Peer-Reviewed Journal Publications:
Mesrie, V., Diener, M. J., & Clark, A. (2018). Trainee attachment to supervisor and perceptions of novice psychotherapist self-efficacy: The moderating role of level of experience. Psychotherapy, 55, 216-221. http://dx.doi.org/10.1037/pst0000191
Abstract: Clinical supervision is often considered to be one of the important tasks in training psychotherapists. The present study investigated the relation between trainees’ attachment to their supervisors and trainees’ perceptions of their own counseling self-efficacy (CSE), as potentially moderated by trainee level of experience. Results indicated that trainees with greater avoidant attachment to their supervisors demonstrated lower levels of CSE. Although the results of the moderator analyses were not statistically significant, levels of avoidance significantly predicted levels of CSE even when controlling for level of experience, whereas levels of anxiety were not found to significantly predict levels of CSE. The study also found that individuals who reported greater levels of experience were more likely to report greater levels of CSE. The implications of the study are discussed, and recommendations for clinical supervision process are offered. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Diener, M. J., Geenen, R., Koelen, J. A., Aarts, F., Gerdes, V. A., Brandjes, D. M., & Hinnen, C. (2016). The significance of attachment quality for obesity: A meta-analytic review. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48, 255-265. doi:10.1037/cbs0000050
Abstract: Theoretical considerations and empirical results suggest that attachment quality is relevant to obesity. This study used meta-analytic methods to systematically examine the empirical, peer-reviewed evidence regarding the relationship between attachment quality and body mass index (BMI) in separate meta-analyses for children and adults. Relevant peer-reviewed literature published between 1990 and 2013 was obtained from PubMed, PsycINFO, and reference lists of included articles. Results of the meta-analysis for studies with adults indicated a small but statistically significant association between attachment quality and BMI (absolute value of weighted average r = .05, p = .03; 95% confidence interval, CI [.004 to .09]; number of independent studies [k] = 7; N = 2,135). Specifically, BMI was negatively associated with attachment security. Publication bias analyses did not demonstrate cause for concern about the results. Results of the meta-analysis for studies with children indicated a small association between attachment quality and BMI that fell just short of statistical significance (absolute value of weighted average r = .08, p = .06; 95% CI [−.004 to .16]; k = 5; N = 8,602). Several moderator variables were examined using the aggregated sample including both adults and children, but none of the analyses yielded statistically significant results. Possible explanations for an impact of attachment quality on obesity might involve the underdevelopment of emotion-regulation and heightened psychophysiological responsiveness, which point to avenues for future research. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Lehmann, M. E., Levy, S. R., Hilsenroth, M. J., Weinberger, J., Fuertes, J., & Diener, M. J. (2015). Evaluating pre-treatment patient insight as a factor in early therapeutic technique. Journal of Psychotherapy Integration, 25, 199–213. doi:10.1037/a0039560
Abstract: The Shedler-Westen Assessment Procedure (SWAP) Insight Scale (Lehmann & Hilsenroth, 2011) was used to assess patient insight before treatment, and the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005) was used to assess subsequent therapist techniques in early treatment sessions. Participants in this study (N = 93) were seeking outpatient treatment at a university-based community clinic. Therapists completed the SWAP Insight Scale to describe their patients after the therapeutic assessment and the first 2 therapy sessions. External raters completed the CPPS from an early treatment session (3rd/4th). Patient pretreatment level of insight was significantly related to CPPS ratings of early session techniques: therapists’ identification of similar relationships over time (CPPS #5; r = .24, p = .02), presentation of alternative understanding of experiences through interpretations (CPPS #13; r = .26, p = .01), and association of recurrent patterns of action/feelings/experiences (CPPS #14; r = .21, p = .05). Evaluation of mediation with different psychotherapy process scales revealed that patient’s agreement with therapists may impact the relationship between insight and CPPS #5. After accounting for therapist effects, the association between insight and CPPS #5 was no longer significant. In sum, these analyses indicate that greater patient insight was associated with more frequent therapist focus on patients’ diverse understanding of experiences, as well as on recurrent patterns of actions, feelings and thoughts throughout the session, during early treatment sessions. These results (CPPS #13 & 14) remained significant when examining issues of global psychopathology, a range of related psychotherapy process variables, and therapist effects. The clinical application of these findings is discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Diener, M. J., & Mesrie, V. (2015). Supervisory process from a supportive-expressive relational psychodynamic approach. Psychotherapy, 52, 153-157. doi:10.1037/a0038085
