https://doi.org/10.4081/ripppo.2023.708
Different epistemic stances for different traumatic experiences: implications for mentalization
Submitted: July 28, 2023
Accepted: November 4, 2023
Published: December 20, 2023
Accepted: November 4, 2023
Abstract Views: 1090
PDF: 511
Supplementary Material: 89
HTML: 49
Supplementary Material: 89
HTML: 49
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Traumatic experiences may impair reflective functioning (RF), making it difficult for individuals to understand their own and others' mental states. Epistemic trust (ET), which enables evaluating social information as reliable and relevant, may vary in association with RF. In this study, we explored the implications of different ET stances (i.e., trust, mistrust, and credulity) in the relation between different childhood traumatic experiences (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and different types of RF impairments (uncertainty and certainty about mental states). A non-clinical community sample of 496 cisgender emerging adults (mage = 24.91, standard deviation = 2.66, 71.85% assigned female at birth, 63.63% heterosexual) reported on their childhood traumatic experiences, ET, and RF. We used structural equation models to examine direct and indirect associations. The results showed significant indirect effects between emotional abuse and uncertainty about mental states through credulity. We also observed significant indirect effects between emotional abuse and certainty about mental states through mistrust and credulity. The findings suggest that a lack of discrimination when evaluating knowledge from others (i.e., credulity) might promote increased uncertainty in RF when emerging adults have experienced emotional abuse in their childhood. Conversely, a tendency to view all information sources as unreliable or ill-intentioned (i.e., mistrust) may foster greater certainty in RF as a protective mechanism against an unreliable and potentially harmful world when combined with childhood emotional abuse. The implications for clinical practice and intervention are discussed.
Allen, J. G. (2018). Mentalizing in the development and treatment of attachment trauma. Abingdon-on-Thames, Routledge.
DOI: https://doi.org/10.4324/9780429477263
Álvarez, M. J., Roura, P., Osés, A., Foguet, Q., Solà, J., & Arrufat, F. X. (2011). Prevalence and clinical impact of childhood trauma in patients with severe mental disorders. Journal of Nervous & Mental Disease, 199(3), 156-161. doi: 10.1097/NMD.0b013e31820c751c.
DOI: https://doi.org/10.1097/NMD.0b013e31820c751c
Bateman, A. W., & Fonagy, P. E. (2012). Handbook of mentalizing in mental health practice. Washington D.C, American Psychiatric Publishing, Inc.
Benzi, I. M. A., Fontana, A., Barone, L., Preti, E., Parolin, L., & Ensink, K. (2023). Emerging personality in adolescence: developmental trajectories, internalizing and externalizing problems, and the role of mentalizing abilities. Journal of Adolescence, 95(3), 537-552. doi: 10.1002/jad.12134.
DOI: https://doi.org/10.1002/jad.12134
Benzi, I. M. A., Fontana, A., & Di Pierro, R. (2023). Maladaptive personality traits and internalizing and externalizing problems: the role of borderline and narcissistic features in adolescence. Clinical Neuropsychiatry, 20(3), 161-172. doi: 10.36131/cnfioritieditore20230301.
Bernstein, D. P., Fink, L., Handelsman, L., & Foote, J. (1994). Childhood Trauma Questionnaire (CTQ) [Database record]. APA PsycTests. https://doi.org/10.1037/t02080-000.
DOI: https://doi.org/10.1037/t02080-000
Berthelot, N., Ensink, K., Bernazzani, O., Normandin, L., Luyten, P., & Fonagy, P. (2015). Intergenerational transmission of attachment in abused and neglected mothers: the role of trauma-specific Reflective Functioning. Infant Mental Health Journal, 36(2), 200-212. doi: 10.1002/imhj.21499.
DOI: https://doi.org/10.1002/imhj.21499
Bollen, K. A. (1989). A new incremental fit index for general structural equation models. Sociological methods & research, 17(3), 303-316.
