Acceptability of paradoxical interventions: Some paradoxes of psychotherapy research.

The opportunity to respond to Cavell, Frentz, and Kelley's (1986) empirical evaluation of the components of our previously reported paradoxical intervention (Kolko & Milan, 1983) provides a forum for discussion of issues pertaining to both paradoxical techniques and alternative psychotherapeutic procedures. Specifically, we elaborate on the conceptualization of paradoxical interventions, significance of client resistance to therapeutic directives, and use and content of reframing in the administration of paradoxical instructions. Clinical and empirical issues are discussed in regard to the process of obtaining informed consent, impact of methodological differences in the interpretation of findings, and pertinence and assessment of social validity in the evaluation of treatment efficacy and acceptability. We hope that such considerations will stimulate thorough examination of the rationale, characteristics, and utility of paradoxical strategies as well as refinement in the practices used to evaluate emerging psychotherapeutic techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis intervention: A review of outcome research.

Critically evaluates crisis intervention studies conducted (a) in community suicide prevention/crisis intervention programs, (b) in psychiatric settings, and (c) with surgical patients. In the 1st area, the impracticality of suicide as an outcome measure and the need for shifting evaluation emphasis from crisis worker performance to client behavior change measures is stressed. Also, the virtual impossibility of demonstrating overall program impact on the community and the need for developing overall program evaluation procedures is noted. Other criticisms are made as follows: Studies in psychiatric settings suffer from considerable methodological shortcomings that prohibit definitive conclusions; studies operationally specifying treatment components are greatly needed here. Studies with surgery patients indicate the necessity for developing intervention techniques most appropriate for individuals differing in their typical manner of dealing with stress. In all settings, outcome measures should be appropriate to the situation and logically related to the goals of intervention. (3? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of paradoxical interventions.

Conducted a meta-analysis of 15 outcome studies on paradoxical interventions (PIs), including 86 effect sizes for PIs and 39 for nonparadoxical treatments. Results indicate a mean effect size of .99 for PIs compared to no-treatment controls, and a mean of .56 when compared to placebo-control groups. An analysis of those studies containing both PIs and nonparadoxical treatments revealed that PIs were consistently and significantly more effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commonsense objectives in paradoxical interventions.

Discusses paradoxical interventions (PIs) in relation to the objectives for which they are used: to alleviate pressure, gain voluntary control, invalidate operating premises, legitimize, make unacceptable actions conscious, and appeal to "oppositionality." It is suggested that organization by objectives can promote better understanding and use of PIs. The appropriateness of presenting the rationale to the client is related to the objectives of the intervention. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (1) the overall effectiveness of psychotherapy for depressed clients, (2) its effectiveness relative to pharmacotherapy, and (3) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled outcome research in psychotherapy: The group comparison approach reassessed.

Contends that the group comparison approach to treatment outcome research is sometimes rejected on the grounds that it ignores individual differences. The present author argues that this rejection is based on a misunderstanding of the research strategy involved and that the group comparison approach, in the framework of a multifactorial design, can reveal those individual differences that are important (i.e., the factors that affect outcome). (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative review of family rating scales: Guidelines for clinicians and researchers.

Evaluates 8 rating procedures used in the assessment of family functioning, using 7 criteria of properties of scales, 2 of rater competence and training, and 3 of psychometric validity and reliability. The following scales are included: Beavers-Timberlawn Family Evaluation Scale and Centripetal/Centrifugal Family Style Scale, McMaster Clinical Rating Scale, Family Assessment Measure Clinical Rating Scale, Global Family Interaction Scales, Clinical Rating Scale for the Circumplex Model of Marital and Family Systems, Global Coding Scheme, and Family Interaction Q-Sort. Psychometric concerns and methodological dilemmas are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiopulmonary resuscitation: a review for clinicians

Modification of the cellular prion protein has been correlated with the acquisition of several neurodegenerative diseases, including kuru, scrapie, bovine spongiform encephalopathy (BSE), and Creutzfeldt-Jakob disease (CJD). Sequence conservation and amino acid identity are known to influence the efficacy of interspecific transmission. We analyzed patterns of interspecific genetic variation with a view toward identifying features related to disease transmission. The reconstructed gene trees and amino acid tree were compared with the species tree, and all discordances observed were related to the species barrier of disease transmission. The rates of synonymous substitution, nonsynonymous substitution, and nucleotide content were determined for the protein-coding gene. Substitutions implicated in each of the prion diseases were found to occur in regions of the protein that are least variable across all species-opposite to the pattern of variability expected from interaction with an infectious pathogen. Amino acid residues related to the species barrier form a single cluster associated with the first alpha-helical domain of the protein. Residues related to sporadic and hereditary human prion disease form two separate clusters, associated with the second and third alpha-helical domains. Taken together, these results are consistent with the view that prion diseases arise from accidents in protein folding, rather than infection with an undiscovered virus-like particle. We speculate that the differences in disease phenotype between transmissable and hereditary forms could result from interactions between different parts of the protein during propagation.     

Peer-assisted learning interventions with elementary school students: A meta-analytic review.

A meta-analytic review of group comparison design studies evaluating peer-assisted learning (PAL) interventions with elementary school students produced positive effect sizes (ESs) indicating increases in achievement (unweighted mean ES = 0.59, SD = 0.90; weighted ES, d = 0.33, p     

Attribution and the double bind in paradoxical interventions.

