Using person-specific networks in psychotherapy: challenges, limitations, and how we could use them anyway (original) (raw)
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Conceptual issues in the choice of a structured psychiatric interview
Comprehensive Psychiatry, 1982
I T HAS BEEN many years now since researchers have relied solely on senior clinicians, staff consensus, or hospital records to assign patients to diagnostic groups. Some three decades of rigorous work in patient assessment and diagnostic decision-making have produced structured psychiatric interviews with high interrater reliability.'-" Instruments such as the Present State Examination (PSE)," the Schedule for Affective Disorders and Schizophrenia (SADS>,13 and the Diagnostic Interview Schedule (DIS)14 provide articulated procedures for conducting the interview and well-defined criteria (with examples) for determining the presence/absence and intensity of psychopathological signs and symptoms. While we have good reason to be well pleased with our advances in this area, there is also reason to take a critical look at structured psychiatric interviews. There seem to be three major errors in using structured psychiatric interviews: (1) we assume that since we use standard probes provided by the interviews' developers, we shall elicit the same information and thus shall be automatically reliable over time; (2) we fail to consider differences in the nature of the cognitive task demanded of the interviewer by different interview procedures; and (3) we fail to make explicit our assumptions about the nature of pathology, the nature of our particular research or clinical objectives, and the relative suitabilities of the different interview schedules. We offer in this article a detailed comparison of two popularly used interviews (the PSE and the SADS) to illustrate the sorts of issues the clinician/ researcher should consider in making an informed choice of available interview schedules. It is not sufficient to arbitrarily pick a structured psychiatric interview to assure appropriate and quality assessment. The interviewer's cognitive task, the conceptualization of psychopathology, and clinical and research objectives also must be considered. THE PRESENT STATE EXAMINATION Conceptual Orientation As reflected in its name, the PSE has been developed to assess an individual's current (within the past month) psychiatric functioning. Its focus is heavily phenomenological in keeping with a European tradition of psychiatry."
A Psycho-Diagnostic Tool for Psychotherapy: Interactional Pattern Analysis (IPA)
Journal of Psychology in Africa, 2013
This article proposes a description of a psycho-diagnostic tool for psychotherapists, the Interactional Pattern Analysis (IPA). Sixteen interpersonal variables are proposed to describe the observable behaviour that constitutes a client's interpersonal style within the context of a particular relationship, such as client-therapist; husband-wife; mother-daughter; friends: context; definition of the relationship; clarity of self-presentation; emotional distance; accurate empathy; congruence and unconditional acceptance; confirmation; expression of needs; linear/circular approach; degree of interpersonal flexibility/rigidity; ability to meta-communicate; adequacy of problem-solving skills; control; potential for eliciting rejection or acceptance; and traumatic incidents. In the context of the psychotherapeutic relationship, trained psychotherapists observe clients' interpersonal styles based on a combination of these interpersonal variables with the intention of proposing a link between clients' patterns of behaviour and their presenting complaints. Based on this connection, appropriate psychotherapeutic interventions can be implemented.
Implementing Dynamic Assessments in Psychotherapy
Assessment, 2016
In this article, we organize multimethod, multitimescale data around the interpersonal situation, a conceptual framework that can be used to integrate personality, psychopathology, and psychotherapy constructs in order to guide the assessment of clinical dynamics. We first describe the key variables of the interpersonal situation model and articulate methods for assessing those variables as they manifest (a) across different levels of personality, (b) across situations, and (c) within situations. We next use a case to demonstrate how to assess aspects of the interpersonal situation in a manner that enhances case conceptualization and facilitates the evaluation of clinical hypotheses. We also use this case to highlight challenges and decisions involved in implementing dynamic assessment in psychotherapy. We conclude by outlining areas in need of further exploration toward a more sophisticated approach to clinical practice that involves the routine assessment of dynamic processes.
University of Groningen Personalized Feedback on Symptom Dynamics of Psychopathology Kroeze
2017
Background and Objectives. In the proposed symptom network approach to psychopathology, psychiatric disorders are assumed to result from the (causal) interplay between symptoms. By implementing this approach we explored whether individual feedback on symptom dynamics complements current categorical classification and treatment. The aim of this proof-of-principle case-study was to explore the feasibility, acceptability and usability of this transdiagnostic approach. Methods. A female patient, aged 67, suffering from treatment resistant anxious and depressive symptoms was treated in our tertiary outpatient clinic for old age psychiatry. She participated in ecological momentary assessments (EMA), which involved intensive repeated measurements of mood and context-related items during two weeks. Visualizations of the interplay between the items were provided by network graphs and were discussed with the patient. Results. Network graphs were discussed with the patient. For example, it was...
