Patient-therapist interdependence: Cognitive and behavioral.

Each of 7 patients saw each of 4 therapists twice. After each session, therapists rated how they thought the patient and therapists should behave during psychotherapy. In addition, these patient and therapist behaviors were independently rated from tapes of the meetings. A balanced 4 * 7 design was utilized. Behavior rating data indicate that therapists are more influenced by patients than patients are by therapists. Comparisons of questionnaire and behavior rating data indicate that differences among therapists are more evident in how therapists think than in how they or patients behave. Implications for understanding the different roles of the psychotherapist are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist-as-fixed-effect fallacy in psychotherapy research.

Studies of psychotherapy involve sampling 2 sets of Ss from 2 populations: patients and therapists. Conclusions about psychotherapy should thus be based on statistical evidence that results are reliable across both patients and therapists. In most published research concerning psychotherapy, no statistical evidence is provided that findings can be generalized beyond the particular sample of therapists studied. In spite of this, researchers tend to draw conclusions concerning psychotherapy and therapists in general. ANOVA designs that allow generalization of results across both therapists and patients are described. The serious problems with inappropriate analyses of variance—treating therapists as a fixed effect or ignoring the therapist factor altogether—are discussed. A review of recently published studies of psychotherapy reveals that most researchers have done one or the other of these inappropriate analyses. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferences for therapists and related expectancies.

60 male and 60 female undergraduates were shown slides of the faces of potential therapists, older males, younger males, older females, and younger females. Ss indicated how much they would like to talk to each individual if they had a personal or vocational problem. They also indicated how they thought each therapist would act in a discussion and what each was like as a person. Older males were the preferred therapists in all cases except for women with personal problems who tended to prefer older women. Preferences seemed to be related to high expectancies on therapy relevant variables, especially understanding, rather than to similarity to the students. Students' social classes and parent-child relationships were not related to preferences. (23 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgical injuries registered in the Norwegian system for patient injuries. Possibilities of the use of the material for quality improvement in Norwegian hospitals

328 surgical "errors" reported to the Norwegian System of Compensation for Injuries to Patients were analysed in order to find out how the errors can be exploited for the purpose of quality improvement. In 8% of the cases the patients had been treated as emergency cases. 7% of the patients had been treated as out-patients. 30% of the patients had become more than 15% permanently disabled as a consequence of the "error". The Norwegian System of Compensation for Injuries to Patients operates with five different categories of errors defined by medical specialty, of which surgery is one. We found that among "surgical errors" 16% of the patients had been treated by an anaesthetist or by a specialist in internal medicine, and 13% had been treated by a gynaecologist. There were several recurring "errors" such as nerve injuries and complications related to general atherosclerosis. A system for categorising errors with a view to quality improvement should be different from other systems of categorisation. We suggest a system based on not only five but all medical specialties. Data from such a system could be used to prepare "pedagogic reports" that can be sent to the managers of services and education in each medical specialty. Thus, by turning surgical errors into "medical treasures", the errors can be exploited to promote quality improvement.     

Therapists' reactions to treatment of survivors of political torture.

Working with survivors of political torture and war trauma can trigger strong emotional responses in the therapist. As more survivors seek treatment, it is essential to identify and develop robust support systems for therapists who help their clients confront nearly unspeakable experiences. The emotional reactions of 6 psychotherapists who worked with traumatized survivors in a refugee treatment center were explored. The psychotherapists' reactions were compared with those of therapists who worked in different treatment settings with other presenting problems. The results of the study show that the strong level of responsibility therapists feel for their traumatized clients may hide an emotional strain and may lead to burnout. Suggestions are offered for supporting therapists in this difficult but important work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cognitive-behavioral relationship record.

The Cognitive-Behavioral Relationship Record is a technique designed to help individual psychotherapy clients make sense of chronic relationship problems and to encourage them to experiment with new behavioral solutions. In this paper, the reader is given step-by-step instructions on how to use the Relationship Record accompanied by case illustrations. By conceptualizing relationships in terms of the interplay between two individuals’ cognitions and behaviors, the Relationship Record gives therapists a new tool to address the circular causality in relationship systems. In addition to its usefulness as a therapeutic technique, it may be seen as a step toward the integration of family systems into cognitive–behavioral therapy, or, more specifically, the assimilation of strategic therapy techniques and concepts into Aaron T. Beck’s school of cognitive therapy. The Relationship Record joins a movement in psychotherapy integration to enhance individual-based therapies by assimilating interpersonal approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Five therapists and one client.

