itc conference grant scientific report

ITC CONFERENCE GRANT

SCIENTIFIC REPORT

This report is submitted for approval by the grantee to the MC Chair. Action number: CA16102 Conference title: 49th Society for Psychotherapy Research International Annual Meeting Conference start and end date: 27/06/2018 to 30/06/2018 Conference attendance start and end date: 27/06/2018 to 30/06/2018 Grantee name: João Francisco Soares da Conceição Tavares Barreto

ACTIVITIES DURING YOUR ATTENDANCE AT THIS CONFERENCE: I arrived in Amsterdam the day before the pre-conference workshops. I attended the workshop “A method for multi-level exploration of the psychotherapy process: New, user-friendly and expanded version of the Discourse Attributes Analysis Program (DAAP)”, from Wilma Bucci’s team, and I had the opportunity to discuss important aspects of their approach that have an impact on the model I have been developing in my PhD work. In the remaining days of the conference, I attended several sessions that addressed my subjects of interest, namely mentalization measurement, in-session mentalization, therapist mentalization, therapist effects, facilitative interpersonal skills, deliberate practice, relationship components, alliance, alliance ruptures and resolutions, patient-therapist match, and methodology. In the last day of the conference, I made my presentation in a panel discussed by Andrzej Werbart. I was also second author to a poster that was presented the day before (“Measuring mentalization through self-report: An adaptation to European Portuguese of the Reflective Functioning Questionnaire (RFQ) and the Mental States Task (MST)” – Nuno Neto Nunes, João Francisco Barreto, Horst Kächele, Maria Emília Costa).

IMPACT ON YOUR RESEARCH AND FUTURE COLLABORATIONS (if applicable) The conference served as an update and an overview of the current agenda in psychotherapy research. It was also an opportunity to share my work with a wider audience and hopefully increase its visibility. The informal contacts that were established during discussions outside the sessions will probably proceed over the months to come. Finally, I end this conference with a more clear and refined idea of the strengths of my own research and the gaps it can fill-in in the current scenario of psychotherapy research. I believe this will help me with the revision of articles that are currently under review and in the final phase of the writing process of my dissertation that I find myself in.

02-07-2018

1

MENTALIZING PSYCHOTHERAPISTS,

PSYCHOTHERAPISTS‘ MENTALIZING, AND THE

ELABORATION OF COUNTERTRANSFERENCE EXPERIENCE

JOÃO FRANCISCO BARRETO1,2,3

PAULA MENA MATOS1,2

1CENTER FOR PSYCHOLOGY AT UNIVERSITY OF PORTO, PORTUGAL2FACULTY OF PSYCHOLOGY AND SCIENCES OF EDUCATION, UNIVERSITY OF PORTO, PORTUGAL3POLYTECHNIC INSTITUTE OF PORTO, PORTUGAL

1. Introduction

2. Objectives

3. Method

4. Results

5. Conclusions

OUTLINE

30th June 2018J. F. Barreto & P. Mena Matos

02-07-2018

2

1. INTRODUCTION


Therapist effects not explained by factors as adherence to treatment manuals, rated competence, professional training, and years of experience (Tracey

et al., 2014; Wampold, 2015)

Relational qualities predict differences – e.g., FIS (Anderson et al., 2016)

But how?

Studying therapists without mentalizing them?

1. INTRODUCTION


Interest in models that realistically portray what goes on in therapists minds (factors → actual psychological processes)

Mentalizing psychotherapists: making sense of what they do in terms of subjective states and mental processes (Bateman & Fonagy, 2010)

…namely, studying psychotherapists mentalizingprocesses in and of themselves

02-07-2018

3

1. INTRODUCTION


Very few studies investigated therapist mentalization

with real patients

Evidence: therapist mentalization, either general “trait”

or case-specific “state”, positively associated with

process and outcome (Bischel, 2012; Cologon et al., 2017;

Diamond et al., 2003; Reading, 2013)

