Introduction to the special section on assessment in psychological treatment: A necessary step for effective intervention.

Great changes are taking place in mental health treatment, because health care providers are placing constraints on therapists. Yet psychologists have been slow to react to these demands and have not incorporated personality measurement in treatment planning to address therapeutic effectiveness. Many therapists initiate therapy without obtaining a personality assessment in the early stages of therapy. Psychological assessment can, however, provide an effective means of detecting problems and motivation for therapy and can, if therapist test feedback is provided, serve to bring about desired behavior change more effectively than if assessment is not used. This Special Section is devoted to the potentially fruitful role psychological assessment can play in treatment planning. The contributors who were invited to write articles were chosen for their expertise in using psychological procedures in treatment planning. Their contributions provide important insights into methods for facilitating psychological therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research-informed benchmarks for psychological treatments: Efficacy studies, effectiveness studies, and beyond.

To examine whether the results of effectiveness studies match those obtained for efficacy studies on the same treatments, we conducted a focused review of the published treatment effectiveness literature. A literature search yielded 35 effectiveness studies for adult disorders (N = 21) and child and adolescent disorders (N = 14). A comparison of data from these studies with benchmarks from recent reviews of efficacy trials revealed treatment completion rates comparable with those found in the efficacy benchmarks. The improvement rates were comparable in effectiveness studies with those reported in randomized clinical trials of treatment efficacy. Despite methodological limitations in many effectiveness studies, these initial data provide encouraging support for the transportability to clinical settings of treatments with established efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of medical and psychological tests.

Comments on the G. J. Meyer et al (see record 2001-00159-003) summary of evidence and issues associated with psychological assessment. H. N. Garb et al conclude that Meyer et al did not establish that psychological test validity is comparable to medical test validity. By focusing on meta-analyses, they ignored results for most medical tests and psychological test scores. Furthermore, although it may appear that they routinely summarized results from meta-analyses, in some cases they actually calculated their own effect sizes. For at least some studies, their effect sizes appear to be misleading, making their review of the literature difficult to interpret. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conversational ethics in psychological dialogues: Discursive and collaborative considerations.

With the linguistic turn in the social sciences have come increased sensitivities to language use. In this paper, we examine such sensitivities as they relate to the conversational practices of psychologists seeking collaborative relationships with clients. In particular, we link ethical practice with developments in discourse theory and research, presenting arguments and evidence for enhanced forms of collaboration and client-centred practice. We conclude with considerations for what we consider "conversational ethics" in psychological practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary evidence on the effectiveness of psychological treatments delivered at a university counseling center.

Treatment data from a university counseling center (UCC) that utilized the Outcome Questionnaire–45.2 (OQ-45; M. J. Lambert et al., 2004), a self-report general clinical symptom measure, was compared against treatment efficacy benchmarks from clinical trials of adult major depression that utilized similar measures. Statistical analyses suggested that the treatment effect size estimate obtained at this counseling center with clients whose level of psychological distress was above the OQ-45 clinical cutoff score was similar to treatment efficacy observed in clinical trials. Analyses on OQ-45 items suggested that clients elevated on 3 items indicating problematic substance use resulted in poorer treatment outcomes. In addition, clients who reported their relational status as separated or divorced had poorer outcomes than did those who reported being partnered or married, and clients reporting intimacy issues resulted in greater numbers of sessions. Although differential treatment effect due to training level was found where interns and other trainees had better pre–post outcome than did staff, interpretation of this result requires great caution because clients perceived to have complicated issues are actively reassigned to staff. More effectiveness investigations at UCCs are warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost offset: Past, present, and future.

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental adherence to child psychologists' recommendations from psychological testing.

Nonadherence to prescribed regimens is a significant cause of treatment failure across pediatric and psychological/psychiatric childhood conditions. Although a modest literature exists for medical conditions, the literature on adherence to psychologists' recommendations is sparse. We review the extant literature on this topic, highlighting areas for further study and intervention. Implications for policy and the practice of psychoeducational assessment are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An empirical analysis of the effectiveness of psychological warfare.

Standardized interviews were held with a sample of Korean and Chinese war prisoners to attempt to determine receptiveness to psychological warfare (PW). Nine factors were studied, including two criterion factors (degree of disaffection shown and degree of willingness to surrender peacefully). Scores on the factors were intercorrelated, and certain partial and multiple correlations were analyzed. The results "appeared to corroborate the major hypothesis… that PW is effective in changing behavior, but its effects are mainly of a precipitating nature that is differential for persons more sensitized to it by their morale and experiences… " (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the effectiveness of computer-delivered personalized drinking feedback interventions for college students.

