Program and Abstracts · 2007 Australia Regional Group Meeting: Society for Psychotherapy Research 2 1.00 Paper sessions [Howard Room] James Loughead1, Lester Luborsky2, Carol Popp2,

2007 Australia Regional Group Meeting: Society for Psychotherapy Research 1

2007 Australia Regional Group Meeting of the Society for Psychotherapy Research

Thursday 6th - Friday 7th December

Program and Abstracts

Thursday 6th December

10am Registration opens 11am Welcome - Conference organizers [Howard Room] Keynote address : Professor Mike Startup, School of Psychology University of

Newcastle, "Therapist treatment adherence to, and client drop-out from, cognitive behaviour therapy for acute psychosis"

12.00 Lunch and Poster Session Posters will be previewed by a 2 minute oral summary by each presenter commencing 12.30

Posters Alicia M. Moxon, Kevin R. Ronan Massey University, Central Queensland University, "Providing

Information to Relatives and Patients about Expressed Emotion and Schizophrenia in a Community Support Setting: A Randomized, Controlled Trial"

Louise Hanson and Robert Schweitzer, Queensland University of Technology, "Understanding Generalized Anxiety from a Psychodynamic Perspective: The Relationship between Attachment Style, Interpersonal Relationships, and Defense Style in the Outcome of Supportive Expressive Group Therapy".

Dianne Lees, Kevin R. Ronan, Child and Adolescent Mental Health Service (CAMHS) Tauranga (NZ), Central Queensland University, "Engagement and Effectiveness of Parent Management Training for Solo High Risk Mothers: A Multiple Baseline Evaluation"

Andreas Comninos & Brin Grenyer, School of Psychology, University of Wollongong. Illawarra Institute of Mental Health, "Optimising Treatment Response for Depressive Disorders: A Clinical Model"

Nicola M. Curtis, Kevin R. Ronan, Naamith Heiblum, Kylie Crelin, Massey University, Department of Behavioural and Social Sciences Central Queensland University, MST Services, Department of Behavioural and Social Sciences Central Queensland University, "Initial Dissemination and Effectiveness of Multisystemetic Treatment in New Zealand: A Benchmarking Study"

Peter J. Kelly, Frank P. Deane, Illawarra Institute for Mental Health University of Wollongong, "Does therapeutic homework improve outcomes for individuals diagnosed with severe mental illness?"

Geoff Lyons, Nadia Crittenden, School of Psychology University of Wollongong. "Examining depressive symptoms, motivational changes and the role of mindfulness in exercise."

Robyn D. Girling-Butcher, Kevin R. Ronan, Massey University Central Queensland University, "Cognitive-Behavioural Therapy for Children with Anxiety Disorders: Evaluation of a Brief Program Reflecting Usual Practice Duration"

Kylie Crellin, Kevin R. Ronan, Kirsten McMurray, Central Queensland University, Central Queensland University, Massey University, "Meta-Analysis of Childhood Anxiety Treatments: Methodological Advancements in an Evaluation of Overall Effectiveness"

Margaret Carley1, Leigh McCullough2, 1Private Practice Cambridge USA, 2Harvard Medial School, "Validation of Affect and Defence Rating Scales"


1.00 Paper sessions

[Howard Room] James Loughead1, Lester Luborsky2, Carol Popp2, Ramaris German2, Daniel Kirk2, Beth

Krause3, Ruben Gur1 , 1Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania; 2Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania; 3Department of Psychology, Social and Health Sciences, Duke University, "Brain Activation During Relationship Narratives: A Core Conflictual Relationship Theme Approach"

Lisa M. Parker and Brin F. S. Grenyer, University of Wollongong School of Psychology, "Measurement of Relationship Patterns in long-term Psychotherapy using the Core Conflictual Theme – Leizig/Ulm method"

Judy Hyde, Macquarie University/University of Sydney, "Fragile narcissists or the guilty good: What drives the personality of the psychotherapist?"

Jeff Ward and Tegan Cruwys, School of Psychology, Australian National University, "Imagining Otherwise: Empathy in everyday life and psychotherapy"

Robert Schweitzer, Banham, J., Birtles, B., and Vromans, L., Bambling, M., Queensland University of Technology. "For Better or Worse: Treatment Trajectories and Outcomes in a Training Psychology Clinic"

[Grawe Room] Margot Schofield and Jan Grant, La Trobe University and Psychotherapy and Counselling

Federation of Australia & Curtin University, "Supervisor and supervisee perspectives on supervision: methodologies to illuminate the learning experience"

Shannon Lightfoot, University of New England, Armidale, "A client’s experience of ‘unsafety in the presence of another’: A relational dilemma in psychotherapy"

Maria Quinn, La Trobe University, Melbourne, Australia, "Therapist’s experience of the treatment of non epileptic seizures. Preliminary findings of a qualitative study"

Deborah Sauvage, Griffith University School of Human Services, "Could Email-Facilitated Qualitative Methodology Ever Be Safe Enough When Researching Harm from the Psychotherapeutic relationship?"

Denise Charman, Victoria University, "Being an Effective Psychotherapist: A Selected Review of Empirical Findings"

3.30pm Afternoon tea 4.00 Special Presentation [Howard Room]

Godfrey T Barrett-Lennard, Honorary Fellow in Psychology, Murdoch University, WA, "Psychotherapy as the healing of relationship: Theory, practice and inquiry in focus"

4.30 Workshop sessions

[Howard Room] Sherwood Waldron, New York Psychoanalytic Society and Institute "Evaluating benefits from

long-term dynamic treatment" [Grawe Room] Sally Brooks1,2, Judy Leung1, 1Gestalt Practitioners Training Sydney & 2Macquarie University, "A

Lived Research Methodology – Phenomenological, Heuristic Enquiry" 6pm Evening - Meet for Drinks at Wollongong Beach (Five Islands Brewery)

Note: there is no formal conference dinner


Friday 7th December 9am Paper sessions

[Howard Room] Carla J. Walton, Nick R. Bendit, Stella C. Dyer, Leslie R. Pollock & Christopher H. Willcox,

Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Brain and Mental Health Research, "Comparing Dialectical Behaviour Therapy and the Conversational Model in the treatment of Borderline Personality Disorder: A pilot study"

Andreas Comninos & Brin Grenyer, School of Psychology, University of Wollongong. Illawarra Institute of Mental Health, "A rapid response to psychotherapy for depression: A qualitative and quantitative analysis of therapy process"

Juanita Kolaric and Jeff Ward, Australian National University, "The development of a procedure for using the reflective functioning scales to code psychotherapy sessions".

[Grawe Room] Denise Charman, Victoria University, "Psychotherapy Research and the Social Model of Health:

A Perspective on Evidence Based Practice" Rhonda Gibson Long & Trevor Crowe, Sydney Gestalt Institute & Illawarra Institute for Mental

Health, "An exploration of ‘real relationship’ in Gestalt Therapy dreamwork" Sally Brooks1 and Linsey Howie2, 1Neridah Practice, Chatswood, Clinical Member Gestalt

Practitioners Training Sydney, Faculty Member Gestalt Australia and New Zealand, and Macquarie University, 2La Trobe University, School of Occupational Therapy, "Therapist-as-Researcher: Applying Phenomenological, heuristic enquiry to investigate the Gestalt therapeutic relationship"

10.30 Morning tea 11am Introduction to keynote : conference organizers [Howard Room] Keynote address : Professor Jacques Barber "The impact of the therapist, the client,

the therapeutic alliance and techniques on outcome" 12.00 Lunch and SPR Australia Area Group Business Meeting. Presentation of

Student Travel Scholarships and Best Conference Presentation Award [Howard Room] 1.30 Workshop sessions

[Howard Room] Margaret Carley, Private Practice Cambridge USA, "Measuring emotion in psychotherapy

process research" [Grawe Room] Margot Schofield, Andrew Bickerdike, Dubravko Jurkovic, Iva Jurkovic, Department of

Counselling and Psychological Health La Trobe University, Psychotherapy and Counselling Federation of Australia, Relationships Australia, "Evaluation of Couple Counselling: Issues and Challenges"

