Using the Achievement of Therapeutic Objectives Scale to Operationalize “Unlocking” of the Unconscious

Article


Hoviatdoost, Pejman, Schweitzer, Robert, Bandarian, Sia, Arthey, Stephen and Izadikhah, Zahra. 2022. "Using the Achievement of Therapeutic Objectives Scale to Operationalize “Unlocking” of the Unconscious ." American Journal of Psychotherapy. 75 (4), pp. 161-167. https://doi.org/10.1176/appi.psychotherapy.20200040
Article Title

Using the Achievement of Therapeutic Objectives Scale to Operationalize “Unlocking” of the Unconscious

ERA Journal ID6081
Article CategoryArticle
AuthorsHoviatdoost, Pejman, Schweitzer, Robert, Bandarian, Sia, Arthey, Stephen and Izadikhah, Zahra
Journal TitleAmerican Journal of Psychotherapy
Journal Citation75 (4), pp. 161-167
Number of Pages7
Year2022
PublisherAmerican Psychiatric Publishing
Place of PublicationUnited States
ISSN0002-9564
Digital Object Identifier (DOI)https://doi.org/10.1176/appi.psychotherapy.20200040
Web Address (URL)https://psychotherapy.psychiatryonline.org/doi/10.1176/appi.psychotherapy.20200040
Abstract

Objective:
Intensive short-term dynamic therapy (ISTDP) is an evidence-based psychotherapy supported by a growing literature base. “Unlocking” of the unconscious is a central process in ISTDP. This study sought to operationalize the concept of unlocking by adopting a detailed process analysis of the early phase of therapy for four patients by using a structured measure, the Achievement of Therapeutic Objectives Scale (ATOS).

Methods:
The ATOS is a measure of psychotherapy processes. A profile of the scale’s cutoff scores was developed to identify episodes of unlocking in videos of 28 ISTDP therapy sessions. Expert raters assessed for episodes of unlocking for up to the first 10 recorded psychotherapy sessions of four participants in a naturalistic private practice setting. Sessions were then rated with the ATOS profile, and these ratings were compared with expert ratings to assess the sensitivity of the ATOS in identifying episodes of unlocking.

Results:
Using the profile of subscale cutoff scores, the ATOS successfully identified seven of 11 episodes of unlocking. A visual analysis of descriptive data indicated that average ATOS subscale scores consistently identified episodes of unlocking and the presence of complex feelings of rage and guilt about the rage. Expert ratings of unlocking and the ATOS ratings were found to have high interrater reliability.

Conclusions:
This pilot study suggests that the ATOS may be adapted to provide a profile that can identify episodes of unlocking of the unconscious. The proposed measure is worthy of further study, representing an initial step toward operationalizing a central process associated with positive outcomes in ISTDP.

KeywordsIntensive Short-Term Dynamic Therapy; Unlocking; Mechanism of Change; ATOS; Psychotherapy
ANZSRC Field of Research 2020529999. Other psychology not elsewhere classified
Public Notes

The accessible file is the accepted version of the paper. Please refer to the URL for the published version.

Byline AffiliationsQueensland University of Technology
Griffith University
Independent Medical Practitioner, Australia
University of Southern Queensland
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