Abstract: Substantial theoretical and empirical focus has been placed on detailing the processes that therapists use in psychotherapy. Relatively limited investigation, however, has been conducted into the utility of the various techniques and processes that supervisors use in facilitating the development of trainee competence to conduct psychotherapy. The present article explores 2 sets of supervisory techniques/processes that can be used to assist novice therapists in the development of clinical skills from a supportive–expressive (Luborsky, 1984) relational (Greenberg & Mitchell, 1983) psychodynamic approach: (a) providing systematic and structured training in interpretation, and (b) facilitating trainee use of countertransference. We detail the theoretical underpinnings and research findings for each supervisory process, followed by presentation of vignettes illustrating supervisor–supervisee interactions that demonstrate the use of these processes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Joseph, D. M., Hilsenroth, M. J., & Diener, M. J. (2014). Patient participation in psychodynamic psychotherapy: Contributions of alliance and therapist technique. American Journal of Psychotherapy, 68, 319-338.
Abstract: The aim of this research is to investigate the relationship among patient participation, technique, and the working alliance during early sessions of psychodynamic psychotherapy. Participants in this study (N = 88) were representative of those actually seeking outpatient treatment at a university-based community clinic. Results demonstrated that greater use of psychodynamic techniques is related to greater patient participation in early session process during psychodynamic psychotherapy (r = .23, p = .03). Moreover, greater use of two specific psychodynamic interventions was found to be significantly related to patient participation: “The therapist encourages the exploration of feelings regarded by the patient as uncomfortable” (r = .24, p = .03),” and “The therapist focuses attention on similarities among the patient’s relationships repeated over time, settings or people” (r = .33, p = .001). The relationship between overall working alliance and patient participation was also found to be significant (r = .50, p = .0001). In addition, results demonstrated that higher levels of various facets of the working alliance are related to greater patient participation: Goals and Tasks (r = .43, p = .0001), Confident Collaboration (r = .39, p = .0002), Bond (r = .37, p = .0003) and Idealized Relationship (r = .34, p = .001). Finally, in order to highlight the relative contribution among alliance, technique, and participation, an examination of mediation was conducted. Results demonstrated that although both alliance and technique independently related to patient participation in a significant manner, alliance and technique were not significantly related to one another, indicating that the criteria for a meditational model were not met.
Copyright of American Journal of Psychotherapy is the property of Association for the Advancement of Psychotherapy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.
Goodman, G., Edwards, K., & Diener, M. J. (2014). Processes of therapeutic change in psychodynamic therapy of two inpatients with borderline personality disorder. Journal of Psychotherapy Integration, 24, 30-45. doi: 10.1037/a0035970
Abstract: [Correction Notice: An Erratum for this article was reported in Vol 24(3) of Journal of Psychotherapy Integration (see record 2014-37846-005). There was an error in Table 2. The corrected Table 2 is presented in the erratum.] Two psychiatric inpatients with borderline personality disorder (BPD) participated in 5 months of three-times-per-week psychodynamic therapy (PDT). Patients completed a measure of psychological distress every week. Forty-four sessions were audiotaped and coded using the Psychotherapy Process Q-Set (PQS) and correlated with PQS prototypes of five treatment models—PDT, cognitive-behavior therapy (CBT), interpersonal therapy (IPT), transference-focused psychotherapy (TFP), and dialectical behavior therapy (DBT). Prototypical CBT process was significantly more prevalent in Patient 1’s than in Patient 2’s treatment. In both treatments combined, prototypical PDT process significantly decreased over time, prototypical CBT process was negatively correlated with distress, and prototypical TFP process was positively correlated with distress. Two PQS items—therapist aloofness and patient feeling inadequate and inferior—were positively correlated with distress for Patient 2. An effective PDT treatment model for severely disturbed BPD inpatients requires technical flexibility to make temporary use of more structured interventions that serve the treatment goal of stabilization. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
