research

UBC Psychotherapy Program members conduct state-of-the-art research, focusing on a wide variety of psychotherapeutic approaches, in order to advance the effective and efficient practice of psychotherapy. This research concentrates on identifying and understanding patient, therapist, and relational processes that influence psychosocial treatments, and on the development, systematization, and integration of efficacious psychotherapeutic interventions. To address these issues, we utilize a variety of research methodologies, including randomized controlled trials, process analyses, comprehensive case examinations, and qualitative analyses. A diverse array of psychotherapies that represent different theoretical orientations (e.g., psychodynamic, cognitive-behavioural, interpersonal) and treatment formats (e.g., individual, group, partial hospitalization) are studied. Federal and provincial government organizations, private foundations, and local hospitals fund our research.

Areas of Interest

Psychotherapy outcome

Psychotherapy outcome research investigates the presence and magnitude of changes that result from participation in psychotherapy. Outcome research, however, is more complex than only testing whether an intervention works at a general level, and necessarily so given the complexity of the psychotherapeutic treatment enterprise. Issues related to differential outcomes among patients are critical for developing a better understanding of whether psychotherapy works, and for whom. Members of the UBC Psychotherapy Program have tackled such important issues. For example, they investigated a wide variety of patient characteristics that are believed to systematically influence response to psychotherapy, including the presence of physical pain, the availability of social support, personality traits, and attachment styles.

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Psychotherapy process

Beyond the issues of determining whether psychotherapy works and for whom, it is important to understand how psychotherapy works. Process research addresses what goes on during treatment that leads to the changes that patients experience as a result of their participation in therapy. It could be argued that process research is the most fundamental area of inquiry in the scientific study of psychotherapy, for only through process research can we begin to develop an understanding of how psychotherapy actually incites change in patients. Members of the UBC Psychotherapy Program have made efforts toward studying psychotherapy processes, investigating such issues as the expression of affect by patients during treatment, the nature of the patient-therapist relationship, and qualities of the therapeutic environment in group therapy.

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Group therapy

Psychotherapy is an inherently complex enterprise, particularly if provided in the context of a group. Relatively few researchers have focused on the dynamics of this complex enterprise, in terms of understanding its indications (For whom is group therapy best suited?), organisation (How should a group be composed to maximize its benefit?), operations (What goes on in group therapy that makes it work?), and delivery (How can a group leader be most effective?). Group therapy is diverse, operating on various levels and engaging multiple players, goals, roles, and relationships. Thus, contributions to the research of group therapy must consider a multitude of issues in order to answer these critical questions. Complex, programmatic lines of research are required to further our understanding of group therapy as a treatment for mental illness. Such programs investigate relationships among patient characteristics, provider characteristics, formal change theories, group process patterns that are believed to facilitate change, and multivariate outcomes. The complexity of testing such relationships requires serial investigations that build upon each other in a systematic way. Members of the UBC Psychotherapy Program have undertaken such investigations in order to develop a better understanding of the efficient and effective use of group therapy.

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Personality disorders

Personality disorders are a topic of considerable interest to clinicians and researchers, in part because they are highly prevalent and difficult to treat. Personality disorders are regarded as one of the most important sources of long-term impairment in both treated and untreated psychiatric populations. The chronic functional impairment of personality disorders creates substantial costs for society. The costs are associated with high levels of unemployment, substance abuse, hospitalisation, marital difficulties, and suicide. As well, individuals with personality disorders are frequent users of health and social services. The costs not only involve the patients themselves, but also the many people (e.g., family, friends, work associates) whose lives they affect. There is immense interest in developing a better understanding of the aetiology, associated pathologies, and treatment of personality disorders. Members of the UBC Psychotherapy Program have made several significant contributions toward this end.

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Narcissism

Literature on narcissistic personality disorder (NPD) is rife with contention and contradiction. Pathological narcissism is commonly encountered in clinical settings, but NPD has been rare in most epidemiological studies. It is widely recognized that the official nosology of the Diagnostic and Statistical Manual of Mental Disorders (DSM), with its stark emphasis on overt grandiosity, obscures clinically salient dimensions of vulnerability that often lie at the core of narcissistic pathology. This disparity has led to a situation in which the term “narcissism” is inconsistently applied and understood in clinical contexts. The NPD diagnosis has a pejorative connotation and is renowned as a “difficult-to- treat” condition, yet there is little empirical evidence regarding its clinical course and management. Consequently, the field continues to grapple with questions about defining, identifying, understanding, and treating pathological narcissism. Members of the UBC Psychotherapy Program have taken a leading role in addressing these questions in the service of better understanding and treating pathological narcissism.

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Alexithymia

Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Alexithymia constricts a person’s ability to elaborate on inner feelings, to engage in abstract thought, and to empathise. They have difficulty presenting material spontaneously, somatize emotional distress, and fixate on minute details of external events. Patients with high levels of alexithymia know that they don’t feel good, but don’t know how to say or describe what they’re feeling. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been negligible. Most research has focused on etiological factors and associated pathologies. Thus, many of the assumptions about psychotherapeutic treatment of an alexithymic patient remain untested. Research conducted by members of the UBC Psychotherapy Program attempts to fill this void.

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Men's mental health

Rates for diagnosed depression have increased worldwide and depression has become a public health concern that is associated with significant disease burden. Comparatively, fewer men than women are diagnosed with depression, and in developed countries the ratio is 2:1. However, commentaries about men’s depression suggest that the lower reported rates may be due to factors such as men’s reluctance to express concerns about their mental health, reticence to seek professional health care services, and lack of development of services that resonate with men. Severe depression is also known to significantly increase the risk for suicide, yet despite low reported rates of depression among men, suicide rates are four times higher in men than women. The discordant relationship between men’s low rates of depression and high suicide rates has stimulated interest in examining men’s depression and associated challenges in more depth. Responding to the need for more dedicated research on this topic, members of the UBC Psychotherapy Program have helped establish the first dedicated research program on men’s mental health in Canada. To learn more about this research program and its projects, please visit Men's Health Research at UBC.

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Suicide

Suicide among boys and men, across all age groups, is a significant global health issue. Consistent with worldwide patterns, Canadian male suicide rates have remained high over the last two decades, occurring at three times the rate of females. Despite being a longstanding issue, men’s experiences of suicidality and pathways to suicide have been largely ignored and are poorly understood, amid widespread failures to sustain men’s community-based suicide prevention programs or implement gender-sensitized professional mental health care services. Members of the UBC Psychotherapy Program have taken a leading role in addressing critical issues that are pertinent to advancing a better understanding of suicidality among boys and men, and how to better meet their service needs.

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Complicated grief

Acute distress is normal following the loss of a loved one. In some cases, grief reactions reach intensities and durations that are extreme, are associated with complications (e.g., physical ailments), and interfere with daily functioning. Such grief reactions are referred to as complicated grief. There is considerable interest in complicated grief as a nosologic entity that is distinct from Major Depression, Panic Disorder, and Posttraumatic Stress Disorder. Members of the UBC Psychotherapy Program have conducted considerable research on the identification of complicated grief, understanding of associated pathologies, and treatment of complicated grief.

Short-Term Interpretive Group Therapy for Complicated Grief, a treatment approach developed by members of the Program, is listed in the National Registry of Evidence-based Programs and Practices (NREPP), a searchable online database of evidence-based mental health and substance abuse interventions.

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