Research in Psychotherapy: Psychopathology, Process and Outcome <p><strong>Research in Psychotherapy: Psychopathology, Process and Outcome</strong> (RIPPPO) is an online, open-access, peer reviewed journal published by the <strong>Italian Area Group of the Society for Psychotherapy Research</strong> (<a href="">SPR Italy Area Group</a>). Its aim is to promoting a fruitful communication between the Italian and International communities, enriching clinicians and researchers mutual collaboration. It welcomes high quality articles from any part of the world, concerning a variety of topics (<em>e.g.</em>, psychotherapy process and outcome, diagnosis and assessment, psychopathology <em>etc.</em>), with different formats (<em>e.g.</em>, reviews, empirical studies, methodological works, clinical studies) and from different epistemological, theoretical and methodological perspectives of the contemporary research in psychotherapy.</p> <p>RIPPPO publishes three issues every year and provides immediate open access to its contents, on the basis of the principle that making research results freely available to researchers and practitioners supports a better exchange of knowledge.</p> <p>This journal does not apply the article processing charge to Authors as it is supported by institutional funds.</p> en-US <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li class="show">the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li class="show">a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> (Francesca Baccino) (Tiziano Taccini) Wed, 31 Jul 2019 12:20:56 +0200 OJS 60 Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial <p>Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a double-blind randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.</p> Sahel Khakpoor, Jahangir Mohammadi Baytmar, Omid Saed ##submission.copyrightStatement## Fri, 09 Aug 2019 00:00:00 +0200 Hikikomori silent epidemic: a case study <p>Psychiatry, as we know it, is at a crucial point because it needs to adapt to the modern time and still maintain the integrity and ethic aspects of the therapeutic alliance. Bearing in mind the rising prevalence of new addictions like Internet and online gaming addictions, one can see that, however, disputed, there is a whole new category of psychiatric illnesses on the rise. An example of these kinds of illnesses is Hikikomori. Hikikomori, or severe social withdrawal, pertains to patients who have stopped participating in everyday routine and would spend the majority of time confined in their room for the period of 6 months or more, with no evident psychosis. Although this syndrome was originally described in Japan, over the course of last few years it has been documented in several parts of the world, spreading like a silent epidemic. Our case study, being the first documented case in Southeast Europe, according to our experience and literature search, is a vivid example of this syndrome. In this report we discuss differential diagnosis, show what kind of therapy was efficient in the successful treatment of this syndrome and how it can be prevented in the future</p> Ante Silić, Jakša Vukojević, Ilaria Čulo, Hrvoje Falak ##submission.copyrightStatement## Tue, 30 Jul 2019 16:10:03 +0200 I am surrounded by death: death as a defining psychic issue within a relational psychoanalytic engagement and the impact of the therapist’s relationship with death <p>Taking inspiration from Frommer, this paper is part of a shift towards incorporating death as a defining psychic issue. With a sense that <em>I am surrounded by death</em>, the author presents two brief vignettes of clinical cases to illustrate the impact of the therapist’s relationship with death on the therapeutic process. Each case shows a different level of engagement with the client when the focus is on death-talk, and reflects, on the one hand, the therapist’s ability and readiness to work with death as an object of analysis, and on the other hand, the therapist’s lack of processing of experiences of death of others, and the resultant <em>failure</em> to successfully work with death in analysis. The one case is arguably more successful therapeutically than the other, and highlights some issues that come into play in the light of the therapist’s relationship with death. These issues are: i) the importance of the therapist’s development with regards to processing experiences of death and dying cannot be underestimated when working with death as an object of scrutiny; ii) empathy remains core to the process and getting in touch with how the client experiences the death of the other. Without recognition, however, no (grief) work can begin. The therapist needs to psychologically recognise the other to be able to connect to, and empathize with, the clients process; iii) the impact of the death of the other often transforms into the work of the impact of the death of self; iv) if clients have a sense that the therapist knows what they are speaking about because the therapist has done some of the work of making meaning of death, clients may feel more confident in working with death as an object of analysis.