DOI: https://doi.org/10.1177/0049124189017003004
Brassard, M. R., Hart, S. N., & Hardy, D. B. (2000). Psychological and emotional abuse of children. In R. T. Ammerman & M. Hersen (Eds.), Case Studies in Family Violence, (pp. 293-319). Dordrecht, Kluwer Academic Publishers. doi: 10.1007/978-1-4615-4171-4_14.
DOI: https://doi.org/10.1007/978-1-4615-4171-4_14
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of Epistemic trust. PloS One, 16(4), e0250264. doi: 10.1371/journal.pone.0250264.
DOI: https://doi.org/10.1371/journal.pone.0250264
Driehuis, S. R. (2021). The relationship between childhood trauma and epistemic trust: a cross-sectional study. Available from: https://studenttheses.uu.nl/bitstream/handle/20.500.12932/994/Driehuis%20%286253547%29%20thesis.pdf?sequence=1&isAllowed=y.
Dubowitz, H., & Bennett, S. (2007). Physical abuse and neglect of children. The Lancet, 369(9576), 1891-1899. doi: 10.1016/S0140-6736(07)60856-3.
DOI: https://doi.org/10.1016/S0140-6736(07)60856-3
Duschinsky, R., & Foster, S. (2021). Mentalising and epistemic trust: the work of Peter Fonagy and colleagues at the Anna Freud Centre (1st ed.). Oxford, Oxford University Press.
DOI: https://doi.org/10.1093/med-psych/9780198871187.003.0001
Duval, J., Ensink, K., Normandin, L., Sharp, C., & Fonagy, P. (2018). Measuring reflective functioning in adolescents: relations to personality disorders and psychological difficulties. Adolescent Psychiatry, 8(1), 5-20. doi: 10.2174/2210676608666180208161619.
DOI: https://doi.org/10.2174/2210676608666180208161619
Ensink, K., Bégin, M., Normandin, L., Godbout, N., & Fonagy, P. (2017). Mentalization and dissociation in the context of trauma: implications for child psychopathology. Journal of Trauma & Dissociation, 18(1), 11-30. doi: 10.1080/15299732.2016.1172536.
DOI: https://doi.org/10.1080/15299732.2016.1172536
Ensink, K., Normandin, L., Plamondon, A., Berthelot, N., & Fonagy, P. (2016). Intergenerational pathways from reflective functioning to infant attachment through parenting. Canadian Journal of Behavioural Science, 48(1), 9-18. doi: 10.1037/cbs0000030.
DOI: https://doi.org/10.1037/cbs0000030
Ensink, K., Normandin, L., Target, M., Fonagy, P., Sabourin, S., & Berthelot, N. (2015). Mentalization in children and mothers in the context of trauma: an initial study of the validity of the child reflective functioning scale. British Journal of Developmental Psychology, 33(2), 203-217. doi: 10.1111/bjdp.12074.
DOI: https://doi.org/10.1111/bjdp.12074
Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy, 51(3), 372-380. doi: 10.1037/a0036505.
DOI: https://doi.org/10.1037/a0036505
Fonagy, P., Campbell, C., & Luyten, P. (2023). Attachment, mentalizing and trauma: then (1992) and now (2022). Brain Sciences, 13(3), 459. doi: 10.3390/brainsci13030459.
DOI: https://doi.org/10.3390/brainsci13030459
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2018). Affect regulation, Mentalization, and the development of the self. London, Routledge.
DOI: https://doi.org/10.4324/9780429471643
Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2017). What we have changed our minds about: part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation, 4, 9. doi: 10.1186/s40479-017-0062-8.
DOI: https://doi.org/10.1186/s40479-017-0062-8
Fonagy, P., Luyten, P., Allison, E., & Campbell, C. (2019). Mentalizing, epistemic trust and the phenomenology of psychotherapy. Psychopathology, 52(2), 94-103. doi: 10.1159/000501526.
