Thinking about thinking in therapy: An examination of clients' understanding of their therapists' intentions.

Two therapists each provided 2 clients time-limited (10 sessions each) therapies. These were examined to discover relations between (a) clients' understanding of therapists' intentions and episode level outcome, (b) similarities and differences between the participants' valuing of different intentions, and (c) shifts in intentions valued from the beginning to the terminal phases of therapy. By using therapists' segmentation of sessions into episodes and a computerized Counselor Intention List, some positive relations between clients' understanding of counselor intention and episode impact were documented. Differences were found between therapists' and clients' valued intentions as were systematic shifts on valued intentions from beginning to end phases of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating play therapy techniques into solution-focused brief therapy.

Solution-focused brief therapy is a recognized therapeutic approach proven effective in time-limited circumstances. This article describes the solution-focused process and presents a framework for integrating the expressive play therapy techniques of art, sandtray, and puppets into the solution-focused model. Three case studies are used to demonstrate this process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Models of brief psychodynamic therapy.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren. This book is suitable for supplementary reading in a graduate psychotherapy course, and is intended for graduate students in the field of clinical and counseling psychology. It is also intended as a concise reference work on brief psychodynamic therapies for clinicians who are or wish to practice in the newer mode of limited goals and limited sessions. The authors consider drive theory based psychotherapy treatment, as well as integrative and eclectic models of brief psychodynamic therapy. In consideration of each of the various approaches, Messer and Warren have primarily concerned themselves with four issues as a focal point of their analysis: (a) the theory of pathology involved; (b) the development of a clinical focus; (c) patient selection considerations, including indications and contraindications; and (d) typical techniques associated with the treatment involved. This text is an excellent addition to the literature, primarily for adjunct reading in graduate courses on psychotherapy. It also affords the opportunity for psychodynamically oriented clinicians to address a need for an overview and grounding in brief treatment models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client as colleague: Therapeutic contracting with the seriously mentally ill.

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through environmental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, and (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client experience of psychodynamic psychotherapy for bulimia nervosa: An interview study.

We examined 14 bulimic clients' experiences of individual psychodynamic psychotherapy through semistructured interviews, which were analyzed using qualitative methods. The results showed that the psychodynamic approach was a challenge to most of the clients. Yet, most clients profited from therapy both symptomatically and with regard to interpersonal relations and affect regulation. There were, however, marked differences in the clients' experiences. One subgroup rather quickly felt that the therapy met their needs, another initially felt challenged by the approach and the therapeutic attitude but ultimately succeeded in using this particular kind of therapy. A third group remained predominantly critical of their therapies. The clinical implications and possible explanations of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectations and preferences.

Client expectations and preferences have been thought by many to influence the client's willingness to engage in and be influenced by the therapist and the process of therapy. Definitions and methods of assessment are presented of clients' expectancy for therapeutic gain; expectations about the roles they and their therapists will play; and their preferences for therapy roles, type of psychotherapy, and demographic features of the therapist. Included is a review of the empirical evidence based on 76 studies of the relation between client expectations and preferences, on the one hand, and the outcome of psychotherapy, on the other hand. Clients' expectations for therapeutic gain are related to outcome in most studies, although no causal conclusions can be drawn. The literature on role expectations is equivocal, and the relatively few studies on client preferences yield primarily negative or mixed results. Finally, specific implications for therapeutic practices are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-presentational view of psychotherapy: Reply to Hill, Gelso and Mohr (2000) and to Arkin and Hermann (2000).

