"Early withdrawal from mental health treatment: Implications for psychotherapy practice": Correction to Barrett et al (2008).

Reports an error in "Early withdrawal from mental health treatment: Implications for psychotherapy practice" by Marna S. Barrett, Wee-Jhong Chua, Paul Crits-Christoph, Mary Beth Gibbons and Don Thompson (Psychotherapy: Theory, Research, Practice, Training, 2008[Jun], Vol 45[2], 247-267). The fourth author’s name was mistakenly left out of the author byline and table of contents. The correct author listing for this article is presented in the erratum. (The following abstract of the original article appeared in record 2008-07317-011.) Despite more than 50 years of research on client attrition from therapy, obstacles to the delivery and success of treatments remain poorly understood, and effective methods to engage and retain clients in therapy are lacking. This article offers a review of the literature on attrition, highlighting the methodological challenges in effectively addressing the complex nature of this problem. Current interventions for reducing attrition are reviewed, and recommendations for implementing these interventions into psychotherapy practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of video-based therapy preparation targeting experiential acceptance or the therapeutic alliance.

Preparation for psychotherapy may enhance the psychotherapeutic process, reduce drop-outs, and improve outcomes, but the effective mechanisms of such preparation are poorly understood. Previous studies have rarely targeted specific processes that are associated with positive therapy outcomes. This randomized experiment compared the effects of preparatory videos that targeted either the Therapeutic Alliance, Experiential Acceptance, or a Control video on early therapeutic process variables in 105 patients seen in individual therapy. Participants watched the videos just before their first therapy session. No significant differences were found between the Alliance and Experiential Acceptance videos on patient recommendations, immediate affective reactions, or working alliance and attrition after the first session. However, the Therapeutic Alliance video produced an immediate increase in negative mood relative to the Control video, whereas the Experiential acceptance video produced a slight increase in positive mood relative to the Alliance video. Surprisingly, patients who viewed the Alliance video were rated significantly lower than the control group on therapist-rated alliance after the first session. These findings suggest there may be specific process effects in the early phase of treatment based on the type of pretraining material used, and also indicate that video-based pretraining efforts could be counterproductive. Furthermore, this research contributes to the literature by providing insights into methodological considerations for future work on the use of technology in psychotherapy and challenges associated with preparing people for successful psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Depression and coronary heart disease in women: Implications for clinical practice and research.

Practicing psychologists who treat depression in women need to consider their depressed clients at heightened risk for heart disease. In this article, the authors review evidence supporting the link between depression in women and their subsequent increased risk for illness and death from coronary heart disease (CHD). Although further research is needed, the evidence to date suggests that women in treatment for depression should, at the very least, be educated about their increased risk for CHD, and, ideally, psychotherapy for depressed women should incorporate interventions designed either to reduce risk factors for CHD, such as obesity, smoking, and alcohol abuse, or to enhance health-maintenance behaviors, such as exercise and adherence to a low-fat diet, which are associated with cardiovascular health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early withdrawal from mental health treatment: Implications for psychotherapy practice.

[Correction Notice: An erratum for this article was reported in Vol 46(2) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-08897-009). The fourth author’s name was mistakenly left out of the author byline and table of contents. The correct author listing for this article is presented in the erratum.] Despite more than 50 years of research on client attrition from therapy, obstacles to the delivery and success of treatments remain poorly understood, and effective methods to engage and retain clients in therapy are lacking. This article offers a review of the literature on attrition, highlighting the methodological challenges in effectively addressing the complex nature of this problem. Current interventions for reducing attrition are reviewed, and recommendations for implementing these interventions into psychotherapy practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical and liability issues concerning invisible rationing.

Managed care companies reduce the cost of mental health services by substituting brief therapy for longer term treatment. When the shorter treatment is as beneficial as the longer, the substitution is advantageous. If, however, the briefer treatment is only partially effective, the substitution is a form of rationing treatment services. Many times the beliefs and values of brief therapists and the policies of managed care combine to create invisible rationing by obscuring information about rationing from the consumer. This process raises serious ethical and liability problems. Guidelines recommended for addressing this problem are (a) evaluating the efficacy of brief therapy through clinical confirmation or quality research, (b) separating principles of psychotherapy from rationing principles, and (c) informing clients of rationing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religiously sensitive rational emotive behavior therapy: Elegant solutions and ethical risks.

