Cognitive–behavioral therapy versus usual clinical care for youth depression: An initial test of transportability to community clinics and clinicians.

Community clinic therapists were randomized to (a) brief training and supervision in cognitive–behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8–15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement—a hypothesis that warrants testing in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: A structural equation model.

Demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients (aged 18–75 yrs) treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effects of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applicability of cognitive-behavior therapy with American Indian individuals.

There is little empirical evidence to support the claim that cognitive- behavior therapy (CBT) is an especially suitable treatment for culturally diverse clients. The purpose of this study was to compare the applicability of CBT in a community sample of European American and American Indian individuals. Participants completed the Cognitive Behavior Therapy Applicability Scale (CBT-AS), in which they rated their preference for characteristics consistent with three tenets of CBT. European Americans rated a stronger preference for CBT's focused in-session behavior and structured therapeutic relationship than did American Indians. Both groups rated the active stance domain of CBT as mutually acceptable. On the basis of the findings, several modifications to CBT for therapists working with American Indian clients are proposed for future investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence and differentiation in individual versus family therapy for adolescent substance abuse.

Treatment adherence and differentiation in dynamic cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse were evaluated with a treatment adherence process measure. Full-length videotapes of 90 treatment sessions (36 clients) were reviewed by nonparticipant raters. Adherence scales for each treatment generated through factor analysis of observational ratings demonstrated sound interrater reliability and internal consistency. Therapists in each condition used techniques unique to their own model and avoided those unique to the competing model. Individual therapists emphasized behavioral and substance-use interventions, whereas family therapists focused on interactional and affective interventions. Challenges in conducting adherence research that compares individual and family treatments are addressed, as are implications of these results for advancing treatment development for adolescent drug users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy.

Reviews the book, A CBT-practitioner’s guide to ACT: How to bridge the gap between cognitive behavioral therapy and acceptance & commitment therapy by Joseph V. Ciarrochi and Ann Bailey (2008). The “third wave” of cognitive behavioural therapy (CBT), with its emphasis on mindfulness and acceptance as core skills to facilitate psychological health, has spurred the development of a number of unique and often provocative therapeutic approaches. Amongst these, acceptance and commitment therapy (ACT) is one that has generated especially fervent support amongst its adherents. The rise of ACT has been ushered in part by a plethora of treatment manuals and self-help materials; however, few of these are explicitly targeted toward professionals well-versed and comfortable with CBT who are not interested in, or ready for, a full conversion to a new therapeutic framework. It is to this audience that Ciarrochi and Bailey have targeted their book, and their successful result is a practical, easy-to-read guidebook that presents a relaxed introduction to the approach. Ciarrochi and Bailey have provided an engaging and user-friendly introduction to ACT in a fashion that will allow experienced therapists to integrate it into their work while retaining much of a basic CBT framework. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Examination of Therapist and Client Behavior in High- and Low-Alliance Sessions In Cognitive-Behavioral Therapy and Process Experiential Therapy.

This study examined therapist and client behaviors in cognitive-behavioral therapy (CBT) and process experiential therapy (PET) in 24 high- and 24 low-alliance sessions. Sequential analyses revealed that client resistance was not a function of therapist directiveness in either therapy. Repeated measures analysis of variance revealed that overall, CBT therapists taught more and asked more directive questions, whereas PET therapists offered more support. However, both CBT and PET therapists provided more support during low-alliance than high-alliance sessions. Clients in PET challenged more and showed greater resistance in low-alliance sessions than clients in CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical supervision from the standpoint of cognitive-behavior therapy.

This article presents an approach to supervising cognitive-behavior therapists that is closely related to the process and content of cognitive-behavior therapy (CBT). The goal of CBT is to help therapists adopt the philosophy of CBT as the basic approach for changing clients' cognitions, emotions, and behaviors. A secondary goal is to teach therapists specific techniques. The seven major features of CBT and their implications for supervision are described: therapy as a meaning-making process; systematic and goal directed therapy; practicing and experiencing; therapy as a collaborative effort; person-focused therapy; the therapists as a facilitator of change and development; and empowerment of the client with self-change skills. Some of the major dilemmas and constraints in CBT supervision that are derived from adapting the principles of therapy to supervision are discussed as well as the need for supervision outcome research and recommendations for its implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concepts, processes and procedures: An introduction to the special issue on integration of concrete operating procedures.

