Auf seiten der Patienten wird die Dimension einer psychologischen Sensibilität fir die Arbeit in allen Formen psychoanalytisch orientierter Therapie generell als wichtig anerkannt. Es gibt jedoch ziemlich wenig Übereinstimmung bezüglich des begrifflichen Kontextes. Bei dem Versuch diese "psychologische Sensibilität" oder "psychological mindedness" zu definieren, haben zahlreiche Autoren psychodynamische Konzepte herangezogen (z.B. Appelbaum, 1973; Bloch, 1979; Tyson & Sandler, 1971; Wolitzky & Reuben, 1974), andere taten dies nicht (z.B. Dollinger et al., 1983; Fenigstein et al., 1975; Farber, 1989). Entsprechend wurde der Terminus "Psychological Mindedness" in Analogie mit einer ganzen Reihe von Begriffen benutzt, wie z.B. "Einsicht", "Introspektion", "Selbst-Bewußtheit", "Fähigkeit der Selbst-Beobachtung" oder "auf das Selbst gerichtete Aufmerksamkeit". Es hat auch verschiedene Versuche gegeben, den Prozeß der psychologischen Sensibilität zu konzeptualisieren (Hall, 1992). So wurde sie z.B. als Motiv, als eine Befähigung, als Erwartung, attributive Haltung, Neigung oder als Interesse aufgefaßt.

The ability to infer psychological meaning in behaviour-referred to as psychological mindedness-has been posited as a patient characteristic that contributes to the therapy process and consequently to therapeutic success. The present study was developed to examine the relationship between patients' psychological mindedness and improvement in patients' personal treatment goals in interpretive and supportive group therapies for complicated grief, along with patients' importance to group process. The study was conducted with a clinical sample of 109 patients (79% female; average 45 years old) receiving treatment for complicated grief. Patients provided severity of distress ratings for individual target objectives at pretreatment and posttreatment. Psychological mindedness was assessed prior to treatment using the video-based, interviewer-rated Psychological Mindedness Assessment Procedure. Patients' importance to the therapy process was rated by therapists and other patients in interpretive and supportive group therapy for complicated grief. Conditional process modelling tested whether psychological mindedness would contribute to patients' goal achievement through patients' importance to group process, moderated by type of therapy. A significant, conditional indirect effect was observed for psychological mindedness as a predictor of improvement in individual target objectives, through patients' importance to group process as rated by therapists, specifically in interpretive therapy. The findings indicate that patients' psychological mindedness significantly contributes to their achievement of individual goals through their contributions to group process in interpretive group therapy. Further research is needed to understand the facilitation of individual goal achievement in supportive therapy.

Objective: The objective of the present study was to examine the nature of patients' work in two types of short-term group psychotherapy. The study sought to investigate the relationship between patients' psychodynamic work versus supportive work in group psychotherapy and treatment outcome at termination and at 6-month follow-up. Psychodynamic work refers to reflection regarding intrapsychic motivations, defenses, and relational patterns, and supportive work refers to practical problem solving. Method: Participants were 110 patients who completed two forms of group therapy for complicated grief: interpretive therapy and supportive therapy. Two types of patients' in-session activity—psychodynamic work and supportive work—were rated by group therapists in both treatments. Pre-post and follow-up outcome domains included general symptoms, grief symptoms, and life dissatisfaction/severity of target objectives. Results: There was no significant difference in the nature of patients' therapeutic work between interpretive and supportive groups. Psychodynamic work was associated with pre-post improvement in grief symptoms. Psychodynamic work was also associated with further improvement in grief symptoms at 6-month follow-up, along with improvement in broader symptom domains. Supportive work was not associated with any pre-post or follow-up benefit. Conclusion: The findings provide evidence that psychodynamic work—focused on the development of insight and self-reflection—in group psychotherapy can contribute to further benefit after the completion of treatment. This finding cut across two approaches to short-term group therapy for complicated grief, suggesting that it may reflect a general curative mechanism of group treatments.