[Correction to Goodman, Anderson, and Diener (2014). (2014). Journal of Psychotherapy Integration, 24, 207. doi:10.1037/a0037788]
Abstract: Reports an error in “Processes of therapeutic change in psychodynamic therapy of two inpatients with borderline personality disorder” by Geoff Goodman, Keiha Anderson and Marc J. Diener (Journal of Psychotherapy Integration, 2014[Mar], Vol 24[1], 30-45). There was an error in Table 2. The corrected Table 2 is presented in the erratum. (The following abstract of the original article appeared in record 2014-08365-004.) Two psychiatric inpatients with borderline personality disorder (BPD) participated in 5 months of three-times-per-week psychodynamic therapy (PDT). Patients completed a measure of psychological distress every week. Forty-four sessions were audiotaped and coded using the Psychotherapy Process Q-Set (PQS) and correlated with PQS prototypes of five treatment models—PDT, cognitive-behavior therapy (CBT), interpersonal therapy (IPT), transference-focused psychotherapy (TFP), and dialectical behavior therapy (DBT). Prototypical CBT process was significantly more prevalent in Patient 1’s than in Patient 2’s treatment. In both treatments combined, prototypical PDT process significantly decreased over time, prototypical CBT process was negatively correlated with distress, and prototypical TFP process was positively correlated with distress. Two PQS items—therapist aloofness and patient feeling inadequate and inferior—were positively correlated with distress for Patient 2. An effective PDT treatment model for severely disturbed BPD inpatients requires technical flexibility to make temporary use of more structured interventions that serve the treatment goal of stabilization. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Monroe, J. M., Diener, M. J., Fowler, J. C., Sexton, J. E., & Hilsenroth, M. J. (2013). The criterion validity of the Mutuality of Autonomy Scale: A meta-analytic review. Psychoanalytic Psychology, 30, 535–566. doi: 10.1037/a0033290
Abstract: The present study consisted of a meta-analytic review of the criterion validity of the Rorschach Mutuality of Autonomy (Urist, 1977) scale. Search procedures yielded 27 independent samples (total N = 1,803, average n = 67, SD = 31) for inclusion in the meta-analysis. Results support the criterion validity of the Mutuality of Autonomy with an average overall weighted effect size of r = .24, p < .001 (95% confidence interval = .18, .29). Publication bias analyses indicate the possibility for bias and demonstrate that the likely impact of any such bias would bring the average overall weighted effect size down to r = .18, p < .001 (95% confidence interval for adjusted effect size = .11, .24). The data were not demonstrably heterogeneous (Q = 37.67, df = 26, p = .07), and all between-study moderator analyses were nonsignificant (p’s > .19) with the exception of the specific type of criterion variable. Implications for future research and clinical practice are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Diener, M. J., & Pierson, M. M. (2013). Technique and therapeutic process from a supportive-expressive relational psychodynamic approach. Psychotherapy, 50, 424–427. doi: 10.1037/a0032404
Abstract: In the present article, the authors identify three sets of clinical techniques central to the mechanisms of change in a supportive-expressive relational psychodynamic approach: (a) emphasis on patient affective experience, (b) identifying and understanding patient interpersonal patterns, and (c) therapeutic immediacy. Theoretical foundations and research findings supporting the utility of each intervention are outlined and briefly discussed. Clinical exchanges demonstrating the application of these techniques are also provided. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Town, J., Diener, M. J., Abbass, A. A., Leichsenring, F., Driessen, E., & Rabung, S. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy, 49, 276-290. doi: 0.1037/a0029564
Abstract: The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d = 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d = 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychodynamic psychotherapy to enable further elucidation of principles that evidently work. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Andión, Ó., Ferrer, M., Matali, J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., & Casas, M.(2012). Effectiveness of combined individual and group Dialectical Behavior Therapy compared to only individual Dialectical Behavior Therapy: A preliminary study. Psychotherapy, 49, 241-250. doi: 10.1037/a0027401
Abstract: Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to confirm the results. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Diener, M. J., Hilsenroth, M. J., Shaffer, S. A., & Sexton, J. E. (2011). A meta-analysis of the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity. Clinical Psychology & Psychotherapy, 18, 464-485. doi: 10.1002/cpp.725