DOI: https://doi.org/10.1159/000501526
Fonagy, P., Steele, M., Steele, H., Moran, G. S., & Higgitt, A. C. (1991). The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201-218. doi: 10.1002/1097-0355(199123)12:3<201::AID-IMHJ2280120307>3.0.CO;2-7.
DOI: https://doi.org/10.1002/1097-0355(199123)12:3<201::AID-IMHJ2280120307>3.0.CO;2-7
Fonagy, P., Target, M., Gergely, G., Allen, J. G., & Bateman, A. W. (2003). The developmental roots of borderline personality disorder in early attachment relationships: a theory and some evidence. Psychoanalytic Inquiry, 23(3), 412-459. doi: 10.1080/07351692309349042.
DOI: https://doi.org/10.1080/07351692309349042
Gergely, G. (2013). Ostensive communication and cultural learning: the natural pedagogy hypothesis. In J. Metcalfe, H. S. Terrace (Eds.), Agency and Joint Attention (pp. 139-151). Oxford, Oxford University Press.
DOI: https://doi.org/10.1093/acprof:oso/9780199988341.003.0008
Gladish, N., Merrill, S. M., & Kobor, M. S. (2022). Childhood trauma and epigenetics: state of the science and future. Current Environmental Health Reports, 9(4), 661-672. doi: 10.1007/s40572-022-00381-5.
DOI: https://doi.org/10.1007/s40572-022-00381-5
Ha, C., Sharp, C., Ensink, K., Fonagy, P., & Cirino, P. (2013). The measurement of reflective function in adolescents with and without borderline traits. Journal of Adolescence, 36(6), 1215-1223. doi: 10.1016/j.adolescence.2013.09.008.
DOI: https://doi.org/10.1016/j.adolescence.2013.09.008
Heleniak, C., Jenness, J. L., Vander Stoep, A., McCauley, E., & McLaughlin, K. A. (2016). Childhood maltreatment exposure and disruptions in emotion regulation: a transdiagnostic pathway to adolescent internalizing and externalizing psychopathology. Cognitive therapy and research, 40(3), 394-415. doi: 10.1007/s10608-015-9735-z.
DOI: https://doi.org/10.1007/s10608-015-9735-z
Huang, Y. L., Fonagy, P., Feigenbaum, J., Montague, P. R., Nolte, T., & London Personality and Mood Disorder Research Consortium. (2020). Multidirectional pathways between attachment, mentalizing, and posttraumatic stress symptomatology in the context of childhood trauma. Psychopathology, 53 doi: 10.1159/000506406.
DOI: https://doi.org/10.1159/000506406
Knox, J. (2016). Epistemic mistrust: a crucial aspect of mentalization in people with a history of abuse? British Journal of Psychotherapy, 32(2), 226-236. doi: 10.1111/bjp.12212.
DOI: https://doi.org/10.1111/bjp.12212
Kuo, J. R., Goldin, P. R., Werner, K., Heimberg, R. G., & Gross, J. J. (2011). Childhood trauma and current psychological functioning in adults with social anxiety disorder. Journal of Anxiety Disorders, 25(4), 467-473. doi: 10.1016/j.janxdis.2010.11.011.
DOI: https://doi.org/10.1016/j.janxdis.2010.11.011
Larsson, S., Andreassen, O. A., Aas, M., Røssberg, J. I., Mork, E., Steen, N. E., Barrett, E. A., Lagerberg, T. V., Peleikis, D., Agartz, I., Melle, I., & Lorentzen, S. (2013). High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder. Comprehensive Psychiatry, 54(2), 123-127. doi: 10.1016/j.comppsych.2012.06.009.
DOI: https://doi.org/10.1016/j.comppsych.2012.06.009
Li, C. H. (2016). The performance of ML, DWLS, and ULS estimation with robust corrections in structural equation models with ordinal variables. Psychological methods, 21(3), 369.