This study evaluated methods of enhancing college students' retention of information provided to them in a computer-delivered personalized drinking feedback intervention and whether enhanced retention reduced alcohol consumption during the two-week period following the intervention. Participants were 98 college students who reported at least one heavy drinking episode in the past two weeks. After participating in an online, personalized drinking feedback intervention, students were randomly assigned to one of three experimental conditions: 1) typical, in which they were simply sent home, 2) reading, in which they were asked to spend the next 20 minutes re-reading the feedback, and 3) recall, in which they were asked to spend the next 20 minutes writing down as much of the information from the feedback as they could remember. Two weeks following the intervention, participants completed a recall test and provided information on their alcohol use during the previous two weeks. Results indicated that participants in the reading and recall conditions retained more of the feedback information than did participants in the typical condition. In addition, participants in the reading and recall conditions reported reduced alcohol consumption in the two-week period following the intervention, compared to those in the typical condition. Information retention partially mediated the effects of the reading and recall conditions on drinking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting.

The study examined the effectiveness of Functional Family Therapy (FFT), as compared to probation services, in a community juvenile justice setting 12 months posttreatment. The study also provides specific insight into the interactive effects of therapist model specific adherence and measures of youth risk and protective factors on behavioral outcomes for a diverse group of adolescents. The findings suggest that FFT was effective in reducing youth behavioral problems, although only when the therapists adhered to the treatment model. High-adherent therapists delivering FFT had a statistically significant reduction of (35%) in felony, a (30%) violent crime, and a marginally significant reduction (21%) in misdemeanor recidivisms, as compared to the control condition. The results represent a significant reduction in serious crimes 1 year after treatment, when delivered by a model adherent therapist. The low-adherent therapists were significantly higher than the control group in recidivism rates. There was an interaction effect between youth risk level and therapist adherence demonstrating that the most difficult families (those with high peer and family risk) had a higher likelihood of successful outcomes when their therapist demonstrated model-specific adherence. These results are discussed within the context of the need and importance of measuring and accounting for model specific adherence in the evaluation of community-based replications of evidence-based family therapy models like FFT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy and Cost-Effectiveness of a Minimal Intervention to Prevent Smoking Relapse: Dismantling the Effects of Amount of Content Versus Contact.

Relapse prevention remains a major challenge to smoking cessation efforts. T. H. Brandon, B. N. Collins, L. M. Juliano, and A. B. Lazev (2000) found that a series of 8 empirically based relapse-prevention booklets mailed to ex-smokers over 1 year significantly reduced relapse. This study dismantled 2 components of that intervention: the amount of content (number of booklets) and the frequency of contact. Content and contact were crossed in a 2 X 2 factorial design. The criteria of at least 1 week of abstinence at baseline was met by 431 participants, 75%-85% of whom returned 12-, 18-, and 24-month follow-up questionnaires. Eight booklets produced consistently higher point-prevalence abstinence rates than did a single booklet, but frequency of contact did not affect outcome. Moreover, the high-content interventions were highly cost-effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative emotional memories in clinical treatment: Theoretical considerations.

The pursuit of empirically supported therapies has resulted in controversy and further division between practicing and academic clinicians. The current article provides an overview of a clinical biopsychological model that may serve to guide assessment and treatment of many psychological problems, with a selective review of the literature supporting the model. One particular area, negative emotional memories, is discussed in theoretical and practical terms as related to the development of clients' psychological problems and how certain therapists' behaviors can positively and negatively affect clients. Next, the theorized effects of psychological treatments on negative memories are discussed. The article concludes with a call for efforts to pursue a neuropsychological model of treatment based on hypothesized causal factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theraplay in the Chinese world: An intervention program for Hong Kong children with internalizing problems.

The primary objective of this study was to evaluate the effectiveness of Theraplay on reducing internalizing problems among young children. Described as at-risk for developing internalizing disorders, 46 children were randomly allocated to either the Theraplay condition or the wait-list control condition. A standardized measure of internalizing symptoms was completed before and after an 8-week period. Results showed that children from the Theraplay condition showed significantly fewer internalizing symptoms when compared to the waitlist group. Qualitative feedback from mothers and children were gathered to further understand the experience of Theraplay activities on the participants. Limitations and suggestions for future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapy processes and outcomes of psychological interventions for women diagnosed with gynecological cancers: A test of the generic process model of psychotherapy.