3pm Afternoon tea 3.30 Workshop sessions

[Howard Room] Caroline Henderson-Brooks, David Butt, Alison Moore, Macquarie University, "Exploring

language as evidence of change" [Grawe Room] Janine Brophy-Dixon, La Trobe University Bundoora Melbourne, "Creating links when threads

are broken: connecting and communicating through postcard art" 5pm Close


Abstracts Abstracts are alphabetical A-Z by first author surname. Index of first authors: Barber - Barrett-Lennard - Brooks - Brophy-Dixon - Carley - Charman - Comninos - Crellin - Curtis - Girling-Butcher - Hanson - Henderson-Brooks - Hyde - Jurkovic - Kelly - Kolaric - Lees - Lightfoot - Long - Loughead - Lyons - Moxon - Parker - Quinn - Sauvage - Schofield - Schweitzer - Startup - Waldron - Walton - Ward Barber Title: The impact of the therapist, the client, the therapeutic alliance and techniques on outcome Author: Jacques Barber, PhD Institution/Affiliation: Professor, Centre for Psychotherapy Research, University of Pennsylvania USA Email: [email protected] Abstract: This presentation will cover methodological issues and recent findings coming out of the research of the impact of the therapeutic alliance and techniques on patients' outcome. I will address the lack of attention paid to three issues when studying the contribution of the therapeutic alliance to outcome: 1) the lack of attention paid to the temporal sequence of the assessment of the alliance and outcome. 2) the lack of attention to the importance of examining the role of therapeutic interventions when studying the impact of alliance on outcome. 3) the lack of attention to the relative contribution of the therapist and the clients to the relation between alliance, techniques and outcome. Data addressing some of these issues in different forms of intervention will be presented. Barrett-Lennard Title: Psychotherapy as the healing of relationship: Theory, practice and inquiry in focus Author: Godfrey T Barrett-Lennard, PhD Institution/affiliations: Honorary Fellow in Psychology, Murdoch University, WA Email address of presenting author: [email protected] Abstract: Traditionally, psychotherapy has focused on conflict, dysfunctional processing of experience or other difficulties within the self or personality. This paper develops the thesis that therapy is or can be centrally about the healing of relationship: relations within the self, in personal microrelationships (family and other) and, potentially, with small groups and larger systems. Fresh search into the basic nature of human relationship, has led through and beyond a familiar bridging or exchange notion implying that individual participants, each moved by their own needs, remain the causative players. Largely replacing this idea is the view that relationships are emergent process entities, having life and influence in their own right. Persons are seen as interdependent relational beings incubated in relationships and always journeying in and among them. Psychotherapy entails a particular class of ‘service’ relationship in which the therapist (T) mostly is presumed to have pivotal agency in the change process. Here, the case is made that each emergent therapy relationship is a unique We/Us partnership system. T and C each trigger the other in a complex systemic process. As example, C’s sharing evokes helpful responsiveness on T’s part, this in turn fostering increased expressiveness by C that then permits a more deeply empathic and releasing response by T, etc. A particular long-term therapy case is closely described, with features and implications informed by and enriching the perspective advanced. Finally, a number of specific implications and proposals for lines of pertinent research are enumerated — which further illustrate the relational emphasis. Psychotherapy is always an interactive-relational and exploratory process that is naturally influenced (via C and T) by its context and interaction with concurrent life relationships. The conception of therapeutic change as relationship healing offers a breadth of practice and inquiry, and a realism of process with highly responsive attention to experience and process in life relationships. Brooks Title: Therapist-as-Researcher: Applying phenomenological, heuristic enquiry to investigate the Gestalt therapeutic relationship Authors: 1st Author/Presenter: Sally Brooks, B.Ed (Hons); MGT, 2nd Author: Linsey Howie, PhD, MA, BA, DipOT Institution/Affiliations: 1st Author/Presenter: Sally Brooks, Neridah Practice, Chatswood; Faculty Member Gestalt Practitioners Training Sydney; Clinical Member Gestalt Australia & New Zealand (GANZ). 2nd Author: School Occupational Therapy, La Trobe University Vic 3068, Australia Email address: [email protected] Abstract: Phenomenological psychological research relies on individuals’ descriptions of, and meanings attributed to phenomena. It does not impose an interpretive framework to understand and analyse experience. To this end, phenomenological research reflects the same epistemology as Gestalt theory and practice and is highly compatible as a research method within the framework of Gestalt methodology. However, while all


phenomenological research may require two or more co-researchers, heuristic enquiry can be both applied to and effective as a form of autobiographical investigation. Drawing from the presenter’s research study into the spoken language of the Gestalt therapeutic relationship, the aims of this paper will be to: 1. Illustrate the philosophy and methods involved in phenomenological heuristic enquiry 2. Describe the clear and defined stages involved in using this methodology, drawing examples from the presenter’s own research thesis 3. Articulate the results of the presenter’s research in the form of an individual depiction which creatively reveals and captures the essence of the phenomenon under study. In a clinical field that is increasingly demanding evidence based practice, heuristic enquiry leads to research outcomes, which is borne out by the rigour and discipline required of any qualitative research method; it also supports the Gestalt practitioner in a constant process of self-awareness and professional and personal development. Brooks Title: A Lived Research Methodology – Phenomenological, Heuristic Enquiry Authors: Sally Brooks B.Ed(Hons), MGT, CMGANZ, Judy Leung PsyD, MAPs Insitution/Affiliations: Gestalt Practitioners Training Sydney Email: [email protected]; [email protected] Abstract: Phenomenological, heuristic enquiry is a form of investigation beginning with a question in the mind of the researcher; it is often a question that has endured for the researcher based on life experiences through the quest to understand oneself and one’s world. Unlike quantitative research the subjective experiences of research participants (including that of the researcher) is privileged and explored without any form of bracketing. Whatever the question, it is essential for the researcher and participants to be prepared to immerse themselves fully in the phenomenon. While heuristic enquiry is essentially autobiographic, with every question there is usually a social or maybe universal significance that applies to the human condition. In this workshop, the facilitators will guide participants through some of the stages of a heuristic process culminating in the development of a creative depiction that captures the essence of the experience. When applied sensitively and ethically, heuristic study can offer the opportunity for exploration and deepened understanding of both clinically presenting issues such as depression and anxiety as well as the immediate experience of the actual qualities of the therapeutic relationship. The aims of the workshop are: 1. To illustrate the potential for heuristic research as a tool for deepening understanding of individual therapeutic relationships and as a contribution to evidence based therapeutic practice on a broader scale. 2. For participants to dynamically experience the different stages of a heuristic enquiry. 3. To stimulate participants’ own thought processes with regard to how heuristic enquiry might be utilised more expansively. Brophy-Dixon Title: Creating links when threads are broken: connecting and communicating through postcard art. Author: Janine Brophy-Dixon Institution: La Trobe University Bundoora Melbourne Email Address: [email protected] Abstract: This workshop will explore incorporating postcard art as an innovative technique in group work and individual psychotherapy practice. As Rubin (1999) suggests to art therapists, ‘…there are many different ways of using art as a therapeutic modality. The specific approach chosen depends upon the goals of the particular intervention, the context in which it occurs, and the range of what is possible’ (p. 209). The presenter has developed this method as a beneficial tool predominately with clients who are experiencing dislocation and separation particularly separation from significant others. For example people who are incarcerated, hospitalized, in drug and alcohol residential rehabilitation, in military service, on student exchange programs and refugees. ‘Images provide people with a means to communicate on a deep level with one another’ (Allen, 1995, p. 198). This concept provides a form of visual communication: a link to significant others. Malchiodi (1998) when referring to the work of art therapists claims, ‘…the creative process inevitably involves taking risks, breaking boundaries, pushing limits and inventing new ideas’ (p. 69). Workshop participants will create postcards and thus gain a possible insight into the benefits of this technique and the connections between postcard art and feelings of dislocation, separation, loss, communication, connection and re-connection. McNiff (1998) supports art therapists undertaking experiential work, ‘… as ways of understanding the significance of what we do within our practice’ (p. 13). Further to this he adds, ‘we will benefit from experimental activities … beginning with our own direct involvement with the different aspects of the art experience’ (p. 204). The concept of postcard art making as a component of art psychotherapy has been utilized extensively by the presenter both in her practice as an art therapist and in her present PhD research. References Allen, P.B. (1995). Art is a Way of Knowing. Boston: Shambhala. Malchiodi, C. (1998). The Art Therapy Sourcebook. Los Angeles: Lowell House. McNiff, S. (1998). Art-Based Research. London and Philadelphia: Jessica Kingsley. Rubin, J.A. (1999). Art Therapy: An Introduction. Philadelphia; Brunner/Mazel.