DOI: https://doi.org/10.1037/met0000093
Liotti, M., Milesi, A., Spitoni, G. F., Tanzilli, A., Speranza, A. M., Parolin, L., ... & Giovanardi, G. (2023). Unpacking trust: The Italian validation of the epistemic trust, mistrust, and credulity questionnaire (ETMCQ). Plos one, 18(1), e0280328. doi: 10.1371/journal.pone.0280328.
DOI: https://doi.org/10.1371/journal.pone.0280328
Locati, F., Benzi, I. M. A., Milesi, A., Campbell, C., Midgley, N., Fonagy, P., & Parolin, L. (2023). Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: a gender‐sensitive structural equation modeling approach. Journal of Adolescence. doi: 10.1002/jad.12226.
DOI: https://doi.org/10.1002/jad.12226
Locati, F., Milesi, A., Conte, F., Campbell, C., Fonagy, P., Ensink, K., & Parolin, L. (2022). Adolescence in lockdown: the protective role of mentalizing and Epistemic trust. Journal of Clinical Psychology, 79(4), 969-984. doi: 10.1002/jclp.23453.
DOI: https://doi.org/10.1002/jclp.23453
Lund, S. H., Bo, S., Bach, B., Jørgensen, M. S., & Simonsen, E. (2022). Mentalizing in adolescents with and without prominent borderline features: validation of the reflective functioning questionnaire for youths (RFQY) and an investigation of the factor structure of hypo- and hypermentalizing. Journal of Personality Assessment, 105(4), 475-486. 12. doi: 10.1080/00223891.2022.2055474.
DOI: https://doi.org/10.1080/00223891.2022.2055474
Luyten, P., Campbell, C., & Fonagy, P. (2020). Borderline personality disorder, complex trauma, and problems with self and identity: a social-communicative approach. Journal of Personality, 88(1), 88-105. doi: 10.1111/jopy.12483.
DOI: https://doi.org/10.1111/jopy.12483
Lyons-Ruth, K., Bureau, J.-F., Holmes, B., Easterbrooks, A., & Brooks, N. H. (2013). Borderline symptoms and suicidality/self-injury in late adolescence: prospectively observed relationship correlates in infancy and childhood. Psychiatry Research, 206(2-3), 273-281. doi: 10.1016/j.psychres.2012.09.030.
DOI: https://doi.org/10.1016/j.psychres.2012.09.030
MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current directions in psychological science, 18(1), 16-20.
DOI: https://doi.org/10.1111/j.1467-8721.2009.01598.x
Martin-Gagnon, G., Fonagy, P., Bégin, M., Normandin, L., & Ensink, K. (2023). Measuring mentalizing in youth: further validation of the reflective functioning questionnaire for youth (RFQY-13). Frontiers in Psychology, 14, 1260281. doi: 10.3389/fpsyg.2023.1260281.
DOI: https://doi.org/10.3389/fpsyg.2023.1260281
McGee, R. A., & Wolfe, D. A. (1991). Psychological maltreatment: toward an operational definition. Development and Psychopathology, 3(1), 3-18. doi: 10.1017/S0954579400005034.
DOI: https://doi.org/10.1017/S0954579400005034
Milesi, A., De Carli, P., Locati, F., Benzi, I., Campbell, C., Fonagy, P., & Parolin, L. (2023). How can I trust you? The role of facial trustworthiness in the development of epistemic and interpersonal trust. Human Development, 37(2), 57-68. doi: 10.1159/000530248.
DOI: https://doi.org/10.1159/000530248
Nikulina, V., Widom, C. S., & Czaja, S. (2011). The role of childhood neglect and childhood poverty in predicting mental health, academic achievement and crime in adulthood. American Journal of Community Psychology, 48(3-4), 309-321. doi: 10.1007/s10464-010-9385-y.
