Counselor theoretical orientation as related to intake judgments.

Investigated the relation between the predominant theoretical orientations (self-identified) of counselors and intake interview judgments by asking 12 senior staff counseling psychologists to rate the problems of 1,443 university students who presented themselves for an intake interview on a 5-point scale. Results show that counselors who were humanistically oriented judged that their clients presented more severe educational problems and characterized their clients as more anxious than did the cognitively oriented psychologists. The 2 groups of counselors did not differ in how they judged the severity of personal problems or predicted length of treatment. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes.

Extending an earlier report of 6-month outcomes, this study reports 12- and 18-month follow-up data for clients (N?=?188) entering a therapeutic community drug treatment program who were randomly assigned to day or residential treatment conditions. Outcomes included Addiction Severity Index composite scores and measures of depression, psychiatric symptoms, and social support. Both groups showed significant change over time. The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity. Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic and treatment overshadowing of vocational problems by personal problems.

Investigated 165 counseling psychologists' vocational diagnostic and treatment decisions when vocational and personal problems are presented concurrently. Participants assessed the same vocational problem either alone or in conjunction with a personal problem of one-half, equal, or double the severity of the vocational problem. Without consideration for counselors' problem preference, ratings of the vocational problem were equivalent across the 3 personal problem severity levels. However, with preferences considered, counseling psychologists who reported greater preference for working with personal problems, in comparison to vocational problems, were less likely to assess, diagnose, and treat the vocational problem than were counseling psychologists who reported equivalent or reversed problem preferences. This biasing effect occurred when the personal problem was of equal or double the severity of the vocational problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: Replication in a larger sample.

Replicating a previous study (M. Barkham et al., 2006), the authors examined rates of improvement in psychotherapy in United Kingdom primary care settings as a function of the number of sessions attended. Included in the study were adult clients who returned valid assessments at the beginning and the end of their treatment, had planned endings, began treatment above the clinical cutoff score, and were seen for 20 or fewer sessions (N = 9,703; 72.4% female; 87.7% Caucasian; average age = 40.9 years). Clients' average assessment scores improved substantially across treatment, with a pretreatment-posttreatment effect size of 1.96; 62.0% achieved reliable and clinically significant improvement (RCSI). Clients' mean pretreatment-posttreatment change was approximately constant regardless of treatment duration (in the range of 0 to 20 sessions); the RCSI rate decreased slightly with treatment duration, as fewer clients fell below the cutoff at longer durations. Results were interpreted as suggesting that therapists and clients tend to make appropriately responsive decisions about treatment duration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. (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)     

Predictors of the longitudinal course of postpartum depression following interpersonal psychotherapy.

Objective: We examined the course and predictors of postpartum depression in the 18 months following interpersonal psychotherapy (IPT). Method: We enrolled 120 community women with major depression in a 12-week randomized trial of individual IPT during the postpartum period (O'Hara, Stuart, Gorman, & Wenzel, 2000). At 6, 12, and 18 months posttreatment, women participated in clinical interviews to establish the course of depression over the previous 6 months. We used survival analyses to characterize recovery and recurrence in the follow-up and growth curve modeling techniques to identify predictors of change in depression during the follow-up period. Potential predictors included severity, chronicity, and personal history of depression. Results: Of 35 women who recovered with acute treatment, 20 (57%) achieved sustained recovery during follow-up; average time to recurrence was 33.40 weeks (SD = 18.43 weeks). Over 80% of women who did not recover with acute treatment experienced recovery at some point during follow-up; average time to recovery was 28.60 weeks (SD = 17.51 weeks). Time depressed each month decreased over the follow-up period. Posttreatment depressive severity and length of the index episode predicted changes in depression over time. Posttreatment depression severity, personal history of depression, and weeks of treatment in the follow-up were significant predictors of time depressed during follow-up. Conclusions: IPT resulted in long-term benefits past the termination of acute treatment, even for women who did not initially recover. Though the vast majority of women who did not recover with acute treatment did recover during the follow-up period, continuation of IPT may accelerate the process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disabuse of the drug metaphor: Psychotherapy process-outcome correlations.

The drug metaphor suggests that if a process component (e.g., interpretation) is an active ingredient of a successful psychotherapy, then administering a relatively high level of it should yield a relatively positive outcome, and levels of the process component and the outcome should be correlated across clients. Measures of 5 theoretically relevant, reliably measured verbal process components were compared with the rate of change in 3 standard symptom intensity measures across the brief treatments of 39 (mainly depressed) psychotherapy clients. The expected significant process-outcome correlations were not found. These results are discussed as they illuminate some misleading assumptions that underlie many conventional studies of psychotherapy process and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Successful outcome and number of sessions: When do counselors think enough is enough?

