The aim of this article is to show how the plan formulation method (PFM), an empirically validate... more The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient's goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians’ in-session feelings.
Journal of Contemporary Psychotherapy, Mar 13, 2022
Psychotherapists can experience various kinds of emotions in response to their patients’ communic... more Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These may be understood in the context of interpersonal dynamics associated with patients’ testing activity. The concept of testing, as part of the patient’s plan for therapy, is explained from the perspective of Control-Mastery Theory. Different kinds of testing behaviors, aimed at disconfirming the patient’s pathogenic beliefs, may evoke different emotions in the therapist. Understanding the patient’s testing strategies can help to make sense of the therapist’s emotional reactions, manage countertransference, and guide therapeutic responses. This paper describes testing behaviors, according to the patient’s compliance and non-compliance with pathogenic beliefs, along with corresponding therapist emotional responses. A descriptive clinical case is provided to illustrate various tests and their associated emotional reactions within a therapy session.
Men have been underrepresented in research investigating the pathway from social anxiety through ... more Men have been underrepresented in research investigating the pathway from social anxiety through loneliness to suicidality. The present study examined loneliness as a mediator between social anxiety and suicidality among men, along with exposure to childhood trauma as a moderator of this pathway. A nationally representative sample of 530 Canadian men completed study measures online. Bootstrapped tests of indirect effects indicated loneliness to be a significant mediator after controlling for depression symptoms, and this mediation effect was moderated by exposure to multiple types of childhood trauma. The link between social anxiety and loneliness––and the mediating effect of loneliness on suicidality––was strongest among men reporting two or more types of childhood trauma. Efforts to mitigate men’s suicidality in the context of social anxiety may benefit from targeting loneliness, with particular attention to the effects of childhood trauma.
Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement... more Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance towards psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g. total testosterone levels < 12.1nmol/l). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT).Aim: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist.Methods: The study presents a 2x3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal / hypogonad...
Aim of the studyThe Fear of COVID-19 Scale is a widely used measurement tool for related anxietie... more Aim of the studyThe Fear of COVID-19 Scale is a widely used measurement tool for related anxieties, however previous studies validating the scale report varying fit indices, often below accepted cut-off points. This suggests re-specification of the scale may be required. The present study aimed to examine the psychometric properties of the English-version of the Fear of COVID-19 Scale in a population of help-seeking males using exploratory (EFA) and confirmatory factor analysis (CFA).Subject or material and methodsData from 621 males aged 18-80 years (mean=38.23, SD=13.59) was collected via a cross-sectional open online survey. Along with the 7-item Fear of COVID-19 Scale, the PHQ-4 and PROMIS Anger Short Form were used to measure probable anxiety, depression and anger. Data were randomly partitioned into two subsamples and separate factor analyses were conducted with robust CFA corrections applied for non-normality.ResultsA 4-item single-factor version of the scale was identified r...
Men’s low job satisfaction has been shown to be associated with greater symptoms of psychological... more Men’s low job satisfaction has been shown to be associated with greater symptoms of psychological distress. Meaning in life may be an important factor in this relationship, but its role as a mediator has not been reported. The present study investigated meaning in life as a mediator in the relationship between job satisfaction and psychological distress among men. A total of 229 employed Canadian men participated in a cross-sectional survey, completing measures of depression and anxiety symptoms, anger severity, job satisfaction, and the presence of meaning in life. Zero-order correlations were calculated, and regression with mediation analyses were conducted; two models were tested: one for anxiety/depression symptoms and one for anger, as the dependent variables. Both mediation models emerged as significant, revealing a significant mediating effect for job satisfaction on the symptoms of psychological distress (anxiety/depression symptoms, anger) through meaning in life, even whil...
Objective: Interpersonal dysfunction is a hallmark feature of borderline personality disorder (BP... more Objective: Interpersonal dysfunction is a hallmark feature of borderline personality disorder (BPD). Representing lifelong relational patterns based in internal representations, quality of object relations (QOR) has been theorized as a core aspect of borderline personality pathology; yet empirical inquiry of this relationship has been limited. The present study investigated the association between QOR and BPD in the context of other salient correlates of BPD.