Carley Title: Validation of Affect and Defense Rating Scales Authors, Affiliations: Margaret Carley, Ph.D., private practice, Cambridge, MA; Leigh McCullough, Ph.D., Harvard Medical School, Boston, MA Email: [email protected] Abstract: The precise ways that emotion and its inhibition operate in psychotherapeutic change are not yet clearly understood. Psychotherapy research has been hampered by the absence of instruments designed to measure the within-session operation of these factors. Moreover, while psychotherapy researchers regularly present evidence of interrater reliability for their instruments, evidence of the validity of these measures is often ignored. This study addressed this issue by examining construct validity of McCullough’s Affective Exposure Scale (AES) and Defensiveness Scale (DEF). Ten-minute segments of 30 videotaped psychotherapy treatments were coded with these instruments, as well as Klein’s Experiencing Scale (EXP) and Perry’s Defense Mechanism Rating Scale (DMRS). Data collected with all four instruments were compared. Results support convergent validity of AES and DEF. Carley Title: Measuring emotion in psychotherapy process research Authors: Margaret Carley, Ph.D. Institution/Affiliations: Private practice, Cambridge, Massachusetts USA Email address of presenting author: [email protected] Abstract: While decades of outcome studies now assure us that psychotherapy can be effective, our knowledge of how or why it is effective is less clear. Psychotherapy process research focuses primarily on within-session action rather than post-treatment outcome. Process research is designed to capture information about the behaviors that occur during psychotherapy sessions in order to explore mechanisms of action in therapeutic change. Affective engagement -- or the opportunity for emotional expression – has been identified in both theory and research as one factor commonly associated with therapeutic change. This workshop will present a brief overview of methodological issues related to measuring emotion in process research, and will offer a hands-on practice session using two research instruments, the Affective Exposure Scale (McCullough et. Al), and the Experiencing Scale (Klein et. al, 1986). Participants will learn about methodological issues generally related to psychotherapy process research as well as special issues related to studying within-session emotional processes. Participants will also benefit from an interactive, hands-on introduction to two instruments used to measure emotional processes in psychotherapy research. Klein, M. H., Mathieu-Coughlan, P. & Kiesler, D.J. (1986). The experiencing scales. In: L. S. Greenberg & W. M. Pinsof (Eds.). The psychotherapeutic process: A research handbook (pp. 21-71). New York: Guilford Press. McCullough, L. M., Larsen, A., Schanche, E. Andrews, S., Kuhn, N., et al. (2004). Achievement of therapeutic objectives scale. Unpublished manuscript. Charman Title: Psychotherapy Research and the Social Model of Health: A perspective on evidence-based practice Author: Denise Charman Institution/Affiliation: Victoria University, Melbourne, Australia Email address: [email protected] Abstract: Endeavours to establish and practice psychological treatments—counselling and psychotherapy--from an evidence base has been preoccupying researchers and practitioners alike. This paper will not enter into the debate about which treatment is evidence based or not. Nor will it enter the debate about which research designs constitute quality evidence. Instead this paper will argue that the questions about treatment effectiveness should be turned around to ask questions about what kind of patients are presenting for psychological treatments, which patients accept those treatments and which patients drop out after the commencement of treatment. It draws upon evidence as it is available, including the findings in Cochrane reviews. Evidence is also considered for their findings in relation to engaging and retaining patients in [medical] treatments. The relevance for providing psychological treatments for the patient with more complex needs and mental disorders are canvassed. Charman Title: Being an effective psychotherapist: A selected review of empirical findings Author: Denise Charman Institution/Affiliation: Victoria University, Melbourne, Australia Email address: [email protected] Abstract: A central assumption of empirically validated treatments (EVTs) is that if treatments are tightly prescribed and efficacious, patient outcomes will effectively be enhanced. However, these EVTs are delivered in the real world by therapists, with their own personas, clinical judgment, and wisdom. Research has found the process of treatment delivery to be as much and more important than the treatments. Interpersonal process has been directly linked to therapy outcomes and also backwards to therapists early parental relationships, confirming clinical wisdom. It is important to be able to identify effective processes. However, there are many difficulties in this endeavour. Operationally defining effectiveness is problematic and ambiguous. Effectiveness is not reliable if based on peer judgement or even supervisors. However, we do not know what peers do think about what constitutes an effective psychotherapist. A small study was undertaken (n=15) of experienced psychodynamic


psychotherapists who identified personal and interpersonal qualities associated with effective therapists. The evidence was reviewed to determine whether these beliefs were substantiated. It appears likely that poor effectiveness may be associated with poor personal qualities (for example, active hostility) and high effectiveness associated with good interpersonal qualities. There are implications for identifying necessary and sufficient qualities as these do not appear to be modified by current training methods. Comninos Title: Optimising Treatment Response for Depressive Disorders: A Clinical Model Authors: Comninos, A., & Grenyer, B. F. S Institution/Affiliations: School of Psychology, University of Wollongong. Illawarra Institute of Mental Health. Email address of presenting author: [email protected] Abstract: It has recently been established that certain clients respond remarkably well to psychotherapy, experiencing most of their treatment gains within the first 6 sessions, while others (who respond more gradually), require up to 20 sessions to achieve the same results. This phenomenon has been found to occur in adolescent and adult populations, across a range of empirically supported psychotherapies. Yet, researchers remain unable to explain why this phenomenon occurs. Aims: This study examines the preconditions of an early response to weekly psychotherapy for depression, in 62 adults. One third (n=23) experienced an early response (ERR), defined as a reduction of at least 50% of their intake Beck Depression Inventory score by week 6. ERR patients were 5 times more likely to recover. Pre-therapy characteristics of non-ERR patients included having lower interpersonal mastery, a more domineering interpersonal style, and greater social isolation and attachment fears concerning intimacy. As a whole, these findings suggest ERR / non-ERR patients present with dissimilar interpersonal patterns, requiring different psychotherapeutic approaches. Method: To add support to this explanation, therapy transcripts of patients’ treatment sessions were rated with the Psychotherapy Process Q-Set (PQS; Jones, 2000). The PQS is a method of systematically characterising therapist-patient interactions. Preliminary PQS data from 18 patients (9 ERR, 9 non-ERR) are presented. Outcomes: Results suggest that interpersonal differences between ERR / non-ERR patients are reflected in psychotherapy process, and this will provide a platform for tailoring future therapy to cases where it is failing. Comninos, A., & Grenyer, B. F. S. The Influence of Interpersonal Factors on the Speed of Recovery From Major Depression. Psychotherapy Research, 17 (2), 239–249. Jones, E. E. (2000). Manual for the Psychotherapy Process Q-Sort. In Therapeutic action: A guide to psychoanalytic therapy (pp. 316–361). Northvale, NJ: Jason Aronson. Comninos Title: A rapid response to psychotherapy for depression: A qualitative and quantitative analysis of therapy process. Authors: Comninos, A., & Grenyer, B. F. S Institution/Affiliations: School of Psychology, University of Wollongong. Illawarra Institute of Mental Health. Email address of presenting author: [email protected] Abstract: Psychotherapy for depression may be particularly beneficial for certain clients. ‘Sudden gain’ and ‘rapid response’ research suggests considerable numbers of patients experience large robust reductions in depression in early sessions, across a range of psychotherapeutic modalities. Yet, surprisingly few studies have identified factors that might help explain this phenomenon. Aims: We aim to determine the therapeutic process variables that set apart rapid and gradual responders. Our previous work found that by Session 6, over one third of patients (23/62) achieved a large mean reduction in symptoms that accounted for 96% of their entire symptom reductions (Comninos & Grenyer, 2007). These rapid responders were 5 times (OR = 5.67, CI: 1.81-17.80) more likely than gradual responders to be classified as remitters by Session 16, and were significantly less depressed at 52 week follow-up. Pretherapy characteristics patients less likely to rapidly respond included lower interpersonal mastery, a more domineering interpersonal style, and greater social isolation and attachment fears concerning intimacy. Methods: Present work involves the analysis of 20 early therapy sessions (10 rapid, 10 gradual responders), which were rated with the Psychotherapy Process Q-Set (PQS; Jones, 2000). The PQS is a pantheoretical method of systematically characterising therapist-patient interactions that provides a meaningful index of process that can be used in comparative analyses. Outcomes: Preliminary results, from 18 participants, suggest that as early as Session 3, rapid responders were at a more advanced stage of therapy. This stage of therapy was characterized by a willingness to work on strong emotions such as guilt. In contrast, gradual responders’ sessions were dominated by externalising and defenses. In-depth results will be presented, including PQS data for all 20 patients, an analysis of the association between therapeutic process and working alliance, and an analysis of an inventory of countertransference (i.e., Friedman & Gelso, 2000). Crellin Title: Meta-Analysis of Childhood Anxiety Treatments: Combining Methodological Advances in an Evaluation of Overall Effectiveness Authors: Kylie Crellin, Kevin R Ronan, Kirsten McMurray Institution/Affiliations: Central Queensland University and Massey University NZ Email: [email protected]


