Impact of psychosocial treatments on associated problems of cocaine-dependent patients.

A previous report from the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (P. Crits-Christoph et al., 1999) found relatively superior cocaine and drug use outcomes for individual drug counseling plus group drug counseling compared with other treatments. Using data from that study, the authors examined the relative efficacy of 4 treatments for cocaine dependence on psychosocial and other addiction-associated problems. The 487 patients were randomly assigned to 6 months of treatment with cognitive therapy, supportive-expressive therapy, or individual drug counseling (each with additional group drug counseling), or to group drug counseling alone. Assessments were made at baseline and monthly for 6 months during the acute treatment phase, with follow-up visits at 9 and 12 months. No significant differences between treatments were found on measures of psychiatric symptoms, employment, medical, legal, familysocial, interpersonal, or alcohol use problems. The authors concluded that the superiority of individual drug counseling in modifying cocaine use does not extend broadly to other addiction-associated problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the alliance and techniques in predicting outcome of supportive-expressive dynamic therapy for cocaine dependence.

We examine the complex relations among therapeutic alliance, adherence to Supportive-Expressive Therapy (SET), therapist competence, and their interactions in predicting change in drug use. Experts rated early therapy sessions of cocaine dependent patients (n = 108) randomized to SET as part of the Collaborative Cocaine Treatment Study. Moderate adherence to SET and competent delivery of SET were separately associated with poorer outcome. Further, strong alliance combined with low levels of SET adherence was associated with a better outcome than moderate or high levels. Moreover, the usage of nonprescribed techniques (i.e., Individual Drug Counseling [IDC]) by SET therapists predicted better outcome in a subsample (n = 36), and SET patients receiving high levels of IDC adherence had less predicted drug use compared with those with high levels of SET techniques. Overall results may suggest that decreasing cocaine use through straightforward drug counseling techniques instead of trying to help patients understand the reasons for their use is a better initial road to recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of outcome of psychosocial treatments for cocaine dependence.

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training related changes in the ways that group trainees structure their knowledge of group counseling leader interventions.

Pathfinder Network Analyses (Schvaneveldt, 1990) was used to examine changes and convergence in the knowledge structure of group counseling interventions, for 33 group counseling trainees and three experienced group therapists. The similarity of each pair of 19 group interventions was obtained by examining the co-occurrence of these interventions across 21 situations depicted in the Group Therapy Questionnaire (GTQ; Wile, Brown, & Pollack, 1970). The Pathfinder analyses of these similarity matrices were used to infer the knowledge structure of group counseling interventions of the trainees (pre and post group practicum class) and the three experienced group therapists. Analyses of the structural features of the pre- and post-training knowledge structures suggested that prior to the practicum class, novice group counselors’ knowledge structures were linear and simplistic and contained fewer circular patterns among the interventions compared with the knowledge structures of the experienced group therapists. As hypothesized the novices’ maps became more complex, hierarchical, evidenced more circular patterns, and were more similar to the experienced therapist’s knowledge structure after the practicum class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence.

This study assessed the effects of training on the performance of 65 therapists in delivering manual-guided therapies to 202 cocaine-dependent patients. Changes in ratings of therapists' adherence and competence was assessed in 3 treatment modalities: supportive-expressive dynamic therapy (SE), cognitive therapy (CT), and individual drug counseling. Effects of manual-guided training on the therapeutic alliance were also assessed. Training effects were examined through a hierarchical linear modeling approach that examined changes both within cases and across training cases. A large effect across cases was detected for training in CT. Supportive-expressive therapists and individual drug counselors demonstrated statistically significant learning trends over sessions but not over training cases. Training in SE and CT did not have a negative impact on the therapeutic alliance, although alliance scores for trainees in drug counseling initially decreased but then rebounded to initial levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of contingency management delivered in the context of group counseling.

