Browsing by Author "Matos, Paula Mena"
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- Attachment mismatches and alliance: through the pitfalls of mentalizing countertransferencePublication . Barreto, João F.; Matos, Paula MenaIndividual and combined attachment dimensions within the dyad may affect therapists’ experiences in ways that hinder mentalizing and threaten the alliance. Previous research on a particular therapists’ mentalizing ability named the elaboration of countertransference experience (ECE) suggests that attachment may affect therapists’ mental processes, which in turn are involved in alliance variations between dyads and over time. In this study, these findings are extended by examining therapist, client, and combined attachment dimensions as moderators of the association between ECE and working alliance. Forty-four assessments from the first 10 psychotherapy sessions of 12 independent dyads were examined. The ECE dimension of reflection/conjecture was positively associated with the alliance bond and total score in therapeutic dyads that differed more in attachment. Possible in-session dynamics at stake are discussed.
- Balancing clinical risk with countertransference management protects alliancePublication . Barreto, João Francisco; Matos, Paula MenaThe working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients’ baseline clinical features affected the early alliance and the possible role of therapists’ countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients’ clinical dimensions were assessed prior to the 2nd session, and therapists’ countertransference management and clients’ ratings of the alliance were measured after the 2nd session. Positive associations were found between clients’ subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.
- Does attachment predict psychotherapists' mentalization with real patients?Publication . Barreto, João Francisco; Saraiva, Luísa; Matos, Paula MenaElaboration of countertransference experience (ECE): implicit and explicit psychological work to which therapists submit experiences with patients (Barreto & Matos, 2016) • Mentalizing process of a particular kind (therapists’ self-oriented mentalizing) through which therapists’ experiences acquire and increase in mental quality (ibd.) • Research addressing psychotherapists’ mentalization is extremely scarce, and very few studies within this field involved real patients as participants • Preliminary findings suggest that therapist mentalization processes benefit therapeutic work (Cologon et al., 2017; Rizq & Target, 2010; Reading, 2013) • Despite established association between the constructs, no studies to our knowledge have yet investigated the impact of attachment on therapist mentalizing processes • Evidence that patients’ attachment dimensions affect therapeutic process (e.g., Diener & Monroe, 2012) • Mixed results concerning the impact of therapist attachment and therapistpatient attachment match on therapy (e.g., Degnan et al., 2016) • Therapist attachment dimensions may impact psychotherapy in interaction with patients variables (Bucci et al., 2015; Schauenburg et al., 2010) • Relational similarity may benefit initial alliance, but dissimilarity may disconfirm transference expectations and facilitate transforming experiences (Bernier & Dozier, 2002; Mallinckrodt et al., 2009)
- Dyadic attachment determinants of session quality in early psychotherapyPublication . Barreto, João Francisco; Matos, Paula MenaIt is sometimes assumed that a counter-complementary stance towards the relational pull exerted by clients plays an important role in the change process (Bernier & Dozier, 2002; Mallinckrodt, 2000). Initial evidence suggests that this can be facilitated by a dissimilar or non-complementary match between relational preferences within the therapeutic dyad and by attachment security in therapists (see Daniel, 2006). In both cases, ‘out of style’/’against type’ responses are more likely to occur, which may help disconfirm clients’ problematic working models of relationships and thus facilitate change (Bowlby, 1988). Presumably, client and therapist attachment dimensions and their combinations will have an effect on session quality (Goodman, 2000). Research in the field is scarce, but tends to support this hypothesis (Bruck et al., 2006; Mohr et al., 2005; Romano et al., 2008). Meanwhile, even less is known concerning the variation of session evaluation over time.
- Elaboration of countertransference experience and the workings of the working alliance.Publication . Barreto, João F.; Matos, Paula MenaAlliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist– client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences and examine the participation of ECE in the resolution of alliance ruptures.
- Inventory of personality organization: Preliminary validation of the European Portuguese versionPublication . Barreto, João Francisco; Matos, Paula MenaPersonality pathology is often organized in two orthogonal axes representing variations in type and severity (Westen et al., 2006). The psychoanalytic model developed by Otto F. Kernberg and colleagues (e.g., Kernberg & Caligor, 2005) is an example of the second trend, consisting of a dimensional approach describing personality organization (PO) in a continuum ranging from normal-neurotic (NPO), through high and low borderline (BPO), to psychotic (PPO) levels. • In this model, borderline-level PO underlies most of the personality disorders considered in the categorical-typological approach held in DSM-IV-TR (APA, 2000). Kernberg’s approach is clinically useful in identifying subthreshold/higher level personality pathology poorly covered by DSM-IV-TR Axis II, and understanding different meanings in common symptoms according to underlying levels of PO (Caligor et al., 2007). • As an effort at operationalization, Kernberg and Clarkin (1995) created the Inventory of Personality Organization (IPO), a self-report questionnaire including 3 primary scales (57 items): Identity Diffusion, Primitive Defenses, and Reality Testing. IPO has been used to investigate the relationship of PO to psychopathology and measure structural change as a psychotherapy outcome (cf. Ellison & Levy, 2011). • IPO has been translated into several languages and latent structure has been tested with clinical and nonclinical population (Berghuis et al., 2008; Iragashi et al., 2009; Lenzenweger et al., 2001; Normandin et al., 2002; Smits et al., 2009), yielding 2- or 3-factor solutions for the 3 primary scales. However, a recent study of the original English-language version conducted with a large nonclinical sample suggests that a 4-factor solution provides a better fit, with factors representing Instability of Self and Others, Instability of Goals, Psychosis, and Instability of Behavior (Ellison & Levy, 2011).
- A mentalization model for the elaboration of countertransference experiencePublication . Barreto, João Francisco; Matos, Paula MenaImplicit and explicit psychological work to which therapists’ experiences are submitted (in and between sessions) • “something more” than managing CT – recognizing, regulating, and deriving meaning from experience • “something more” than dealing with resistances – elaboration includes both working out/working over (psychische Verarbeitung) and working through (Durcharbeitung) (McDougall, 1985) • therapists’ raw experience acquires (and increases in) mental quality and becomes available for meaning-making and judicious clinical use, involving a close interconnection and integration between implicit-spontaneous and explicit-reflective psychological processes • dialectic, transformative, integrative, contextual, and agency-enhancing process of making “clinically relevant” sense of experience leading to emergence of new meaning and new experience • countertransference (CT) understood as joint creation (Gabbard, 2001) and comprising diverse experiential components (subjective CT, objective CT, therapeutic attitude, emerging experience) (Barreto & Matos, 2016)
- Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapyPublication . Barreto, João Francisco; Matos, Paula MenaAs a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.
- Navigating the countertransference experience: A transtheoretical specifist modelPublication . Barreto, João Francisco; Matos, Paula MenaThe attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision.
- Personality organization, emotion regulation, and symptom distressPublication . Barreto, João Francisco; Matos, Paula MenaEvidence suggests that the severity of personality difficulties, regardless of their type, may be the most important determinant of current and future dysfunction (Hopwood et al., 2011). Otto F. Kernberg’s model of personality organization (PO) describes severity of personality disturbance as a continuum from normal-neurotic functioning, through borderline, to psychotic personality, along which the predominance of primitive defenses and the concomitant identity disturbance augments, with reality testing compromised in the psychotic pole (e.g., Kernberg & Caligor, 2005). The increasing influence of primitive, intense emotions lacking integration often manifest in affect dysregulation and behavioral correlates such as anger expression and impulsive self-destructive behaviors (Clarkin, Yeomans, & Kernberg, 2006). Still, there is little research into the paths through which PO affects symptoms, in which emotion (dys)regulation must play an important role.