Addressing Multiple Relationships Between Clients and Therapists in Lesbian, Gay, Bisexual, and Transgender Communities.

Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner Violence Before and After Couples-Based Alcoholism Treatment for Male Alcoholic Patients: The Role of Treatment Involvement and Abstinence.

This study examined partner violence before and after behavioral couples therapy (BCT) for 303 married or cohabiting male alcoholic patients and used a demographically matched nonalcoholic comparison sample. In the year before BCT, 60% of alcoholic patients had been violent toward their female partner, 5 times the comparison sample rate of 12%. In the 1st and 2nd year after BCT, violence decreased significantly from the year before BCT, and clinically significant violence reductions occurred for patients whose alcoholism was remitted after BCT. Structural equation modeling indicated that greater treatment involvement (attending BCT sessions and using BCT-targeted behaviors) was related to lower violence after BCT and that this association was mediated by reduced problem drinking and enhanced relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of Psychotherapeutic Benefit of Lesbian, Gay, and Bisexual Clients: The Effects of Sexual Orientation Matching and Other Factors.

[Correction Notice: An erratum for this article was reported in Vol 41(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-16875-001). On page 293, Table 3 is incorrectly identified as Table 2, and on pages 294-295, Table 2 is incorrectly identified as Table 3.] Predictors of the level of benefit derived from nearly 2,000 psychotherapy episodes reported by a nationwide, nonprobability sample of 600 lesbian, gay, and bisexual clients were analyzed using ordinary least squares regression, corrected by generalized-estimating-equation (GEE) procedures for lack of independence in the data. Among the positive predictors of benefit are the following: the year the episode began; the number of sessions in the episode; the client's identifying him- or herself as gay, lesbian, or bisexual at the beginning of the episode and being unconflicted about it; and having a therapist who is female, gay, or lesbian or who trained as a social worker or a psychologist. Negative predictors include having a therapist who is an analyst, who uses reparative therapy, or who violates sexual boundaries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child Anxiety Treatment: Outcomes in Adolescence and Impact on Substance Use and Depression at 7.4-Year Follow-Up.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist effects in outpatient psychotherapy: A three-level growth curve approach.

Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Indicators of Client Engagement: Influences on Alcohol Treatment Satisfaction and Outcomes.

This investigation explored the relationship of client engagement variables (client expectations, therapeutic/working alliance, and session attendance) with treatment satisfaction and posttreatment drinking-related outcomes using data from 2 outpatient alcohol treatment studies (N = 208). Path analysis was used to test a model in which engagement variables jointly influence client satisfaction with treatment and subsequent drinking-related outcomes. The proposed model fit well with the data and accounted for 14-23% of the variance in posttreatment outcomes. The relationships in the model suggest that the link between treatment satisfaction and outcome is clarified by examining client engagement variables, which relate indirectly to outcome by means of client satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol-Focused Spouse Involvement and Behavioral Couples Therapy: Evaluation of Enhancements to Drinking Reduction Treatment for Male Problem Drinkers.

This study evaluated the effects of alcohol-focused spouse involvement and behavioral couples therapy (BCT) in group drinking reduction treatment for male problem drinkers. Sixty-four male clients and their female partners were randomly assigned to 1 of 3 conditions: treatment for problem drinkers only (PDO), couples alcohol-focused treatment, or the latter combined with BCT. Clients whose partners were included in treatment evidenced fewer heavy drinking days and more abstinent/light drinking days in the year following treatment, relative to PDO clients. The combination of alcohol-focused spouse involvement and BCT yielded no better outcomes than alcohol-focused spouse involvement alone. Drinking consequences, spouse behavioral support for drinking reduction, and relationship satisfaction showed no effects of treatment condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using Behavioral Theories of Choice to Predict Drinking Outcomes Following a Brief Intervention.