Abstract: This poster will present the findings from a current meta-analysis of childhood anxiety treatment outcome studies, reflecting advancements in methodology and reporting. Included in this study are 21 primary outcome studies (N = 1475) and six follow-up studies. Previous researchers (e.g., In-Albon & Schneider, 2007; Soler & Weatherall, 2007) have recently conducted meta-analyses examining the efficacy of treatments for childhood anxiety disorders. The current meta-analysis was done to overcome limitations in the methodologies of these studies (e.g., inclusion/exclusion criteria, the calculation of unconventional effect sizes, insufficient descriptive statistics). Furthermore, this study used both conventional and updated strategies for conducting meta-analyses, reflecting and extending research in the child depression area (Weisz, McCarty, & Valeri, 2006). One purpose was to facilitate more accurate comparisons across different meta-analyses examining the treatment of anxiety disorders for both children and adults (e.g., Ghahramanlou, 2003) and the treatment of other childhood, and adult, disorders such as depression (e.g., Weisz et al., 2006). In addition to presenting both traditional and updated between group effect sizes, a number of other effect sizes are to be presented: within-group effect sizes, follow-up effect sizes (both between and within), and proportional effect sizes (for diagnosis outcome). Additionally, based on heterogeneity within the sample of studies, a number of moderator analyses are to be conducted to examine potential sources of variance. Curtis Title: Initial Dissemination and Effectiveness of Multisystemic Treatment in New Zealand: A Benchmarking Study Authors: Nicola M. Curtis, Ph.D. Kevin R. Ronan, Ph.D. Naamith Heiblum, Ph.D. Kylie Crellin, B.Psych (Hons) Institution/Affiliations: New Zealand and Central Queensland University Email address of presenting author: [email protected] Abstract: Multisystemic Therapy has begun to be disseminated in New Zealand and represent one of the preferred approaches of a recent national interagency plan for severe conduct disorder and antisocial behaviour. Findings from a recent meta-analysis have suggested that dissemination of Multisystemic Therapy may be subject to setting effects (Curtis, Ronan, & Borduin, 2004). This study reflected features previously associated with lower effect sizes. Therefore, one aim of this effectiveness study was to compare findings from the initial dissemination of MST in community mental health settings in New Zealand with findings from US-based randomized controlled trials. Sixty five antisocial youth, along with their families, participated in the study across three different settings. Findings demonstrated significant pre- to post-treatment improvements in most indicators of ultimate (i.e., offending behavior) and instrumental (i.e., youth compliance, family relations) treatment outcomes. Reductions in offending variables continued to improve across follow-up intervals. Further, successful treatment completion rates in this study (98%) were significantly greater compared to the average completion rate found in previous MST studies. Additional benchmarking indicated that effect sizes compared favourably with those seen in previous MST research focused on juvenile offenders. Families generally reported high levels of satisfaction with the program. Most also felt that it met youth and family cultural needs. Issues related to continuing dissemination of MST, including an expanded role for benchmarking, are discussed. Girling-Butcher Title: Cognitive-Behavioral Therapy for Children with Anxiety Disorders: Evaluation of a Brief Program Reflecting Usual Practice Duration Authors: Robyn D. Girling-Butcher, Kevin R. Ronan Institution/Affiliations: Massey University NZ, Central Queensland University Email: [email protected] Abstract: Four anxiety disordered 8-11 year-old children (aged 8-11 years) and their parents participated in a shortened version of an efficacious cognitive-behavioral program for anxiety in children (Kendall et al., 1992; Ronan & Deane, 1998), designed to reflect therapy duration found in usual clinical practice. A modified multiple-baseline design was used that reflected clinic setting pragmatics (Hayes, 1981; Kazdin, 2003) while continuing to reflect an allegiance to systematic evaluation. For ongoing evaluation, weekly measures of the child’s trait anxiety and coping ability were obtained from the child and parents. In addition, a battery of measures was used to evaluate outcomes following treatment and at two follow-up intervals. Emphasising increased parent involvement, and earlier introduction of exposure sessions, the program was found to lead to marked changes in child functioning. In particular, all children showed improvement on self-report, parent report, and independent clinician’s ratings over the course of treatment. Moreover, scores on relevant indices were all within a non-deviant range following intervention, and all four children no longer qualified for an anxiety diagnosis at post-treatment and at 3- and 12-month follow-up. Findings are discussed in terms of implementation and evaluation in practice settings (e.g., comorbidity, critical components of treatment, use of single case designs). Suggestions for future research include testing the effectiveness of this brief program on a large and diverse sample of children. Additional research is also required to find out to what extent the increased parental involvement of this program enhances the impact of treatment in the larger context of addressing features of the research-practice gap. In light of findings here suggesting the earlier introduction of exposure sessions to be advantageous, another related issue for future research should aim to identify the active ingredients in childhood anxiety programs. Overall, findings provide preliminary support for the effectiveness of a brief cognitive-behavioral program for treating anxiety disorders in children, compatible with some of the needs of service delivery settings.