1. INTRODUCTION


ELABORATION OF COUNTERTRANSFERENCE EXPERIENCE (ECE) (Barreto & Matos, 2018)

psychological work to which therapists submit experiences with patients in and between sessions

mentalization process of a particular kind, mainly directed towards self (countertransference experience)

implicit-spontaneous and explicit-reflectivepsychological processes

02-07-2018

4

1. INTRODUCTION


Our model: ECE Rating System (Barreto & Matos, 2018)

intended to be applied to therapists’ post-session comments – suited to naturalistic and longitudinal research and warranting access to therapists’ experiences and elaborative processes

two primary independent dimensions

EXPERIENCING (implicit/spontaneous psychological work; increasing subjectivation, ownership, appropriation, or containment of immediate experience)

REFLECTIVE ELABORATION (explicit/controlled psychologicalwork; effort to explain, organize, or make sense (facts, ideas, experiences))

1. INTRODUCTION


Six countertransference positions (Racker, 1968) (mental

attitudes towards experience, regardless content)

02-07-2018

5


DIMENSION DESCRIPTION AND RATING

EXPERIENCINGIncreasing subjectivation, ownership, appropriation, or containment of immediate experience

0 - Detached 1 2 - Disruptive 3 4 - Containing

REFLECTIVE

ELABORATION

Effort to explain, organize, or make sense (facts, ideas, experiences)

0 - Description/ expression 1

Active meaning-making

2 - Simple explanation 34 - Investigation/

exploration

EPISTEMIC POSITION

Experienced relation between therapist’s psychic reality and external reality (therapeutic

process, client)

0 - Equation 1 2 - Separation/ isolation 3 4 - Dialectic

EXPERIENTIAL

GROUNDEDNESS

Extent to which therapist’s observations process/integrate and are anchored in concrete

aspects of experience

0 - Absent 1 2 - Diffuse 3 4 - Vivid

EMOTIONAL

DIFFERENTIATION

Complexity and discriminative capacity with which emotional themes (from therapist and/or

client) are treated

0 - Diffuse/ absent 1 2 - Simple 3 4 - Complex

TEMPORAL FOCUS

Articulation of past and immediate perspectives; differentiation and integration between

past protagonist and present narrator perspectives

0 - Past 1 2 - Present 3 4 - Present-past

INTERNAL FOCUSExtent to which internal experience is attended to and explored

0 - Absent 1 2 - Implicit 3 4 - Explicit

DIMENSIONS OF ELABORATION OF COUNTERTRANSFERENCE EXPERIENCE

1. INTRODUCTION


influences from literature on mentalization,

experiencing, referential process, narrative

research, and countertransference (e.g., Bouchard et al.,

1995, 2008; Bucci, 2002; Ensink et al., 2013; Fonagy et al., 1998;

Habermas, 2006; Habermas & Diel, 2010; Klein et al., 1986; Lecours &

Bouchard, 1997; Tansey & Burke, 1989; Vermote, 2005)

02-07-2018

6

1. INTRODUCTION


Preliminary findings with the ECE Rating System (Barreto,

Saraiva, & Matos, 2018)

mostly good to excellent interrater reliability

ICC (2,2) (n = 55)

Experiencing .88

Reflective Elaboration .74

Epistemic Position .84

Experiential Groundedness .76

Emotional Differentiation .82

Temporal Focus .54

Internal Focus .96

Total .94

1. INTRODUCTION


Preliminary findings with the ECE Rating System (Barreto,

Saraiva, & Matos, 2018)

EFA (PAF, Varimax): two latent orthogonal factors account for 78.8% of

the variance (N = 75)

F1 F2

Experiencing 0.94

Reflective Elaboration 0.90

Epistemic Position 0.69

Experiential Groundedness 0.61 0.62

Emotional Differentiation 0.60

Temporal Focus 0.58

Internal Focus 0.93

F1 – immersion in/containing of subjective

experience (implicit elaboration)

F2 – reflection/conjecture (explicit meaning-

making)

02-07-2018

7

1. INTRODUCTION


(…) I realized I have doubts about her engagement in theprocess. She is very rigorous with assiduity and schedule, butprefers to “digest” the subjects before she brings them to session. (…) This makes me feel uneasy about the work we’redoing, maybe also because I realize I’m directing too much. Still, I like her and she elicits in me a nearly maternal wish to see her doing well.

