Description of Research Expertise

Process Research

My research focuses on investigating the efficacy of psychotherapy and attempting to uncover the mechanisms of change involved in different psychotherapies, including psychodynamic and cognitive therapies. For the most part, my research has focused on patients with depression, panic disorders, personality disorders, cocaine dependence and interpersonal problems. The main areas of my research include:
• The role of the acquisition of compensatory skills and other meta-cognitive skills during therapy.
• Research on the therapeutic alliance and its relation with therapeutic process and outcome
• Research on therapists' intervention, including examining the relation among therapists' adherence to treatment protocols (manuals) and therapists' competent delivery oftherapeutic interventions on patients' outcome.
• Research on the relation among therapeutic alliance, therapists' intervention, patients' characteristics and outcome of psychotherapy
• Personality and social cognition research, especially as relevant to core conflicts and dysfunctional interpersonal patterns


Acquisition of compensatory skills and other metacognitive skills during psychotherapy
In cognitive therapy, Barber & DeRubeis (1989) proposed that the acquisition of compensatory, metacognitive skills was responsible for the finding that CT is better at preventing relapse than short-term pharmacotherapy. We developed a measure for assessing those compensatory skills, named the Ways of Responding, (Barber & DeRubeis,1991) and have presented preliminary data that CT patients indeed seem to acquire these skills (Barber & DeRubeis, 2001). The compensatory skills model is being further tested as part of an NIMH-funded multi-site study of CT conducted by DeRubeis and Hollon, which was recently completed at Penn and Vanderbilt.

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Research on the therapeutic alliance and its relation to therapeutic process and outcome
I have examined the importance of the therapist-patient relationship in relation to outcome of psychotherapy. In the research on the therapeutic alliance, I have overcome methodological limitations of previous research and shown that the patient-therapist relationship (therapeutic alliance) in brief dynamic therapy was a predictor of subsequent change in symptoms, taking into consideration the fact that the quality of the therapeutic relationship itself was strengthened by the patient's prior symptomatic improvement. In other words, I showed that alliance predicted subsequent symptomatic change above and beyond the fact that patients who have good alliance had also previously improved symptomatically (Barber et al. 1999, 2000). In addition, I have published on the role of alliance in predicting outcome and patient retention of different psychotherapies for cocaine-dependent patients (Barber et al. 1999, 2001).

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Research on therapists' intervention in different psychotherapies
My research has addressed the question of which therapeutic interventions impact outcome. Much of that work has involved the development of measures of adherence and competence of therapists conducting a specific form of short-term dynamic psychotherapy, namely supportive expressive dynamic therapy (SET). In addition to providing a way to assess whether the intended treatment was indeed delivered, these scales are used in testing hypotheses about the relation of therapists' interventions to treatment outcome. Using one of these scales for SE (Barber & Crits-Christoph, 1996) on a sample of patients with major depressive disorder, we have shown that competent delivery of specific, theoretically driven interventions (e.g., expressive/interpretive techniques), rather than using other therapeutic interventions, was critical to patients' subsequent symptomatic improvement. Furthermore, we have shown that the competent delivery of those expressive/ interpretative techniques predicted further change in depression, even taking into account "nonspecific factors" such as the quality of the therapeutic relationship and earlier symptomatic improvement (Barber, Crits-Christoph & Luborsky, 1996).

I received a five-year RO1 from the NIDA to further develop and assess therapists' adherence and competence in each of the treatment conditions of the NIDA Collaborative Cocaine Treatment Study (CCTS; Crits-Christoph et al., 1999). As part of that grant, we developed new measures of adherence/competence for individual drug counseling (Barber, Mercer et al., 1997), cognitive therapy (Barber, Liese & Abrams, 2003), and dynamic therapy (Barber, Krakauer et al., 1997). We have shown that the treatments used in the NIDA CCTS were indeed distinguishable and distinct (Barber, Foltz, Crits-Christoph,& Chittams, 2003). More recently, we have examined the interplay between adherence and alliance in predicting cocaine- dependent patients' outcome in Individual Drug Counseling (Barber et al, 2006). Among others, we demonstrated a curvilinear relation between adherence to Individual Drug Counseling techniques and drug outcome (Barber et al., 2006). More recently, Barber et al. (2008) examined the role of techniques and therapeutic alliance in the psychodynamic arm of the CCTS, demonstrating that patients improvement in that arm was not due to the use of dynamic techniques but rather due to the use of Individual Drug Counseling techniques.

In the last few years, Kevin S. McCarthy , a Penn psychology graduate student and I have been working on developing a multi theoretical measure of therapists' interventions, the Multitheoretical List of Therapeutic Interventions, that can be used by therapists, patients or independent observers to describe the therapeutic interventions used in a therapy session. Also, at the Karolinska Institute, together with Annika Lindgren who is now working with Christer Sandhal and me on her Ph.D., Robert Weinryb and I have collaborated on developing an adherence measure for a Kernberg's inspired dynamic therapy for patients with borderline personality disorders. Annika Lindgren, Alexander Wilczek, Marie Asberg, Asa Nilsone in Sweden and I are working on a paper examining the role of the alliance in Dialectical Behavioral Therapy and in Kernberg's inspired dynamic psychotherapy for suicidal women with borderline personality disorders.

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Personality and social cognition research

CCRT research
Other research that I do addresses assessing interpersonal patterns, especially maladaptive patterns. In my earlier work, I contributed to the systematization of a lexicon of standard categories for the core conflict relationship themes (CCRTs) method that was published as a chapter in Luborsky and Crits-Christoph's Understanding Transference: The CCRT (Barber, Crits-Christoph, & Luborsky, 1990, 1998). Many studies around the world currently use these standard categories. These categories have been translated into many languages, including German, French, Italian, Hebrew, Swedish, Spanish, Japanese, Portuguese, Finnish, Russian, Chinese, and Korean.