Objective: Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based outpatient treatment would increase attendance and drug abstinence relative to standard care. Method: Substance abusing patients (N = 239) initiating outpatient treatment at 2 community-based clinics were randomized to standard care with frequent urine sample monitoring for 12 weeks (SC) or that same treatment with CM delivered in the context of group counseling sessions. In the CM condition, patients earned opportunities to put their names in a hat based on attendance and submission of drug-negative samples. At group counseling sessions, therapists selected names randomly from the hat, and individuals whose names were drawn won prizes ranging from $1 to $100. Results: Patients assigned to CM earned a median of $160 in prizes, and they attended significantly more days of treatment (d = 0.25), remained in treatment for more continuous weeks (d = 0.40), and achieved longer durations of drug abstinence (d = 0.26) than patients randomized to SC. Group adherence and therapeutic alliance also improved with CM. In addition, HIV risk behaviors were significantly lower in CM relative to SC patients during early phases of treatment and at the 12-month follow-up. Conclusions: These data demonstrate that CM delivered in the context of outpatient group counseling can increase attendance and improve drug abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An exploration of experiences and preferences in clinical supervision with play therapists.

Clinical supervision plays a significant role in the counseling profession. Understanding and refining the supervisory process can foster development in the training of therapists in general and play therapists in particular, ultimately resulting in better mental health services for children. This study was designed to explore the experiences and preferences of play therapists in clinical supervision. Participants (N = 559) completed a Web-hosted survey that included items related to their current and preferred supervision experiences as well as a demographic questionnaire. A subset of the respondents (N = 238) completed questions related to their current supervision experiences. Findings suggest that: (a) a substantial number of participants were not receiving supervision for their work in play therapy, (b) supervisees prefer a combination of group and individual supervision, (c) supervisor professional identity as a play therapist and credential are salient supervisee preferences, and (d) compared to current supervision experiences, supervisee preferences had a noteworthy impact on practical significance demonstrated through large, moderate, and small effect sizes. Results from the study offer an opportunity for professionals to consider changes in how supervision is provided to therapists who work with children in play settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Let's be realistic: When grief counseling is effective and when it's not.

Comments on the article by D. Larson and W. Hoyt (see record 2007-11559-003) which argued that bereavement researchers have erroneously and unscientifically advocated the pessimistic conclusion that grief counseling is ineffective and perhaps even harmful. They proclaimed that the news is actually good: Grief counseling is not harmful but is as effective as other forms of psychotherapy. Therefore, they concluded, most or all bereaved people should be considered candidates for treatment. This kind of unwarranted optimism is as dangerous, if not more so, than an overly cautious pessimism. The current authors contend that the debate should be focused on (a) fine tuning assessment instruments so that they can best identify those bereaved people in serious clinical need and (b) further developing effective treatments that can more judiciously intervene when intervention is called for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling.

Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elementary school children's perceptions of play therapy in school settings.

Seven elementary school children's perceptions of the process of counseling with school counselors who utilized play therapy techniques were explored through a qualitative investigation. Findings included the importance of the therapeutic relationship, emotional expressiveness, and creative play. Better choices, decreased anxiety, increased empathy, and bolstered self-confidence were reported by participants as a result of participation in the counseling process. Additionally, participants articulated their preference for a mixture of traditional verbal interventions and play therapy techniques to solve problems in counseling. Implications for play therapists and counselors who utilize play therapy techniques in school settings are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of group and individual programs in vocational guidance.

60 male college students were divided into 3 groups: 20 received vocational counseling individually, 20 received counseling in groups, 20 received no counseling. All Ss indicated their tentative vocational choices, how certain they were of them, and how satisfied they were with them both before and after the experimental period. With original scores held constant, both group and individual counsellees were significantly more certain of their choices, more satisfied with them, and probably more realistic in them than the controls. "The time-saving quality of the group program, together with its demonstrated effectiveness, argues for the institution of group programs in vocational guidance." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training in counseling and psychotherapy: An evaluation of an integrated didactic and experiential approach.

