Predictive Validity of Patient and Therapist Attachment and Introject Styles

Bruck, Elena; Winston, Mark; Aderholt, Sarah; Muran, Christopher

doi:10.1176/appi.psychotherapy.2006.60.4.393

Cited by 49 publications

(70 citation statements)

References 34 publications

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“…Attrition rates were consistent with the literature (Wierzbicki and Pekaric, 1993) as well as other studies at BPRP (Bruck et al, 2006). Table 3 shows the number and percentages of missing data for patients and therapists on the different outcome scales, including amount of missing data due to dropout versus noncompliance.…”

Section: Missing Outcome Datasupporting

confidence: 87%

Impact of Therapist Emotional Intelligence on Psychotherapy

Kaplowitz¹,

Safran²,

Muran³

2011

Journal of Nervous &Amp; Mental Disease

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The concept of emotional intelligence (EI) describes a set of emotional skills that may comprise efficacious therapist variables. The present study is the first to investigate EI among psychotherapists. Based on conceptual overlaps between the EI model and psychotherapy models, as well as a review of empirical evidence from both literatures, we make several predictions of how therapist EI impacts treatment. In a small pilot study, we assessed psychotherapist EI to determine its relation to psychotherapy outcome and process. Therapists with higher ratings of EI achieved better therapist-rated outcome results and lower drop-out rates compared with therapists with lower ratings of EI. Though not hypothesized, higher therapist EI was significantly associated with increased patient assessment compliance. There was no relationship between early working alliance ratings and therapist EI. Findings offer preliminary support for the relevance of therapist EI to psychotherapy.

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Section: Missing Outcome Datasupporting

confidence: 87%

Impact of Therapist Emotional Intelligence on Psychotherapy

Kaplowitz¹,

Safran²,

Muran³

2011

Journal of Nervous &Amp; Mental Disease

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“…Clinically, we remain largely unable to accurately distinguish between patients who will attempt or die by suicide and patients who will not [1,2]. Clinicians’ emotional responses to patients (broadly speaking, their countertransference) have long and increasingly been recognized as an important factor in treatment outcome [3,4], however they have received relatively little attention in the literature on suicidal patients. Rather, current research on acute suicide prediction has focused largely on warning signs that are patient-dependent, such as precipitating events [5-9], behavior changes [10,11], or intense affective states [12-19].…”

Section: Introductionmentioning

confidence: 99%

“…These retrospective clinical studies have focused almost exclusively on countertransference hate and/or negative countertransference in general, finding feelings of anxiety and hostility as those most prominently elicited by suicidal patients [34,36]. The studies share a common conclusion that emotional responses must be recognized and acknowledged, and present evidence that the management of the clinicians’ emotional response is correlated with therapeutic outcome [3,22,37]. Quantifying clinicians’ emotional responses may thus potentially enhance suicide risk assessment.…”

Section: Introductionmentioning

confidence: 99%

Distinctive emotional responses of clinicians to suicide-attempting patients - a comparative study

et al. 2013

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BackgroundClinician responses to patients have been recognized as an important factor in treatment outcome. Clinician responses to suicidal patients have received little attention in the literature however, and no quantitative studies have been published. Further, although patients with high versus low lethality suicidal behaviors have been speculated to represent two distinct populations, clinicians’ emotional responses to them have not been examined.MethodsClinicians’ responses to their patients when last seeing them prior to patients’ suicide attempt or death were assessed retrospectively with the Therapist Response/Countertransference Questionnaire, administered anonymously via an Internet survey service. Scores on individual items and subscale scores were compared between groups, and linear discriminant analysis was applied to determine the combination of items that best discriminated between groups.ResultsClinicians reported on patients who completed suicide, made high-lethality attempts, low-lethality attempts, or died unexpected non-suicidal deaths in a total of 82 cases. We found that clinicians treating imminently suicidal patients had less positive feelings towards these patients than for non-suicidal patients, but had higher hopes for their treatment, while finding themselves notably more overwhelmed, distressed by, and to some degree avoidant of them. Further, we found that the specific paradoxical combination of hopefulness and distress/avoidance was a significant discriminator between suicidal patients and those who died unexpected non-suicidal deaths with 90% sensitivity and 56% specificity. In addition, we identified one questionnaire item that discriminated significantly between high- and low-lethality suicide patients.ConclusionsClinicians’ emotional responses to patients at risk versus not at risk for imminent suicide attempt may be distinct in ways consistent with responses theorized by Maltsberger and Buie in 1974. Prospective replication is needed to confirm these results, however. Our findings demonstrate the feasibility of using quantitative self-report methodologies for investigation of the relationship between clinicians’ emotional responses to suicidal patients and suicide risk.

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“…Indeed, patients working with case managers with more deactivating strategies have a stronger working alliance with clients with less deactivating strategies (Tyrell, Dozier, Teague, & Fallot, 1999). This finding was reproduced by Bruck et al who found that the greater the difference in attachment style between patient and therapist, the better the therapeutic outcome (Bruck, Arnold, Aderhold, & Muran, 2006).…”

Section: Information Regarding Relationshipsmentioning

confidence: 61%

Attachment in the Psychiatric Curriculum

Katzman

Fabbro

2017

Psychodynamic Psychiatry

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Psychiatric trainees are expected to learn the fundamental concepts of psychodynamic psychotherapy, but they often struggle to understand and appreciate the relevance of this work. An introduction to attachment theory can go a long way toward assisting our trainees in understanding the relevance of psychodynamic psychiatry. To help programs develop this component of their curriculum, we summarize the history of the development of the attachment paradigm including the Strange Situation and Adult Attachment Interview (AAI), useful tools to teach these concepts, as well as ramifications of this work. We provide a summary of information regarding the evidence base connected to this paradigm, potential clinical relevance, health implications, work from neuroscience, and infant intervention models to assist in bringing psychodynamic concepts to life. Exposure to the attachment paradigm provides a model of intervention, prevention, and hope for our trainees as they transition from learning phenomenologic models of psychiatric diagnostics to other paradigms of human development and intervention.

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Predictive Validity of Patient and Therapist Attachment and Introject Styles

Cited by 49 publications

References 34 publications

Impact of Therapist Emotional Intelligence on Psychotherapy

Impact of Therapist Emotional Intelligence on Psychotherapy

Distinctive emotional responses of clinicians to suicide-attempting patients - a comparative study

Attachment in the Psychiatric Curriculum

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