Introduction: In Pakistan there is dearth of research on deliberate self-harm (DSH) and its predictors among adolescents. While the lack of research in Pakistan can be partly attributed to the sacrilegious status, criminalization and stigmatization attached to DSH, it is also an attribute of paucity of Urdu versions of the standardized psychological instruments. Previous research in developed countries has indicated that attachment theory can be used as a useful framework to understand the development of austere psychopathologies like DSH, as well as for studying pathways of interaction of interpersonal and intrapersonal factors of psychopathologies. In this study, standardized psychological instruments are translated into Urdu language as a first step. These instruments are then used to study pathways of interaction of interpersonal and intrapersonal factors of DSH, conceptualized within attachment framework. Method: The study was conducted in two steps. In step 1, Youth Health Risk Behavior Survey (YHRB), Inventory of Interpersonal Problems-32 (IIP-32) and Significant Others Scale (SOS), were translated into Urdu language. Along with these scales, Urdu translated versions of Hospital Anxiety and Depression Scale (HADS), Adolescent Relationship Scales Questionnaire (ARSQ), Life Events scale (LES) from CASE questionnaire and Family Affluence Scale-II (FAS-II) were reviewed for accuracy of translation through expert judgement and psychometric evaluation. Secondly, a cross sectional survey was conducted with 1290 adolescents (10 - 19 years age) using the translated Urdu versions of the instruments and demographic pro forma. Structural equation modelling was used to study the pathways of associations between predictors of DSH. Results: The extensive process of translation resulted in establishment of semantic, content, technical and construct equivalence of the translated instruments with the original English versions. Multiple imputation was performed to account for missing values in SPSS 20. Important structural adaptations were made in the scales based on factor analyses conducted in M plus. After modifications, all scales showed satisfactory CFI (≥ 0.90) and RMSEA (≤ 0.06). Results of the survey indicated that the prevalence of DSH (with, without and ambivalent suicidal intentions) was 7%. Two SEM models were constructed involving both mediation and moderation pathways. Results of Model 1 showed association of attachment with DSH was double mediated by social support, depression and anxiety. Model 2 also confirmed association of attachment with DSH with double mediation through relationship style problems, depression and anxiety. In order to understand the contextual picture of the concepts studied in this research both SEM models were also constructed by controlling for demographic factors. This resulted in confirming age, gender and family affluence as significant contributors but with very small effects. Discussion and conclusion: In the present study translation of the instruments helped in building a reservoir for future research. The results of translation and validation of instruments indicated that cultural differences, language needs and age must be accounted for while using standardized psychological instruments. Taking into consideration specific cultural and demographic background of Pakistan, this study also confirms the key role of attachment in influencing interaction of predictors of DSH. It is suggested that intrapersonal and interpersonal factors are influential points of intervention for designing clinical, school and community based awareness and prevention programs for DSH. The thesis also discusses the implications for policy guidelines along with recommendations for future research and other applications of the study.

abstract: This work analyzed the role of interpersonal problems in interaction with ethnicity to predict psychotherapy outcome. A total of 262 individuals, who underwent psychotherapy at a counseling training facility, completed the Outcome Questionnaire-45 (OQ-45) and the reduced version of the Inventory of Interpersonal Problems (IIP-32). This study posited the following research question: Is the magnitude of the effect of ethnicity on treatment outcome conditional on certain IP dimensions (dominance or affiliation)? The purpose of this research was to determine whether or not ethnicity, represented by 3 ethnic groups (Whites, Hispanics, and Asians), was related to treatment outcome, and if this relationship was moderated by two interpersonal distress dimensions: dominance and affiliation. The results of the hierarchical regression analyses indicated that ethnicity did not predict post-treatment outcome gain, and neither affiliation nor dominance was a moderator of the relationship between outcome and ethnicity. / Dissertation/Thesis / M.C. Counseling 2011