Tested the hypothesis that clear identification of an internal, nonvolitional agent of therapeutic change would enhance therapeutic change and the maintenance of change in response to paradoxical interventions (PIs) and explored the double-bind explanation of PIs. 29 depressed (as determined by the Beck Depression Inventory [BDI]) college students were assigned to 1 of 3 interview treatments containing PIs: A no-elaboration condition contained only PIs; a developmental-meaning condition contained an additional paragraph explicitly identifying a developmental agent of change; and a metacommunication condition contained an additional paragraph explicitly identifying the paradoxical nature and intent of the treatment. At follow-up, Ss completed a battery that included the BDI, a self-perception inventory, and the Barrett-Lennard Relationship Inventory. Results indicate that PIs that explicitly identified an internal, nonvolitional cause of change resulted in decreased external attribution of change but not greater therapeutic change. Explaining the double-bind aspects of PIs resulted in favorable client views of therapists but diminished the immediate therapeutic effects of the interventions. Results suggest that clients' perceptions of the qualities of their therapists and clients' attributions about the causes of their behaviors may not be causes of therapeutic change but simply additional dependent variables in the therapeutic process. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analytic review of marital therapy outcome research.

This meta-analytic review examines the findings of 15 methodologically rigorous marital therapy outcome studies reported in 19 journal articles. These findings were used to assess the efficacy of three treatment approaches in fostering change in spouses' relationship-related behavior, cognitions, affect, and general assessment of their relationship. Behavioral marital therapy (BMT), cognitive-behavioral marital therapy (CBMT), and insight-oriented marital therapy (IOMT) were all found to be more effective than no treatment in bringing change in spouses' behavior and in the general assessment of their relationship. IOMT was more effective than BMT or CBMT in bringing change in spouses' general relationship assessment, while CBMT was the only approach that induced significant change in spouses' posttherapy relationship-related cognitions. The role of meta-analytic reviews of marital therapy approaches is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifestyle interventions for youth who are overweight: A meta-analytic review.

Objective: Clear evidence suggests that lifestyle interventions can be helpful in the treatment of youth who are overweight, but translational research is needed to address the gap between treatment research and clinical care. Design: This meta-analysis integrated the results of 66 treatment–control comparisons and 59 alternate treatment comparisons evaluating lifestyle interventions for children and adolescents who were overweight. Main Outcome Measures: Between-groups differences in weight-related outcomes and other health-related behaviors at the end of treatment. Results: Lifestyle interventions were effective in a range of settings and with a range of participants. Even relatively brief programs had benefits apparent months after the end of treatment. A key component appeared to be the expectation that parents would be actively involved in treatment. Program benefits included not only better weight management but also better eating habits. Conclusion: The results suggest that lifestyle interventions can be effective under a wide range of conditions not limited to the highly controlled conditions of efficacy studies. Parent involvement is associated with significantly better results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behaviour-therapy research with children: A critical review.

Evaluated behavior-therapy research with children published from 1965-1969 as to experimental design and execution. Studies were examined for use of control groups, base line, systematic variation of treatment, unbiased O, and follow up. Results indicate most studies to be inadequate. (French summary) (63 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why clinicians infrequently do research.

Findings from several studies have indicated that the scientist-practitioner model (which stresses the integration of research into clinical practice) is infrequently adopted by practicing clinical psychologists. Although many hypotheses have been offered, there have been no empirical examinations of the reasons why clinicians infrequently engage in research. In this study, 79 practicing clinical psychologists completed a questionnaire focusing on perceived impediments to clinical research. A number of inhibiting factors were identified, but the intrinsic and extrinsic contingencies associated with the conduct of research were most salient. Other concerns included ethics, the impact of research on the clinical process, and the unavailability of appropriate research designs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient interventions for adolescent substance abuse: A quality of evidence review.

Previous reviews of outpatient interventions for adolescent substance abuse have been limited in the extent to which they considered the methodological quality of individual studies. The authors assessed 31 randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality. A quality of evidence score was calculated for each study and used to compare the evidence in support of different outpatient interventions. Across studies, frequently reported methodological attributes included presence of an active comparison condition, reporting of baseline data, use of treatment manuals, and verification of self-reported outcomes. Infrequently reported attributes included power and determination of sample size, techniques to randomize participants to condition, specification of hypotheses and primary outcomes, use of treatment adherence ratings, blind assessment, and inclusion of dropouts in the analysis. Treatment models with evidence of immediate superiority in 2 or more methodologically stronger studies included ecological family therapy, brief motivational interventions, and cognitive-behavioral therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responsivity of professional clinicians to requests for research participation.

Mailed 8 different types of requests for research participation to psychologists and psychiatrists (N = 412) employed in Canadian mental health facilities. There was a better response to requests for participation as research Ss than to more informal appeals. Responsivity was inversely related to expected visibility, including lack of anonymity of response. Results suggest that fear of evaluation largely determined response rates in studies soliciting clinicians to participate in research. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A primer for conducting child psychotherapy outcome research.

Presents basic principles for conducting child psychotherapy outcome research and suggests that a multivariate framework is needed to illuminate important mechanisms of change in effective child psychotherapy. Issues related to type of treatment, therapist variables, child problems, context, research design, and statistical concerns are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of paradoxical interventions within a prison psychiatric facility.

Describes inmate personality characteristics and paradoxical techniques used in 4 interventions in a prison psychiatric facility. The cases of male inmates involved malingering, possible suicide, parental problem behaviors, and manipulation of the system. It is suggested that in selected cases, paradoxical strategies tap the client's strengths, help avoid adversarial relationships and power struggles, and produce change quickly. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)