DOI: https://doi.org/10.1007/s10464-010-9385-y
Nöthling, J., Malan-Müller, S., Abrahams, N., Hemmings, S. M. J., & Seedat, S. (2020). Epigenetic alterations associated with childhood trauma and adult mental health outcomes: a systematic review. World Journal of Biological Psychiatry, 21(7), 493-512. doi: 10.1080/15622975.2019.1583369.
DOI: https://doi.org/10.1080/15622975.2019.1583369
Orme, W., Bowersox, L., Vanwoerden, S., Fonagy, P., & Sharp, C. (2019). The relation between epistemic trust and borderline pathology in an adolescent inpatient sample. Borderline Personality Disorder and Emotion Dysregulation, 6, 13. doi: 10.1186/s40479-019-0110-7.
DOI: https://doi.org/10.1186/s40479-019-0110-7
Parolin, L. A. L., Benzi, I. M. A., Fanti, E., Milesi, A., Cipresso, P., & Preti, E. (2021). Italia ti ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic. Research in Psychotherapy: Psychopathology, Process, and Outcome, 24(1), 517. doi: 10.4081/ripppo.2021.517.
DOI: https://doi.org/10.4081/ripppo.2021.517
Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: a neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7(1), 33-51.
DOI: https://doi.org/10.1016/S1056-4993(18)30258-X
R Core Team, R. (2013). R: A language and environment for statistical computing. Vienna, R Foundation for Statistical Computing.
Revelle, W., & Revelle, M. W. (2015). Package ‘psych’. The comprehensive R archive network, 337(338).
Rosseel, Y., Oberski, D., Byrnes, J., Vanbrabant, L., Savalei, V., Merkle, E., ... & Jorgensen, T. (2017). Package ‘lavaan’. Retrieved June, 17(1), 2017.
Sacchi, C., Vieno, A., & Simonelli, A. (2018). Italian validation of the Childhood Trauma Questionnaire—Short Form on a college group. Psychological Trauma: Theory, Research, Practice, and Policy, 10(5), 563–571. https://doi.org/10.1037/tra0000333.
DOI: https://doi.org/10.1037/tra0000333
Sharp, C., & Fonagy, P. (2015). Practitioner review: borderline personality disorder in adolescence–recent conceptualization, intervention, and implications for clinical practice. Journal of Child Psychology and Psychiatry, 56(12), 1266-1288. doi: 10.1111/jcpp.12449.
DOI: https://doi.org/10.1111/jcpp.12449
Sharp, C., & Venta, A. (2013). Mentalizing problems in children and adolescents. In N. Midgley, I. Vrouva (Eds.), Minding the child (pp. 35-53). Abingdon-on-Thames, Routledge.
Sharp, C., Williams, L. L., Ha, C., Baumgardner, J., Michonski, J., Seals, R., Patel, A. B., Bleiberg, E., & Fonagy, P. (2009). The development of a mentalization-based outcomes and research protocol for an adolescent inpatient unit. Bulletin of the Menninger Clinic, 73(4), 311-338. doi: 10.1521/bumc.2009.73.4.311.
DOI: https://doi.org/10.1521/bumc.2009.73.4.311
Simon, J., Luetzow, A., & Conte, J. R. (2020). Thirty years of the convention on the rights of the child: Developments in child sexual abuse and exploitation. Child Abuse & Neglect, 110(Part 1), 104399. doi: 10.1016/j.chiabu.2020.104399.
DOI: https://doi.org/10.1016/j.chiabu.2020.104399
Sperber, D., Clément, F., Heintz, C., Mascaro, O., Mercier, H., Origgi, G., & Wilson, D. (2010). Epistemic vigilance. Mind & Language, 25(4), 359-393. doi: 10.1111/j.1468-0017.2010.01394.x.
DOI: https://doi.org/10.1111/j.1468-0017.2010.01394.x
Stoltenborgh, M., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2013). The neglect of child neglect: a meta-analytic review of the prevalence of neglect. Social Psychiatry and Psychiatric Epidemiology, 48(3), 345-355. doi: 10.1007/s00127-012-0549-y.