</p> Zelda Gillian Knight ##submission.copyrightStatement## Tue, 30 Jul 2019 16:06:47 +0200 Personal style of the therapist and personality dimensions in a sample of Argentinian therapists <p>The Personal Style of the Therapist (PST) is an important aspect to assess in the therapeutic process. Previous research has explored therapist’s profiles and their differences according to a variety of theoretical orientations, as well as the association between these profiles and personality traits. This study aims to put together these lines of research through a cluster analysis. The specific goals were to describe the profiles of therapists with respect to the functions of the PST and personality traits; and to analyze whether the professionals’ profiles and their theoretical orientations were related. The sample was comprised of 546 Argentinian therapists. The Personal Style of the Therapist Questionnaire (PST-Q) and the Big Five Inventory (BFI) were used as measuring instruments. Using the methodology of hierarchical analysis based on a cluster analysis integrating the five factors of the PST, a four-cluster solution was confirmed to be the most satisfactory. Subsequently, a cluster analysis of k-means based on the five factors of each test (PST-Q and BFI) was performed. Finally, the relationship between the clusters and theoretical orientation and years of clinical practice was assessed, rendering positive outcomes. The results are discussed based on previous research studies and the significance of studying the therapist’s personal variables and their connection with psychotherapy efficacy.</p> Leandro Martín Casari, Mirta Susana Ison, Beatriz Margarita María Gómez ##submission.copyrightStatement## Tue, 30 Jul 2019 16:03:55 +0200 Dysfunctional personality traits: relationship with Five Factor Model, adaptation and symptomatology in a community sample from Buenos Aires <p>The paper introduces an analysis of the dimensional maladaptive personality traits model stated in the section III of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), conducted on a community sample composed of 906 adults from Buenos Aires, Argentina. Data were gathered using a socio-demographic survey as well as the Personality Inventory for DSM-5 (PID-5), the Big Five Inventory (BFI), the Symptom Check List 90-R (SCL-90-R), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). A joint exploratory factor analysis was carried out including the PID-5’s 25 facets along with BFI’s 5 factors as input variables. Findings showed a 5-factor structure mostly coincident with DSM-5’s hypotheses as well as with previous research. Besides, correlations calculated between PID-5 and BFI scores behaved according to theoretical hypotheses. By means of a two-stage cluster analysis which used WHODAS 2.0 score and the Global Severity Index index from SCL-90-R as segmentation criteria, two groups were differentiated: The High-Adaptation/Low-Symptomatology group <em>vs</em> the Low- Adaptation/High-Symptomatology one. The second group obtained significantly higher means in the five domains, and in 24 of the 25 facets of PID-5.</p> Juliana Beatriz Stover, Alejandro Castro Solano, Mercedes Fernández Liporace ##submission.copyrightStatement## Tue, 30 Jul 2019 16:00:12 +0200 Psychological and physiological effects of emotion focused training for self-compassion and self-protection <p>Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is a novel intervention developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and existing programs designed to cultivate compassion. EFT-SCP is designed to encourage participants to cultivate self-compassion and protective anger as a way of reducing selfcriticism. Our goal was to investigate the effect of this group-based intervention on self-criticism, self-protection, and self-compassion. A total of 73 students were assigned to the EFT-SCP intervention (<em>n</em>=19), no-treatment control (<em>n</em>=34) or to an active control group (<em>n</em>=20). The intervention group met weekly for 1.5 hours and were instructed to incorporate EFT-SCP tasks into their daily life for 12 weeks. Whilst the no-treatment group did not undergo an intervention, the active control group completed an adapted expressive writing task once a week. In addition to the assessment of heart rate variability during imagery tasks, participants also completed self-reported measures of self-compassion and self-criticism before and after the intervention. Compared with both control groups, the intervention group showed a significant increase in heart rate variability following EFT-SCP (during self-critical imagery, P=.049; probability of superiority was .63, and during self-compassionate imagery P=.007; probability of superiority was .62, both effect sizes were medium) and significant decreases in self-criticism (Hated Self P=.017; .34 and Inadequate Self P&lt;.001; .33) and selfuncompassionate responding (P&lt;.001; .39). All three effect sizes were small. Participating in EFT-SCP had a positive effect on psychological and physiological outcomes.</p> Júlia Halamová, Jana Koróniová, Martin Kanovský, Mária Kénesy Túniyová, Nuriye Kupeli ##submission.copyrightStatement## Tue, 30 Jul 2019 15:49:14 +0200 Is it possible to improve early childhood development with a video-feedback intervention directed at the mother-father-child triad? <p>Relationships with primary caregivers provide the context for early childhood development, and evaluating those relationships during the early years can detect difficulties that may influence future mental health. Video feedback is a valuable intervention tool in early childhood, both for family relationships and child development. An intervention was implemented using this technique, focused on mother-father-child triads that were experiencing difficulties in social-emotional development. Participants were 80 mother-fatherinfant triads (experimental group, EG=40, control group, CG=40), with children between 1 and 3 years old. Socio-emotional difficulties decreased significantly in the children who received the intervention (Wilks λ=0.930, F (1, 78)=5.907; P=.017). There was also an increase in psychomotor development in communication (Wilks λ=0.948, F (1, 78) =4.284; P=.042) and fine motor skills (Wilks λ=0.875, F (1, 78)=11.185; P=.001) in children in the EG compared with children in the CG.