abstract: This study examined the relationship of client pretreatment interpersonal problems (measured by the Inventory of Interpersonal Problems) to the therapeutic alliance (as measured early in treatment by a self report version of the Working Alliance Inventory‐ Short) using multilevel modeling to account for client and counselor variables. Specifically, the correlations of dominance, hostility and cold/distance interpersonal problems with the initial working alliance were investigated. Participants consisted of 144 clients and 44 graduate student counselors at the Counselor Training Center at Arizona State University. The intraclass value of .23 indicated there is a sizable effect, with counselor differences accounting for 23% of the variance in client alliance ratings, supporting the use of multilevel modeling. There was a dominance counselor gender interaction with working alliance scores. Clients who had problems with dominance reported higher working alliance scores with male counselors while clients who had problems with submissiveness reported higher working alliance scores with female counselors. Hostile dominance interpersonal problems were associated with lower initial working alliance scores regardless of counselor gender. Implications for clinical practice are discussed. / Dissertation/Thesis / M.C. Counseling Psychology 2012

There is extensive research on depression and interpersonal problems, but research has not addressed these concepts in relation to mutuality and human motivation. Therefore, the purpose of the current study is to consider the associations between intimacy motivation and mutuality of closest relationships and how, when combined, the two connect to depressive experiences and the occurrence of interpersonal problems. Of the 7 original hypotheses suggested, 2 were supported while 5 were not. Perhaps the most interesting finding, and certainly the one with the most practical application, came from the two supported hypotheses. The analyses show that interpersonal problem subtypes are associated with specific depressive subtypes by operationalizing the demand/withdraw pattern of conflict. The exploratory findings also suggest a possible mediation of gender and depression by mutuality.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

No description available.

Despite evidence for the efficacy of interpersonal psychotherapy (IPT) for depression, there remains little understanding of its specific change-promoting ingredients. This study aimed to establish candidate change mechanisms by identifying whether patients’ interpersonal (theory-specific) and cognitive (theory-nonspecific) characteristics change in an adaptive direction during IPT, and whether such changes differentially relate to depression reduction and improvement in global functioning. The four interpersonal variables and one cognitive variable measured all changed significantly in an adaptive direction, with medium to large effect sizes. Reduced interpersonal problems were marginally associated with self-reported depression reduction (β = 2.846, p = .062), and greater satisfaction with social support was marginally associated with depression reduction (β = -1.423, p = .081). Unexpectedly, reduced romantic relationship adjustment was related to depression reduction (β = 2.028, p = .008 for self-rated depression and β = 1.474, p = .022 for clinician-rated depression), and increased attachment avoidance was marginally related to better clinician-rated global functioning (β = 1.501, p = .09). Thus, theory-relevant interpersonal variables emerged as candidate change mechanisms, and the findings are discussed with respect to their research and practice implications.

No description available.

No description available.

This study investigated temporal patterns of therapeutic alliance development across treatment and their relationship to outcome, and the relationship between client attachment styles and interpersonal problems and alliance strength and patterns across treatment. Sixty-six clients diagnosed with major depression participated in one of two 16-week treatment conditions: Process-experiential therapy and Cognitive-behavioural therapy. Results revealed two alliance “shape” patterns; Stable Linear and Steep Linear-Quadratic, as well as two alliance “shape and level” patterns; High Strength Linear-Quadratic and Low-to-Mid Strength Stable. Results indicated that the two alliance “shape” patterns did not differentially predict treatment outcome. With respect to “shape and level” patterns, results revealed that clients with a High Strength Linear-Quadratic alliance pattern had better treatment outcomes than clients with a Low-to-Mid Strength Stable alliance pattern. In terms of client attachment style, results indicated that clients with a Steep Linear-Quadratic “shape” pattern report more discomfort with closeness at pre-treatment. Further, clients with a High-Strength Linear-Quadratic “shape and level” pattern report more confidence and less need for approval at pre-treatment. With respect to client interpersonal problems, results revealed that clients with a Steep Linear- Quadratic “shape” pattern report being more cold and distant at pre-treatment and clients with a Low-Mid Strength Stable “shape and level” pattern report being more socially inhibited, less assertive, and more overly-accommodating at pre-treatment. Lastly, results revealed that specific client attachment characteristics and interpersonal problems differentially predict total average alliance strength as well as the average strength of the client and therapist bond across treatment.