Psychological mindedness is regarded as an important patient characteristic that can influence the course of psychotherapy. The purpose of this study was to investigate the relationship between patients' capacity for psychological mindedness and aspects of the group psychotherapy process as experienced and rated by therapists and other group members. Participants were 110 patients who completed two forms of short-term group therapy for the treatment of complicated grief. Psychological mindedness was assessed at pretreatment by external raters using a video-interview procedure. Group therapists assessed patients' therapeutic work and therapeutic alliance following each group therapy session. Therapists and other group members rated each patient's expression of emotion and provided appraisals of their cohesion to each patient throughout the course of therapy. Psychological mindedness was found to be positively associated with several group process variables as rated by the therapist and other group members.

In the United States, there is a National Registry of Evidence-Based Programs and Practices (NREPP), which is a listing of treatments and interventions in psychotherapy. In 2012, NREPP invited our research team to submit an application for registration of our short-term interpretive group therapy for patients experiencing complicated grief, which we had used since 1986. From the beginning, we experienced difficulties that seemed to be largely attributable to a lack of professional skills required of the director. The director and her team used the metaphor of American football to describe parts of application process. Despite continuing difficulties, we finally completed the application process on time. Eventually, the reviews of the application were completed and the application was approved. The information we provide in this article mainly concerns the trials and tribulations associated with the application process. Overall, the process was frustrating and time-consuming. Consideration of additional variables, such as patient personality characteristics, would likely have provided a more useful set of findings.

Group psychotherapy provides unique opportunities for clinical errors in the selection of patients and composition of therapy groups. This article introduces some of the difficulties and complexities that can be associated with group composition and patient selection errors. Clinical vignettes from psychodynamic/interpersonal psychotherapy groups are used to illustrate three variations of group composition and selection errors. The first vignette depicts an error in selecting a disruptive patient into a fledgling group. The second vignette portrays an unsuccessful integration of a withdrawn, inhibited patient into an active, exploratory group. The third scenario illustrates challenges associated with poor quality of object relations in homogeneous group composition. Although research on group therapy composition and patient selection is limited, relevant empirical literature is integrated in our discussion of clinical implications and recommendations. (PsycINFO Database Record

Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.

Readiness for change, as assessed by the readiness and motivation interview (RMI), predicts a number of clinical outcome variables in eating disorders including enrollment in intensive treatment, symptom change, dropout, and relapse. Although clinically useful, the training and administration of the RMI is time consuming. The purpose of this research was to (a) develop a self-report, symptom-specific version of the RMI, the readiness and motivation questionnaire (RMQ), that can be used to assess readiness for change across all eating disorder diagnoses and (b) establish its psychometric properties. The RMQ provides stage of change, internality, and confidence scores for each of 4 eating disorder symptom domains (restriction, bingeing, and cognitive and compensatory behaviors). Individuals (N = 244) with current eating disorder diagnoses completed the RMQ and measures of convergent, discriminant, and criterion validity. Similar to the RMI scores, readiness scores on the RMQ differed according to symptom domain. Regarding criterion validity, RMQ scores were significantly associated with ratings of anticipated difficulty of recovery activities and completion of recovery activities. The RMQ contributed significant unique variance to anticipated difficulty of recovery activities, beyond those accounted for by the RMI and a questionnaire measure of global readiness. The RMQ is thus an acceptable alternative to the RMI, providing global and domain-specific readiness information when time or cost prohibits use of an interview.