</p> Marcia Olhaberry, María José León, Catalina Sieverson, Marta Escobar, Daniela Iribarren, Irma Morales-Reyes, Constanza Mena, Fanny Leyton ##submission.copyrightStatement## Tue, 30 Jul 2019 15:24:53 +0200 The flip side of collaborative alliance: a single-case study <p>The present single case study explored whether a positive collaboration may conceal some of the patient’s dysfunctional interpersonal schemas, hence reflecting a <em>non-authentic</em> collaboration. In particular, we reasoned that conceiving collaborations only as adaptive relations may prevent a comprehensive insight of the therapeutic relationship itself. To explore this possibility, we used an intersubjective approach that emphasizes the integration of specific and non-specific factors in an interdependent way. In particular, we assessed different constructs (<em>i.e</em>. therapeutic alliance, technical interventions, defense mechanism, therapeutic relationship) of the therapeutic process and combined them through statistical methods able to investigate the micro- and macro-analytic processes that define each interaction. Results of a single case study (Sara) showed that the collaborative functioning may hold back many critical aspects, that hardly conciliate with the classic positive definition of collaboration. These findings, therefore, indicate that Sara’s collaborative alliance works mainly as a <em>pseudo-alliance</em>.</p> Francesca Locati, Pietro De Carli, Margherita Lang, Laura Parolin ##submission.copyrightStatement## Tue, 30 Jul 2019 15:16:56 +0200 The Alliance Negotiation Scale: Portuguese adaptation <p>The transtheoretical conceptualization of the working alliance and the ensuing evaluation tools tend to overestimate the collaboration between therapist and patient and to disregard the negotiation. The degree to which therapists and patients are able to negotiate their disagreements between goals and tasks is an important variable for establishing and maintaining the alliance. The purpose of this study was to adapt the Alliance Negotiation Scale – which operationalizes the theoretical construct of negotiation – to the Portuguese population. A translation and study of the psychometric traits of the scale are presented. After a backward-translation of the scale it was distributed, with the help of therapists, to a sample of 120 participants, all patients in therapeutic process. The scale showed a similar structure to its previous versions, and adequate levels of internal consistency (α=.82). These results reinforce the quality of the scale, construct’s relevance and its transtheoretical nature. These results are a step forward for Portuguese therapists’ and researchers’ ability to evaluate the bond between patient and therapist and to compare results from different countries.</p> Maria Inês Galvão, Ana Nunes da Silva, António Branco Vasco ##submission.copyrightStatement## Tue, 30 Jul 2019 15:12:32 +0200 Alliance challenges in the treatment of a narcissistic patient: the case of Alex <p>People with pathological narcisism, with their conflicted sense of grandiosity and vulnerability, often pose a variety of therapeutic challenges, which may impede these patients’ ability to benefit from psychotherapy. To offer a case illustration and provide insight into the intrinsic difficulties of working with this patient group, we examined the treatment of a fictional character, Alex, from the TV series In Treatment. Based on the Shedler-Westen Assessment Procedure-200 we diagnosed Alex with pathological narcissism, and evaluated the treatment process (seven sessions) by reporting on measurements of session-by-session change in explicit working alliance, implicit language alliance, and ruptures and repairs. Over the course of treatment, the working alliance (Working Alliance Inventory-Observer scale) fluctuated with a particularly low bond at session five, identified as a rupture (Rupture Resolution Rating System). Language analysis (Linguistic Inquiry and Word Count) showed that the unconscious aspects of the alliance started to deteriorate just before the rupture occurred. The results illustrate how therapists might be pulled to collude with narcissistic patients’ grandiosity, with the risk of neglecting their vulnerability. This fictional portrayal of a treatment with a narcissistic patient may be widely shared with researchers, students and therapists alike, offering a common locus of scholarly attention, and an innovative tool for teaching. Given the lack of empirical treatments for pathological narcissism and the great therapeutic challenges narcissistic patients present, further research and development of clinical guidelines are warranted.</p> Hemrie Zalman, Katie Aafjes-van Doorn, Catherine F. Eubanks ##submission.copyrightStatement## Tue, 30 Jul 2019 15:05:58 +0200