Abstract: The present study examined the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity. Search procedures yielded 13 independent samples (total N = 1402, average n = 108, standard deviation = 90) for inclusion in the meta‐analysis. Inter‐rater reliability analyses demonstrated that coding of effect sizes and moderator variables was completed with good to excellent reliability. Results indicated that higher EII scores were associated with greater psychiatric severity, with an overall weighted effect size of r = 0.29, p = 0.000002 (95% confidence interval = 0.17–0.40), supporting the EII’s validity as a measure of psychological impairment. Publication bias analyses did not indicate any significant cause for concern regarding the results. The data were demonstrably heterogeneous (Q = 56.82, p = 0.0000001), and results of post‐hoc tests indicated that effect sizes with dependent variables obtained via researcher ratings were significantly larger than any of the following: effect sizes with dependent variables obtained via clinician ratings, informant ratings, information about level of treatment or placement status or self‐report ratings (p’s = 0.0005, 0.003, <0.001, <0.001, respectively). In addition, there was a trend for effect sizes based on performance‐based measures to be larger than those based on information about level of treatment or placement status (p = 0.098) as well as those based on self‐report measures (p = 0.076). Other moderator analyses were non‐significant (p’s > 0.10). Copyright © 2010 John Wiley & Sons, Ltd.
Diener, M. J., & Monroe, J. M. (2011). The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review. Psychotherapy, 48, 237-248. doi:10.1037/a0022425
Abstract: The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p< .001 (95% confidence interval = .10–.23). Publication bias analyses did not indicate any cause for concern regarding the results. The data were not demonstrably heterogeneous (Q = 6.10, df = 16, p = .99), and all between-study moderator analyses were nonsignificant (p values >.10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47, 637-645. doi: 10.1037/a0021175
Abstract: This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Diener, M. J., Hilsenroth, M. J., & Weinberger, J. (2009). A primer on meta-analysis of correlation coefficients: The relationship between patient-reported therapeutic alliance and adult attachment style as an illustration. Psychotherapy Research, 19, 519-526.
Abstract: The aim of this article is twofold: to offer an introduction to meta-analysis using correlation coefficients to facilitate greater understanding of meta-analytic findings and to guide those interested in conducting meta-analyses. The authors review calculations for a weighted average effect size, the statistical significance of this effect, a test of homogeneity, confidence intervals, and file drawer analysis. They provide a running example of the relationship between patient-reported therapeutic alliance and adult attachment style. Results (k = 12, N = 581.17, weighted average r = .17, p < .0001, 95% confidence interval=.13–.21) indicated a positive, statistically significant relationship, suggesting that greater attachment security is associated with stronger therapeutic alliances, whereas greater attachment insecurity is associated with weaker therapeutic alliances. File drawer results suggested that some caution is warranted in terms of the size of the effect.
†Diener, M. J., Hilsenroth, M. J., & Weinberger, J. (2007). Therapist affect focus and patient outcomes in psychodynamic psychotherapy: A meta-analysis. American Journal of Psychiatry, 164, 936-941.
Abstract: Objective: The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. Method: Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies. Results: The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect. Conclusions: These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.
†Abstracted and reviewed in Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis. [Abstract 12007005776] Database of Abstracts of Reviews of Effects, available http://www.crd.york.ac.uk/crdweb/ [2008, 3 Nov.]. Abstract of: Therapist affect focus and patient outcomes in psychodynamic psychotherapy: A meta-analysis.
Diener, M. J., Hilsenroth, M. J., & Weinberger, J.
American Journal of Psychiatry. 2007:164; 936-941.
Diener, M. J., & Hilsenroth, M. J. (2004). Multi-method validity assessment of the SWAP-200 Dysphoric Q-Factor. The Journal of Nervous and Mental Disease, 192, 479-486.
Abstract: The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.
Book Chapters and Other Publications:
Hilsenroth, M. J., & Diener, M. J. (2017). Some effective strategies for the supervision of psychodynamic psychotherapy. In T. Rousmaniere, R. Goodyear, S. Miller, & B. Wampold (Eds.), The cycle of excellence: Using deliberate practice in supervision, training, and independent practice (pp. 163-188). New York: John Wiley & Sons, Inc.