els of alexithymia among general psychiatric outpatients, and whether their effects on alexithymia differed. The study used data from a randomized trial that investigated the efficacy of interpretive and supportive forms of dynamically informed, short-term, time-limited individual psychotherapy (20 weekly 50-min sessions) (please see Piper et al. [9] for a full description of the trial including methodology and treatment descriptions). The sample for the present study consisted of 112 patients who completed treatment and provided data at three assessment times (baseline, after therapy, 6-month follow-up). The participants’ average age was 35 years (SD = 9.8, range = 19–62). Sixty-one percent were women. Forty-one percent were married or living with a partner, 66% had at least a highschool education, 74% reported receiving previous psychiatric treatment, but fewer (8%) had a history of psychiatric hospitalization. The most prevalent axis I diagnosis was major depression (58%), and for axis II it was avoidant personality disorder (31%). Ethics approval for the study was received, and the subjects participated with informed voluntary written consent. Alexithymia was assessed with the self-report Toronto Alexithymia Scale 20 (TAS 20) [10] . In addition to a total score, the TAS-20 yields scores for three factor scales: difficulty identifying feelings, difficulty describing feelings and externally oriented thinking. In order to control for the potential confounding of changes in depressive symptoms, we also had patients complete the Beck Depression Inventory [11] . The TAS-20 and Beck Depression Inventory were completed by patients at baseline, after therapy and at the 6-month follow-up. Change in alexithymia was examined using repeated measures analysis of variance. Change in depressive symptoms between baseline and 6-month follow-up served as a covariate in the analyses; form of therapy served as the between-subjects factor. Table 1 presents the means and standard deviations for each TAS20 variable, by treatment condition and assessment time, along with the F values for the analyses. A significant interaction between time and form of therapy was identified for the TAS-20 total score, F(2, 108) = 3.92, p = 0.024, indicating a systematic difference in the degree of change in alexithymia between interpretive therapy and supportive therapy. As shown in table 1 , there was a significantly greater decrease in alexithymia from baseline to the posttherapy assessment among those in supportive therapy relative to those who received interpretive therapy, F(1, 109) = 8.47, p = 0.004. During the period between posttherapy and 6-month follow-up assessments, however, the change in alexithymia for each form of therapy was similar and did not differ significantly. A significant interaction between time and form of therapy was also shown for the TAS-20 factor 1, F(2, 108) = 3.79, p = 0.027. As table 1 illustrates, patients in supportive therapy experienced considerably greater reductions in TAS-20 factor 1 scores from baseline to posttherapy exam than patients in interpretive theraClinicians are often confronted with patients who have great difficulty identifying and expressing feelings or addressing the emotional aspects of their lives. Such patients may suffer from alexithymia. Alexithymia is understood as a trait deficit in the cognitive processing of emotional experience such that individuals have a limited capacity to symbolize emotions and elaborate upon emotional experience [1] . Patients who suffer from alexithymia present a particular challenge, for they are deficient in those skills that make up the crux of psychotherapy: an ability to differentiate, verbalize and discuss subjective experiences and emotion. Alexithymia limits a person’s capacity to elaborate on inner experiences, to engage in abstract thought, and to appreciate the perspectives of other people. Patients with high levels of alexithymia seldom present material spontaneously and will often fixate on physical symptoms and minute details of external events. A therapeutic alliance with alexithymic individuals may be difficult as they tend to keep people at a distance and avoid interpersonal closeness [2] . The lack of integration between affect and cognition, the use of immature defences, and a proclivity toward impulsive behaviour [3, 4] can significantly complicate treatment [5] . The possibility of alexithymic features being modified by psychotherapeutic intervention remains a topic of great debate but minimal empirical investigation. Some have reported promising results indicating that alexithymia may decrease during psychotherapy [6, 7] . However, none compared active treatments to determine whether alexithymia is differentially affected by different therapies. A widely held assumption is that interpretive or expressive forms of psychotherapy are ill-suited for alexithymic patients and that supportive therapy is likely to be more effective with these patients [8] . It is believed that interpretive or expressive therapies rely too much on the skills that alexithymic patients appear to lack. Instead, more directive and externally focused therapies like supportive therapy are believed to fit better with alexithymic patients’ cognitive style and adapt better to their limitations regarding lack of introspection and affective communication. Yet, to our knowledge, no study has tested these assumptions. The present study examined whether interpretive psychotherapy and supportive psychotherapy were effective in reducing levReceived: March 1, 2012 Accepted after revision: June 7, 2012 Published online: November 6, 2012