The Lancet Psychiatry
Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way and used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis.
Personalized Feedback on Symptom Dynamics of Psychopathology: A Proof-of-Principle Study
Background and Objectives. In the proposed symptom network approach to psychopathology, psychiatric disorders are assumed to result from the (causal) interplay between symptoms. By implementing this approach we explored whether individual feedback on symptom dynamics complements current categorical classification and treatment. The aim of this proof-of-principle case-study was to explore the feasibility, acceptability and usability of this transdiagnostic approach. Methods. A female patient, aged 67, suffering from treatment resistant anxious and depressive symptoms was treated in our tertiary outpatient clinic for old age psychiatry. She participated in ecological momentary assessments (EMA), which involved intensive repeated measurements of mood and context-related items during two weeks. Visualizations of the interplay between the items were provided by network graphs and were discussed with the patient. Results. Network graphs were discussed with the patient. For example, it was hypothesized and discussed with the patient that feeling relaxed increased physical activity, causing physical discomfort in the following hours. Physical discomfort caused stress as its symptoms resembled her feared somatic anxiety symptoms. This increased the patient's insight that stress, expressed as somatic symptoms, played a central role in her panic disorder. This started a dialogue on how to cope with stress caused by somatic (anxiety) symptoms and provided a rationale for the patient to start an interoceptive exposure intervention she had repeatedly refused before. Limitations. The observed symptom dynamics may not be generalizable to any other random two weeks. Conclusions. Personalized diagnosis of psychopathology incorporating complex symptom dynamics is feasible and a promising addition to current categorical diagnostic systems and could guide intervention selection. This merits further exploration.
Frontiers in Psychology, 2024
Introduction: Psychiatric comorbidities have proven a consistent challenge. Recent approaches emphasize the need to move away from categorical descriptions of symptom clusters towards a dimensional view of mental disorders. From the perspective of phenomenological psychopathology, this shift is not enough, as a more detailed understanding of patients’ lived experience is necessary as well. One phenomenology-informed approach suggests that we can better understand the nature of psychiatric disorders through personalized network models, a comprehensive description of a person’s lifeworld in the form of salient nodes and the relationships between them. We present a detailed case study of a patient with multiple comorbidities, maladaptive coping mechanisms, and adverse childhood experiences. Methods: The case was followed for a period of two years, during which we collected multiple streams of data, ranging from phenomenological interviews,neuropsychological assessments, language analysis, and semi-structured interviews (Examination of Anomalous Self Experience and Examination of Anomalous World Experience). We analytically constructed a personalized network model of his lifeworld. Results: We identified an experiential category “the crisis of objectivity” as the core psychopathological theme of his lifeworld. It refers to his persistent mistrust towards any information that he obtains that he appraises as originating in his subjectivity. We can developmentally trace the crisis of objectivity to his adverse childhood experience, as well as him experiencing a psychotic episode in earnest. He developed various maladaptive coping mechanisms in order to compensate for his psychotic symptoms. Interestingly, we found correspondence between his subjective reports and other sources of data. Discussion: Hernan exhibits difficulties in multiple Research Domain Criteria constructs. While we can say that social sensorimotor, positive valence, and negative valence systems dysfunctions are likely associated with primary deficit (originating in his adverse childhood experience), his cognitive symptoms may be tied to his maladaptive coping mechanisms (although, they might be related to his primary disorder as well).
New Developments for Case Conceptualization in Emotion-Focused Therapy
Clinical psychology & psychotherapy, 2014
Emotion-focused therapy (EFT) has increasingly made use of case conceptualization. The current paper presents a development in the case conceptualization approach of EFT. It takes inspiration from recent research on emotion transformation in EFT. The case conceptualization presented here can guide the therapist in listening to the client's narrative and in observing the client's emotional presentation in sessions. Through observing regularities, the therapist can tentatively determine core emotion schemes' organizations, triggers that bring about the emotional pain, the client's self-treatment that contributes to the pain, the fear of emotional pain that drives avoidance and emotional interruption strategies. The framework recognizes global distress, into which the client falls, as a result of his or her inability to process the underlying pain, the underlying core pain and the unmet needs embedded in it. This conceptual framework then informs therapists as to which ...