Reviews the book, Five therapists and one client by Raymond J. Corsini (see record 1993-97589-000). To address the question of how the course of therapy would differ depending on the therapist's basic orientation, Corsini created a fictitious client with relatively minor but persistent problems. Therapists from five major systems of psychotherapy were chosen to write very specifically about how they would treat this client. The five systems include Adlerian, person-centered, rationale-emotive, behavioral, and eclectic. The book is divided into six chapters with one chapter for each of the five systems and an introductory chapter in which the problems of the client are given. This is an informative book for professionals, students, and those who are simply interested in the process of psychotherapy and human growth. The book provides very practical, basic information about the therapeutic process from five different perspectives as well as deeper theoretical insight into these respective approaches. Even the sophisticated reader will find much of value in Corsini's book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intersecting losses: Working with the inevitable vicissitudes in therapist and client lives.

Therapists working with clients with severe trauma histories over long periods of time may find themselves managing traumatic events in their own lives—illness, divorce, death—at the same time as they are assisting their clients to live productively with their painful pasts. While a few accounts exist describing how therapists deal with single overwhelming events, very little has been written about how therapists manage ongoing or prolonged episodes of severe stressors with a busy clinical practice of clients with severe trauma histories. Yet, we know that support for therapists is crucial to longevity in the field and we also know that learning from the experience of others is a highly recommended form of support. This paper is an account by a senior clinician of how she has maintained a productive clinical practice despite personal losses. Therapists who struggle with personal losses probably deal with choices related to self-disclosure more than therapists who do not have such experiences; they have repeated opportunities to establish appropriate and effective levels of self-disclosure for them and the people with whom they work. The paper presents a template for thinking about the risks and benefits of self-disclosure while at the same time modeling a level of self-disclosure that may be beneficial to therapists looking for examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacokinetics of SPECT radiopharmaceuticals for imaging hypoxic tissues

Low back pain (LBP), a common illness that may progress to chronic disability, costs many billions for care, lost work, and compensation. Conventional medicine does not effectively restore chronic LBP patients to work; multidisciplinary rehabilitation does, but limited or delayed access risks unnecessary costs, additional morbidity, and permanent disability. The authors examine costs of delayed treatment for 23 disabled LBP patients in a rehabilitation program. Compensation costs average $26,159 per patient, a sum covering treatment for 3 patients. Additional medical and societal costs are estimated. Factors causing delay, such as economic incentives and ignorance about pain, and policies to remediate these problems, are discussed.     

A preliminary study of an attraction-barrier model of patients' commitment and responses to dissatisfaction in psychotherapy.

In a cross-sectional study, 168 psychotherapy patients (mean age 24.57 yrs) reported on how they dealt with problems pertaining to the therapist or the therapy process. Ss were asked to think about a session in therapy when they experienced a problem or dissatisfying event pertaining to the therapist or the therapy process. It was found that commitment to therapy mediated the effect of level of Ss' disclosure in therapy in endorsing constructive accommodation (voice and loyalty as opposed to exit and neglect) to deal with the dissatisfying events. Severity of the dissatisfying event with the therapist had direct effects on increasing the use of voice and exit and decreasing loyalty; it also had indirect effects on accommodation via the mediating variable of commitment. The results are explained jointly in terms of G. Levinger's (1999) attraction-barrier model of commitment and C. E. Rusbult et al.'s (1991) model of accommodation processes. It is concluded that the proposed conceptual framework, derived from theory and research on the social psychology of personal relationships, may be useful in understanding when interpersonal problems between patients and therapists encourage patients to withdraw or drop out of therapy before it is therapeutically appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment style.

This article provides a brief review of attachment theory and recent research studies on its implications for individual psychotherapy. Attachment theory offers a conceptual framework that helps illuminate how past experiences with caregivers might influence current transactions between therapist and patient. Both patients and therapists may form internal working models that are based, in part, on early experiences of interpersonal responsiveness. Such working models are reflected in secure, anxious-ambivalent, and anxious-avoidant attachment styles, which describe whether patients (and therapists) tend to be comfortable and confident in relationships, fearful of abandonment, or defensively separate. Recent studies showed that attachment styles in the context of therapy can be measured reliably and related to therapeutic process (e.g., the alliance) and outcome (e.g., treatment response). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychotherapy with psychotherapists.

