To carry out a three year randomised controlled trial of a specialist behaviour therapy service for adults with learning disabilities compared with treatment as usual, within South Essex Partnership NHS Trust. The study is funded by the South Essex Partnership NHS Trust (ISRCTN62134865).

Challenging behaviour is common in people with intellectual disabilities, but there is a paucity of specialist services in most areas. Currently, most of the care is provided by local community based intellectual disabilities teams whilst specialist care is usually hospital based and situated away from the clients' residence. South Essex Partnership NHS Trust provides such a specialist service to people with intellectual disabilities and challenging behaviour within a five sector locality.

68 participants will be randomly assigned either to specialist intervention or treatment as usual group. Structured interviews are conducted with clients and their carers at baseline and at three and six month follow-up. Main outcome is reduction in challenging behaviour. Secondary outcomes are reduction in carer burden and costs.

Will report on the first 2 years of a 3-year trial.

Intervention research is very scarce if not completely lacking in the field of intellectual disabilities mental health. We anticipate that the data from this study will provide evidence not only for further research but also for service developments and improvement in patient care.

Insufficient evidence exists for a viable choice between long and short-term psychotherapy in the treatment of psychiatric disorders. This study compares the effectiveness of long-term and short-term psychodynamic psychotherapy in the treatment of mood and anxiety disorders.

The Helsinki Psychotherapy Study is a randomized clinical trial based on 229 psychiatric outpatients from the Helsinki area, with depressive or anxiety disorder. The patients were randomly assigned to either long-term or short-term psychodynamic psychotherapy. The patients were followed for 3 years from start of therapy. Primary outcome measures were depressive symptoms, measured by the self-report Beck Depression Inventory (BDI) and the observer-related Hamilton Depression Rating Scale (HDRS), and anxiety symptoms measured by the self-report Symptom Check List, Anxiety scale (SCL-90-Anx) and the observer-related Hamilton Anxiety Rating Scale (HARS).

A statistically significant 49-64% reduction of symptoms was noted for the 4 outcome measures during the 3-year follow-up. Short-term psychodynamic psychotherapy was more effective than long-term psychodynamic psychotherapy during the first year of follow-up showing 15%-27% lower scores for the outcome measures. During the second year of follow-up no significant differences were found between the two psychotherapy groups. After 3 years of follow-up, long-term psychodynamic psychotherapy appeared to be more effective with 14%-37% lower scores of the outcome measures.

Short-term psychodynamic psychotherapy is more effective than long-term psychodynamic psychotherapy during its treatment period but in the long run long-term psychotherapy is more effective than short-term psychotherapy.

An unfinished process of grief can disrupt further growth and development especially if the loss of close person happens in childhood. The objective of this case report is to point out the importance of grief resolving as one of frequent causes of depression.

Case Report

The case shown is one of young man, occurring due to depressive symptoms. During the interview it was found that the patient had lost a brother 20 years before, and has neither ever cried over him after his death, nor has the subject ever been talked about in his family. In the integrative psychotherapeutic approach, the inclusion and emphatic bonding are followed by the gradual grief resolving process through re-experiencing the pain, the formation and transfer of memories and adjustment to the environment without the beloved person. After the grief resolving has been completed, the symptoms of depression subside. The patient remains in psychotherapeutic treatment with a goal to study further relationship and relating to other people.

Nowadays worldwide Cognitive Behaviour Therapy(CBT) is considered the therapy of choice for many psychiatric disorders. Its effectiveness has been noteworthy particularly for anxiety disorders and depression however due to the nature of Autism Spectrum Disorders(ASD) it has not been considered appropriate. The aim of the presentation will be to stress the importance of applying CBT with High Functioning Autism and Aspegers syndrome in adolescents and adults and to suggest ways that it can be modified to suit the needs of this population.

A comparison will be made of the main methods and techniques that are used in CBT programs for anxiety and mood disorders with state of the art methods for ASD and what modifications one might make particularly in terms of psychoeducation and cognitive restructuring.

