1. What contributions have the authors mentioned in the paper "Plan analysis for bipolar affective disorder running head: plan analysis for bipolar affective disorder psychotherapeutic case conceptualization using plan analysis for bipolar affective disorder plan analysis for bipolar affective disorder" ?
The authors applied Plan Analysis as a research tool ( Caspar, 1995 ) to N = 30 inpatients presenting Bipolar Affective Disorder, who were interviewed twice.. These subtypes are discussed with regard to inherent plananalytic conflicts, specific emotions and coping Plans, as well as symptom level and type.. While these recent developments are encouraging and the structure of manualized treatments highly meaningful for the treatment of this challenging group of patients, to their knowledge no systematic psychotherapeutic case conceptualization approach – based on the individual case has yet been applied to this population.. The objectives of this article are to contribute to the question of psychotherapeutic case conceptualization by using the Plan Analysis approach ( Caspar, 2007 ; Caspar, 1996 ), more specifically, to ( 1 ) Enhance the psychotherapist ’ s conceptualization of patients ’ problems presenting BD and ( 2 ) Optimize treatment planning, including effective PLAN ANALYSIS FOR BIPOLAR AFFECTIVE DISORDER 4 implementation of manualized treatment strategies and the construction of a tailor-made therapeutic relationship.. Plan Analysis Plan Analysis is based on the works by Grawe & Dziewas in 1976 ( Grawe, 1980 ) who observed in behavior group therapy that basic behavioral concepts were not sufficient to explain difficult interpersonal patterns presented by the patients.. The basic principle of Plan Analysis is the instrumental vantage point: the patient ’ s behavioral ( self-reported or in-session clinician-observed verbal and non-verbal ) patterns are related to Plans and higher-order motives ( or goals and needs ) responding to the question: “ Which purpose, conscious or unconscious, underlies an individual ’ s behaviors and experiences ? ” ( Caspar, 1997, p. 260 ).. Generally, the presence of countless specific answers to this question, related to a patient ’ s situation and interactional behavior, oblige the psychotherapist to prioritize, structure and hierarchize the information within a framework of instrumental connections, i. e., as a Plan structure.. Four cases are envisaged by the approach as regards the linkage between emotions and Plans ( Caspar, 1997 ; 2007 ): ( 1 ) A negative emotion arises when Plans are threatened or blocked ; ( 2 ) Plans shape emotions ; ( 3 ) Plans are used as coping to face emotions ; ( 4 ) Emotion has itself an instrumental function.. This means that adaptational processes – the way the individual aims at eliminating or avoiding unpleasant emotional arousal – are conceptualized by Plan Analysis.. METHOD Sample A total of 30 inpatients with Bipolar Affective Disorders ( BD ) were included in the study.. 4x or. 5x ] or F31. 6 [ 296. 6x ] ) and were included in the study irrespective of the nature of the most recent phase or of the level of chronicity.. Data analysis for each patient follows a three-step procedure: ( 1 ) Conduct of tape-recorded clinical interviews ( see under procedure ), including post-session note-taking by the interviewer regarding the patient ’ s insession non-verbal behavior ; ( 2 ) Establishment of chronologically-structured “ extensions ” on relevant instrumental manifestations ( Breuer, 1985, cited by Caspar, 1996 ) for each patient, based on verbal and non-verbal cues in the recording and in the sessions notes ( this intermediate step is specific to the research context and enhances transparency in the process of inferring Plans from concrete behaviors ) ; ( 3 ) Construction of an individualized Plan Analysis based on the extensions, as well as of emotion frames for each rated emotion, encompassing the four aspects of emotion from an instrumental perspective ( see Introduction section ).. For each of the ten compared Plans, the following correspondence criteria and ratings were applied: 1 point for correspondence in the Plan itself, 2 points for correspondence in hierarchically superior Plans and 2 points for correspondence in hierarchically inferior Plans, yielding a possible total of 5 points.. The author completed an intensive one-week-training at Austen Riggs Center, Stockbridge, USA, and later underwent regular supervision with senior supervisors in psychodynamic psychotherapy.. All interviews were conducted in French by the author.. Only two patients had to be excluded from the study due to non-feasibility of the research interview ; all other patients responding to the inclusion criteria and willing to participate were included.. Only N = 18 patients respected this PLAN ANALYSIS FOR BIPOLAR AFFECTIVE DISORDER 11 appointment, despite great efforts on the part of the researcher.. The study was endorsed by the expert ethical committee of the psychiatric hospital.. All Plan Analyses were done by the author ; reliability was established with fully-trained colleagues and students on a randomly chosen 10 % of all cases ( for the results see under Results section ).. The establishment of a prototypical Plan structure respected the following 4 steps ( inspired by Ansmann, 2002 ): ( 1 ) An inventory of all Plans was established, encompassing Plans and goals, excluding related observed behaviors.. These Plans were investigated concerning the relevant instrumental connections among them: the authors took into account only those instrumental linkages which presented at least 5 occurrences out of 30 cases.. Unlike Ansmann ( 2002 ) who performed a confirmatory study on theory-driven plananalytic subtypes of Borderline Personality Disorder, to their knowledge, BD has not been investigated with regard to subtypes.. Thus, subtype formation in this study was exploratory and the strategy differed slightly from that used by Ansmann.. ( 1 ) For Plan Analyses, an overall acceptable average concordance between the author and three fully-trained raters was 64 % ( Case 1: 81 % ; Case 2: 64 %, Case 3: 48 % ).. Furthermore, three other cases from this sample rated by the author were presented in supervision classes and were approved by the senior supervisor.. Because the frequencies per subtype were therefore all very low and the betweengroup differences not noteworthy, the authors present only the overall results.. Results suggest the presence of two subtypes based on plananalytic principles: emotion control and relationship control, along with a mixed form.. As such, the prototypical Plan structure for depression ( Caspar, 1995 ) shows that these patients have difficulty in controlling aggression and anger ; they produce many avoidance Plans ( e. g., Plans like “ Avoid further deceptions in relationships ” and “ Avoid social contacts ” ) ; they have high expectations ( e. g., a Plan like “ Be a perfect mother for your children ” ), which serve to replace certain needs ( e. g., the need for proximity and affection ), along with an argument for avoidance of the pursuit of related goals ( e. g., resulting a conviction such as “ I am too vulnerable to be a perfect mother, so I ’ d rather not even try to ” ).. Each component obtained a rating of 1 for perfect correspondence: type of emotion, blocked/threatened Plan and coping Plan ( the aspects of emotion shaping Plans and of instrumentality of emotion were left aside for reliability analysis and also for further examination ), yielding a possible total of 3 for each emotion.
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