[The book in which this chapter appears is the 2018 Winner of the American Psychological Association Supervision & Training Section’s Outstanding Publication of the Year Award.]
Abstract: Theorists and researchers have provided a rich literature illustrating the clinical applications of evidence for various processes, context, and treatments used by therapists to promote beneficial patient outcomes (Wampold & Imel, 2015). Guidance for clinical supervisors in training therapists, by contrast, has received less attention. The research we review in this chapter comes primarily from empirical investigations conducted by the lab group of the first author, specifically from a programmatic study of psychodynamic psychotherapy delivered by graduate clinicians in a university—based community outpatient psychological training clinic, using a hybrid effectiveness/efficacy research model and video recordings of sessions (Hilsenroth, 2007). Given the nature of the study’s methodology, specifically the systematic, structured, and comprehensive training of the study therapists (graduate clinicians), these findings provide at least some, albeit limited, empirical evidence for the results of one approach to deliberate practice in the supervision of psychodynamic psychotherapy. These issues fall into four categories, each of which we discuss in turn: (a) psychodynamic techniques associated with outcome, (b) psychodynamic techniques associated with alliance, (c) empirical research on graduate trainees learning psychodynamic psychotherapy, and (d) methods for training therapists in psychodynamic psychotherapy.
Diener, M. J., Hilsenroth, M. J., Weinberger, J., & Monroe, J. M. (2013). A primer on meta-analysis of correlation coefficients: The relation between patient-reported therapeutic alliance and adult attachment style as an illustration. In W. Lutz, & S. Knox (Eds.), Quantitative and qualitative methods in psychotherapy research (pp. 235-246). New York: Taylor and Francis.
Abstract: Meta-analytic approaches were devised to correct for deficiencies in the more traditional narrative and vote-counting procedures for research reviews. These limitations include selection bias, Type II errors, and erroneous conclusions due to complex findings (for more detail on these issues, see Cooper & Rosenthal, 1980; Glass, 1976; Hunter & Schmidt, 1990). Meta-analysis, by contrast, often leads to more conclusive findings and suggests a more systematic and empirically sophisticated approach at research synthesis (Hunter & Schmidt, 1990). Berkeljon and Baldwin (see Chapter 14, Berkeljon and Baldwin, this volume) provide a general overview of meta-analytic procedures for psychotherapy outcome research involving standardized mean difference scores, specifically the effect size metric known as d. The present chapter, by contrast, focuses on meta-analysis using correlation coefficients as the effect size metric.
Diener, M. J. (2013). An introduction to the Rorschach Performance Assessment System (R-PAS). Independent Practitioner, 33 12-14.
Abstract: The Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011), published in the fall of last year, builds off Exner’s Comprehensive System (CS; Exner, 2003) for the Rorschach Inkblot Method (RIM; Weiner, 2003). It presents a number of substantive changes in administration, coding, interpretation, as well as use of normative reference groups. In many ways, these changes reflect R-PAS authors’ attempts to directly address criticisms of the CS published most recently by a group of several authors (e.g., Grove, Barden, Garb, & Lilienfeld, 2002; Lilienfeld, Wood, & Garb, 2000; Wood, Lilienfeld, Garb, & Nezworski, 2000; Wood, Nezworski, Garb, & Lilienfeld, 2001; Wood, Nezworski, & Stejskal, 1996; cf., Society for Personality Assessment, 2005) and to incorporate accumulated research findings (Meyer et al., 2011). Subsequent to Exner’s death in 2006 and the inability to use the CS title, Meyer and colleagues (2011) developed a Rorschach system that they have called the R-PAS. The overview of the R-PAS presented below follows the sequence in which clinicians use the system, i.e., focusing first on administration, coding, norms, and finally interpretation.
Diener, M. J., Hilsenroth, M. J., Cromer, T. D., Pesale, F. P., & Slavin-Mulford, J. (2012). Love’s labors lost? Therapeutic assessment of depression. In S. E. Finn, C. T. Fischer, & L. Handler (Eds.), Collaborative/Therapeutic Assessment: A casebook and guide (pp. 47-67). New York: John Wiley & Sons, Inc.