(…) Still shows some regrets and defends against the sense of failure. Socratic dialogue aiming at a normalization of the mourning process and valorization of the gains achieved. Academically more functional (…)

1. INTRODUCTION


(…) I realized I have doubts about her engagement in theprocess. She is very rigorous with assiduity and schedule, butprefers to “digest” the subjects before she brings them to session. (…) This makes me feel uneasy about the work we’redoing, maybe also because I realize I’m directing too much. Still, I like her and she elicits in me a nearly maternal wish to see her doing well. – high ECE comment (25.5)

(…) Still shows some regrets and defends against the sense of failure. Socratic dialogue aiming at a normalization of the mourning process and valorization of the gains achieved. Academically more functional (…) – low ECE comment (8.5)

02-07-2018

8

1. INTRODUCTION


We expect that…

good ECE is involved in therapeutic relational processes

ECE enhances responsiveness to emerging processes

ECE is involved in therapist-patient relational (mis)matchand its impact on process

ECE is more relevant with more challenging CT experiences (symptom severity, level of personality functioning, therapist attachment insecurity, relational match, …)

2. OBJECTIVES


test ECE (F1 and F2) as predictor of alliance

variation between- and within-dyads

study effect of therapist-patient attachment match

on ECE (F1 and F2)

examine attachment match as a moderator of the

association between ECE (F1 and F2) and alliance

02-07-2018

9

3. METHOD

30th June 2018

Participants

14 independent dyads (52 assessments)

Patients:

19 to 58 years

(M = 28.6, SD

= 13.4)

10 F and 4 M

Therapists:

28 to 55 years of age (M = 40.9, SD = 8.1)

11 F and 3 M

4 to 23 years of experience (M = 13.3, SD

= 6.1)

5 psychoanalytic/dynamic, 2

humanistic/experiential, 3 cognitive-

behavioral, 1 systemic, 2 eclectic/integrative,

1 cognitive-behavioral + eclectic/integrative

J. F. Barreto & P. Mena Matos

3. METHOD


Instruments ECR – Relationship Structures (Fraley et al., 2011; Portuguese version by

Moreira et al., 2014): avoidance (α=.78(C)/.93(T)), anxiety(α=.87(C)/.90(T)), discrepancy coefficients (absolute difference between scores on Avoid and Anx)

WAI – Short Revised (Hatcher & Gillaspy, 2006; Portuguese version by Ramos,

2008): bond (α=.83 to 94), tasks/goals (α=.91 to 96)

ECE Rating System (Barreto & Matos, 2018): F1 (immersion in/ containing of subjective experience), F2 (reflection/conjecture)

02-07-2018

10

3. METHOD


Procedure

invitations through formal contacts with psychotherapy societies, professional organizations and peer nomination technique

inclusion: adults in individual psychotherapy/ psychological support

all data collected anonymously and online(LimeSurvey 1.87®), after informed consent, in separate for each individual participant

3. METHOD


Procedure – design

T0

before

sess 2

T1

sess 2

T2

sess 5

T3

sess 8

T4

sess 10

C Att All All All All

T Att ECE ECE ECE ECE

02-07-2018

11

3. METHOD


Procedure

Instruction for therapist post-session comments:

(a) register impressions, reactions, or associations triggered in you by this session as sincerely and spontaneously as possible;

(b) write fluidly, in "stream-of-consciousness", avoiding corrections and concerns with text organization or linguistic inaccuracies;

(c) what you write will NOT be regarded as a full account of your experience – you are not expected to present it.