Mahrer (1989b) described integration on the basis of concrete operating procedures as one of the more promising approaches to psychotherapy integration. In an attempt to examine this integrative approach, therapists from a variety of theoretical orientations were invited to share examples of how they had integrated into their preferred therapeutic approach interventions that were originally developed outside that framework. The articles in this special section provide illustrations of integration of specific procedures into four different theoretical frameworks. Although the articles discuss the incorporation of a wide variety of different types of interventions, as a group they suggest (a) that therapist operating procedures are understood more in terms of providing resources for an active collaborating client than as creating an impact upon the client, (b) that all therapist activities including procedures aimed at achieving problem resolution instantiate the therapeutic relationship, thus blurring the distinction between working on the relationship and working on client issues, and (c) that it is both possible and valuable for therapists to be flexible and creative in integrating new procedures into their therapeutic work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the use of symbolic labels in psychotherapy outcome research: Comment on Wills, Faitler, and Snyder.

Wills, Faitler, and Snyder (1987) identified distinctive therapist behaviors, trained therapists to implement these techniques, and demonstrated that trained raters could reliably categorize different behaviors. The criteria used to operationalize certain behaviors as behavioral marital therapy and others as insight-oriented marital therapy were arbitrary and are not consistent with either theoretical conceptualizations or the applied utilization of these therapeutic approaches. Future comparative psychotherapy research should avoid such labels and focus on empirical validation of the most effective therapy behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p     

Characteristics of effective therapists: Further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient treatment of depression to take longer than did moderately and less effective therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals.

Two versions of cognitive-behavioral therapy (CBT), one with religious content (RCT) and one with standard protocol (NRCT), were used to treat 19–20 religious patients each. 59 religious patients who met the Research Diagnostic Criteria for nonpsychotic, nonbipolar depression were treated in 18–20 1-hr sessions over 3 mo. Religious and nonreligious therapists were used in each CBT group. Pastoral counseling (PCT) treatment-as-usual and waiting-list control (WLC) conditions each contained 10–21 patients. RCT and PCT patients reported significantly lower posttreatment depression and adjustment scores than did either the NRCT or the WLC condition. The CBT difference was due largely to superior performance of the nonreligious therapists (with dissimilar values to the patients) in the RCT over the NRCT condition. Improvement in the 3 treatment conditions was equal at 3-mo and 2-yr follow-ups and greater than posttreatment WLC improvement levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy training and intervention use on session outcome.

Objective: This study was an investigation of the relationships among therapist training variables, psychotherapy process, and session outcome in a psychotherapy training clinic. The aims were to assess the relationship between “training as usual” and intervention use in individual psychotherapy, to investigate the relationship between therapist intervention use and session outcome, and to test whether training variables moderate this relationship. Method: Graduate student therapists (n = 19; mean age = 27 years; 79% women; 84% White) provided information about their training and completed a measure of intervention use (Multitheoretical List of Therapeutic Interventions; McCarthy & Barber, 2009) and clients (n = 42; mean age = 33 years; 64% women; 95% White) completed a measure of session outcome (Session Progress Scale; Kolden, 1991) after each session of individual psychotherapy. Results: With regard to intervention use and session outcome, no main effects were found for the training variables. Consequently, tests of moderation were not performed. The final model for intervention use and session outcome yielded main effects for time-varying interpersonal therapy and time-varying common factor use, and a 3-way interaction among time-varying cognitive–behavioral (CBT) intervention use, between-patient common factor use, and between-therapist common factor use. Patients who received more common factor interventions on average rated sessions as less helpful when more CBT interventions were employed; this finding was stronger for patients who were being treated by therapists with higher average levels of common factor use. Conclusions: Implications for training are discussed, with particular attention paid to the importance of clinical decision making and the complex interaction between common and unique technical factors in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of therapist pregnancy on the process of counseling and psychotherapy.