Hanson Title: Understanding Generalised Anxiety Disorder from a Psychodynamic Perspective: The Relationship between Attachment Style, Interpersonal Relationships, and Defence Style in the Outcome of Supportive Expressive Group Therapy Authors: Louise Hanson and Robert Schweitzer Institution/Affiliation: Queensland University of Technology Email: [email protected] Abstract: It has been argued that generalised anxiety disorder (GAD) represents what was traditionally termed a neurosis. Interpersonal theorists have emphasised the role of interpersonal relationships in the development of the neuroses. The intent of the current study is to investigate whether particular interpersonal characteristics of patients with the diagnosis of GAD, namely, adult attachment style, interpersonal problems, and defence mechanisms relate to the outcome of treatment. Participants were block allocated to one of two treatment groups, cognitive behavioural therapy (CBT) group or supportive-expressive (SE) psychodynamic therapy group. The Experiences in Close Relationships (ECR), The Inventory of Interpersonal Problems (IIP), and Defense Style Questionnaire (DSQ) along with symptom measures were completed by participants pre- and post-treatment. The intent of this study is to determine whether those with the diagnosis of GAD have a differing interpersonal profile. It is predicted that overall, participants will be characterised with an unsecure attachment style; interpersonal problems related to difficulties being assertive, overly nurturant, exploitable and socially inhibited; and the use of the defence mechanism of repression. It is predicted that the SE group therapy, which emphasises interpersonal relationships, will result in a significant change in participant’s interpersonal style in successfully treated patients in comparison to successful outcomes in the CBT group. The study has implications for understanding the mechanisms associated with the successful psychotherapeutic treatment of GAD. Henderson-Brooks Title: Exploring language as evidence of change Authors: Dr Caroline Henderson-Brooks, A/Prof David Butt, Dr Alison Moore Institution/ Affiliations: Macquarie University Email Address of Presenting Author: [email protected] Abstract: Psychotherapists reliably know when patients have made progress in the development of self. Given that psychotherapy treatment primarily occurs in language, how can we make our understanding of the relationship between language change and therapeutic progress more explicit, so that it can be available for scrutiny in research and training? What changes in language count as evidence of success for any given treatment model? Outcome studies can demonstrate decreased incidence of self-harm and reduced health costs as external evidence of change (e.g., Stevenson and Meares 1992, 1999). It is perhaps more difficult to substantiate changes in language as evidence of changes in self, but the need for linguistic evidence is acknowledged within psychotherapy. For instance, Meares et al. (2005: 662) suggest ‘the indices of beneficial change will be found in the structure of the therapeutic conversation’. In this workshop we draw on our ongoing NHMRC-funded joint research project between therapists and linguists, based on 60 transcribed sessions from one particular treatment model, the Conversational Model of psychotherapy. Using extended excerpts of therapist-patient talk we discuss what it is that therapists are responding to in patient talk and how together they create a conversation of change. These profiles enable linguistic indices of successful and less successful therapy. There will be opportunity for critical discussion and for feedback on how the indices might work with other therapeutic approaches, with the aim of fostering a growing interaction between different therapy models and between different disciplines. Hyde Title: Fragile narcissists or the guilty good: What drives the personality of the psychotherapist? Author: Judy Hyde Institution/Affiliations: Macquarie University/University of Sydney Email address of presenting author: [email protected] Abstract: Aims: Testing proposals by Alice Miller that psychotherapists are driven by fragile narcissism or, as thought by Nancy McWilliams, depressive dynamics, this paper will present preliminary findings from a group of 6 studies that test out these propositions to better understand what attracts the psychotherapist to their vocation and brings satisfaction in the work. Methods: Using the O’Brien Multiphasic Narcissistic Inventory (OMNI, O’Brien, 1987, 1988), measuring various aspects of narcissism, including the particular type of fragile narcissism proposed by Miller, and the Personality Adjective Checklist (PACL, Strack, 1991), modified to include a depressive dimension, these studies compare non-pathological personality dynamics amongst geologists, and clinical and academic psychologists. These questionnaires are also utilised to examine how particular personality dynamics relate to the psychotherapist’s choice of therapeutic model. Comparing applicants to the fields of clinical and counselling psychology with a group of movie-goers on various aspects of narcissism using the OMNI and the Narcissistic Injury Scale (Slyter, 1991), Miller’s proposition that fragile narcissism distinguishes those wishing to work as psychotherapists is further examined. Further analyses to be undertaken examining the predictability different personality styles have on work satisfaction and choice of therapeutic model will also be described. Results from the studies will be examined in terms of developmental and activated situational narcissism.


Outcomes: Questions about the studies will be welcomed and suggestions for future directions in the examination of this fascinating topic will be explored. Jurkovic Title: Workshop on Evaluation of Couple Counselling: Issues and Challenges. Paper 2: Measuring couple relationship functioning Authors: Iva Jurkovic1, Dubravko Jurkovic1, Margot Schofield1,2, Andrew Bickerdike3 Institution/Affiliation: 1. Department of Counselling and Psychological Health, La Trobe University; 2. Psychotherapy and Counselling Federation of Australia, 3. Relationships Australia (Victoria) Email: [email protected] Abstract: The central construct in couple counselling research is relationship functioning and satisfaction. This paper presents a review of different measures of relationship functioning and relationship satisfaction, including the Dyadic Adjustment Scale (DAS; Spanier, 1976), the Marital Satisfaction Inventory – Revised (MSI-R; Snyder, 1997), and the Couples Satisfaction Index (CSI 32; Funk & Rogge, 2007). We describe the properties of the measures and evidence of their sensitivity to change over the course of couple counselling, and then present a rationale for selecting the CSI 32 for our evaluation of the short and long-term effectiveness of couple counselling. The CSI 32 is a self-report 32-item scale that appears to be theoretically grounded, relevant, valid and reliable (Funk & Rogge). The scale was developed using principal component analysis and item response theory applied to the large item pool collected from various widely used measures. The CSI 32 scale appears to be far more sensitive to detecting real change in relationships over time than for example the DAS or the MSI-R, so it can have particular value for both researchers and clinicians. Funk, J.L. & Rogge, R.D. (2007). Testing the Ruler With Item Response Theory: Increasing Precision of Measurement for Relationship Satisfaction With the Couples Satisfaction Index. Journal of Family Psychology, in print. Snyder, D.K. (1997). Marital Satisfaction Inventory – Revised. Los Angeles: Western Psychological Services. Spanier, G. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15 – 28. Jurkovic Title: Workshop on Evaluation of Couple Counselling: Issues and Challenges. Paper 3: Methods and challenges in recruitment through community agencies: A collaborative model Authors: Dubravko Jurkovic1, Iva Jurkovic1, Andrew Bickerdike2, Margot Schofield1,3 Institution/Affiliation: 1. Department of Counselling and Psychological Health, La Trobe University, 2. Relationships Australia (Victoria), 3. Psychotherapy and Counselling Federation of Australia Email: [email protected] Abstract: Recruitment in large community-based evaluation studies can be a considerable challenge. Our evaluation of couple counselling involved developing a model of recruitment across eight diverse and busy counselling agencies. This presentation describes the development of a collaborative approach to engaging the agency staff, and identifies the key issues and difficulties addressed. The collaborative model involved engaging agency staff from early in the project design and negotiating clear roles and responsibilities pertaining to recruitment. The main factors associated with recruitment difficulties were found to be organizational barriers such as time constraints, different administrative models across agencies, and the large proportion of part-time and casual staff. Administration staff are the first point of contact and the first to discuss the research project with clients, and thus act as gatekeepers who may either facilitate or inhibit recruitment. To enhance recruitment outcomes over the one-year recruitment period, ongoing communication and at least monthly visits to the staff in all agencies is a priority for the researchers. The presentation outlines various methods used to monitor recruitment progress, solve problems as they arise, and keep the staff motivated. These methods included incentives to stimulate and encourage recruitment, and provide rewards and recognition for achieving recruitment milestones. Kelly Title: Does therapeutic homework improve outcomes for individuals diagnosed with severe mental illness? Author: Dr. Peter J. Kelly, Prof. Frank P. Deane Institution/Affiliation: Illawarra Institute for Mental Health University of Wollongong Email: [email protected] Abstract: Introduction. Homework refers to activities completed by individuals between therapeutic sessions which are designed to help them make progress toward their treatment goals. Homework has been recommended for use by mental health case managers as part treatment for clients with severe mental illness (SMI). Research has not previously examined if homework improves outcomes for individuals with SMI. Method. The current research was conducted as an effectiveness study and examined the actual use of homework by case managers working in clinical practice. Case managers were trained in a systematic approach to homework administration and were provided with carbonised Homework Administration Pads to assist with homework implementation. A Hierarchical Linear Modelling (HLM) approach was used to examine the relationship between homework and outcome for all participants in the study (N = 242). Results. The total number of homework assignments administered to each


