Ethical competence in psychotherapy termination.

The termination of an active psychotherapy relationship can be a very complex process. It calls for a blending of clinical, practical, and ethical factors that become the foundation for the required level of reasonable professional conduct in this area. Competence in termination requires that the psychotherapist first have a strong foundation in ethics and second understand how to apply the ethical principles and standards in unique and varied clinical settings. In this article, we highlight the necessary foundational competence in ethical knowledge and link this knowledge to practical steps as a general guide for functional competence in psychotherapy termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI-2 random responding indices: Validation using a self-report methodology.

Investigated the validity of F, back F, and variable response inconsistency indices of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for detection of self-reported partially random responding in several samples, including college students, community volunteers, and job applicants. Substantial numbers of Ss admitted to providing some random responses, with 29–60% of the various samples acknowledging an average of 12–38 random responses in their MMPI-2 answers. For all groups, with the expected exception of job applicants, the appropriate MMPI-2 validity indices were reliably and positively correlated with self-estimates of random responses. Available data suggested that random responding occurred most commonly toward the end of the test, although significant numbers indicated that they had scattered their random responses throughout the test. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A time-frame model of termination in psychotherapy.

Presents a 7-session time-frame model for the termination of individual psychotherapy. Issues appropriate for discussion during those sessions are identified—review of therapy, content, the therapy relationship, and separation and loss. Suggested modifications of the model, depending on such factors as presenting client concerns, duration of treatment, and emphasis that the therapist places on the therapeutic relationship as a vehicle for change, are described. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors in premature termination in long-term psychotherapy.

Examined the relationship between patient and therapist variables and the incidence of premature termination at a private outpatient psychotherapy clinic. Using a qualitative rating scheme, 718 long-term psychotherapy cases were reviewed to determine whether termination had been premature. The 273 cases judged to be premature terminations were compared with the patient population as a whole on 10 patient variables. For 27 psychotherapist-Ss (aged 29–68 yrs), the rates of premature termination among their patients were examined with reference to 9 therapist variables. Results indicate that premature patient terminators differed significantly on race, age, source of referral, type of payment, employer, presenting complaint, and diagnosis. Psychologists were found to have significantly lower rates of premature termination among their patients than psychiatrists or social workers. Therapists who had undergone personal therapy showed significantly lower rates than those who had no therapy. Therapists' defense style and life stresses did not relate significantly to rates of premature termination. Results are discussed in terms of motivational factors in patients and identification with the values of long-term psychotherapy by therapists. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of back random responding: Effectiveness of MMPI-2 and Personality Assessment Inventory validity indices.

Two experiments examined the detection and effects of back random responding (BRR) on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI). Experiment 1 revealed that MMPI-2 Clinical and Content scales were relatively resistant to the effects of BRR. Fb--F ≥ 20T was the most effective index for identifying invalid protocols. Experiment 2 revealed greater susceptibility of the PAI interpretive scales to the effects of BRR and less successful detection of BRR. The most effective PAI validity index was the combined indicator, ICN ≥ at 73T or INF ≥ 75T. Clinical and empirical implications of these findings are discussed, and tentative modifications to the MMPI-2 interpretative guidelines are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client factors related to premature termination of psychotherapy.

Investigated client factors related to the premature termination of counseling or psychotherapy. A review of 287 mental health center client files revealed 3 variables that were found to be significantly related to premature termination: diagnosis, presenting problem, and previous psychiatric experience. Early terminators had less previous contact with psychiatric services, were usually not psychotic, and presented with problems in the area of interpersonal relationships. Results suggest that community education activities, informed consent procedures, therapist knowledge of the early terminator's profile, and a wider range of services, including more groups, may improve community mental health center service delivery to these clients. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal indices of arousal in group psychotherapy.

Examined psychometric properties of a nonverbal measure of arousal in psychotherapy (J. K. Burgoon et al, 1989) used with depressed clients in 2 types of group psychotherapy: experiential (n?=?18) and cognitive (n?=?13). Results indicate that both general and specific aspects of emotional arousal can be reliably rated from nonverbal behaviors. Vocalic tension, nervous vocalizations and laughter, kinesic random movement, and vocal expressiveness were associated with higher global arousal. A 2nd study looked at the relationship between nonverbal arousal and within-session benefits in the 2 group psychotherapies. A depressed S experiencing positive response to therapy and one experiencing a poor response were studied from each type of therapy. Different patterns of arousal characterized the different group therapy modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of substance abuse in psychotherapy clients: The effectiveness of the MMPI-2 substance abuse scales.

The Minnesota Multiphasic Personality Inventory—2 (MMPI—2) contains 3 scales, the MacAndrew Alcoholism Scale—Revised (MAC—R), the Addiction Potential Scale (APS), and the Addiction Acknowledgement Scale (AAS), that were developed to identify alcohol and drug abusing individuals. The current study was designed to measure the effectiveness of these scales at detecting substance abuse problems in a community-based mental health sample. MAC—R, APS, and AAS scores were obtained from 64 therapists who identified 68 substance abusing and 392 nonabusing psychotherapy clients. The results indicated that mean scores on all 3 scales were higher for the substance abusers than for nonabusers. Furthermore, discriminant analysis found all 3 scales to be effective screening tools. The AAS was the best single predictor, and a combination of the AAS and MAC—R provided the best overall discrimination. The implications of early substance abuse detection on treatment effectiveness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 Between Two Tribes and With the MMPI-2 Normative Group.