Reviews the book, Psychotherapy with psychotherapists edited by Florence W. Kaslow (see record 1990-98484-000). There has been little written about doing psychotherapy with patients who are themselves psychotherapists, despite the fact that many therapists have been in therapy and some have provided treatment for other therapists. This book presents a good overview of many of the issues involved when therapist treats therapist, although there are no real surprises or conceptual breakthroughs. Regardless of theoretical orientation or preferred treatment modality, several common problem areas emerge having to do with boundaries, confidentiality, pride, competition, and countertransference. There is still a clear need for research, including investigation of the supposed efficacy of treatment as training. More discussion and detailed case examples of treatment from the perspective of the therapist-patients would have been desirable. These relatively minor qualifications notwithstanding, therapists will find much here to stimulate and inform their work with therapist-patients. There are fewer "therapists' therapists" than there are therapist-patients, however, and this suggests an even larger readership: trainees and practicing clinicians in treatment. This book may not only help therapists to be therapists to their patients, but should also help therapists to be patients to their therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family therapy in context.

Demonstrates the utility of a way of thinking about clinical work that assumes that the smallest context within which to think about therapy includes the following variables: therapists, clients, the context in which therapy occurs, and the larger systems with which therapists or clients are involved. Two case examples are given to show the relevance and interrelationship of these variables with particular attention being paid to the effects of the treatment context on the conduct of therapy. Data from some initial studies exploring the effectiveness of this notion of therapy are presented, as are considerations of the kind of professional identity most suited for this kind of work and the problems presented by this identity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual relations in therapeutic situations

Patients who feel sexually violated by their therapists may complain to the health authorities. During recent years there has been an increasing number of such complaints. 15 cases were under investigation at the Directorate of Health in July 1992. Most of the doctors and psychologists involved had long therapeutic experience. The sexual contacts were of highly divergent types. In the majority of cases the therapists lacked the capacity to draw clear borderlines between professional and private life. Some of the therapists had a tendency to belittle the contacts. Sexual contact between patient and therapist has a detrimental effect upon the relationship and the mental functioning of the patients. Therapists acquainted with colleagues' sexual violations should react swiftly. Too lenient and permissive ethical and social attitudes towards sexual relationships between therapist and patient may be conducive to further abuse. It is important to incorporate the study and discussion of these problems into both the basic and postgraduate education of therapists. Therapists who have violated the norms for decent behaviour need professional support.     

Perceptions of acute care physical therapy practice: issues for physical therapist preparation

BACKGROUND AND PURPOSE: Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. SUBJECTS AND METHODS: A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. RESULTS: Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. CONCLUSION AND DISCUSSION: Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.     

Enlarged cerebrospinal fluid spaces in opiate-dependent male patients: a stereological CT study

Total knee arthroplasty was evaluated in 10 patients with post-traumatic osteoarthrosis secondary to work-related knee injuries (age- and sex-matched with 10 controls who had total knee arthroplasties for nonwork-related osteoarthrosis) to determine if Workers' Compensation status influenced treatment outcome. Using the Hospital for Special Surgery Knee Rating System (maximum possible score: 100), most recent follow-up scores averaged 64.1 for Workers' Compensation patients and 91.9 for controls. Subjective indices (pain, function) were significantly different between groups (p < 0.05), but objective indices (range of motion, strength, deformity, instability) were not. No significant differences were noted between groups on either immediate postoperative or most recent follow-up radiographs (which were assessed for alignment and radiolucencies at implant surfaces, respectively). Suboptimal outcomes can be anticipated in total knee arthroplasties performed on Workers' Compensation patients, particularly in cases where claims have not been settled at the time of surgery.     

An experimental inquiry into transference roles and age.

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25–35) and older (60–70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health care benefits and perceptions of health insurance agents.

Many professionals play a role in evaluating and defining health service coverage in the current marketplace. It is useful to professional psychologists to understand how their perceptions of the current coverage of mental health services are similar to or different from those of other professionals. The authors examined the views of health insurance agents. Both psychologists and insurance agents agreed that, mental health benefits were adequate to effectively treat mild mental health problems, coverage was inadequate to treat major mental illness. Psychologists and insurance agents differed in their perceptions of whether patients and therapists used benefits unnecessarily. (PsycINFO Database Record (c) 2010 APA, all rights reserved)