Behavioral theories of choice predict that substance use is partly a function of the relative value of drugs in relation to other available reinforcers. This study evaluated this hypothesis in the context of predicting drinking outcomes following an alcohol abuse intervention. Participants (N=54, 69% female, 31% male) were college student heavy drinkers who completed a single-session motivational intervention. Students completed a baseline measure of substance-related and substance-free activity participation and enjoyment. Only women showed a significant reduction in drinking at the 6-month follow-up, and the ratio of substance-related to substance-free reinforcement accounted for unique variance in their drinking outcomes. Women who at baseline derived a smaller proportion of their total reinforcement from substance use showed lower levels of follow-up drinking, even after the authors controlled for baseline drinking level. Male and female participants who reduced their drinking showed increased proportional reinforcement from substance-free activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influences of Mood, Depression History, and Treatment Modality on Outcomes in Smoking Cessation.

The relationship between major depressive disorder (MDD), treatment modality, and mood was evaluated in smokers participating in cessation programs. Participants (N = 549, 53.7% women, 46.3% men, 28% endorsing past MDD episodes) were randomly assigned to a cognitive-behavioral treatment (CBT) or health education (HE) intervention. Participants with a history of recurrent MDD (MDD-R) had higher rates of abstinence in CBT compared with HE even when the contribution of mood and the interaction between mood and an MDD × Treatment variable were included in the model. Likewise, higher levels of mood disturbance were reported by MDD-R smokers compared with those reporting a single episode. The study replicated results reported by R. A. Brown et al. (2001) and expanded upon them by evaluating the differential contribution of poor mood on cessation outcomes relative to MDD history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In Defense of Cultural Competency in Psychotherapy and Treatment.

Cultural competency guidelines and policies are being widely established. Yet some critics have challenged the evidence for cultural competency and the lack of efficacy studies that demonstrate its outcomes. Various positions are examined that discuss cultural competency research. They include the need for more resources for research, scientific practices that overlook ethnic research findings, fruitfulness of theory-driven rather than population-based research, problems in defining cultural competency as a technique, and development of policies in the absence of research. Implications of these positions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Impact of Patient-Centered Information on Patients' Treatment Satisfaction and Outcomes in Traumatic Brain Injury Rehabilitation.

Objective: To evaluate the effects on patients with traumatic brain injury (TBI) of detailed, personalized information about their injuries, acute care treatment, and rehabilitation progress. Participants: Twenty-eight former or present military personnel (mean age = 30 years) with moderate to severe TBI (mean of 29 days spent in intensive care before admission to TBI unit). Design: Two (personalized information vs. general information) × 2 (high- vs. low-patient preference for health care information) factorial design. Interpersonal behavior of patients, information providers, and health care staff were measured by the Impact Message Inventory. Outcome Measures: Rehabilitation Intensity of Therapy Scale, Functional Independence Measure, Treatment Satisfaction Questionnaire. Results: Patients given personalized information exerted greater effort in physical therapy, made greater improvement in functional independence, and were more satisfied with rehabilitation treatment. Patient preference for information and ratings of interpersonal behavior were largely unrelated to patient outcomes. Conclusion: Cognitively impaired TBI patients can benefit from interventions designed to enhance their sense of control and personal involvement in their own care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of Chronic Pain in Rehabilitation: Outcomes Measures in Clinical Trials and Clinical Practice.

Objective: Chronic pain, or pain that lasts for months or even years, is prevalent among patients in rehabilitation settings, and treatment is costly. People with chronic pain often suffer physical limitations and emotional distress. As new treatments become available and clinical trials are initiated, it is important to measure outcomes in an effort to determine the efficacy of treatment interventions. This article provides a review of the core domains of outcomes assessment among people with chronic pain, including recommendations for outcome measures to be used in clinical trials and clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes.

The efficacy of psychological interventions for children has long been debated among mental health professionals; however, only recently has this issue received national attention, with the U.S. Public Health Service (2000) emphasizing the critical need for early intervention and empirically validated treatments tailored to children's maturational needs. Play therapy is a developmentally responsive intervention widely used by child therapists but often criticized for lacking an adequate research base to support its growing practice. A meta-analysis of 93 controlled outcome studies (published 1953-2000) was conducted to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness. The overall treatment effect for play therapy interventions was 0.80 standard deviations. Further analysis revealed that effects were more positive for humanistic than for nonhumanistic treatments and that using parents in play therapy produced the largest effects. Play therapy appeared equally effective across age, gender, and presenting issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral and Humanistic Group Treatment for Children With Learning Disabilities: A Comparison of Outcomes and Process.