Journal of Aggression, Maltreatment & Trauma, 2021
ABSTRACT Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD)... more ABSTRACT Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD) symptoms. Posttraumatic negative self-appraisals (i.e., posttraumatic shame and self-blame) have also been empirically supported as contributors to PTSD symptom severity following traumatic events. These associations are well known; however, the pathways between maladaptive schemas and PTSD symptoms remain largely unclear. The present study aimed to examine the mediating effects of posttraumatic negative self-appraisals (shame and self-blame) on the association between maladaptive schemas and PTSD symptom severity in patients completing a partial hospitalization program. Patients (N = 98) completed measures of early maladaptive schemas, posttraumatic shame, posttraumatic self-blame, and PTSD symptom severity at intake. Posttraumatic negative self-appraisals mediated the association between maladaptive schemas and PTSD symptom severity. When we examined the specific mediating effects of shame and blame – rather than negative self-appraisals overall – shame was a significant mediator (b = .153, 95% CI [.031, .296]), but not blame (b = .038, 95% CI [−.083, .204]). Further, posttraumatic shame mediated the association between two of the four schema domains – disconnection & rejection (b = .092, 95% CI [.030, .201]) and impaired autonomy & performance (b = .047, 95% CI [.002, .124]) – and PTSD symptom severity. These findings highlight the importance of posttraumatic shame in the association between maladaptive schemas and PTSD symptom severity. Theoretical and practical implications are discussed.
Journal of Primary Care & Community Health, 2020
Objective: Men with depression are known to have significant challenges with health service engag... more Objective: Men with depression are known to have significant challenges with health service engagement. The current study sought to better understand attitudinal and structural mental health care barriers among those men identified as symptomatic for symptoms of major depression. Design: Cross-sectional study with data provided by Canadian men via a nationally representative online survey. Outcomes examined depression, suicide risk, and barriers to mental health services. Participants: A total of 117 men (mean age = 42.36 years) reporting symptoms of major depression consistent with moderate severity as identified by the Patient Health Questionnaire–Depression Module (PHQ-9). Results: In all, 51.3% of the sample reported previously receiving counselling or psychotherapy for mental health concerns. The majority (63.2%) reported past 2-week suicide or self-harm ideation; however, only a small proportion (8.5%) were currently engaged with professional mental health support. Logistic re...
BackgroundSuicidal ideation and the self‐conscious emotions of guilt and shame are frequently enc... more BackgroundSuicidal ideation and the self‐conscious emotions of guilt and shame are frequently encountered in psychotherapy. However, research regarding the relationship between self‐conscious emotions and suicidal thoughts has been limited, particularly in the context of women's experiences of childhood sexual abuse.AimsThe purpose of this study was to investigate the relationship between suicidal ideation and experiences of guilt and shame among women seeking psychotherapy, and to examine the role of childhood sexual trauma in this relationship.Materials and MethodsParticipants were 68 women attending an outpatient psychotherapy clinic who completed questionnaire measures of depression, guilt and shame, suicidal ideation, and childhood trauma.ResultsZero‐order and partial correlations found direct positive associations between frequency of suicidal thoughts and both guilt and shame. Hierarchical regression analysis found significant interactions between sexual abuse and self‐co...
The International journal of social psychiatry, Jan 24, 2016
Despite links between early relational experiences and psychopathology, data regarding childhood ... more Despite links between early relational experiences and psychopathology, data regarding childhood emotional neglect among Canadian mental health services users are scarce. To explore the absence of emotional support experiences reported by Canadian psychiatric outpatients, and to examine the relationship between childhood emotional support and borderline personality disorder (BPD) features. A survey regarding childhood emotional support was completed by consecutively admitted adult outpatients, along with self-report assessments of symptom distress and BPD features. A substantial proportion of outpatients reported absent emotional support experiences. After controlling for the effects of age and symptom distress, childhood emotional support was found to be significantly negatively associated with BPD features. The findings add further support to the need for clinical attention to the early relational experiences of mental health service users.