60 counselors rated 166 female and 97 male clients seen at a university counseling center over a 3-yr period on 4 outcome measures: psychic distress, interpersonal relations, performance, and overall severity of client's problem. Improvement was studied as a function of the number of weekly sessions for which clients were seen. Results reveal that through 20 sessions there was a strong and consistent (across all outcome measures) positive linear relationship between treatment length and counselor-assessed outcome. After 20 sessions, however, additional counseling was no longer associated with further increases in the rate of improvement. The "failure zone" reported in some earlier studies was not observed. The implications of these findings for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lack of synchronized seasonal variation in the intensity of psychological problems.

Temporal variation in the subjective intensity of psychological problems identified by 40 psychotherapy clients (most diagnosed as depressed) was investigated longitudinally. Each client rated the intensity of 10 individualized problems 3 times per week (on Tuesdays, Thursdays, and Sundays) for an average of 6 mo. Ratings from all clients were spread over 3 yrs. When scores were statistically adjusted for client differences and average rate of improvement, no significant variation among months was found, regardless of problem content or client gender. Standard assessment measures administered 4 times to each client also failed to show systematic seasonal variation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing as a therapist: Stress-related growth through parenting a child in crisis.

Stress-related growth following a variety of highly stressful experiences is receiving increased attention. However, one area that has not yet been addressed is the growth that therapists may experience in their own personal life through encounters with trauma and personal struggles and how this growth might carry forward to the work that they do with their clients in the practice of psychotherapy. In the present article, the authors describe stress-related growth and use it as a framework to examine the stressful experience and ultimate growth of a therapist dealing with a family member's emotional crises. Three areas of her growth as a therapist are examined: strengthened understanding of the therapeutic process from the client's viewpoint, additional strategies for approaching the change process, and increased empathy for parents and clients. The article concludes with recommendations for therapists experiencing personal struggles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing a model of change in the experiential treatment of depression.

In this study, we measured emotional processing and the alliance across 3 phases of therapy (beginning, working, and termination) for 74 clients who each received brief experiential psychotherapy for depression. Using path analysis, we proposed and tested a model of relationships between these 2 processes across phases of therapy and how these processes relate to predict improvement in the domains of depressive and general symptoms, self-esteem, and interpersonal problems after experiential treatment. Both therapy processes significantly increased across phases of therapy. Controlling for both client processes at the beginning of therapy, working phase emotional processing was found to directly and best predict reductions in depressive and general symptoms, and it could directly predict gains in self-esteem. Within working and termination phases of therapy, the alliance significantly contributed to emotional processing and indirectly contributed to outcome. Surprisingly, beginning therapy alliance (measured after Session 1) also directly predicted all outcomes. Furthermore, only clients’ beginning therapy process predicted reductions in interpersonal problems. Therefore, although the proposed theory of change was supported, clients’ beginning therapy processes may constrain clients’ success in experiential treatment and in particular their outcomes in some problem domains related to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms of symptom reduction in treatment for obsessions.

Objective: We explored the dynamic relationship between cognition and obsession severity during 2 different treatments for primary obsessions, examining evidence for the hypothesis that symptom reduction would be mediated by appraisals about the meaning of unwanted intrusive thoughts. Method: Data from a recent randomized controlled trial were analyzed with traditional mediation analyses and latent difference scores. The trial had compared cognitive behavioral therapy and stress management training among 73 patients with primary obsessions. Mediation analyses were conducted with pre-, post-, and follow-up scores on the Obsessions subscale of the Yale–Brown Obsessive Compulsive Scale and 2 self-report measures of cognitions related to obsessive-compulsive disorder. Bivariate dual change score (BDCS) analyses were conducted with weekly assessments of obsession severity and appraisals of personal significance. Results: Change in most cognitions related to obsessive-compulsive disorder accounted for reduction in obsession severity during the course of treatment and follow-up. BDCS analyses of the longitudinal data, however, indicated prior obsession severity is a leading indicator of subsequent change in appraisals, rather than the reverse. Analyses also suggested cognitive behavioral therapy is more effective than stress management training when symptoms are severe and that stress management training is more advantageous in the context of mild-to-moderate obsessions. Conclusions: The traditional mediation analysis indicated that appraisal change is a tenable mediator of obsession reduction, but the BDCS results raise doubts about the causal direction. The results highlight the importance of examining the dynamic relationship between putative mediators and outcome variables, and they suggest interesting hypotheses about mechanisms in treatment of obsessions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The professionalization of English prison psychologists.