Rational emotive behavior therapy (REBT) can be an elegant treatment modality for explicitly religious clients. This is true in spite of the traditional antireligious stance of Albert Ellis. In this article, the authors summarize the evolution of Ellis's views on religion and mental health, consider potential ethical dilemmas caused by utilizing REBT with religious clients, and recommend strategies for reducing violation of ethical and specialty guidelines in work with religious clients. The authors conclude by proposing a general model for religiously sensitive psychotherapy, which may serve to undergird theorizing and research on the application of REBT and other treatment approaches to religious clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient and therapist variables in the treatment of low-income patients.

Cites research on therapy with low-income patients. Because negative results for such clients appear early in treatment, therapist and patient variables operative during that period require careful attention, e.g., attrition rates and outcome data have been found to relate directly to therapists' attitudes toward treating low-income patients. Dealing with their negative attitudes through educational or supervisory procedures reduces negative outcomes. The course of treatment is also critically shaped by patients' attitudes and expectations concerning therapy. All social classes share expectancies about the nature and duration of treatment. Attempts to adjust the goals and the format of therapy to reflect patient needs, expectations, and reality problems more accurately produce marked reductions in attrition rates. Behavioral and time-limited procedures serve as useful examples of alternative treatment procedures that can be effectively adjusted to low-income mental health needs. (21/2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family and individual therapy in anorexia nervosa. A 5-year follow-up

The high prevalence of premature attrition from psychotherapy is a phenomenon which has been well recognized in the psychological literature. The pressing concern that a number of clients may not be benefiting from treatment because they are dropping out has led to a plethora of research in the area of individual psychotherapy. No studies, however, have attempted to investigate the characteristics of dropout in group cognitive behaviour therapy for depression. To address this gap in research, the present study examined the factors associated with dropout in a group cognitive behaviour therapy for depression, using 131 Ss who went through the group therapy for 12 weeks. The results showed that sociodemographic measures (e.g. age) and measures of depressive symptoms (e.g. depression scores) did not discriminate dropouts from completers. An investigation of patterns of mood changes in the course of the therapy also failed to find significant differences between the dropouts and completers. However, weekly therapist rating of client participation revealed that dropouts participated significantly less than completers during the therapy sessions. The results are discussed in light of the findings of current literature and future research in premature attrition.     

Structure and stabilizing of psychotherapy for low-prognosis clients.

Studied the effects of an extratherapy intervention with 55 low-prognosis clients in connection with time-limited, client-centered psychotherapy. The intervention consisted of 2 parts involving 4 1/2-hr outside-of-therapy sessions for each client with an investigator-not the therapist-before the 2nd, 3rd, 5th, and 8th therapy hours. Intervention was aimed at reducing attrition and training clients to participate more productively in the therapy process. It was found that attrition can be reduced significantly, total therapy involvement lengthened, and client process altered for more constructive personality change. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of full-day and half-day workshops for health care providers in techniques for increasing resistant clients' motivation.

Are psychotherapy training workshops worth the time and money? The current study examined the effectiveness of 3-hr and 6-hr versions of a workshop for health care providers in techniques for increasing motivation in resistant clients. Role plays were used to examine pretraining and posttraining behavior of graduate student and clinician participants from various health care fields. Both workshops were associated with higher levels of workshop-consistent behavior and lower levels of workshop-inconsistent behavior. Degree status (student or clinician) and openness to the material were not related to these changes. Results suggest potential guidelines for clinicians to determine whether a training opportunity would be useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racism: Calling a Spade a Spade.

Research has documented the deleterious effects of racism on the mental health of people of color. However, the practice of psychotherapy sorely underutilizes these important findings, thereby providing less-than-optimum care. Through the presentation of research and personal stories, the author discusses the necessity of naming racism and of identifying its effects. Guidelines are suggested for transforming difficult racial dialogues into healing experiences for clients, and the necessity of taking stands against racism inside and outside of the therapy office is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A motivational interviewing and common factors approach to change in working with alcohol use and abuse in college students.

The authors describe an approach for intervening with college students who present for self-referred or mandated treatment for alcohol or other drug issues. The authors offer a conceptual framework for working with such clients that is influenced by the evidence-based motivational interviewing literature and the evidence-based common factors approach to psychotherapy in general. Implications for practice are elaborated on and exemplified through a case study that includes motivational interviewing's guiding principles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The hour of departure: Predicting attrition in the training clinic from role expectancies.