Objective: Little attention has been paid to the role of nonspecific therapy processes in the efficacy of psychological interventions for individuals diagnosed with cancer. The goal of the current study was to examine the three constructs from the generic model of psychotherapy (GMP): therapeutic alliance, therapeutic realizations, and therapeutic openness/involvement in the treatment outcome of women with gynecological cancers attending either a 7-session supportive counseling intervention or a coping and communication skills intervention. Method: Two hundred and three women completed measures of alliance, realizations, and openness after Intervention Sessions 2, 3, and 6, as well as measures of depressive symptoms after these sessions and 6 months after the pre-intervention assessment (posttreatment). Results: Consistent with the GMP, in early sessions, therapeutic bond predicted openness in terms of positive affect experienced during sessions, and both aspects of openness (positive and negative affect), in turn, predicted more therapeutic realizations. Therapeutic realizations predicted perceptions of greater session progress, and greater therapeutic bond predicted more therapeutic realizations. When early session GMP variables were used to predict later GMP processes and outcomes and posttreatment outcomes, early therapeutic bond predicted later session therapeutic realizations directly and indirectly via emotional arousal, emotional arousal predicted session progress, session progress predicted lower postsession depressive symptoms, and depressive symptoms as rated after Session 6 predicted depressive symptoms 3 months posttreatment. However, a number of additional associations among GMP processes were found. Conclusions: Our results suggest that therapy processes played a role in predicting both short- and long-term treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maximizing the effectiveness of psychology in public mental health services.

Rather than a preoccupation with diagnosis and pathology, psychologists should direct their attention to the capacity of individuals for adaptation and adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdisaster psychological intervention since 9/11.

A wealth of research and experience after 9/11 has led to the development of evidence-based and evidence-informed guidelines and strategies to support the design and implementation of public mental health programs after terrorism and disaster. This article reviews advances that have been made in a variety of areas, including development of improved metrics and methodologies for conducting needs assessment, screening, surveillance, and program evaluation; clarification of risk and resilience factors as these relate to varying outcome trajectories for survivors and inform interventions; development and implementation of evidence-based and evidence-informed early, midterm, and late interventions for children, adults, and families; adaptation of interventions for cultural, ethnic, and minority groups; improvement in strategies to expand access to postdisaster mental health services; and enhancement of training methods and platforms for workforce development among psychologists, paraprofessionals, and other disaster responders. Continuing improvement of psychologists' national capacity to respond to catastrophic events will require more systematic research to strengthen the evidence base for postdisaster screening and interventions and effective methods and platforms for training. Policy decisions are clearly needed that enhance federal funding to increase availability and access to services, especially for longer term care. Traumatic bereavement represents a critical area for future research, as much needs to be done to clarify issues related to reactions and adaptation to a traumatic death. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The Sell decision: Implications for psychological assessment and treatment.

This article describes 2 important practice considerations affirmed in the U.S. Supreme Court's Sell v. United States (2002) decision: (a) the importance of providing least restrictive services prior to interventions that violate patients' liberty interests, and (b) contextual and environmental factors may be considered in clinical determinations of dangerousness. The psychological treatment of behavior disorders fall within the purview of least restrictive or intrusive interventions compared with the involuntary administration of psychoactive medications. To legitimately comply with the least restrictive criterion, the provision of psychological services is essential. This long-held criterion is rarely acknowledged today as providers use restricted service arrays and attempt to resolve complex and co-occurring behavior problems with medications and restraints. Less restrictive psychological interventions are required for effective treatment of challenging behaviors. A 2nd significant implication lies in the court's affirmation that it is legitimate to consider contextual factors such as history and current environmental conditions in determining dangerousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing the Costs, Benefits, Cost-Benefit Ratio, and Cost-Effectiveness of Marital and Family Treatments: Why We Should and How We Can.

The vast majority of outcome studies examining the effects of marital and family treatments focus exclusively on indicators of and changes in familial functioning and individual members' psychosocial adjustment, but fail to measure, report, or analyze treatment costs, benefits, cost-benefit ratio, or cost-effectiveness. Because of growing concerns about spiraling health care costs, clinical and economic outcomes constitute equally important and complementary aspects of any evaluation of marital and family treatments. The twofold purpose of this article is to define different components of cost analyses of health-related interventions, including marital and family treatments, and to describe methods for calculating and integrating clinical and cost outcome information when evaluating marital and family treatments. There are significant opportunities to promote the use of such treatments by conducting and reporting the results of cost analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral Activation Group Therapy in Public Mental Health Settings: A Pilot Investigation.

Depression is among the most common psychiatric disorders seen in mental health practices. Although effective treatments for the condition exist, managed care pressures providers to utilize empirically supported, cost-effective treatments. Behavioral activation (BA) treatment for depression has emerged in recent years as a promising, cost-effective intervention for major depressive disorder. If its effectiveness could be established. BA delivered through a group format would offer additional cost effectiveness over its individual therapy counterpart. This investigation examined the effects of behavioral activation group therapy (BAGT) for depression in public mental health settings. The results suggest that BAGT can be a valuable addition to the practicing psychologist's set of interventions to use with depressed clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)