Abstract: Presents the case of ‘Joy,’ a 30-year-old single, Caucasian female who sought therapy after a recent and sudden end to the 6-month relationship with her female partner. In explaining her motivation for seeking services at this time, Joy pointed to this breakup and another area of her life in which she had been struggling. She explained that although she had been working as a physical therapy assistant for several years now, she had lost interest in the work and was considering alternative professions. Although Joy presented initially for psychotherapy, her clinician discussed the option of conducting a thorough assessment before initiating formal psychotherapy. Joy filled out several self-report measures, including the Brief Symptom Inventory; the Inventory for Interpersonal Problems; and the Personality Assessment Inventory. A follow-up clinical interview covered areas of Joy’s background and history that were not sufficiently reviewed in the initial meeting. During this session, the clinician assessed Joy for criteria of several relevant diagnoses, including major depressive disorder, dysthymic disorder, eating disorder, and avoidant personality disorder. The final assessment session consisted of a therapeutic, collaborative feedback session. Joy developed an initially strong alliance during her therapeutic assessment, which she experienced as deep and meaningful. Joy demonstrated robust improvement across many different symptom and interpersonal areas, and she found her treatment to be very productive, helpful in changing how she feels about herself, and, perhaps particularly salient, very useful in achieving positive change in the initial target complaints and symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Diener, M. J. (2010). Cohen’s d. In I. B. Weiner & W. E. Craighead (Eds.), Corsini’s Encyclopedia of Psychology (4th ed., Vol. 1, pp. 355-356). Hoboken, NJ: Wiley.
Abstract: Cohen’s (1988) d is one of several statistics used to examine differences between means, e.g., the difference in mean outcome between participants who received treatment X and participants who received treatment Y. This difference score, calculated in standard deviation units, falls under the broader category of effect sizes. Effect sizes provide an important complement to traditional null hypothesis statistical significance testing. The traditional p value indicates the likelihood of obtaining the observed results if the null hypothesis is true (Cohen, 1988). It does not, however, offer any information about the magnitude of the research findings (e.g., how much of a difference it makes if someone receives treatment X vs. treatment Y; Rosenthal & Rosnow, 2008). Cohen’s d offers an effective way of obtaining this information from means and standard deviations calculated in primary research.
Diener, M. J., & Hilsenroth, M. J. (2009). Affect-focused techniques in psychodynamic psychotherapy. In R. A. Levy, & J. S. Ablon (Eds.), Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice (pp. 227-247). Totowa, New Jersey: The Humana Press Inc.
Abstract: In a review of the research literature contrasting psychodynamic–interpersonal (PI) and cognitive–behavioral (CB) treatment, Blagys and Hilsenroth [1, 2] identified seven techniques/processes that distinguished PI from CB therapies. In particular, PI treatments contained greater frequency of emotion focus and encouraged patients to express their feelings. This affect-focused process garnered the most evidence for distinguishing PI from CB [1, 2], suggesting a heightened attention in psychodynamic treatments to patient emotions..
Diener, M. J. (2007, Fall). The utility of therapist affect focus in psychodynamic psychotherapy. Psychologist-Psychoanalyst, 27, 19-20.
Abstract: This paper begins with a brief review of meta-analytic research concerning the efficacy and effectiveness of psychodynamic psychotherapy, particularly short-term psychodynamic psychotherapy (STPP). Next, the paper reviews results of a recent meta-analysis that examined the relationship between therapist affect focus and patient outcome in STPP. Key findings and implications of these studies are highlighted.
Editorial Positions
- Consulting Editor, Psychotherapy: Theory, Research, Practice, Training
- Consulting Editor, Journal of Psychotherapy Integration
- Consulting Editor, Journal of Contemporary Psychotherapy
- Consulting Editor (previously), Journal of Personality Assessment
- Ad Hoc Reviewer (previously)
- Addiction Research & Theory
- Clinical Psychology: Science and Practice
- Journal of Counseling Psychology
- Journal of Nervous and Mental Disease
- Journal of Personality Assessment
- Psychiatry Research
- Psychotherapy Research