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Psychotherapy role expectations and experiences - Discrepancy and therapeutic alliance among patients with substance use disorders
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
Stockholm University, Stockholm, Sweden.
2014 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 87, no 4, 411-424 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy.

DESIGN: A naturalistic study design was used with data collected prior to therapy and during the first 6 months of therapy.

METHOD: Patients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n = 41; n = 24 in individual therapy and n = 17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version.

RESULTS: For patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention.

CONCLUSION: The finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout.

PRACTITIONER POINTS: In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 87, no 4, 411-424 p.
Keyword [en]
Psychotherapy; Treatment Expectations; Therapeutic alliance, Addiction; Dependence
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-104748DOI: 10.1111/papt.12021ISI: 000344784300003PubMedID: 24415529OAI: oai:DiVA.org:liu-104748DiVA: diva2:698809
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05
In thesis
1. Psychotherapy for Substance Use Disorders – the importance of affects
Open this publication in new window or tab >>Psychotherapy for Substance Use Disorders – the importance of affects
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Psykoterapi för substansbrukssyndrom – betydelsen av affekter
Abstract [en]

Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.

The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.

In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.

In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking.

Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition.

Abstract [sv]

Substansberoende är en allvarlig störning och samsjuklighet ofta förekommande Den stora variationen av svårigheter kräver olika behandlingsalternativ. Syftet med avhandlingen var att undersöka affekters roll i psykoterapi för populationen. Ytterligare syften var att undersöka betydelsen av gemensamma faktorer i psykoterapi samt normera ett självskattningsformulär för affektfobi. I studie I undersöktes skillnaden mellan patienters förväntningar, erfarenheter av terapi och allians. I studie II utvärderades de psykometriska egenskaperna hos affektfobitestet. I studie III och IV undersöktes genomförbarheten av affektfobiterapi individuellt och i grupp. Resultaten av studierna visade att större skillnad mellan rollförväntningar inför- och erfarenheter av terapi var signifikant korrelerade med lägre allians i gruppterapi. Affektfobitestets psykometriska egenskaper var tillfredsställande avseende skalan som helhet. Affektfobiterapi visade sig öka adaptiv affektiv förmåga och självmedkänsla, men behandlingen gav inget säkert stöd för påverkan på substansbruket. Slutsatserna är att fokus på affekter i terapi för substansberoende har betydelse och att affektfobiterapi är en genomförbar behandling för populationen. Genom att undersöka förväntningar och rädslor inför terapi kan avhopp förhindras.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 82 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 726Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 202
Keyword
Substance Use Disorders, comorbidities, ADHD, emotions, psychodynamic psychotherapy, self-compassion, common factors, Substansbrukssyndrom, samsjuklighet, ADHD, emotioner, psykodynamisk terapi, självmedkänsla, gemensamma faktorer
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-143192 (URN)9789176854297 (ISBN)
Public defence
2017-12-15, I:101, I-huset, Campus Valla, Linköping, 10:00 (English)
Supervisors
Note

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Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2017-11-22Bibliographically approved

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