client and the quality of homework completion predicted improvement on the Health of Nation Outcome Measure (HoNOS). When examining just those individuals who were assigned homework (n = 129), the total number of homework assignments administered also predicted improvements on the Kessler 10 (K10). The quantity or quality of homework completed did not predict improvements on recovery orientated mental health measures (i.e. RAS, MHR). Discussion. These results support of the use of systematic homework administration procedures with individuals diagnosed with SMI although in the effect sizes were small. Future research would benefit from examining factors to promote the consistent use of systematic homework administration procedures by mental health case managers. Kolaric Title: The development of a procedure for using the reflective functioning scale to code psychotherapy sessions Authors: Juanita Kolaric and Jeff Ward Institution/Affiliations: Australian National University Email: [email protected] Abstract: Mentalizing - the capacity to reflect on mental states in oneself and others - is hypothesized by Fonagy and colleagues to underpin healthy intrapersonal and interpersonal functioning. The Reflective Functioning Scale (RFS) has been developed by Fonagy et al to assess mentalizing ability and is used to code transcripts from the Adult Attachment Interview (AAI), which is a standardized, semi-structured interview for assessing attachment style. The current research was designed to develop a procedure for using the RFS to assess mentalizing ability as shown by clients in psychotherapy sessions. Audio-tapes of eight therapy dyads utilizing differing therapeutic approaches and for differing therapy lengths comprised the data pool of some 90 therapy sessions. From these, a subset of forty audio-tapes were selected to cover the range of therapy stages (ie. early, middle and late therapy sessions). These sessions were transcribed berbatim and coded using a form of the RFS that we adapted for this purpose. The therapy clients were also administered the AAI, which was also coded using the RFS for validation purposes. Adapting the RFS for coding psychotherapy sessions required decisions to be made about session selection, units for analysis, weighting of client responses where there were greater inherent demands for mentalizing, and determination of the overall RFS score. The procedure developed for the RFS in this study resulted in a reliable, valid and usable adaptation for coding psychotherapy sessions. Now that the RFS has been adapted for psychotherapy sessions, it will be possible to investigate at a detailed process level, a number of questions concerning the way in which psychotherapy enhances mentalizing. Lees Title: Engagement and Effectiveness of Parent Management Training for Solo High Risk Mothers: A Multiple Baseline Evaluation. Authors: Dianne Lees, Kevin R Ronan Institution/Affiliations: Child and Adolescent Mental Health Service (CAMHS), Tauranga (NZ); Central Queensland University Email: [email protected] Abstract: The Incredible Years parent training program has recently begun to be disseminated in New Zealand. This program reflects a preferred approach of a recent national interagency plan for the prevention and treatment of severe conduct disorder and antisocial behaviour. The present study assessed the initial effectiveness of The Incredible Years parent training program in New Zealand, carried out in a child and adolescent community mental health setting. In light of multiple risk factors for early drop-out in all participants, this study also used a number of economical strategies designed to increase engagement. A multiple baseline across participants design was used. Four research participants attended a 2-hour group treatment session weekly for twenty weeks, with planned booster sessions at 2 and 4 months following treatment. Participants were all solo mothers with sons between 6 and 9 years of age who met the DSM IV criteria for ADHD. In addition to risk for early drop-out, all families had a number of risk factors for poor outcomes (e.g., sole parenting, maternal depression, low SES, severe behaviour disruption). Family functioning was assessed from the pre-treatment interview schedule, measures of child behavior (Conners, Strengths and Difficulties Questionnaire, daily ratings of child behavior) and parent functioning (BDI-II, Parental Stress Index, weekly ratings on specific areas of family functioning, group goals). Participants also completed program satisfaction and program evaluation measures. Results showed that (a) all mothers engaged Lightfoot Title: A client’s experience of ‘unsafety in the presence of another’: A relational dilemma in psychotherapy Author: Shannon Lightfoot Institution/Affiliations: University of New England, Armidale Email: [email protected] Abstract: Explorations of the client’s experience in the counselling and psychotherapy literature largely advantage the voice of the practitioner-as-expert with the client’s voice fragmented to fit the practitioner-researcher’s script or standpoint. Desiring to privilege and empower the voice of the client, I have taken the post-modern narrative turn and utilised innovative methodologies to story the client’s experiential knowing and meaning for research.


My autoethnographical inquiry spans the initial nine months of the client’s third attempt in less than a year to form a working alliance with a psychotherapist. It enters and explores the phenomenological experience of ‘unsafety in the presence of another’ as-lived by a mature-aged adult having attachment difficulties arising from complex trauma experiences. This presentation will introduce the topic and focus of my Masters investigation, outline the rationale for an autoethnographical process and product, discuss aims and objectives, safety and ethical issues, and analysis methods. A segment of the storied data will be viewed. Long Title: An exploration of ‘real relationship’ in Gestalt Therapy dreamwork Authors: Rhonda Gibson Long & Trevor Crowe Institution/Affiliations: Sydney Gestalt Institute & Illawarra Institute for Mental Health Email: [email protected] or [email protected] Abstract: Dreams can inform us of our truth and deepen our genuine connection with others. By "letting the dream work on us rather than us working on the dream…the inner wisdom speaks to the daylight ego" (Bate & Higgins, 1994, p.118). In genuine dialogic contact, operationalising Buber's "elements of the interhuman" (e.g. presence, unreserved communication, inclusion and confirmation) aims to facilitate peak "I-Thou" experiences (Jacobs, 1998). Thus the dream becomes an exquisite medium for creating meaningful connection intra-psychically within the client and interpersonally with the therapist. There is a correspondence between the notion of Buber’s "I-Thou" relationship and Gelso et al’s (2005) research on the measurement of "real relationship" that examine genuiness and realism between the therapist and client. Aims To explore the relationship between the degree of genuineness and realism between the therapist and the client during Gestalt Therapy dreamwork and the client’s perception of immediate and longer term impacts of the dreamwork. Methods 15 different clients completed Gestalt Therapy dreamwork sessions. The clients and therapists completed the Real Relationship Inventory (client and therapist versions respectively – Gelso et at 2005 & 2006). Client reflections on immediate and subsequent outcomes related to the dreamwork were also collected. Two case studies using post therapy session interviews (one session using dreamwork the other not using dreamwork for both cases) are also reported. Outcomes Preliminary results regarding the clients’ descriptions of outcomes and the relationship with realism and genuiness of the therapeutic contact during the dreamwork sessions will be reported and discussed. Loughead Title: Brain Activation During Relationship Narratives: A Core Conflictual Relationship Theme Approach Authors: James Loughead1, Lester Luborsky2, Carol Popp2, Ramaris German2, Daniel Kirk2, Beth Krause3 , Ruben Gur1 Institution/Affiliations: 1Brain Behavior Laboratory, Department of Psychiatry, University of Pennsylvania; 2Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania; 3Department of Psychology, Social and Health Sciences, Duke University Email: [email protected] (Carol Popp Weingarten) Abstract: Aims: Psychotherapy is widely practiced throughout the world, yet little is known about the neurobiological substrate. An activity common to many forms of psychotherapy is the recounting of autobiographical narratives about interpersonal relationships. We combined the Relationships Anecdotes Paradigm (RAP), of the core conflictual relationship theme (CCRT) method, and functional magnetic resonance imaging (fMRI) to identify brain regions associated with autobiographical relationship narratives. Methods: Healthy participants (N=11) told fourteen 1-minute RAP narratives that were scored using the CCRT method. Six 30-second autobiographical Personal narratives and six 30-second non-autobiographical Control narratives were presented in a block-design fMRI experiment. Outcomes: We hypothesized that autobiographical Personal narratives containing CCRT relationship themes would tap cognitive and emotional aspects of episodic memory; and narratives with higher CCRT content would show greater activation in emotional centers such as the amygdala. Results showed greater activation in regions involved with episodic memory for Personal compared to Control narratives. When examining only the Personal stories, the High CCRT compared to Low CRT conditions revealed greater activation in the inferior temporal gyrus, lingual gyrus, postcentral gyrus, parahippocampal gyrus, and precuneus. Lyons Title: Examining depressive symptoms, motivational changes and the role of mindfulness in exercise. Authors: Geoff Lyons, Dr. Nadia Crittenden Institution/Affiliations: School of Psychology, University of Wollongong Email: [email protected] Abstract: The use of exercise as a component of activity scheduling is considered a core therapeutic strategy in the management of depressive symptoms. Individuals deprived from engaging in physical activity experience increased somatic complaints and depressive symptoms. Research suggests that interventions promoting mindfulness can effectively reduce the occurrence of depressive relapses (Ma & Teasdale, 2004). The current research used a 14 day home-based mindfulness intervention to test the hypothesis that a cultivation of mindfulness could reduce the onset and severity of depressive symptoms following exercise deprivation. Method. Forty-five undergraduate students were randomly allocated into either a control group (n = 15), an exercise deprivation group (n = 15) or an exercise deprivation plus mindfulness intervention group (n = 15). The