DOI: https://doi.org/10.1007/s00127-012-0549-y
Tanzilli, A., Cibelli, A., Liotti, M., Fiorentino, F., Williams, R., & Lingiardi, V. (2022). Personality, defenses, mentalization, and epistemic trust related to pandemic containment strategies and the COVID-19 vaccine: a sequential mediation model. International Journal of Environmental Research and Public Health, 19(21), 14290. doi: 10.3390/ijerph192114290.
DOI: https://doi.org/10.3390/ijerph192114290
Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navalta, C. P., & Kim, D. M. (2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience & Biobehavioral Reviews, 27(1-2), 33-44. doi: 10.1016/S0149-7634(03)00007-1.
DOI: https://doi.org/10.1016/S0149-7634(03)00007-1
Thompson, A. E., & Kaplan, C. A. (1996). Childhood emotional abuse. British Journal of Psychiatry, 168(2), 143-148. doi: 10.1192/bjp.168.2.143.
DOI: https://doi.org/10.1192/bjp.168.2.143
Tmej, A., Fischer-Kern, M., Doering, S., Alexopoulos, J., & Buchheim, A. (2018). Changes in attachment representation in psychotherapy: is reflective functioning the crucial factor?. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 64(3), 222-236. doi: 10.13109/zptm.2018.64.3.222.
DOI: https://doi.org/10.13109/zptm.2018.64.3.222
Torjesen, I. (2019). Childhood trauma doubles risk of mental health conditions. BMJ, 364, l854. doi: 10.1136/bmj.l854.
DOI: https://doi.org/10.1136/bmj.l854
Turniansky, H., Ben-Dor, D., Krivoy, A., Weizman, A., & Shoval, G. (2019). A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients - a naturalistic study. Child Abuse & Neglect, 98, 104222. doi: 10.1016/j.chiabu.2019.104222.
DOI: https://doi.org/10.1016/j.chiabu.2019.104222
Ullman, J. B., & Bentler, P. M. (2012). Structural equation modeling. Handbook of Psychology, Second Edition, 2.
DOI: https://doi.org/10.1002/9781118133880.hop202023
Wu, N. S., Schairer, L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35(1), 68-71. doi: 10.1016/j.addbeh.2009.09.003.
DOI: https://doi.org/10.1016/j.addbeh.2009.09.003
Xie, P., Wu, K., Zheng, Y., Guo, Y., Yang, Y., He, J., Ding, Y., & Peng, H. (2018). Prevalence of childhood trauma and correlations between childhood trauma, suicidal ideation, and social support in patients with depression, bipolar disorder, and schizophrenia in southern China. Journal of Affective Disorders, 228, 41-48. doi: 10.1016/j.jad.2017.11.011.
DOI: https://doi.org/10.1016/j.jad.2017.11.011
How to Cite
Benzi, I. M. A., Carone, N., Parolin, L., Martin-Gagnon, G., Ensink, K., & Fontana, A. (2023). Different epistemic stances for different traumatic experiences: implications for mentalization. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). https://doi.org/10.4081/ripppo.2023.708
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Irene Messina, Pietro Spataro, Alessandro Grecucci, Danielle M. Moskow, Cristina Marogna, Stefan G. Hofmann, Interpersonal emotion regulation questionnaire: psychometric properties of the Italian version and associations with psychopathology , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 2 (2022)
- Christopher B. Harte, Raymond C. Hawkins II, Impact of personality disorder comorbidity on cognitive-behavioral therapy outcome for mood and anxiety disorders: results from a university training clinic , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 19 No. 2 (2016)
- Petr Doležal, Michal Čevelíček, Tomáš Řiháček, Jan Roubal, Roman Hytych, Lucia Ukropová, Why did she leave? Development of working alliance in a case of psychotherapy for depression , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 22 No. 2 (2019)
You may also start an advanced similarity search for this article.