The authors of this study examined the outcomes and processes of 2 types of group treatment--cognitive-behavioral treatment groups (CBTG) and humanistic group therapy (HGT)--offered to 200 elementary schoolchildren in a center for students with learning disabilities in Israel. Results indicated that the addition of either type of group treatment to individual academic assistance was more effective than the latter alone on most measures. In fact, on the majority of measures, group treatment without academic assistance was more effective than just individual assistance. Finally, HGT was more effective than CBTG on most measures. Most of the outcomes were sustained at follow-up, and some even increased from termination to follow-up, although effect sizes were quite low. Process measures included the Client Behavior System and the therapist Helping Skills System, which were measured at 5 points in time. Differences between the 2 treatment types were revealed on both process measures, including differences in the growth curve of these behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Reactance as a Predictor of Outcome in the Treatment of Chronic Depression.

This study examined whether reactance would negatively influence treatment outcome in 347 patients diagnosed with chronic forms of depression and treated at 9 sites with either Nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), or combination therapy. Contrary to our hypotheses, reactance positively predicted treatment outcome in CBASP on 2 of 4 scales. These effects were independent of the therapeutic alliance, which also positively predicted outcome. Reactance did not predict outcome in the groups receiving medication alone or in combination with CBASP. The findings suggest that reactance may be an asset in psychotherapy among chronically depressed individuals and that reactant patients can benefit from directive psychotherapy when therapists flexibly respond to perturbations in the therapeutic relationship. Results support the importance of Aptitude × Treatment interactions in psychotherapy outcome. The direction and significance of such interactions may vary with different forms of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors.

Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as predictors of their implementation. Randomized controlled trials of psychosocial interventions published in 6 influential psychological and psychiatric journals were reviewed and coded for treatment integrity implementation. Results indicate that investigations that systematically addressed treatment integrity procedures are virtually absent in the literature. Treatment integrity was adequately addressed for only 3.50% of the evaluated psychosocial interventions. Journal of publication and treatment approach predicted integrity implementation. Skill-building treatments (e.g., cognitive-behavioral) as compared with non-skill-building interventions (e.g., psychodynamic, nondirective counseling) were implemented with higher attention to integrity procedures. Guidelines for implementation of treatment integrity procedures need to be reevaluated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of physical exercise in alcoholism treatment and recovery.

A growing body of literature has demonstrated that physical exercise is associated with favorable mental health outcomes. Exercise has the potential to be an accessible and affordable adjunct treatment option for persons with alcohol use disorders (AUD); however, exercise-based interventions have rarely been applied to this population. The authors examine the potential role of physical exercise in the process of recovery from AUD. Possible physiological, psychological, and social mechanisms whereby exercise may exert influence on alcohol use outcomes are outlined. Studies examining the effects of physical exercise on alcohol and other addictive behaviors are reviewed, and the viability of structured, exercise-based adjunct interventions for AUD populations is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy.

This investigation examined the relationship between gender (client, therapist, and client/therapist dyad) and various psychotherapy-related variables for clients with mood and/or anxiety disorders. In several instances, both client and therapist gender predicted treatment retention and psychological symptom changes during 3 months of therapy. In general, female clients were more likely to advance beyond the initial intake assessment and also complete 3 months of therapy. Conversely, male clients were more likely to withdraw from therapy after the initial intake assessment. Specific client/therapist gender pairing predicted treatment retention in the mood disorder subsample and trait anxiety symptom severity in the anxiety disorder subsample. Some findings should be interpreted with caution, as there were small group samples in a few of the analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Community-Based Treatment for Substance-Abusing Adolescents: 12-Month Outcomes of Youths Entering Phoenix Academy or Alternative Probation Dispositions.

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)