusive in the sense that most of it has been conducted mostly with cross-sectional and self-report data so it is possible that different patterns of findings could emerge from analyzing more "objective" markers of psychopathology or from studying the dimensional vs. categorical nature of intensive longitudinal data across individuals.…”