3. METHOD


Data analysis

longitudinal multilevel analysis (2 levels: sessions within dyads)

REML estimation

level 2 predictors grand-mean centered

level 1 predictors group-mean centered

factor scores (F1 and F2) obtained with Bartlett method

effect sizes: explained variance – Pseudo-R2 (Singer & Willet, 2003)

IBM SPSS Statistics 24

02-07-2018

12

4. RESULTS

INITIAL ECE (T1) – ALLIANCE BOND (n=12/44)

around 1/3 of differences BETWEEN DYADS in alliance BOND

positively predicted by therapists INITIAL IMMERSION IN/

CONTAINING OF CT EXPERIENCE (F1) (after session 2)

35.1% level-2 variance

F1 at T1

4. RESULTS

ATTACHMENT DISCREPANCY – ECE F1 (N=14/52)

ANXIETY DISCREPANCY hinders IMMERSION IN/

CONTAINING OF CT EXPERIENCE (F1)


02-07-2018

13

ATT ANXIETY DISCREPANCY x ECE (F2) – ALLIANCE BOND (n=12/44)

WITHIN-CASE changes in therapist REFLECTION/ CONJECTURE

tend to positively predict changes in alliance BOND in MORE

DISSIMILAR dyads (anxiety discrepancy x F2 ~1/5 bond

variation)


4. RESULTS

ATT AVOIDANCE DISCREP x ECE (F2) – ALLIANCE BOND (n=12/44)

WITHIN-CASE changes in therapist REFLECTION/ CONJECTURE

tend to positively predict changes in alliance BOND in MORE

DISSIMILAR dyads (avoidance discrepancy x F2 ~1/10 bond

variation)


4. RESULTS

02-07-2018

14

ATT AVOIDANCE DISCREPANCY x ECE (F2) – ALLIANCE T/G (n=12/44)

WITHIN-CASE changes in therapist REFLECTION/ CONJECTUREtend to positively predict changes in alliance T/G in MORE DISSIMILAR dyads (avoidance discrepancy x F2 ~1/25 T/G variation)


4. RESULTS

5. CONCLUSIONS


ECE seems useful to study alliance

F1 (initial) more involved in differences between

dyads (causality? client or therapist factor?)

F2 more involved in rupture resolutions?

attachment dissimilarity (anxiety) can hinder

therapist elaboration (ECE F1)

but therapist elaboration (ECE F2) can benefit

alliance in more dissimilar dyads

02-07-2018

15

5. CONCLUSIONS


limitations and future directions:

sample size and statistical power – increased risk of

type II errors, type I errors, and inflated significant

effect sizes (Ioannidis, 2008; McNeish & Stapleton, 2016; Yarkoni,

2009)

3-level design (sessions within clients within therapists) –

disentangle therapist/client contributions to ECE

only 4 time-points across first 10 sessions – no outcome

data; stage of therapy?

IN CASE YOU’RE INTERESTED…


Barreto, J. F., & Matos, P. M. (2018). Mentalizingcountertransference? A model for research on the elaboration of countertransference experience in psychotherapy. Clinical Psychology and Psychotherapy, 25, 427-439. doi: 10.1002/cpp.2177

Barreto, J. F., Saraiva, L., & Matos, P. M. (under review). Mentalizing psychotherapists, psychotherapists’ mentalizing: Results from a naturalistic longitudinal study.

Barreto, J. F., & Matos, P. M. (under review). Elaboration of countertransference experience and the workings of the working alliance.

02-07-2018

16

João Francisco BARRETO

[email protected]

Thank you for your attention!