The available evidence from current research will be reviewed particularly for comorbid cases of Aspergers and Obssesive Compulsive Disorder.

A discussion of the potential benefits and limitations of modifying CBT treatments as well as training psychiatrists and Clinical Psychologists on issues surrounding ASD will be discussed.

Negative affect and somatization are closely linked to symptoms of neurotic disorders. Negative affect consist of different negative emotions e.g. anxiety and hostility.

The study included a total of 52 inpatients of the day care clinic, 13 men and 39 women, aged 20-56 years. They suffered from neurotic, somatoform and personality disorders. All the patients participated in the group psychodynamic psychotherapy. The therapy lasted 12 weeks, there were 2 sessions of 1.5 hour every working day. The patients were examined before, immediately after and 3 months after the therapy. Negative affect, somatization and general psychological distress were assessed with SCL-90-R, GHQ-30 and PSE (a part of SCAN 2.0) questionnaires.

Mean values of anxiety and depressive symptoms, somatic symptoms and general psychological distress changed in like manner. They dropped of about 1/3 of initial value during the therapy and then stayed stable for 3 months after the therapy. Differences between first and second as well as third assessment were statistically significant whereas between second and third assessment were not. A pattern of change in hostility (SCL-90-R subscale) was different. Mean value of hostility did not change significantly during the therapy and then dropped significantly 3 months later.

Anxiety and hostility could be triggered separately and it is important to assess them both in terms of improvement. Short psychodynamic group psychotherapy is effective in reducing symptoms of anxiety, depression and somatization, but not effective in reducing hostility assessed 3 months afterwards.

Self Psychology represents a recent development of psychoanalysis which puts a lot of emphasis on empathy.

Empathy is generically considered one of the necessary therapeutic tools of a good clinician but its use in psychiatry appears to be generic and vague. This article aims to review the Self Psychological concept of empathy and its place in the Self Psychological conceptualization of the therapeutic process. It also investigate how Self Psychology can be apply in the context of psychiatric setting.

Review of current existent literature regarding the concept of empathy in Self Psychology and Self Psychology application in psychiatry setting, utilising the main database research tools. Extrapolation of the main therapeutic factors proposed by Self Psychology and evaluation of their possible application in the context of the more significant psychiatric settings.

Empathy appears to be central in Self Psychology conceptualization of the therapeutic process. Such therapeutic process appears to be reasonably applicable in different psychiatric settings.

Self Psychology can offer a considerable contribution to psychiatry in terms of better defining the role of empathy and emphatic attunement in the therapeutic process and thus enhancing the therapeutic outcome.

Nevertheless a lot questions remain open: can a treatment originally thought for a psychoanalytic setting being exported in the psychiatric setting? Can Self Psychology being applied by professionals who have not undergone a full psychoanalytic training?

Further empirical research is needed to evaluate possible contribution of Self Psychology in psychiatric setting.

Aim of this study is to emphasize the value of group psychotherapy in a “acute cases” department of psychiatry clinic during the first days of unwilling hospitalization

We studied an open group of patients of the closed department during the first days of their unwilling hospitalization, a doctor, a nurse and a social worker. Mini and BPRS scales were used. The diagnosis was determined by DSM IV.

Although at first, group therapy was regarded to be too difficult for these patients, we tried to develop a climate of acceptance, safety and empathy and so, the group therapy was taking part twice a week. At first, patients were in embarrassment, they were suspicious, afraid, and unable to get in a discussion in the context of a group. Next weeks, patients who had taken part in the first groups of psychotherapy, started to help the other patients to participate in the group therapy. As the time passed, the patients and the four professionals were participating with the same ability. Patients exchanged opinions about the psychiatric illnesses, they expressed their emotions, their fears, and they worked out with their anger.