The self-presentational view of psychotherapy challenges current assumptions about the benefits of high levels of clients' openness in therapy (A. E. Kelly, 2000; see record 2000-08364-001). The author responds to questions about whether clients' discretion really is linked to favorable therapy process ratings and outcomes (see record 2000-08364-002 and 2000-08364-003). She also addresses problems that may emerge if readers apply a narrow definition of self-presentation as a form of deliberate manipulation, rather than the intended definition of consciously or unconsciously showing oneself to be a particular kind of person for audiences. A brief review of the evidence on the role of audience feedback in self-concept change is offered, along with suggestions for explaining self-concept change to clients. The author concludes by clarifying and reasserting her suggestion that it is acceptable for clients to reveal the themes as opposed to details of their problems that seem particularly heinous or humiliating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and bulimia nervosa: evaluation and long-term follow-up of two conflict-orientated treatment conditions

Analytic in-patient therapy (n = 32) and systemic out-patient therapy (n = 39) were applied to patients with bulimia nervosa, and the effects were evaluated 14, 26 and 38 months after the start of the treatments. Our assumptions about the general efficacy of both conflict-orientated techniques were confirmed: both therapies satisfactorily reduced the symptomatic behaviour, as well as secondary factors related to bulimia nervosa, in the long term. However, we could not identify differential effects of the two treatment regimes, which we had expected with regard to the very different therapeutic approaches. The similarities of outcome of both therapies predominate, with slightly better results in the case of the analytic in-patient treatment. The results are discussed with regard to the assumption that specific healing factors are involved in conflict-orientated treatments in addition to the "common factors' of psychotherapy.     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sandtray therapy with a 24-year-old woman in the residual phase of schizophrenia.

Sandtray therapy is a clinical tool for helping a client express and understand his or her unconscious dynamics. It utilizes a sandtray and anywhere from a few hundred to a few thousand figurines in the room for the client to select from. These figurines cover a wide range of people, situations, and objects, from the most ordinary to the mythical. The client makes a story in the sand, which the client and therapist then discuss. It is standard therapeutic wisdom that one should not use techniques involving fantasy with psychotic clients since it is typically too hard for both them and the clinician to contain those fantasies in a healthy manner. Although this is very often true, the authors offer an example of how they were able to use sandtray to great therapeutic advantage with a schizophrenic client in the residual phase of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directions for clinical research and genomic research into the next decade: implications for informatics

Managed care continues to revolutionize the provision of mental health services in the United States. Long-term, open-ended therapies have been replaced by short-term, highly focused interventions. Increasingly, managed care organizations rely on standardized preferred practice guidelines to give direction and focus to social work and other therapeutic interventions. Critics argue that changes effected by managed care, particularly the use of treatment guidelines, depersonalize the client-worker relationship and significantly reduce the role of empathy in the therapeutic process. Moreover, these critics suggest that overall client satisfaction with mental health services has deteriorated. This article presents a study that examined clients' perceptions of empathy and overall satisfaction with managed behavioral health care when the clients were in unstructured individual therapy or in time-limited standardized group therapy. The results reveal no significant difference in the clients' perception of empathy or of their overall satisfaction regardless of the type of treatment they received. This article describes the rationale and design of the study, presents the results, and discusses the implications for social work practice.     

An Integrative Therapy Framework: Research and Practice.

Research in human development and studies on therapy process and outcome respectively address similar questions: How does change come about and what influences it? Very similar answers emerge from these two research domains. Both have much to offer to the contemporary endeavors for therapy integration. The comparisons of the findings combined with clinical experience provide a basis for an integrative framework for therapeutic practice that can be applied to any therapy model. The components of the framework are used to discuss differences and similarities among 3 major therapeutic models. Practice is seen as a starting point for integration, which ultimately happens at an individual level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diet therapy for organ transplantation. A problem-based approach

Nutrition plays a vital role in the recovery, health, and life expectancy of transplant recipients. Because the medical problems differ between the acute recovery and chronic maintenance phases following transplantation, nutrient requirements and nutrition therapies are unique and distinctly different between these 2 periods. Nutrition therapy during the acute post-transplant phase is aimed at promoting healing. Nutrition and pharmaceutical therapies during the long-term post-transplant phase are intended to prevent and treat common problems such as obesity, diabetes, hyperlipidemia, hypertension, and osteoporosis. Nutrition goals and therapies should be individualized based on the specific complications each patient experiences.     

Clients' internal representations of their therapists.