We examined disposition, course, and outcome for 100 outpatients offered short-term individual dynamic therapy as a primary treatment for recurrent major depression. Evaluations using the Hamilton Rating Scale for Depression (HAM-D) were conducted regularly during the year after referral. Patients failing to show a response (50% decrease in pre-treatment HAM-D scores) were referred for consultation regarding “augmentation” of therapy with antidepressant medication. Nineteen referrals failed to meet inclusion-exclusion criteria, reflecting therapist overestimation of the severity of patients' depressive symptoms; referring therapists also missed other salient clinical issues. Fourteen patients completed assessments but did not start therapy; “decliners” were more likely to report previous admissions and thus may have opted for hospitalization. Sixty-seven patients started therapy; 18 dropped out (26.9%). Of the 49 therapy completers, 23 (46.9%) did not receive augmented treatment; 20 (40.8%) demonstrated evidence of recovery during the year while 3 (6.1%) did not. Of the 26 patients (53.1%) prescribed antidepressants, 16 (32.7%) demonstrated evidence of recovery and 10 (20.4%) did not. Patient clusters also showed distinct trajectories of change on the HAM-D over the year after referral. Patients who received augmented treatment but showed no evidence of recovery scored significantly higher on indices of alexithymia. Clinical implications of the findings are considered.

Participants (n = 68) were consecutively admitted patients to the Core Program of the Richmond Mental Health Outpatient Services, a psychotherapy service that receives referrals from family physicians and community mental health agencies. Diagnostic assessments were not performed for this study. However, diagnoses provided by the referring sources indicated that 70% of subjects presented with a depressive disorder and 20% presented with an anxiety disorder. Participants’ average age was 42.5 years (SD = 10.5, range = 19–61). Seventy-three percent were women. Forty percent were married or living with a partner, 73% were educated beyond high school, 88% reported receiving previous psychiatric treatment, but fewer (18%) had a history of psychiatric hospitalization. Ethics approval for the study was received and subjects participated with informed voluntary written consent. The type D personality scale (DS14) is a 14-item scale comprised of two subscales: a 7-item subscale which measures negative affectivity (NA), and a 7-item subscale measuring social inhibition (SI) [1] . Participants who score highly on both NA and SI using a cutoff point of 6 10 on both scales are classified as having a type D personality. The Toronto Alexithymia Scale 20 [16] is a 20-item scale composed of three subscales. It provides an overall score for alexithymia, as well as subscores for each of the three core factors of alexithymia: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. The Beck Depression Inventory (BDI-II) [17] was used to control for depressive symptom severity due to the potential confounding effect of depression on the assessment of alexithymia and type D personality [18] . Analysis of covariance was performed to examine the association between a designation of type D personality and alexithymia. Depressive symptoms (BDI score) served as a covariate. Given recent findings suggesting that type D may be more appropriately treated as a dimensional construct [19] , we also calculated partial correlations (controlling for depressive symptoms) to assess the association between type D (NA ! SI) and alexithymia. Finally, partial correlations were calculated to assess the associations between the components of type D personality and alexithymia, while controlling for depressive symptom severity. Among the 68 participants, 56 (82.4%) were classified as having type D personality by using the recommended cutoff point of

Objective: Efforts to improve the effectiveness of day treatment should attend to factors that influence treatment response. Our prospective study identified predictors of response to day treatment for personality disorder (PD). Method: Patients with a PD, consecutively admitted to a day treatment program, were assessed with self-report and interview measures. Predictors included personality characteristic, demographic, initial disturbance, and PD variables. Patients' overall response to treatment was classified as better, same, or worse, based on change in multiple outcome measures. A comprehensive approach to multivariate modelling was used. Results: The likelihood of being classified as better significantly increased if the patient was more psychologically minded, used avoidance-oriented coping strategies, and had a high level of baseline symptom severity. Probability of being classified as better decreased if the patient had a substance use disorder and a history of high service use. Conclusions: Identifying factors that affect response to day treatment can help clinicians make better selection decisions or take measures to modify treatment.