Currently, about 90 psychologists are employed in the English prison service. Their major tasks are to (a) advise the prison governor and senior managerial staff on such topics as staff morale, inmate management, and communication; (b) train the staff; (c) diagnose, assess, and interpret psychological test information to match treatment to the inmate in allocation decisions; (d) provide treatment (e.g., individual and group counseling and psychotherapy, social skills training, and behavior modification); and (e) conduct research, especially on the effectiveness of treatments, the prediction of behavior after release, and validity of psychological tests and other assessment techniques. Major professional problems facing prison psychologists are (a) ethical issues (e.g., confidentiality, informed consent, and whether their clients are the prison staff or the prisoners; (b) restrictions on communication with professional colleagues; (c) lack of a recognized training course; (d) their status as specialist advisers rather than as part of the management structure; and (e) their lack of influence on governmental committees dealing with penal policy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting.

Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused research—a method of enhancing outcome via continuous progress feedback—holds promise to address these problems. Although feedback has been demonstrated to improve individual psychotherapy outcomes, no studies have examined couple therapy. The current study investigated the effects of providing treatment progress and alliance information to both clients and therapists during couple therapy. Outpatients (N = 410) at a community family counseling clinic were randomly assigned to 1 of 2 groups: treatment as usual (TAU) or feedback. Couples in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment, achieved nearly 4 times the rate of clinically significant change, and maintained a significant advantage on the primary measure at 6-month follow-up while attaining a significantly lower rate of separation or divorce. Mounting evidence of feedback effects with different measures and populations suggests that the time for routine tracking of client progress has arrived. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of congruence between counselor interpretations and client beliefs.

Hypothesized that clients receiving interpretations discrepant from their prior beliefs about the problem would improve more than clients receiving interpretations congruent with their beliefs. 39 undergraduates with procrastination problems were placed into 2 groups according to their beliefs in external factors as the cause of procrastination and in personal effort as the solution to procrastination. They received short-term counseling from an interpretational framework that either contradicted or complemented those beliefs. Two experienced counselors conducted both treatments. Results do not support the hypothesis but provide evidence for the opposite position. Ss in the congruence conditions showed greater expectation to change and a tendency toward greater change and satisfaction with change than those in the discrepancy conditions. A stronger effect, however, was due to the interpretations alone, which substantially changed Ss' beliefs about the cause and controllability of their problems. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and anxiety among women in an urban setting in Zimbabwe

There has been little investigation of the side-effects experienced by women receiving adjuvant carboplatin in the treatment of ovarian cancer. This study aimed to describe the range of problems experienced by patients and to estimate incidence and severity of side-effects over the treatment period. Eleven patients participated and completed a 75-item self-report questionnaire at each course of treatment. Severity of each side-effect was graded from 0 to 4. Patients also stated which had been the worst side effect at each course. The response rate was 94%. Seventy-two side-effects were reported. Fatigue emerged as both the most common and the most 'troublesome' side-effect. Nausea, difficulty sleeping, taste change, and constipation were also ranked highly. Although limited by a small sample size, this study suggests patients undergoing carboplatin experience a wide range of problems, many of which merit further investigation.     

Comorbidity of opiate dependence and mental disorders

In a 5-year-follow-up study of 350 opiate addicts in contact with a drug help system in Hamburg, 272 clients (78%) were interviewed a second time after 1 year. The objective of the study was to examine the correlation between mental disorders and drug consumption and its relationship to clients' general life situation. In the majority of the opiate addicts, a pattern of polydrug consumption was observed, but the amount of drugs consumed was clearly lower after 1 year. In the initial survey, a mental disorder according to ICD-10 could be diagnosed for 55% of the sample. Among groups formed by the severity and course of mental disorders or their symptoms, a significant correlation was observed, particularly at the time of follow-up, between the extent of drug consumption and the course of the mental disorder. Other areas, like physical health or social problems/conflicts, were also related to comorbidity (i.e., heavy drug consumption and/or mental disorder). These interrelationships should be taken into account in treatment, care and guidance to increase the prospects for successful treatment.     

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory. There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)