Short-term family intervention: A therapy outcome study.

Attempted to modify the destructive communication patterns of delinquent families by systematically shaping in behaviors characteristic of adaptive family systems (increased reciprocity, greater activity, and increased clarity). Based on direct observation of family interaction in a discussion task with 20 teenage delinquents and their families, results indicate a significant change in the 4 interaction measures, while 2 indexes of questionnaire agreement remained unchanged. Use of a rigorous experimental design that controlled for pretest sensitization, maturation, and nonspecific professional attention demonstrated that these changes did not occur as a function of extraneous variables. The need for rigorous process research regarding the characteristics of specific target populations coupled with equally sound outcome research that can then evaluate change within these populations is emphasized by the results. (35 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist empathy, genuineness, and warmth and patient therapeutic outcome.

A study aimed at cross-validating previous research suggesting that the levels of the therapist's accurate empathy, nonpossessive warmth, and genuineness were causally related to the degree of patient improvement or deterioration. An equal number of "good" or "poor" therapy prospects were randomly assigned to 4 resident psychiatrists (10 patients each) for 4 mo. of psychotherapy. Results tended to confirm the importance of the 3 therapeutic conditions in combination and of empathy and genuineness separately. Negative findings for separate analysis of therapist's warmth were interpreted in terms of its negative correlation with empathy and genuineness in the present sample. On the overall measure for all patients, therapists providing high therapeutic conditions had 90% patient improvement while those providing lower conditions had 50% improvement. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in sibling behavior following family intervention.

Reports changes in the behavior of the 55 siblings of 27 treated predelinquents. Siblings were 3 yrs old or older. The parents of the referred predelinquents had been trained in social learning techniques of child management. Prior analyses of home observation data showed significantly reduced rates of deviant behaviors for the identified problem children. These reductions were maintained over a 12-mo follow-up. The child management procedures taught to the parents were presumably applied to siblings as well as to the identified problem child. Analyses were conducted for the data from the siblings. The baseline data show no significant differences between siblings and identified problem children. At termination of treatment, there were significant reductions in rates of deviant behavior for the siblings. Follow-up results show the effects were maintained over 6 mo. Some clinical implications of home intervention programs for socially aggressive boys and their siblings are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist experience, general clinical ability, and treatment outcome in schizophrenia.

Knowledge of the effect of therapist training and experience on the outcome of treatment of schizophrenic patients is scanty. The present article presents data systematically collected in the course of a controlled comparison of the effects of 5 different treatment methods in schizophrenia (individual psychotherapy, ataractic drug treatment, individual psychotherapy and drug treatment, ECT, and "milieu" care) involving 228 1st-admission schizophrenics without significant prior treatment and 38 psychiatric residents or recently graduated psychiatrists. Among the 23 outcome variables studied (including the Menninger Health-Sickness Scale, the Camarillo Dynamic Assessment Scale, the MMPI, the Communication subscale of the MACC Behavioral Adjustment Scale, and the Clyde Mood Scale), there was not a single instance in which the effect of therapist experience and general clinical ability was significantly related to outcome. There appeared to be, however, differences among therapists' results that were not related to experience and general clinical ability, particularly in relation to the length of time that they kept their patients in hospital. Drug treatment tended to override but perhaps not entirely eliminate these effects. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist interpersonal skills: Process, outcome, methodological considerations, and recommendations for future research.

Reviews psychotherapeutic outcomes as they are related to such therapist interpersonal skills as empathy, regard, and genuineness. Professional and paraprofessional training programs that have grown out of the client-centered framework are also discussed. In addition, empirical research concerning confounding variables and the methodological shortcomings of this research domain are reviewed. Conclusions include (a) the idea that Rogerian hypotheses have been only modestly supported, and (b) that the lack of support is due both to the difficulties encountered in sampling and rating therapy sessions and to the failure of client-centered theory to specify more precisely the times when specific conditions (such as empathy) might be most facilitative. It is noted that judges' ratings of audiotape recordings of counseling have not provided better predictions of positive therapeutic outcome than have client perception measures of the counseling process. It is concluded that the efficacy of popular interpersonal skills training models has not been demonstrated. It is recommended that in addition to multiple criterion measures, researchers apply multiple process measures to assess the nature of the therapeutic relationship in outcome studies. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic variables, base rates, and personality characteristics associated with recidivism in male delinquents.

Studied demographic variables, base rates, and personality characteristics of 455 adolescent male delinquents in 3 studies. The total population discharged from a treatment-oriented facility was followed, and data were recovered from 98%. The recidivism rate was 37.5%, which compares to the recidivism base rates found in similar rehabilitation facilities. Significantly higher rates of recidivism were found among the younger delinquents, delinquents with prior institutional experience, and delinquents who had previously run away from an institution. Measures of impulse control and foresight and planning ability derived from the Porteus Maze Test differentiated 10 recidivists from 10 nonrecidivists. A follow-up study of 68 consecutively discharged Ss from the same institution replicated the findings with respect to impulse control but not foresight and planning ability. One measure of future time perspective and some staff ratings were also related to recidivism. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A methodological and substantive review of intervention outcome studies for families undergoing divorce.