In addition to having potentially deleterious effects on clients in distress, client attrition also thwarts efforts by trainee clinicians to develop psychotherapy competencies that are uniquely associated with providing middle- or late-stage treatment. Within the established literature, one well-replicated correlate of attrition is client expectations. Thus, the following study investigated whether client attrition within a training clinic could be prospectively predicted from pretreatment expectancies. To that end, all adult clients presenting for an intake at a training clinic completed the Psychotherapy Expectancy Inventory—Revised (PEI–R). First, normative reference ranges for the PEI–R total and factor scores were developed. Next, analyses revealed that these reference ranges had good specificity in prospectively identifying clients that subsequently prematurely terminated treatment. Moreover, the computed positive likelihood ratios revealed that an individual who obtains a total score outside of the reference range is 7 times more likely to prematurely terminate therapy in comparison with individuals obtaining scores within the normative reference range. Training clinics are therefore encouraged to routinely administer the PEI–R as a means of identifying individuals at risk for attrition and defining which role expectations may need to be modified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway.

[Correction Notice: An erratum for this article was reported in Vol 42(3) of Professional Psychology: Research and Practice (see record 2011-11548-002). The author's affiliations were listed incorrectly. The correct affiliations are in the correction.] How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Length of psychotherapy for clients seen in private practice.

Length of treatment for all clients (N?=?100) seen for psychotherapy during 1975 by 7 therapists in a private practice psychological clinic was examined to determine the relative frequency of long-term (>25 sessions) vs short-term (≤25 sessions) psychotherapy. Clients were young, middle class, intelligent, and mildly to moderately disturbed. The median length of treatment was 8 sessions. Fully 80% of the clients had left treatment before receiving 25 sessions. This finding mirrors the trend for public treatment settings. Results reaffirm the necessity of further research and development of short-term treatment techniques designed to effectively utilize the brief time even private clients spend in psychotherapy. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychotherapy clients: Rationale and suggestions.

Few practitioners provide systematic preparatory information to beginning psychotherapy clients, although research data suggest that such preparation enhances therapeutic outcome. It is recommended that psychotherapists provide written information early in the treatment process. Although each practitioner may wish to add or delete certain components, it is suggested that such pamphlets should describe the nature of psychotherapy, responsibilities of the client and therapist, confidentiality, effectiveness and risks of treatment, alternative helping systems, and channels for registering complaints about treatment. Excerpts from such a preparatory pamphlet are included. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arbitrary metrics: Implications for identifying evidence-based treatments.

Research designed to establish the empirical underpinnings of psychotherapy relies heavily on arbitrary metrics, and researchers often do not know if clients receiving an evidence-based treatment have improved in everyday life or changed in a way that makes a difference, apart from the changes the arbitrary metrics may have shown. In other words, it is possible that evidence-based treatments with effects demonstrated on arbitrary metrics do not actually help people, that is, reduce their symptoms and improve their functioning. Clarifying the nature of arbitrary metrics and assessing their implications are important initial steps. Needed next steps are detailing the range of strategies to better connect arbitrary measures to real-world referents and developing measures in which arbitrariness is eliminated or minimized from the start. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of cancellation in an Oregon involuntary commitment program

The problem of attrition from mental health care programs before such services begin is poorly understood. The present research has identified several variables which predict first appointment cancellations for Oregon involuntary commitment petitioners in behalf of potential clients. The value of such variables is discussed in terms of petitioner attrition from involuntary commitment programs, mental health needs of those petitioning for the involuntary commitment of "allegedly mentally ill" persons, increased mental health program efficiency, and economic benefits for underbudgeted and understaffed mental health care programs. Recommendations to improve community mental health programs in general, and involuntary commitment programs in particular are presented.     

"Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway": Correction to Nordgreen and Havik (2011).

Reports an error in "Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway" by Tine Nordgreen and Odd E. Havik (Professional Psychology: Research and Practice, 2011[Apr], Vol 42[2], 185-191). The authors' affiliations were listed incorrectly. The correct affiliations are provided in the erratum. (The following abstract of the original article appeared in record 2011-08009-010.) How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)