Central Relationship Questionnaire
During the last decade, I have developed a self-report questionnaire to assess central relationship patterns, called the Central Relationship Questionnaire (CRQ, Barber, Foltz, & Weinryb, 1998). This research has been funded by a five year NIMH RO1 “Measuring Outcome of Dynamic Therapy.” The CRQ has been translated into Hebrew, German, Swedish and Spanish. Using the CRQ and the CCRT, we have tested the assumption that the consistency of maladaptive interpersonal patterns is associated with a greater degree of dysfunction (Barber, Foltz et al. 2002: Foltz, Barber et al. 1999; Wilczek et al., 2000) and discovered in one instance that greater consistency was associated with greater mental health (Foltz et al, 1999). Kevin McCarthy and I have recently published a revised version of the CRQ. We have already made that version of the CRQ available to dozens of researchers around the world.

Central Relationship among Second Generation Holocaust Survivors
In Israel , the CRQ is being used in many studies, including one examining interpersonal characteristics of second generation Holocaust survivors (Wiseman, Barber, et al., 2002; Wiseman & Barber, 2007, 2007). This study has been funded by the US-Israel Binational Foundation (Dr. Hadas Wiseman from Haifa University as Israeli PI, and myself as US PI). A detailed description of the material obtained during the interviews of these children of holocaust survivors is available in our upcoming book: Echoes of the Trauma: Relationship Themes and Emotions in the Narratives of the Children of Holocaust Survivors , published by Cambridge University Press during the summer of 2008.

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Outcomes Research

Over the years, I have conducted and participated in a number of outcome studies of psychotherapy:
• Psychotherapies for Panic Disorder Study
• Pilot study for SE for Depression
• Pilot study for SE for Avoidant and Obsessive Compulsive PD
• NIDA Cocaine Collaborative Treatments Study
• Treatments for Depression Study
• The Huddinge 's randomized clinical trial of patients with personality disorders ( Sweden ).


Psychotherapies for Panic Disorder.
I am the PI (Dianne Chambless, Ph.D., Co-PI) of a large, NIMH-funded, randomized clinical trial (click here for the PTPD website) comparing panic focused psychodynamic therapy, cognitive-behavioral therapy and applied relaxation for panic disorder. The study begun in 2007 and intend to recruit 117 patients at Penn and another 117 at Cornell Medical School in New York City (PI, Barbara Milrod, M.D).


Pilot study for SE for Depression
Pilot study for SE for Depression:
Together with Lester Luborsky, Paul Crits-Christoph and John Cacciola, we conducted a small pilot study for SE for depression (Luborsky et al. 1996). This pilot study later led to the Treatments for Depression Study (See below).

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Pilot study for SE for Avoidant and Obsessive Compulsive Personality Disorder (PD).
This pilot study was funded as part of the NIMH Clinical Research Center for the Study of Psychotherapy in the early 90s. I conducted a pilot study for both personality disorders using SE. Drs. A.T. Beck and Newman conducted a parallel study using cognitive therapy. In SE, we found that the treatment was very effective for Obsessive Compulsive PD patients but a bit less effective for those patients with Avoidant PD (Barber, Morse et al., 1997).

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NIDA Cocaine Collaborative Treatments Study
This NIDA multisite study evaluated the efficacy of Beck's cognitive therapy, Luborsky's supportive-expressive dynamic therapy, Woody's individual drug counseling, and group drug counseling for cocaine -dependent patients (Crits-Christoph et al. 1999). The study demonstrated that drug counseling was more effective than either cognitive or dynamic therapy. In addition to working with Lester Luborsky in the Penn site of the study, I was funded by NIDA to develop adherence/competence measures for each individual treatment to evaluate treatment integrity of the entire study and I examined the role of therapists' interventions on outcome in the study (Barber et al., 2004, 2006, 2008).

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Treatments for Depression Study.
I am the PI of a large, NIMH-funded, randomized clinical trial (click here for the TDS website) comparing supportive-expressive dynamic therapy and an SSRI (sertraline followed by venlafaxine) and pill placebo for major depression. We have randomized 156 patients, half of them are members of minority group. We are currently begining to analyze the data of this major trial

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The Stockholm City Council's and the Karolinska Institute's Psychotherapy Project (SKIP Project)
For the last decade, I have been collaborating with Marie Asberg , Alexander Wilczek and the late Robert Weinryb on a variety of projects. One of these is an examination of the efficacy of dynamic therapy inspired by Kernberg's Transference Focused Therapy vs. Linehan's dialectical-behavioral therapy vs. treatment as usual for suicidal borderline patients in collaboration with Marie Asberg , Asa Nilsonne, and Alexander Wilczek . In this project, more than one hundred patients have been randomized to the three treatments and will be followed for up to five years.

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The Huddinge study of patients with Personality Disorders ( Sweden )
Dr. Robert Weinryb and I were the supervisors of three senior psychologists who conducted a large scale, randomized clinical trial comparing manualized SE to non manualized, community-based dynamic therapy for patients with any personality disorder. Two of those students, Kristina Noren and Bo Vinnars, are my current Ph.D. supervisees at the Karolinska Institute in Stockholm. Bo Vinnars got his Ph.D in March 08.

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Description of Clinical Expertise

Treatment of depression, panic disorder, interpersonal issues and personality disorders. Brief Dynamic Therapy.