Recently, many interventions have been designed to help family members who are adjusting to divorce. This article reviews 15 studies that included both a treatment and a control group (7 adult and 8 child intervention studies). First, reports were examined according to a methodological checklist. Research in this area is at a very preliminary stage, and methodologically sophisticated studies are not the norm. Second, psychometric adequacy of the measures used was examined. The majority of investigators used psychometrically sound measures; however, it was rare for researchers to use only well-validated measures. Third, findings revealed that group interventions for children have produced only modest gains. Effect sizes reported in adult interventions are comparable to those found in the adult psychotherapy literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence/competence and treatment outcome: A meta-analytic review.

Objective: The authors conducted a meta-analytic review of adherence–outcome and competence–outcome findings, and examined plausible moderators of these relations. Method: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. Results: R-type effect size estimates were derived from 32 adherence–outcome and 17 competence–outcome findings. Neither the mean weighted adherence–outcome (r = .02) nor competence–outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence–outcome and competence–outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence–outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. Conclusions: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence–outcome and competence–outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient characteristics and outcome in psychotherapy and behavior therapy.

94 psychoneurotic or personality disordered patients received 4 mo of analytically oriented psychotherapy, behavior therapy, or waiting list treatment. The demographic variables included age (early twenties), sex (60% female), marital status (26% married), number of siblings (2), and birth order. Neither active treatment was more effective than the other with any type of symptom (including affective ones), although both were more consistently effective than the waiting list. With psychotherapy, relatively greater success was associated with less overall pathology on the MMPI and higher socioeconomic status. Psychotherapy was least effective with Ss who scored high on the Hysteria and Psychopathic Deviate scales. There was also a strong but nonsignificant trend for more improvement in psychotherapy Ss who were younger, female, married, later born, more intelligent, and from smaller families. Behavior therapy was more effective with those who scored high on the Hysteria and Mania scales and seemed to be effective with a broader range of patients. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist and client: Two views of the process and outcome of psychotherapy.

At termination of their therapeutic relationships, 8 male and 7 female therapists (aged 26–59 yrs) along with their 38 male and 37 female clients (aged 19–40 yrs) each independently and anonymously completed a questionnaire concerning the process and efficacy of therapy. Unlike previous findings, the clients rated therapeutic outcome more favorably than did their therapists. In addition, each group attributed the change to different aspects of the therapeutic relationship. Both the aspects cited and the ratings differed as a function of the sex of both therapist and client. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems.

This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of adherence predicted the largest declines in internalizing behaviors, with high and low adherence predicting smaller improvements (curvilinear effect). Therapist competence did not predict outcome and did not moderate adherence-outcome relations; however, competence findings are tentative due to relatively low interrater reliability for the competence ratings. Clinical and research implications for attending to both linear and curvilinear adherence effects in manualized treatments for behavior disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist competence and patient outcome in interpersonal psychotherapy of depression.

This article examines whether the therapist's level of competence in conducting interpersonal psychotherapy of depression (IPT) is associated with patient improvement. Data from 35 depressed outpatients treated for up to 16 sessions as part of the IPT training program for the National Institute of Mental Health Treatment of Depression Collaborative Research Program were used. Multiple regression analyses were performed to predict outcome from 4th-session ratings of therapist skill while controlling for important pretreatment patient characteristics including level of depression, social adjustment, and expectations of treatment outcome. The results showed that measures of therapist performance contributed significantly to the prediction of patient-rated change and change in the apathy associated with depression but not to measures of social adjustment at 16 weeks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple assessment of behavior modification with families.

Criticizes the analysis and interpretation of the paper-and-pencil outcome measures used by S. M. Eyberg and S. M. Johnson (see record 1974-32950-001) in a study of behavior modification with families. It is noted that no distinction was made as to which of the 5 measures were needed for a case to be a success and that of the 12 "successful" families, 5 had a negative outcome on 2 of 3 observations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal gatekeeping, coparenting quality, and fathering behavior in families with infants.