The comparability of the MMPI-2 in American Indians with the MMPI-2 normative group was investigated in a sample of 535 Southwestern and 297 Plains American Indian tribal members with contrasting sociocultural and historical origins. Both American Indian tribal groups had clinically significant higher T scores (>5 T points) on 5 validity and clinical scales, 6 content scales, and 2 supplementary scales than did the MMPI-2 normative group. There were no significant differences between the 2 tribal groups on any of the MMPI-2 clinical, content, or supplementary scales. Matching members of both tribes with persons in the MMPI-2 normative group on the basis of age, gender, and education reduced the magnitude of the differences between the 2 groups on all of these scales, although the differences in T scores still exceeded 5 T points. It appears likely that the MMPI-2 differences of these 2 American Indian groups from the normative group may reflect their adverse historical, social, and economic conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting termination and continuation status in psychotherapy using the transtheoretical model.

Measures from the transtheoretical model of change (TMC) were compared to traditional client characteristic variables as predictors of psychotherapy client termination and continuation. According to the TMC, stages of change, processes of change, decisional balance, and levels of attribution are core dimensions of behavior change in psychotherapy. 60 pairs of therapists (mean age 35 yrs) and 18–71 yr old clients were given questionnaires assessing demographics, distress symptoms, and dimensions of the TMC. Therapists also completed an Assessment of Client's Termination Status questionnaire. Client characteristics were not significant predictors but the transtheoretical variables of stages of change, processes of change, and decisional balance for therapy were excellent predictors. A discriminative function analysis correctly classified 92% of the clients into two groups: (1) premature terminators and (2) appropriate terminators and therapy continuers. Discussion focused on the importance of matching therapy to client's stage of change in order to reduce the average rate of 40% of clients terminating therapy prematurely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying early dropouts from psychotherapy.

A rapid method of identifying those patients not likely to remain in treatment over an initial period was developed using patients' self-ratings on the Counseling Readiness Scale (CRS) derived from the Adjective Check List and ratings by the intake worker. These data were collected on all applicants to a student counseling service for 2 1-yr periods. The CRS and interview ratings were tested singly and in various combinations to find those that discriminated between early terminators and those remaining in treatment. In the 1st sample (106 Ss), the optimal screen consisted of any 2 of the following: a CRS score of 63 or below by the intake worker on "difficulty of remaining in treatment," and/or on "patient's ability to generate inner life data in the interview." This multiple criterion was cross-validated on a 2nd sample of 89 cases. 62% of those predicted to drop did. Finally, in a 3rd sample (36 Ss) selected to meet this criterion, 62.5% failed to return except for those receiving special preparatory training. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature termination in the midst of psychotherapy: Three psychoanalytic perspectives.

Reviews the perspectives of the drive/structural, object relations, and self-psychology models as to premature termination. A case history is presented of a man in his late twenties who ended therapy after 2.5 yrs. Examining the commonalities in the application of the 3 models, a central issue is apparent: the man's conflicts over dependency. Whether these conflicts are construed as resistance to experiencing passive feminine desires, as separation–individuation conflicts, or as fears of retraumatization by an unattuned self-object, issues of dependence are central to the patient's leaving treatment prematurely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach and TAT indices of homosexuality in overt homosexuals, neurotics, and normal males.

Rorschach and TAT protocols of 20 male overt homosexuals, 20 male neurotics, and 20 normal male students were compared in order to determine whether proposed homosexual signs were discriminative. The homosexual group gave a significantly greater mean number of the Rorschach and TAT signs than did either nonhomosexual group. "Within the homosexual group, correlation between the number of Rorschach signs and number of TAT signs produced by each S proved significant, serving as a check on the validity of both schemes and indicating the consistency of these 2 diverse measures of homosexuality." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The termination process in open-ended psychotherapy: Guidelines for clinical practice.

Presents observations from survey and clinical material from 20 psychotherapists concerning how they handle termination. It is noted that countertransference frequently creates complex reactions in therapists that can confuse and prolong the therapeutic process. Suggested guidelines for termination in open-ended therapy are discussed, including overt discussions at the outset of therapy regarding how termination will be identified and handled, awareness of cues that indicate the therapeutic relationship is changing, provision for a final review of treatment, and continued availability of the therapist following termination of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comparability of MMPI and MMPI-2 scales and profiles.

The revised form of the Minnesota Multiphasic Personality Inventory (MMPI-2) incorporates a number of changes that necessitate an investigation into the comparability of its scale scores and clinical profile to those of the original MMPI. In the current study, differences between scores obtained by 189 college students who completed both the original and revised forms of the MMPI were compared with differences between scores obtained by 188 other students who were administered the original form twice. Results indicated substantial congruence between the cross-administration stability of scores and profiles obtained by the two groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between the Rorschach and assessment of the capacity to engage in short-term dynamic psychotherapy.

Administered the Rorschach and a capacity-for-dynamic-process scale to 42 adults (aged 18–65 yrs) in short-term psychotherapy. A 5-variable stepwise regression model demonstrated a strong association between personality attributes assessed through the Rorschach and judgments of Ss' potential for engaging in dynamic psychotherapy. Common factors from Rorschach protocols were organizational activity, deviant responses, and experience potential. Texture and lambda were unique predictor variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)