Intimate relationships with former clients: National survey of attitudes and behavior among practitioners.

A national survey of American Psychological Association (APA) Division 29 (Psychotherapy) members was conducted to gain information about attitudes and behavior in regard to intimate relationships with former clients. The response rate was 39.5%. Among respondents, 44.7% felt that such relationships were highly unethical, 23.9% felt that they were somewhat unethical, 22.9% felt that they were neither ethical nor unethical, and the remaining respondents felt that they were somewhat or highly ethical. Respondents felt that time since termination was the major factor that should be taken into account in determining the ethics of the situation. Eleven percent of the sample acknowledged having had intimate relationships with former clients, which was nearly four times the rate admitting intimate relationships with current clients (3.1%). The need for the establishment of APA ethical guidelines is clearly indicated in the data. Suggestions in this regard, based on the current data, are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High expression of thymidylate synthase is associated with the drug resistance of gastric carcinoma to high dose 5-fluorouracil-based systemic chemotherapy

BACKGROUND: In the past 4 years, the weekly 24-hour infusion of high dose 5-fluorouracil (5-FU) and leucovorin in the treatment of patients with advanced gastric carcinoma has been prospectively studied at the authors' institution. This has enabled them to explore the possibility that the level of expression of thymidylate synthase (TS), the target enzyme of 5-FU, is related to the drug sensitivity of gastric carcinoma to 5-FU-based chemotherapy. METHODS: To be eligible for this study, patients were required to have received high dose 5-FU and leucovorin chemotherapy (weekly 24-hour infusions of 5-FU, 2,600 mg/m2, and leucovorin, 300 mg/m2) and to have had adequate prechemotherapy gastric carcinoma tissues for immunohistochemical study. TS106 monoclonal antibody was used to detect the expression of TS. A visual scoring system, which ranged from 0 to 3+, was adopted by 2 independent pathologists to semiquantitate the intensity of TS expression. RESULTS: Between 1993 and 1996, a total of 30 patients, 18 men and 12 women, with a median age of 61.5 years, were enrolled. Of these patients, 16 (53.3%) and 14 (46.7%) had high and low expression of TS, respectively. Two of the 16 patients (12.5%) with high expression of TS and 13 of the 14 patients (92.9%) with low expression of TS responded to chemotherapy (P < 0.001, chi-square test). The median overall survival was 10 months for patients with low TS expression and 4 months for patients with high TS expression (P < 0.01, log rank test). CONCLUSIONS: The data from this study suggest that the expression of TS, as determined by immunohistochemistry, is a relatively reliable indicator of whether 5-FU should be used in the treatment of patients with gastric carcinoma.     

Antiphospholipid antibodies: an epiphenomenon in Tourette syndrome

Antiphospholipids (aPLAs) have been previously identified in children with Tourette syndrome (TS), which has led to the speculation that these antibodies might have a pathophysiologic role in this disorder. Therefore, 21 healthy children and adolescents with TS, whose ages ranged from 7 to 17 years, underwent laboratory studies designed to diagnose the lupus anticoagulant, anticardiolipin (aCL) antibodies [immunoglobulin (Ig) G, IgA, and IgM], and antinuclear antibodies. Although five subjects had at least one value that differed from accepted laboratory standards, the changes were marginal in four of them. Lupus anticoagulant was identified in one patient, based on a minimal requirement of a prolonged dilute Russell viper venom time, clotting studies that did not correct after mixture with normal plasma, and an abnormal platelet neutralization procedure. A prolonged (but correctable) activated partial thromboplastin time was found in one individual, and aCL IgG was marginally increased in three subjects. Two (10%) of a control population of 20 same-age children also had low positive aCL IgG levels. There were no differences in tics (onset, type, frequency, severity, and family history) or comorbid features between children with normal or "abnormal" laboratory study results. Our data suggest that the presence of aPLAs in TS represents an epiphenomenon rather than a pathophysiologic mechanism.     

Abstinence or controlled drinking goals for problem drinkers: A randomized clinical trial.

24 adult problem drinkers were assigned to brief behavioral treatment with either an abstinence (AB) or a controlled drinking (CD) goal. Self-report and collateral report data reflect significant overall reduction in alcohol consumption and projected blood alcohol peaks at 3-mo and at 3.5-yr follow-up intervals. AB and CD Ss did not differ significantly from each other on outcome variables at any point before or after treatment. At 3.5 yrs, 4 Ss had been abstinent for at least 12 mo, 3 had been moderate and asymptomatic drinkers for at least 12 mo, 5 were improved but still somewhat impaired, 8 were unimproved, 3 refused to be interviewed, and 1 could not be located. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient feedback on satisfaction with direct services received at a community mental health center: A two-year study.