The present study examined the role of maternal gatekeeping behavior in relation to fathers' relative involvement and competence in child care in 97 families with infant children. Parents' beliefs about fathers' roles were assessed prior to their infant's birth. Parents' perceptions of maternal gatekeeping behavior (encouragement and criticism) and coparenting relationship quality were assessed at 3.5 months postpartum. The authors assessed fathers' relative involvement and competence in child care using a combination of parent report and observational measures. Results suggest that even after accounting for parents' beliefs about the paternal role and the overall quality of the coparenting relationship, greater maternal encouragement was associated with higher parent-reported relative father involvement. Moreover, maternal encouragement mediated the association between coparenting quality and reported relative father involvement. With respect to fathers' observed behavior, fathers' beliefs and parents' perceptions of coparenting relationship quality were relevant only when mothers engaged in low levels of criticism and high levels of encouragement, respectively. These findings are consistent with the notion that mothers may shape father involvement through their roles as "gatekeepers." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coparenting, family process, and family structure: Implications for preschoolers' externalizing behavior problems.

This study examined how aspects of triadic-level family interaction relate to preschoolers' externalizing behavior problems. The quality of coparenting, family affective processes, and family structure was assessed at 3 years, and mothers, fathers, and teachers reported on children's externalizing behavior problems at 4 years. High levels of supportive coparenting and more adaptive family structures were associated with fewer externalizing behavior problems, whereas high levels of undermining coparenting and negative affect and less adaptive family structures were associated with more externalizing behavior problems. Moreover, the quality of family affectivity and family structure interacted with coparenting and appeared to influence its effects on the family. This study highlights the importance of focusing on triadic, family-level variables for understanding children's behavior problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An adaptive approach to family intervention: Linking engagement in family-centered intervention to reductions in adolescent problem behavior.

This study used Complier Average Causal Effect analysis (CACE; see G. Imbens & D. Rubin, 1997) to examine the impact of an adaptive approach to family intervention in the public schools on rates of substance use and antisocial behavior among students ages 11-17. Students were randomly assigned to a family-centered intervention (N = 998) in 6th grade and offered a multilevel intervention that included (a) a universal classroom-based intervention, (b) the Family Check-Up (selected; T. J. Dishion & K. Kavanagh, 2003), and (c) family management treatment (indicated). All services were voluntary, and approximately 25% of the families engaged in the selected and indicated levels. Participation in the Family Check-Up was predicted by 6th-grade teacher ratings of risk, youth reports of family conflict, and the absence of biological fathers from the youths' primary home. Relative to randomized matched controls, adolescents whose parents engaged in the Family Check-Up exhibited less growth in alcohol, tobacco, and marijuana use and problem behavior during ages 11 through 17, along with decreased risk for substance use diagnoses and police records of arrests by age 18. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist interpretation, patient-therapist interpersonal process, and outcome in psychodynamic psychotherapy for avoidant personality disorder.

[Correction Notice: An erratum for this article was reported in Vol 43(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2006-12148-017). The correct legend for Figure 1 on page 500 should read as follows: Figure 1. The SASB circumplex model, cluster version, interpersonal surfaces. Adapted from Benjamin (1993), Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, copyright Guilford Press, and from: Benjamin (1987), Use of the SASB dimensional model to develop treatment plans for personality disorders, I: Narcissism. Journal of Personality Disorders, 1, 43-70, copyright Guilford Press.] The authors examined the link between interpretive techniques, the therapeutic relationship, and outcome in psychodynamic psychotherapy. Two independent teams of judges each coded one early session from patients diagnosed with avoidant personality disorder. Results revealed (a) an inverse association between concentration of interpretation and favorable patient outcome; (b) that small amounts of disaffiliative patient-therapist transactions before, during, and after interpretations were reliably or meaningfully associated with negative patient change; and (c) concentration of interpretation was positively associated with disaffiliative therapy process before and during interpretation and negatively associated with affiliative patient responses to interpretation. The results suggest that therapists who persisted with interpretations had more hostile interactions with patients and had patients who reacted with less warmth than therapists who used interpretations more judiciously. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist behavior as a determinant for client noncompliance: A paradox for the behavior modifier.

Examined the immediate impact of therapist behavior on client noncompliance in 2 studies involving 12 3.8–13.1 yr old socially aggressive children and their families. One family participated in both studies. Observation systems describing client and therapist behavior were used to code videotaped therapy sessions. In Study 1, the therapist behaviors teach and confront were associated with significant increases in the likelihood of client noncompliant reactions. Therapist behaviors facilitate and support were followed by reliable decreases in client noncompliance. In Study 2, the therapist behaviors teach and confront were manipulated in a series of single-S ABAB reversal designs. Results demonstrate that changes in therapist behaviors produced increases in client noncompliance. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antecedents to outcome in group counseling with institutionalized juvenile delinquents: Effects of therapeutic conditions, patient self-exploration, alternate sessions, and vicarious therapy pretraining.

An alternate session regimen led to poorer outcome in 40 female and 40 male 14-18 yr. old juvenile delinquents; vicarious therapy pretraining and depth of self-exploration did not lead to different levels of outcome; but high levels of therapist conditions led to significantly better outcome than did low levels. Results are compared with conflicting results obtained with adult hospitalized and out-patient groups. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)