Depression and Somatic Symptoms Scale (Ching-I, Li-Jen, Yi-Jen, & Chia-Yih, 2006) and Freiburg Mindfulness Inventory (Walach, Buchheld, Buttenmüller & Schmidt, 2006) were collected at baseline and on day 14. Results. The exercise deprivation condition resulted in significant increases in cognitive and somatic depressive symptoms. No significant differences were seen between participants who engaged in mindfulness training and those who did not. Mindfulness levels significantly decreased in the exercise deprivation group compared to participants in the exercise deprivation plus mindfulness intervention group. Discussion. These results present preliminary evidence of a reciprocal relationship between mindfulness and the onset of depressive symptomology. This result suggests that exercise may be beneficial in holding mindfulness levels stable during the onset of psychological distress, potentially enhancing the individual’s coping mechanisms. References. Ching-I, H., Li-Jen, W., Yi-Jen, S., & Chia-Yih, L., (2006). Depression and somatic symptoms scale: A new scale with both depression and somatic symptoms emphasized. Psychiatry and Clinical Neurosciences, 60, 700-708. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting Clinical Psychology, 72, 31-40. Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness-the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences, 40, 1543-1555. Moxon Title: Providing Information to Relatives and Patients about Expressed Emotion and Schizophrenia in a Community Support Setting: A Randomized, Controlled Trial Authors: Alicia M. Moxon, Kevin R. Ronan Institution/Affiliations: Massey University NZ, Central Queensland University Email address: [email protected] Abstract: The present study aimed to enhance family members’ knowledge about schizophrenia and expressed emotion (EE), and awareness of their current coping strategies by conducting a brief educational intervention (Moxon & Ronan, 1999) and evaluation designed to overcome methodological shortcomings of past studies. People diagnosed with schizophrenia were recruited into the study along with family members. Relatives and clients were randomly allocated to a treatment group or a wait-list control group. The intervention itself was a two session format designed to increase knowledge and provide coping strategies. The intervention was also delivered in a manner designed to elicit active involvement as well as provide social reinforcement. Findings showed that knowledge increased significantly after the intervention condition. This knowledge was maintained at a three-month follow-up. The control condition reflected no changes in knowledge. Other results showed that both relatives’ and clients’ EE ratings significantly decreased from pre- to post-test. Changes in total EE scores improved after treatment by over twice the magnitude compared to the control condition. All gains were maintained at the three-month follow-up, with continuing improvement seen in family members’ negative attitudes. The analyses overall suggested that although knowledge increased as a result of education, the decreases in EE appeared to be due to education perhaps combined with non-specific factors such as social and community-based support. These issues are considered in terms of implementation in community settings and in terms of future research. Parker Title: Measurement of relationship patterns in long-term psychotherapy using the Core Conflictual Relationship Theme- Leizig/Ulm method Authors: Dr Lisa M. Parker and Assoc Prof Brin F.S. Grenyer Affiliation/Institution: Specialist Psychological Services, Illawarra Mental Health and Illawarra Institute for Mental Health University of Wollongong Email: [email protected] Abstract: The ability to measure relationship themes within the therapeutic environment, regardless of psychotherapeutic modality, has been facilitated by the traditions of the Core Conflictual Relationship Theme (CCRT) method. Recent methodological developments of the CCRT method has produced the Core Conflictual Relationship Theme-Leizig/Ulm (or "logically unified"), a reformulation of Luborsky’s tailor-made and category systems. This paper will report on an application of the CCRT-LU system to an examination of relational patterns of patients receiving long term psychoanalytic psychotherapy. The study reports on the extent to which relational patterns are modifiable as indicated by the following shifts: (1) the ‘response of other’ [RO] and ‘response of self’ [RS] components of the CCRT formulation will become more harmonious across the course of therapy; (2) interpersonal relationship themes will become more pervasive, as indicated by an increase in the number of endorsed categories on the RO and RS components; and, (3) the patient’s freedom to act will increase as indicated by an increase in valence ratings on the RS component. The findings will be related to theoretical principles of the change process. Quinn Title: Therapist’s experience of the treatment of non epileptic seizures. Preliminary findings of a qualitative study. Author: Maria Quinn (M Couns) Affiliation: PhD student, La Trobe University, Melbourne, Australia Email: [email protected]


Abstract: Non-epileptic seizures (NES) are paroxysmal (fit like) behavioural events that resemble epileptic attacks but lack clinical features and simultaneous electrographic features as measured by electroencephalogram (EEG). This paper presents some findings of a qualitative study of client and therapists’ experiences of the treatment of NES. Aims of the study included: to document features of therapy that characterise positive therapeutic outcomes for clients with NES, to describe characteristics of therapists who have provided successful therapy for client’s with NES and to formulate conceptualisations of NES in positive terms. That is, in terms other than ‘not epilepsy’, on the basis of successful treatment approaches. Eight therapists and seven client’s participated in in-depth interviews about their experiences of treatment of NES, and made their case notes available for document research. A grounded theory analysis of data from four therapist interviews forms the basis of the results presented in this paper. The core category emerging from this analysis has been termed "awareness of the effects of trauma". Therapist’s who have successfully treated NES have an awareness of the effects of trauma. This paper presents details of this category and related axial categories. These include therapists’ investigatory approach in therapy and their conceptualisation of their clients’ symptoms as part of a dissociative response to trauma. Treatment features related to the core category are presented. Implications of a lack of awareness of the effects of trauma and some factors contributing to this lack of awareness are discussed. Sauvage Title: Could Email-Facilitated Qualitative Methodology Ever be Safe Enough When Researching Harm from the Psychotherapeutic Relationship? Authors: Deborah Sauvage Institution/Affiliations: Griffith University School of Human Services Email: [email protected] Abstract: This paper presents a research proposal born out of a concern that more information is needed about the experiences of clients who have experienced "harm" from the psychotherapeutic relationship itself. Some research indicates that healing outcomes of client change from therapy are influenced, in order of their relative contribution to change, by the following factors: extra-therapeutic client-related factors (40%); therapeutic relationship factors (30%); placebo, hope, and/or expectancy (15%); and structure, model or technique (15%) (Miller et al, l997, p 24). In light of the significance of relationship factors in change, the proposed project is aimed at increasing knowledge about the specific "therapeutic relationship factors" linked with risks of harm. Ethical and methodological dilemmas in researching such a sensitive topic are significant. The method for the research would be qualitative, based on interviews. There are tensions around issues of anonymity, emotional distancing versus containment and safety, and the need for research participants to structure their participation in a way that suits them. Could a choice of either face-to-face interviews, or email facilitated dialogue, or both, ever create a "safe enough" research environment for this topic? "Email-Facilitated Reflective Dialogue" is a method that has been developed and used effectively in other sensitive research (McAuliffe 2003, Egan, Chenoweth and McAuliffe 2006). This presentation offers participants the opportunity to learn about this methodology and to reflect on the possible issues and application in psychotherapy research. Furthermore, input from colleagues would be greatly appreciated to further explore issues about feasibility and methodology of this proposed research project. Egan, J., Chenoweth, L., and McAuliffe D., (2006) "Email Facilitated Qualitative Interviews with Traumatic Brain Injury Survivors: a New and Accessible Method", Brain Injury, 20, 12, Nov, 1283-1294. McAuliffe, D. (2003) Challenging Methodological Traditions: Research by Email, The Qualitative Report, 8, 1, Jun, 57-69 Miller, S., Duncan, B., & Hubble, M., (1997) Escape From Babel: Toward a Unifying Language for Psychotherapy Practice, New York: Norton. Schofield Title: Workshop on Evaluation of Couple Counselling: Issues and Challenges. Paper 1: Effectiveness evaluation of couple counselling: Design and methodological issues Authors: Margot Schofield1,2, Andrew Bickerdike3, Dubravko Jurkovic1 and Iva Jurkovic1 Institution/Affiliation: 1. Department of Counselling and Psychological Health, La Trobe University; 2. Psychotherapy and Counselling Federation of Australia, 3. Relationships Australia (Victoria) Email: [email protected] Abstract: The evaluation of couple counselling poses particular methodological challenges due to the sensitive nature of researching distressed couples, the lack of viable control groups, and difficulties in recruitment, retention, and missing data. This presentation describes the design of an effectiveness study which aims to evaluate the short and long-term effectiveness of couple counselling undertaken in partnership with Relationships Australia Victoria. The study aims to map the profiles and needs of clients seeking relationship counselling and relationship enhancement services, and to undertake a quasi-experimental effectiveness evaluation of couple counselling and relationship enhancement programs, using both group and single case longitudinal designs among a naturalistic sample of clients presenting for agency-based relationship services. Schofield Title: Supervisor and supervisee perspectives on supervision: methodologies to illuminate the learning experience Authors: Prof Margot Schofield1 and Assoc Prof Jan Grant2