254 adolescent and adult patients from 2 successive years at a new mental health center evaluated the help they received 3–21 mo after termination of treatment. Less than 15% of them felt that they had not been helped by therapy. Replicated results illustrated that the more Ss felt that the therapists were interested in them, the more they felt helped. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis.

A meta-analysis was performed on 18 studies in which a cognitive–behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive–behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies.

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Closed reduction and tendon transfer for treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy

Dislocation of the glenohumeral joint developed, in the first few years of life, in eight children who had brachial plexus birth palsy. The palsy involved the fifth and sixth cervical nerve roots in six children and the fifth, sixth, and seventh cervical nerve roots in two. All of the children had a release of the insertions of the pectoralis major, latissimus dorsi, and teres major followed by a closed reduction of the glenohumeral joint. The latissimus dorsi and the teres major were then transferred to the rotator cuff. All of the children had a well located glenohumeral joint with at least 25 degrees (mean, 51 degrees) of external rotation and at least 135 degrees (mean, 164 degrees) of abduction at the latest follow-up examination, at least two years postoperatively. Strength in abduction increased at least one grade, and strength in external rotation increased at least two grades. The improved motion and strength allowed the children to place the hands more effectively above the head and helped them to perform activities of daily living easily.     

Do Psychologists Adhere to the Clinical Practice Guidelines for Tobacco Cessation? A Survey of Practitioners.

Practicing psychologists are well positioned to provide at least minimal interventions for tobacco dependence among their clients. Because smoking covaries with psychopathology, a substantial proportion of psychologists' clients are likely to be smokers. Psychologists have expertise in motivating behavior change, and they have greater contact and stronger relationships with their patients than do most other health providers. Despite these advantages, the current study found that psychologists were less likely to intervene for tobacco use than for other client behaviors, such as alcohol or illicit drug abuse. Psychologists do not regularly ask their clients whether they smoke, advise them to quit, assess their willingness to quit, assist them with quitting, or arrange follow-up. Recommendations for additional training are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

This powerful opening of the heart: how ritual affirms lesbian identity

This study was undertaken to examine the ways in which ritual helps affirm lesbian identity. The study explored two types of rituals commonly used among lesbians: commitment ceremonies and baby naming or child dedication ceremonies. Six in-depth interviews were conducted with lesbians who had participated in rituals which they perceived as affirming to their identities. The major findings showed that the respondents were in significant agreement that their rituals helped solidify lesbian identity through the confrontation of internalized and external homophobia. Subjects reported that this process subsequently fortified them in their daily battles against oppression. Of further significance, the respondents all specified that in several ways, their ritual helped provide balance and establish equilibrium between the many disparate experiences that result from living in a homophobic society. Implications will specify ways that therapists can use ritual as a tool in helping lesbian clients solidify and affirm their identities.     

Role Induction: A Method for Enhancing Early Retention in Outpatient Drug-Free Treatment.

Retention in outpatient drug-free treatment is poor, with many clients terminating prior to receiving therapeutic benefit. This randomized clinical trial compared the impact on retention and drug use of an individual role induction session conducted at intake with the standard group orientation offered at the clinic. Results of interim analyses indicated that participants assigned to role induction (n = 180) were retained for more days, more likely to attend at least one postorientation session, and more satisfied with the treatment program than were those assigned to standard treatment (n = 87). Preliminary results suggest that role induction is a brief technique that shows promise for retaining clients through the critical first 3 months of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Becoming psychotherapists: Experiences of novice trainees in a beginning graduate class.

The authors investigated the experiences related to becoming psychotherapists for 5 counseling psychology doctoral trainees in their first prepracticum course. Qualitative analyses of weekly journals indicated that trainees discussed challenges related to becoming psychotherapists (e.g., being self-critical, having troubling reactions to clients, learning to use helping skills), gains made during the semester related to becoming psychotherapists (e.g., using helping skills more effectively, becoming less self-critical, being able to connect with clients), as well as experiences in supervision and activities that helped them cope with their anxieties. Results are discussed in 5 broad areas: feelings about self in role of psychotherapist, awareness of reactions to clients, learning and using helping skills, reactions to supervision, and experiences that fostered growth. Implications for training and research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapists' attitudes toward clients reporting mystical experiences.