Reviewed research on the relationship between the therapeutic process and potential outcome. Research concerning the impact of a therapist's pregnancy on the psychotherapeutic process was discussed in the context of 5 components that are thought to lead to the outcome of the therapeutic process. These components included the therapeutic contract, therapeutic interventions, the therapeutic bond, the patient's self-relatedness, and therapeutic realizations. Setting clear therapeutic limitations, holding conjoint sessions in transferring clients to new therapists, and considering the role of client diagnosis are important considerations for pregnant therapists in negotiating the therapeutic contract. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating substance-abuse patients with histories of violence: Reactions, perspectives, and interventions.

One of the more troubling experiences that occurs in the psychotherapy of addicted persons is when they relate stories concerning their involvements with past acts of violence. Whether these events are regretted or not, they often arouse strong feelings in therapists and can present both patients and clinicians with questions about how to proceed. Attribution theory can be a useful tool for understanding the feelings and countertransference that arises, and a combination of insights from the field of posttraumatic stress disorder (PTSD) treatment and existential therapy, along with a focus on the question of character, are a potential foundation for the development of therapeutic interventions. The relationship between substance abuse and violence, the importance of treatment context, and the interdependence of identity and action are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The clinical management of client dynamics and fees for psychotherapy: Implications for research and practice.

Research indicates that there is no clear relationship between fees and therapy effectiveness, although fees do impact the therapeutic process. By integrating E. Fromm's (1947) personality theory with a typology of client dynamics in response to fees, it is suggested that therapists are aided in the conceptualization of client dynamics and are able to develop proactive treatment interventions. For example, receptive clients may use fees to get attention, to foster helplessness, or to maintain ties with the therapist in the therapeutic relationship. Dynamics of exploitative, hoarding, and marketing clients are also outlined. A major benefit of the typology is that therapists can assess, evaluate, and interpret clients' dynamics in terms of goals, needs, feelings, and behavioral expressions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist differences in cognitive–behavioral psychotherapy for generalized anxiety disorder: A pilot study.

Little is known about factors differentiating more and less effective therapists or the mechanisms through which therapists influence outcome. In the present study, the performance of a small sample of 4 therapists was compared in the context of delivering cognitive–behavioral psychotherapy (CBT) to 32 clients with generalized anxiety disorder. More effective therapists were characterized by higher observer-rated CBT competence, higher client outcome expectations and client treatment credibility assessments, and higher early treatment client ratings of therapeutic alliance quality. Higher early CBT competence was associated with higher client midtreatment outcome expectations, which in turn were associated with better posttreatment outcomes. Although these findings are preliminary given the small sample of therapists and clients, they suggest that the common factor of outcome expectations might be a mechanism through which the specific factor of psychotherapist competence exerts its influence on treatment outcome. The implications of these findings and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Interpersonal psychotherapy of depression.

Reviews the book, Interpersonal psychotherapy of depression by Gerald L. Klerman, Myrna M. Weissman, Bruce J. Rounsaville, and Eve S. Chevron (1984). The authors state their intention to "describe the theoretical and empirical basis for interpersonal psychotherapy of depression," and also "offer a guide to the planning and conduct of the therapy." They do both, and waste no words. The book is organized into three parts. In the first part, the authors present an overview of the theory of the interpersonal approach of the use of interpersonal psychotherapy for depression, objectively offer both favorable and unfavorable findings from completed studies, and outline several studies in progress. The chapters in Part Two clarify how one conducts interpersonal therapy of depression. Part Three addresses the combination of psychotherapy with pharmacotherapy and the professional requirements of the therapist. This book is clearly written, well referenced, and easily understood by beginners who might not have the perspective, as well as by busy veterans who want to learn something new without plowing through mountains of theory and data. It would be useful for students in training, and extremely valuable to the legions of relatively inexperienced front-line mental health center therapists who are required to use time-limited approaches with depressed patients, often without having much structure for what they are doing. More experienced therapists who treat ambulatory depressed patients will add to their clinical skills and enjoy the process. The authors have turned their manual into a useful book that competes most favorably with other texts on short-term approaches to therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)