Termination processes in psychotherapy vary widely across patients, therapists, and therapies. Wh... more Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
The aim of this article is to show how the plan formulation method (PFM), an empirically validate... more The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient's goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians’ in-session feelings.
Journal of Contemporary Psychotherapy, Mar 13, 2022
Psychotherapists can experience various kinds of emotions in response to their patients’ communic... more Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These may be understood in the context of interpersonal dynamics associated with patients’ testing activity. The concept of testing, as part of the patient’s plan for therapy, is explained from the perspective of Control-Mastery Theory. Different kinds of testing behaviors, aimed at disconfirming the patient’s pathogenic beliefs, may evoke different emotions in the therapist. Understanding the patient’s testing strategies can help to make sense of the therapist’s emotional reactions, manage countertransference, and guide therapeutic responses. This paper describes testing behaviors, according to the patient’s compliance and non-compliance with pathogenic beliefs, along with corresponding therapist emotional responses. A descriptive clinical case is provided to illustrate various tests and their associated emotional reactions within a therapy session.
Men have been underrepresented in research investigating the pathway from social anxiety through ... more Men have been underrepresented in research investigating the pathway from social anxiety through loneliness to suicidality. The present study examined loneliness as a mediator between social anxiety and suicidality among men, along with exposure to childhood trauma as a moderator of this pathway. A nationally representative sample of 530 Canadian men completed study measures online. Bootstrapped tests of indirect effects indicated loneliness to be a significant mediator after controlling for depression symptoms, and this mediation effect was moderated by exposure to multiple types of childhood trauma. The link between social anxiety and loneliness––and the mediating effect of loneliness on suicidality––was strongest among men reporting two or more types of childhood trauma. Efforts to mitigate men’s suicidality in the context of social anxiety may benefit from targeting loneliness, with particular attention to the effects of childhood trauma.
Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement... more Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance towards psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g. total testosterone levels < 12.1nmol/l). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT).Aim: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist.Methods: The study presents a 2x3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal / hypogonad...
Aim of the studyThe Fear of COVID-19 Scale is a widely used measurement tool for related anxietie... more Aim of the studyThe Fear of COVID-19 Scale is a widely used measurement tool for related anxieties, however previous studies validating the scale report varying fit indices, often below accepted cut-off points. This suggests re-specification of the scale may be required. The present study aimed to examine the psychometric properties of the English-version of the Fear of COVID-19 Scale in a population of help-seeking males using exploratory (EFA) and confirmatory factor analysis (CFA).Subject or material and methodsData from 621 males aged 18-80 years (mean=38.23, SD=13.59) was collected via a cross-sectional open online survey. Along with the 7-item Fear of COVID-19 Scale, the PHQ-4 and PROMIS Anger Short Form were used to measure probable anxiety, depression and anger. Data were randomly partitioned into two subsamples and separate factor analyses were conducted with robust CFA corrections applied for non-normality.ResultsA 4-item single-factor version of the scale was identified r...
Men’s low job satisfaction has been shown to be associated with greater symptoms of psychological... more Men’s low job satisfaction has been shown to be associated with greater symptoms of psychological distress. Meaning in life may be an important factor in this relationship, but its role as a mediator has not been reported. The present study investigated meaning in life as a mediator in the relationship between job satisfaction and psychological distress among men. A total of 229 employed Canadian men participated in a cross-sectional survey, completing measures of depression and anxiety symptoms, anger severity, job satisfaction, and the presence of meaning in life. Zero-order correlations were calculated, and regression with mediation analyses were conducted; two models were tested: one for anxiety/depression symptoms and one for anger, as the dependent variables. Both mediation models emerged as significant, revealing a significant mediating effect for job satisfaction on the symptoms of psychological distress (anxiety/depression symptoms, anger) through meaning in life, even whil...
Objective: Interpersonal dysfunction is a hallmark feature of borderline personality disorder (BP... more Objective: Interpersonal dysfunction is a hallmark feature of borderline personality disorder (BPD). Representing lifelong relational patterns based in internal representations, quality of object relations (QOR) has been theorized as a core aspect of borderline personality pathology; yet empirical inquiry of this relationship has been limited. The present study investigated the association between QOR and BPD in the context of other salient correlates of BPD.