Studied the proportion of therapy clients who report mystical experiences, the diagnostic attitudes of their therapists, and the influence of personal and professional factors on attitudes toward these clients by analyzing the survey responses of 285 32–82 yr old psychotherapists (primarily males). Of the 20,670 clients seen during a 12-mo period, 4.5% reported a mystical experience; 67% of Ss had seen at least one such client during that period. Psychodynamic and behavioral therapists attributed significantly more pathology to such clients than did humanistic/existential therapists. Responses suggested that some therapists were biased in their diagnostic attitudes toward clients reporting mystical experiences. 50% of Ss said they had personally had a mystical experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of therapist comfort with sexual concerns of clients.

Discusses the necessity for therapists in training to go through a process of examining their personal sexual beliefs and attitudes before they can be comfortable with the kind of sexual material brought up by many clients. The reactions of therapists in training to a course in which they use methods that are specifically intended to help them with the process of becoming comfortable with client sexual concerns are described. Feedback from students suggests that they go through at least 4 overlapping stages of comfort with the kind of sexual material that is likely to be presented by their clients. These stages are (1) an examination of their views and concerns about their own personal sexual issues, (2) increasing awareness and appreciation of problems and emotional reactions as the clients experience them, (3) a new freedom in discussing sexual matters, and (4) an awareness of a new level of comfort with clients and increased willingness to share sexual material. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking outcomes following drink refusal skills training: Differential effects for African American and non-Hispanic White clients.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Characterization of transition sleep episodes in baseline EEG recordings of adult rats

By scoring 5-s EEG epochs and calculating spectral power of consecutive EEG segments as short as 1-s, transition sleep (TS) episodes were identified in baseline recordings of adult rats. TS episodes were characterized by the abrupt appearance of theta and alpha waves within an ongoing period of slow-wave sleep (SS). They were followed by paradoxical sleep (PS) or, somewhat more frequently, by a period of wakefulness (W) that often led to an additional SS. Statistical values of the main variables of TS-->(W) and TS-->(PS) episodes are presented, together with comparable data concerning previous SS and following W or PS episodes. On the whole, TS episodes were more numerous than PS episodes, and less numerous than SS episodes. Their average duration was considerably shorter. As a consequence of the identification of TS and of brief W or PS epochs intervening within SS, the number of SS episodes was estimated to be considerably higher than previously assessed, and their average duration considerably shorter.     

Social skills training to improve alcoholics' vocational interpersonal competency.

Many clients seeking vocational assistance may already possess the necessary job skills for satisfactory employment but need training to develop adequate interpersonal skills for finding and holding a job. In this study, 3 clients admitted to an alcohol abuse treatment program volunteered for social skills training related to difficult on-the-job situations. In a multiple-baseline single-case design across behaviors, modeling alone and modeling plus focused instruction were employed to improve several target behaviors. In general, though modeling was somewhat successful, the addition of focused instructions greatly enhanced treatment effects. Furthermore, these behavioral changes were maintained at a 6-mo follow-up session. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug abuse day treatment: a randomized clinical trial comparing day and residential treatment programs

Clients entering a therapeutic community (TC)-oriented drug treatment program were randomly assigned to day or residential conditions and interviewed at 2 weeks and 6 months after admission. Outcomes included Addiction Severity Index composite scores and summary scores for the Beck Depression Inventory, Symptom Checklist-90-R, and a social support scale. Only clients who remained in treatment for at least 2 weeks were included. The mean age of the sample (N = 261) was 32.9 (SD = 6.7 years) and the mean education level was 12.1 years (SD = 1.9 years); 30% were women. Comparison of outcome scores at 6 months between groups, while controlling for baseline values, indicated greater improvement for residential clients on social problems and psychiatric symptoms. The groups were similar on the 8 remaining outcomes, including measures of alcohol and drug problems. Overall, the level of improvement among day treatment clients was not significantly different from that of residential clients.     

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)     

Effects of psychotherapy on comorbid conditions in generalized anxiety disorder.

Comorbid diagnoses were examined in 55 principal generalized anxiety disorder (GAD) clients and the effect of treatment for the principal disorder on those conditions was evaluated. High rates of comorbid diagnoses were present at pretherapy, with social and simple phobia being most common. The presence of additional diagnoses declined dramatically from pretherapy to follow-up and was significantly greater among clients for whom the GAD therapy had been successful than among clients for whom GAD outcome had been ambiguous. This was generally true regardless of whether clients reported at follow-up that they had received further therapy since the posttherapy assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)