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NOTAS IMPORTANTES COMUNS A TODAS AS VIAGENSDOCUMENTOS NECESSÁRIOS:- Em todas as viagens os passageiros adultos, crianças e bebés devem estar munidos de bilhete de identidade ou passaporte válidos.- Para todos os países que não pertençam à União Europeia, o documento exigido é o passaporte, sendo que este, na maioria dos casos, tem que ter validade mínimade 6 meses. Para obter um passaporte poderá fazê-lo na loja do cidadão ou no Governo Civil. Alertamos que, na maioria dos países, já não se aceitam Passaportesfamiliares e para os Estados Unidos da América é exigido passaporte biométrico.- Os menores quando não forem acompanhados por quem exerça o poder paternal, só podem entrar ou sair do território nacional exibindo autorização para o efeito. Areferida autorização deve constar de documento escrito, datado e com a assinatura de quem exerce o poder paternal legalmente certificado, conferindo ainda, quandoseja este o caso, poderes de acompanhamento por parte de terceiros, devidamente identificados.

ALTERAÇÃO DE PREÇOS:De acordo com a legislação vigente os preços contratados no acto da reserva poderão sofrer alterações, devidamente justificados por variações no custo dostransportes, dos combustíveis, direitos, taxas e flutuações cambiais, desde que sejam comunicados ao cliente com uma antecedência mínima de 20 dias. Taisalterações conferem ao cliente o direito a optar por uma viagem alternativa ou à rescisão do contrato e ao reembolso integral dos montantes pagos.

Para os efeitos do estabelecido na Lei nº 67/98 de 26 Outubro da Protecção de Dados Pessoais da República Portuguesa, informamos que os seus dados pessoaisserão integrados numa base de dados propriedade de HALCON VIAGENS, S.U.Lda, para a gestão do serviço contratado e que se encontra devidamente inscrito naComissão Nacional de Protecção de Dados (CNPD).

Além disso, em cumprimento do estabelecido na Política de Publicidade não Autorizada regulada pelo Decreto-Lei 7/2004 da República Portuguesa, que sobrepõe aDirectiva de comércio electrónico na versão modificada pelo Decreto-Lei 62/2009 da República Portuguesa e o artigo 13 da Directiva de Comunicações Electrónicas, aHALCON VIAGENS, S.U.Lda comunica aos titulares dos dados a sua intenção de lhes enviar informações comerciais por correio electrónico ou por qualquer outro meiode comunicação electrónica equivalente.

De igual modo, o titular autoriza a HALCON VIAGENS, S.U.Lda a que os referidos dados possam ser cedidos ou, conforme o caso, partilhados com terceiros quefaçam parte do Grupo de Empresas Globalia Corporación Empresarial S.A. e que, em cada momento, se encontrem referidos na página de Internet www.globalia.com,para que possam ser utilizados por estas, com os objectivos idênticos aos descritos para a HALCON VIAGENS, S.U.Lda.

Nos casos em que o titular seja detentor de algum tipo de cortesia comercial (cheques prenda, cartões de promoção, descontos adicionais, etc.) e que decida transferira cortesia comercial para um terceiro, para sua utilização e usufruto, declara que informou o mesmo, de forma expressa, que os dados pessoais do terceiro,necessários para a activação da cortesia comercial, serão utilizados com idênticos objectivos aos expressados anteriormente.

Se deseja exercer os seus direitos de acesso, rectificação, cancelamento e oposição ao tratamento dos seus dados de carácter pessoal fornecidos a HALCONVIAGENS, S.U.Lda, deverá comunicá-lo, por escrito, a LOPD Globalia Corporación. Polígono Son Noguera. Carretera Arenal-Llucmajor, KM 21,5 C.P.: 07620.Llucmajor. Islas Baleares – Espanha. Esta comunicação também poderá ser realizada através do envio de mensagem por correio electrónico para o endereç[email protected].

Indique se autoriza a utilização dos seus dados de contacto para receber descontos, promoções especiais ou informação de serviços de HALCON VIAGENS, S.U.Ldaou de outras empresas do grupo Globalia (companhia aérea, hotéis, agência de viagens, operador turístico, aluguer de veículos, telecomunicações, gestão de eventose transporte de passageiros, etc.):

O Sim, autorizo O Sim, autorizo, mas apenas a HALCON VIAGENS, S.U.Lda O Não, não autorizo. Não desejo receber descontos ou promoções especiais, nem qualquer outro tipo de informação comercial.

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