Journal of Aggression, Maltreatment & Trauma, 2021
ABSTRACT Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD)... more ABSTRACT Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD) symptoms. Posttraumatic negative self-appraisals (i.e., posttraumatic shame and self-blame) have also been empirically supported as contributors to PTSD symptom severity following traumatic events. These associations are well known; however, the pathways between maladaptive schemas and PTSD symptoms remain largely unclear. The present study aimed to examine the mediating effects of posttraumatic negative self-appraisals (shame and self-blame) on the association between maladaptive schemas and PTSD symptom severity in patients completing a partial hospitalization program. Patients (N = 98) completed measures of early maladaptive schemas, posttraumatic shame, posttraumatic self-blame, and PTSD symptom severity at intake. Posttraumatic negative self-appraisals mediated the association between maladaptive schemas and PTSD symptom severity. When we examined the specific mediating effects of shame and blame – rather than negative self-appraisals overall – shame was a significant mediator (b = .153, 95% CI [.031, .296]), but not blame (b = .038, 95% CI [−.083, .204]). Further, posttraumatic shame mediated the association between two of the four schema domains – disconnection & rejection (b = .092, 95% CI [.030, .201]) and impaired autonomy & performance (b = .047, 95% CI [.002, .124]) – and PTSD symptom severity. These findings highlight the importance of posttraumatic shame in the association between maladaptive schemas and PTSD symptom severity. Theoretical and practical implications are discussed.
Journal of Primary Care & Community Health, 2020
Objective: Men with depression are known to have significant challenges with health service engag... more Objective: Men with depression are known to have significant challenges with health service engagement. The current study sought to better understand attitudinal and structural mental health care barriers among those men identified as symptomatic for symptoms of major depression. Design: Cross-sectional study with data provided by Canadian men via a nationally representative online survey. Outcomes examined depression, suicide risk, and barriers to mental health services. Participants: A total of 117 men (mean age = 42.36 years) reporting symptoms of major depression consistent with moderate severity as identified by the Patient Health Questionnaire–Depression Module (PHQ-9). Results: In all, 51.3% of the sample reported previously receiving counselling or psychotherapy for mental health concerns. The majority (63.2%) reported past 2-week suicide or self-harm ideation; however, only a small proportion (8.5%) were currently engaged with professional mental health support. Logistic re...
BackgroundSuicidal ideation and the self‐conscious emotions of guilt and shame are frequently enc... more BackgroundSuicidal ideation and the self‐conscious emotions of guilt and shame are frequently encountered in psychotherapy. However, research regarding the relationship between self‐conscious emotions and suicidal thoughts has been limited, particularly in the context of women's experiences of childhood sexual abuse.AimsThe purpose of this study was to investigate the relationship between suicidal ideation and experiences of guilt and shame among women seeking psychotherapy, and to examine the role of childhood sexual trauma in this relationship.Materials and MethodsParticipants were 68 women attending an outpatient psychotherapy clinic who completed questionnaire measures of depression, guilt and shame, suicidal ideation, and childhood trauma.ResultsZero‐order and partial correlations found direct positive associations between frequency of suicidal thoughts and both guilt and shame. Hierarchical regression analysis found significant interactions between sexual abuse and self‐co...
The International journal of social psychiatry, Jan 24, 2016
Despite links between early relational experiences and psychopathology, data regarding childhood ... more Despite links between early relational experiences and psychopathology, data regarding childhood emotional neglect among Canadian mental health services users are scarce. To explore the absence of emotional support experiences reported by Canadian psychiatric outpatients, and to examine the relationship between childhood emotional support and borderline personality disorder (BPD) features. A survey regarding childhood emotional support was completed by consecutively admitted adult outpatients, along with self-report assessments of symptom distress and BPD features. A substantial proportion of outpatients reported absent emotional support experiences. After controlling for the effects of age and symptom distress, childhood emotional support was found to be significantly negatively associated with BPD features. The findings add further support to the need for clinical attention to the early relational experiences of mental health service users.
Termination processes in psychotherapy vary widely across patients, therapists, and therapies. Wh... more Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Papers by David Kealy