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      Exploring the outcomes of psychotherapy sessions: how do therapists' responsiveness and emotional responses to patients with personality disorders affect the depth of elaboration?

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          Abstract

          Background

          The impact of depth of elaboration in individual psychotherapy sessions on overall treatment effectiveness was found in the empirical literature. In the best sessions, relevant content is processed with greater depth; in contrast, in the shallower sessions, the emerging content is more superficial. Evidence suggests that achieving a high level of depth is closely related to specific therapist characteristics and relational dimensions (including clinicians' emotional responses to patients). The present study aimed to (a) compare therapist responsiveness and countertransference patterns in psychotherapy sessions with different levels of depth of elaboration; and (b) examine if the positive countertransference pattern mediated the relationship between therapist responsiveness and depth of elaboration.

          Methods

          Eighty-four clinicians were asked to select one patient with personality disorders in their care and complete the Depth Scale of the Session Evaluation Questionnaire, the Patient's Experience of Attunement and Responsiveness Scale, and the Therapist Response Questionnaire concerning one of their sessions.

          Results

          The results showed that sessions with higher levels of depth of elaboration were characterized by greater therapist responsiveness and more positive countertransference. Conversely, poor therapist responsiveness and hostile/angry, disengaged, and helpless/inadequate countertransference responses were found in shallower sessions. Moreover, positive countertransference mediated the relationship between therapist responsiveness and depth of elaboration.

          Conclusion

          This study sought to shed light on the processes underlying the outcomes of psychotherapeutic sessions, highlighting the strong impact of relational factors. Advancing knowledge of these mechanisms seems crucial to identifying the active ingredients of the therapeutic process and understanding what (does not) promote successful outcomes.

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          Most cited references92

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          Diagnostic and Statistical Manual of Mental Disorders : DSM-5-TR

          "The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), is the most comprehensive, current, and critical resource for clinical practice available to today's mental health clinicians and researchers. DSM-5-TR includes fully revised text and references, updated diagnostic criteria and ICD-10-CM codes since DSM-5 was published in 2013. It features a new disorder, prolonged grief disorder, as well as codes for suicidal behavior available to all clinicians of any discipline without the requirement of any other diagnosis. With contributions from over 200 subject matter experts, this updated volume boasts the most current text updates based on the scientific literature. Now in four-color and with the ability to authenticate each printed copy, DSM-5-TR provides a cohesive, updated presentation of criteria, diagnostic codes, and text. This latest volume offers a common language for clinicians involved in the diagnosis and study of mental disorders and facilitates an objective assessment of symptom presentations across a variety of clinical settings-inpatient, outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care. Important updates in DSM-5-TR include 1) fully revised text for each disorder with updated sections on associated features, prevalence, development and course, risk and prognostic factors, culture, diagnostic markers, suicide, differential diagnosis, and more; 2) addition of prolonged grief disorder (PGD) to Section II; 3) over 70 modified criteria sets with helpful clarifications since publication of DSM-5; 4) fully updated Introduction and Use of the Manual to guide usage and provide context for important terminology; 5) considerations of the impact of racism and discrimination on mental disorders integrated into the text; 6) new codes to flag and monitor suicidal behavior, available to all clinicians of any discipline and without the requirement of any other diagnosis; 7) fully updated ICD-10-CM codes implemented since 2013, including over 50 coding updates new to DSM-5-TR for substance intoxication and withdrawal and other disorders"--
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            Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation.

            There have been numerous treatments in the clinical research literature about various design, analysis, and interpretation considerations when testing hypotheses about mechanisms and contingencies of effects, popularly known as mediation and moderation analysis. In this paper we address the practice of mediation and moderation analysis using linear regression in the pages of Behaviour Research and Therapy and offer some observations and recommendations, debunk some popular myths, describe some new advances, and provide an example of mediation, moderation, and their integration as conditional process analysis using the PROCESS macro for SPSS and SAS. Our goal is to nudge clinical researchers away from historically significant but increasingly old school approaches toward modifications, revisions, and extensions that characterize more modern thinking about the analysis of the mechanisms and contingencies of effects.
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              The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations

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                Author and article information

                Contributors
                URI : http://loop.frontiersin.org/people/2663097/overviewRole: Role: Role:
                URI : http://loop.frontiersin.org/people/1146337/overviewRole: Role:
                URI : http://loop.frontiersin.org/people/192943/overviewRole: Role:
                URI : http://loop.frontiersin.org/people/417769/overviewRole: Role:
                URI : http://loop.frontiersin.org/people/630924/overviewRole: Role: Role: Role: Role:
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                05 September 2024
                2024
                : 15
                : 1390754
                Affiliations
                [1] 1Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome , Rome, Italy
                [2] 2Center for Individual and Couple Therapy , Genoa, Italy
                [3] 3Third Center of Cognitive Psychotherapy , Rome, Italy
                Author notes

                Edited by: Osmano Oasi, Catholic University of the Sacred Heart, Italy

                Reviewed by: Carolina Altimir, Alberto Hurtado University, Chile

                Raffaella Passeggia, University of Naples Federico II, Italy

                Irene Messina, Mercatorum University, Italy

                *Correspondence: Flavia Fiorentino flavia.fiorentino@ 123456uniroma1.it
                Article
                10.3389/fpsyg.2024.1390754
                11412111
                39301007
                77e469e1-9bc2-4e22-9c2b-641c6163d525
                Copyright © 2024 Fiorentino, Gualco, Carcione, Lingiardi and Tanzilli.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 23 February 2024
                : 13 August 2024
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 95, Pages: 10, Words: 8254
                Funding
                Funded by: Sapienza Università di Roma, doi 10.13039/501100004271;
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study received funds from Sapienza University of Rome for the project Therapist responsiveness in the treatment of patients with personality disorders (protocol number RM1221816C707527; principal investigator: AT).
                Categories
                Psychology
                Brief Research Report
                Custom metadata
                Psychology for Clinical Settings

                Clinical Psychology & Psychiatry
                psychotherapy process,session outcome,depth of elaboration,responsiveness,therapist emotional responses,trq,pear,seq

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