It was very helpful especially with patients who were concealed their symptoms and they understood that they had to be in treatment because of the best of their psychic health

Group therapy is necessity not only for the therapeutic interventions in outpatients but for patients in closed psychiatric departments.

Cognitive behavioral therapy in combination with appropriate psychopharmacotherapy represents sovereign therapeutical procedure in the treatment of patients with anxiety disorder.

To improve the practical skills of students in clinical patients management we use following steps in training:

1. 1) videopresentation of typical case of disorder (e.g. posttraumatic stress disorder)

2. 2) short description of psychopathology, diagnosis, etiopatogenesis a and treatment strategies

3. 3) videopresentation of the first contact with patient, assessment, evaluation and psychoeducation, eventually treatment strategies (e.g. exposure in imagination)

4. 4) analysis of main steps of the video presentation with emphasis to the structure of the interview, open questioning, empathetic listening and positive force of the patient

5. 5) modelling of approach with group of students (leader plays a role of a patient and participants practice the approach)

6. 6) role playing in small groups of three students with video-monitoring of their work

7. 7) video-feedback and discussion of the advantages and disadvantages of the work of monitored group.

Students like this approach and evaluated it very highly in every school year training evaluation.

Using multimedia tools, role playing and videofeedback can help to develope practical skills of students more than classical approach.

Supported by project 1M0517 MZCR.

To adapt the Assertive Community Treatment (ACT) Model for use for use among hard-to-treat people with severe mental illness (SMI) in a medium-size mental health service area in The Netherlands.

Our adaptation does not include individual research assessments of clients in order to minimize their burden and maximize their participation in the services. It consists of three inter-related phases. Phase One includes: a) identification of 30 of the most difficult patients to treat for this trial, among long-term care clients (N: 820) of Renier van Arkel Psychiatric Services in s-Hertogenbosch; b) Collection of one-year Case Register data on participant's service use and clinical and demographic variables prior to this trial. Phase Two includes: a) Provision of in-vivo training to a team to work with the ACT methodology; b) Assessing over a year the provision of ACT, including follow-up service use and data collection from charts on substance use, quality of life and case-management. In Phase Three, we adapt ACT for use in our area and produce an intervention manual based on our experience in this trial, collected data, and on our overall clinical and research experience with hard-to-engage populations.

We successfully identified our target group, initiated the team in-vivo training and the ACT service provision. The rest of the study is still being implemented.

Initial assessments suggest that adapting an evidence-based intervention based on collection of clinical implementation data and non-intrusive collection of available service use and clinical variables data might be a useful method.

In this study, we aimed to find the differences between patients' and psychiatrists' perspectives with regard to therapeutic factors in group psychotherapy, by using Yalom's 60-item curative factor questionnaire.

A sample of 60 psychiatric patients (19 male, 41 female), who had admitted to a university psychiatric inpatient clinic and who had attended a “here-and-now” focused interpersonally-oriented group psychotherapy were chosen for this study. Their mean age was 38.4±11.0, and their psychiatric diagnoses were as follows: unipolar depression (46.7%), schizophrenia (16.7%), bipolar affective disorder (10.0%), anxiety disorders (10.0%), substance dependence (10.0%) and other (5.0%). 31.7% of them were diagnosed with a comorbid personality disorder. Before they were discharged from the hospital, they were asked to fill the Yalom's 60-item curative factor questionnaire, which was also filled for each patient by a psychiatrist, who had attended or supervised the group psychotherapy of these patients.

The top three curative factors were; existential factors, instillation of hope and self-understanding for patients, and installation of hope, existential factor and cohesiveness for psychiatrist. There were statistically significant differences among patients with different properties and between patients and psychiatrist for many items with regard to perceived “most helpful” therapeutic factors.

Patients gender, age, educational level and comorbid Axis II diagnosis influence the perceived therapeutic factors, while Axis I diagnosis and number of attended meetings do not. Patients and doctors seem to have different ideas about the importance of different therapeutic factors during patients healing processes in group psychotherapy.