Institution/Affiliation: 1. La Trobe University and Psychotherapy and Counselling Federation of Australia, 2. Curtin University Email: [email protected] Abstract: Clinical supervision is one of the major processes of ongoing learning and support for therapists. This paper describes a qualitative in-depth interview study which explored how supervisors and supervisees experience supervision. The sample comprised 6 supervisor-supervisee dyads. The supervisors were all senior members of the profession with considerable expertise in supervision. Interviews were first conducted with supervisors on their theory of supervision and application of that theory in practice. An Interpersonal Recall Method was then used to independently explore supervisor and supervisee reflections on one of their videotaped supervision sessions. The paper reports preliminary findings on both supervisor and supervisee reports of helpful and unhelpful experiences of supervision and discusses the potential of the methodology for a complex series of analyses to help us better understand the processes of supervision. Schweitzer Title: For Better or Worse: Treatment Trajectories and Outcomes in a Training Psychology Clinic Authors: Schweitzer, R., Banham, J., Birtles, B., and Vromans, L., Bambling, M. Institution/Affiliations: Queensland University of Technology Email: [email protected] Abstract: Rosenzweig first drew attention to the importance of the person of the therapist playing a critical role in the outcome of psychotherapy in 1936. Since this time, there has been an increasing emphasis upon the therapeutic technique as the agent for change, often to the point of minimising the person of the therapist in accounting for psychotherapeutic outcome. The current research program undertaken over the past three years sought to address the following questions: how effective are trainee therapists, how well do therapists judge their own efficacy, what are the characteristics of effective therapists, and how might we improve therapeutic effectiveness in a trainee clinic? Eleven trainee therapists participated in the initial study utilising the Outcome Questionnaire-45 in the tracking of 60 clients over the course of their treatment. In addition we examined the therapeutic transcripts of effective therapy sessions and compared these to less successful sessions in a related study. Results to date indicate that treatment trajectories vary significantly based upon the therapist and clinically significant change occurs in about half of the clients treated in the clinic. Utilising treatment trajectories to identify individual therapist effectiveness raises the accountability of the therapists to not only their professional peers, but more importantly to their patients. Implementing research paradigms that track real-time patient change and therapist effectiveness would enable the future study of what makes an optimum therapist. Startup Title: "Therapist treatment adherence to, and client drop-out from, cognitive behaviour therapy for acute psychosis." Author: Mike Startup Institution/Affiliations: Professor, School of Psychology, University of Newcastle, Australia Email: [email protected] Abstract: In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, the patients who were offered CBT but dropped out of treatment prematurely had outcomes that were no worse than the patients who stayed in. This curious finding has subsequently been investigated by comparing the stay-ins and the drop-outs for: (1) differences in therapists’ interventions, (2) the quality of the therapeutic alliance, (3) the patients’ recovery styles, and (4) insight during recovery from an acute psychotic episode. The results from these studies suggest that the drop-outs and the stay-ins had different but equally valid recovery styles. Rather than try to alter patients’ recovery styles, a more appropriate aim might be to match treatment to the patients’ styles. Waldron Title: Evaluating benefits from long-term dynamic treatment Author: Sherwood Waldron Institution/Affiliation: New York Psychoanalytic Society and Institute Contact: [email protected] Abstract: Results of a 22 year project in New York to assess process and outcome in dynamic therapy and analysis will be described. The Analytic Process Scales (APS) group developed scales for evaluating the nature and quality of the process in tape-recorded treatments, then developed an application of the Shedler-Westen Assessment Procedure (SWAP) to evaluate change in the course of treatment, based upon detailed clinician judgments. Findings relevant to our field include: 1. Immediate benefit to the patient was not attributable to the particular kind of therapist communication, but was attributable to the clinician-judged quality of the communication, providing evidence that the development and maintenance of the relationship is as important as the conveying of insight or understanding. 2. Therapist’s and patient’s contributions could both be of high quality, as judged by our senior clinicians, but the degree to which they were working together would often change in the course of work together, with


corresponding changes in the results of treatment. Thus strategies evaluating the content of therapy across cases tend to miss the crucial individual elements which together develop and sustain the working alliance. 3. The labels used to describe a given therapy may have very little relationship to that which provides therapeutic benefit. We found in applying the Analytic Process Scales to a CBT case in comparison with a dynamic case, that dynamic elements were prominent in the CBT case. 4. The slow accumulation of benefits in psychotherapy has been difficult to measure heretofore, but with new methodologies we now are in a position to assess the relationship between intensity and duration of therapy and benefit, and to find out from individual cases whether the number of sessions per week has any direct relationship with achieved benefit over time. One conclusion we and others have drawn: the field needs a series of intensive individual case studies at this time. Walton Title: Comparing Dialectical Behaviour Therapy and the Conversational Model in the treatment of Borderline Personality Disorder: A pilot study Authors: Carla J. Walton, Nick R. Bendit, Stella C. Dyer, Leslie R. Pollock & Christopher H. Willcox Institutions / Affiliations: Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Brain and Mental Health Research Email: [email protected] Abstract: Linehan’s Dialectical Behaviour Therapy (DBT) has become the gold standard for psychotherapeutic treatment of Borderline Personality Disorder. Results have consistently shown significant reductions in suicidal and self-mutilating behaviours as well as an improvement in quality-of-life (Linehan, 2000). To date, there have been very few Randomised Controlled Trials comparing DBT to another treatment that has controlled trial evidence for efficacy in treating BPD. Russell Meares has developed an adapted form of psychoanalytic therapy called the Conversational Model (CM; Meares & Stevenson 2000; Meares 2004), and published a waiting list control study which showed reduced rates of deliberate self-harm, significant reductions in hopelessness and depression, and improvements in social functioning (Stevenson & Meares 1992). This presentation outlines a pilot study designed to determine the feasibility of a larger scale randomised controlled trial comparing DBT with CM. In view of previous research, it is hypothesised that DBT will be more effective at reducing deliberate self-harm than CM, but less effective at reducing depression. The trial took place at the Centre for Psychotherapy, a specialist service of the Hunter New England Mental Health Service for persons with a diagnosis of BPD who self harm frequently. Participants were referred via the usual pathways for clinical care at the Centre for Psychotherapy. Those who consented to participate in the trial were randomly allocated to either DBT or CM. Pre-treatment data has been collected for 20 participants. The overall design of the study and preliminary descriptive data will be presented. Ward Title: Imagining otherwise: Empathy in everyday life and psychotherapy Authors: Jeff Ward and Tegan Cruwys Institution/Affiliations: School of Psychology, Australian National University Email: Jeff. [email protected] Abstract : Reviews of the empathy literature have consistently concluded that there is strong evidence that empathy is an important part of an effective psychotherapeutic process, but that a clear conceptualization of empathy has yet to be achieved. This lack of clarity about the concept hampers both research and training in the field of psychotherapy. Recent work in philosophy and neuroscience has the potential to contribute to a clearer conceptualization of empathy. In this study, we focus on the work of the philosopher Peter Goldie, who has used narratological theory to propose that there are a number of ways in which we imagine the experience of others when they tell us stories about their lives. These include imagining ourselves in the situation, imagining ourselves as the other person, imagining ourselves as a participant observer and viewing the situation from the outside like a camera. We interviewed 20 non-psychotherapists and 15 psychotherapists using a qualitative methodology to determine whether these ways of imagining others could be reported on and were familiar to respondents. In addition, we examined differences between psychotherapists and non psychotherapists and men and women in the use of various techniques. The results suggest that Goldie has developed a valid taxonomy of the different ways in which we imagine the experience others, and that there are differences across the groups in the techniques employed. In addition to the four methods suggested by Goldie, we identified a fifth emotional process of affective attunement, which can be differentiated from both emotional contagion and identification.

2007 Australia Regional Group Meeting of the Society for Psychotherapy Research www.psychotherapyresearch.org Enquiries : Brin Grenyer ([email protected])

Documents

Program and Abstracts · 2007 Australia Regional Group Meeting: Society for Psychotherapy Research 2 1.00 Paper sessions [Howard Room] James Loughead1, Lester Luborsky2, Carol Popp2,