Thirteen adults in long-term individual psychotherapy were interviewed regarding their internal representations (defined as bringing to awareness the internalized "image") of their therapists. Results indicated that in the context of a good therapeutic relationship, clients' internal representations combined auditory, visual, and kinesthetic (i.e., felt presence) modalities; were triggered when clients thought about past or future sessions, or when distressed; occurred in diverse locations; and varied in frequency, duration, and intensity. Clients felt positively about their representations and used them to introspect or influence therapy within sessions, beyond sessions, or both. The frequency of, comfort with, and use of clients' internal representations increased over the course of therapy, and the representations benefited the therapy and therapeutic relationship. Therapists tended not to take a deliberate role in creating clients' internal representations, and few clients discussed their internal representations with their therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief therapy prevalence and training: A national survey of psychologists.

Psychologists find themselves ill-prepared to meet the increasing demand for briefer and briefer therapies. Members of APA Divisions 12 (Clinical Psychology) and 29 (Psychotherapy) were surveyed (N?=?1,250; return rate?=?57%) regarding their practice of and training in brief therapy. Results indicate that almost all (89%) of the respondents perform some brief therapy and, on average, spend half their time doing it. With regard to training, however, half of those conducting brief therapy have never taken any brief therapy courses. Additional findings indicate theoretical orientation, gender, region, practice site, and setting are significantly related to the amount of brief therapy delivered. Overall, the amount and helpfulness of brief therapy training are significantly related to one's skill, satisfaction, and positive attitude toward brief therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significant events and the analysis of immediate therapeutic impacts.

Presents a framework for rating clients' experiences of the immediate, in-session effects of significant therapist interventions. The framework was derived from an initial cluster analytic study of brief therapeutic interviews and developed into a therapeutic-impacts content-analysis system. The measure was applied to 3 samples of significant therapist interventions taken from actual therapy sessions. Some therapeutic impacts were associated with the same therapist response modes in both initial analog and actual therapy samples, but, in general, analog and therapy samples differed in response modes associated with particular impacts. For example, insight was associated with open questions in the analog interviews but with interpretation in ongoing therapy, and clients felt reassured by therapist reassurance in the brief one-shot interview but felt reassured by reflection and self-disclosure in ongoing treatment. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morita therapy: Its basic features and cognitive intervention for anxiety treatment.

Describes Morita therapy as being centered around positive reinterpretation of anxiety in order to stimulate attentional, attitudinal, and behavioral change in self-preoccupied anxious clients. It promotes clients' behavioral commitment to constructive and productive activities. The shinkeishitsusho disposition is regarded as a combination of predispositional nervousness and hypersensitivity and learned and habituated cognitive patterns of anxious self-preoccupation. The aim of the therapy is not to reject the nervous disposition but to modify clients' dysfunctional cognitive and behavioral patterns to reduce unproductive self-preoccupation. The therapy promotes clients' acceptance of their predispositional nervous sensitivity and anxiousness, not as personal weaknesses but as potentially functional and constructive qualities as they are redirected toward concrete tasks and realistic action-taking. Therapeutic progress is thus initiated when clients take a positive view of their previously rejected nervous dispositions and successfully apply it to practical activities for productive purposes. Similarities and differences between Morita therapy and rational-emotive therapy are noted. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative analysis of interleukin 15 and interleukin 2 for induction of killer activity and of type 2 cytokine production by mononuclear cells from lung cancer patients

Simple bone cyst (SBC) is a benign fluid-filled cavity found primarily at the proximal ends of long bones in children. Treatments proposed for SBC range from observation to intralesional curettage and bone grafting, which are all associated with uncertainty and complications. Because of these factors, a relatively noninvasive protocol with osteoinductive autogenic bone marrow was instituted. Twelve patients were identified with SBCs. Bone marrow was aspirated from the patient's iliac crests and injected into the cyst cavity. Follow-up ranged from 9 to 57 months. Eight (67%) patients demonstrated substantial healing, two (17%) showed partial healing, and two (17%) did not respond to bone marrow therapy. The advantages suggested by bone marrow injection over the currently practiced methods include a higher success rate with a single injection and earlier healing.