An approach to training in counseling and psychotherapy integrating the didactic-intellectual approach which emphasizes the shaping of therapist behavior with the experiential approach which focuses upon therapist development and growth was successfully implemented with both a group of graduate students in clinical psychology and a group of lay hospital personnel, including 3 attendants, a volunteer worker, and an industrial therapist. The program relied heavily upon scales which in previous and extensive research had been predictive of positive patient outcome in estimating levels of therapist empathy, positive regard, and congruence and patient depth of self-exploration. It was found that the trainees could be brought to function at levels of effective therapy quite commensurate to those of more experienced therapists in less than 100 hours of training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Those who learn have a responsibility to teach”: Black therapists' experiences supervising Black therapist trainees.

This phenomenological study examined how 12 Black psychotherapists in college counseling centers around the country experienced the supervision of Black therapist trainees. Participants described how their relationships and methods of supervision differed when working in same-race dyads. They reported feeling closer to their Black supervisees in ways that often felt familial. The therapists described serving as mentors for their Black supervisees. They also reported discussing race more frequently in supervision, and they perceived that their Black supervisees felt safer having Black supervisors. The study also suggests implications for the training of ethnic minority therapists and supervisors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Counseling and Therapy Skills.

Reviews the book, Counseling and Therapy Skills by David G. Martin (1983). The stated goal of this book is "to communicate more than an academic understanding of the principles of therapy: to give the reader skills that can actually be applied in the counseling setting" (p. vii). The first six chapters focus on the concept of empathy, listening skills, facilitative responding, confrontation, giving control to the client, and relationship issues. The second part book consists primarily of illustrations of therapy by five therapists (including the author). This material is followed by four chapters on the special topics of behavioural interventions, assessment, ethical issues, and how to conduct initial and final interviews. The author concludes with a theoretical section of four chapters in which he briefly discusses contributions by some of the "schools" of therapy, and then addresses the relationship between anxiety and distress, some theoretical principles underlying therapy, and the research evidence on the effectiveness of empathic responding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How does group process research inform leaders of counseling and psychotherapy groups?

This article focuses on processes in groups with children conducted in the school and the lessons that practitioners can learn. It includes issues of screening and selection processes, therapeutic factors, feedback in the group, child behavior, and leader behavior. Overall, it seems that group processes with children are somewhat unique. Knowing and understanding them may help group therapists improve their work with children in small counseling groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential effects of three vocational counseling treatments.

Compared 3 treatments which included 2 self-administering counseling modes, Holland's Self-Directed Search (SDS), a modification of the SDS entitled Individual Vocational Planning (IVP), and traditional vocational counseling. 113 undergraduates seeking counseling at a college counseling center were randomly assigned to 1 of the 3 treatment or control groups. Pre- and posttest scores were obtained on frequency and variety of vocational information seeking, satisfaction with treatment, and other measures. In addition, differential costs of providing the treatments were examined. Results indicate that all treatments were about equally effective as measured and the college users appeared equally satisfied with them. Cost analysis indicated that the traditional counseling treatment cost 6 times more per S than SDS and 4 times more than the IVP. Low delivery cost and comparable effectiveness provide evidence for the self-administrable treatment modes as additional alternatives to traditional methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Behavioral family counseling and naltrexone for male opioid-dependent patients.

Men (N=124) entering treatment for opioid dependence who were living with a family member were randomly assigned to one of two 24-week treatments: (a) behavioral family counseling (BFC) plus individual treatment (patients had both individual and family sessions and took naltrexone daily in presence of family member) or (b) individual-based treatment only (IBT; patients were given naltrexone and were asked in counseling sessions about their compliance, but there was no family involvement). BFC patients, compared with their IBT counterparts, ingested more doses of naltrexone, attended more scheduled treatment sessions, had more days abstinent from opioids and other drugs during treatment and during the year after treatment, and had fewer drug-related, legal, and family problems at 1-year follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)