Relation between years of psychotherapeutic experience and conceptualizations, interventions, and treatment plan costs.

In this study we investigated the relation between years of experience and psychotherapists' conceptualizations, interventions, and treatment plan costs. Thirty-eight therapists evaluated two case vignettes containing a psychosocial history and therapy session material. The therapists answered open-ended queries concerning their conceptualizations about the patient, intervention strategies, and treatment recommendations. Independent clinical raters rated the responses, using the Psychotherapy Judgment Rating Scale. Conceptualization and intervention categories associated with the psychodynamic orientation were positively related to years of experience. Categories not associated with the psychodynamic orientation demonstrated negative relations. In contrast to less experienced therapists, the more experienced therapists were more facilitative, rated the patients as more disordered, and recommended more costly treatment plans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic interventions in physical health: Unexpected opportunities.

Agrees with M. E. Olbrisch's (1977) theses on the effectiveness and economic efficiency of psychotherapeutic interventions in physical health. A study of alcoholics is described that found less improvement in physical well-being, compared with interpersonal relations and emotional stability, during abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic interventions in physical health: Effectiveness and economic efficiency.

Reviews the literature to determine (a) whether psychotherapy exerts a favorable influence on physical health, and (b) whether psychotherapy can be employed to change physical health on a cost-effective basis. Research with overutilizers of medical services, surgical patients, and other groups is discussed in terms of methodological adequacy, and problems faced by researchers in these areas are explored. The effectiveness and economic efficiency of psychotherapeutic preparation for surgery is strongly supported. Studies with overutilizers are promising, but randomized experiments are needed. Implications for inclusion of coverage of psychotherapy under national health insurance are discussed. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic and other hospital treatment criteria: The dilemma.

Inconsistent findings with regard to the result of treatment was assumed to be, at least in part, a function of different criteria for improvement utilized. Data regarding 66 items involving test material, demographic, clinical history, and follow-up information were intercorrelated and the matrix factor-analyzed. 7 relatively unrelated factors were found, but of all the items, only one seemed to be related to good post-hospital adjustment: a group therapy rating. It was concluded that a universal criterion for evaluating therapy was not found, but that personal interaction within the hospital was worthy of further investigation. From Psyc Abstracts 36:04:4IE98F. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' conceptualizations of alcoholism: Measurement and implications for treatment decisions.

An understanding of alcoholism scale was developed and tested for assessing the beliefs of 170 treatment providers regarding the nature and causes of alcoholism. Two reliable factors emerged, the 1st of which blended disease, moral, and characterological models (the disease model beliefs subscale), and the 2nd of which emphasized psychosocial factors (the psychosocial beliefs subscale). High scorers on the disease model beliefs subscale were more likely to be in recovery themselves and showed less flexibility in setting treatment goals for clients in an analog task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in moral reasoning: A comparison of the use of justice and care orientations.

Examined the adequacy of L. Kohlberg's (1971) cognitive-developmental model as a representation of female moral reasoning. Specifically, the claims of C. Gilligan (1982) that there are 2 conceptions of morality—one described as a morality of justice, on which Kohlberg's scheme is based, and one described as a morality of care, seen by Gilligan as more representative of female thinking about moral conflict—were studied. 101 male and 101 female undergraduates filled out a self-report questionnaire on moral dilemmas they had experienced. They then rated their use of both justice and care orientations in resolving those dilemmas. Ss also completed the Interpersonal Disposition Inventory and semantic differential items. The use of the 2 orientations was examined in relationship to S gender, sex role, and perceptions of the 2 orientations. Few significant differences were obtained, except that female Ss were more consistent in their use of a care orientation and male Ss were more consistent in their use of a justice orientation. More feminine males were more likely to report the use of a care orientation than less feminine males. Male and female reasoning about moral conflict is examined in the light of these 2 perspectives, and the relationship of sex roles to endorsement of each perspective is discussed. (23 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa.

Examined the relative efficacy of cognitive-behavioral and behavioral treatment approaches for bulimia nervosa. Female bulimic Ss were randomly assigned to cognitive-behavioral, behavioral, or attention placebo conditions. At posttreatment, 92% of the cognitive-behavioral group, 100% of the behavioral group, and 69% of the nonspecific self-monitoring group were abstinent from binge eating–purging. At 6-mo follow-up, 69% of the cognitive-behavioral group, 38% of the behavioral group, and 15% of the nonspecific self-monitoring group were abstinent from binge eating and purging. The results support the conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that directly addresses maladaptive cognitions, problematic behaviors, and the development of more adaptive coping skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The costs of radiosurgical treatment: comparison between gamma knife and linear accelerator

Radiosurgical treatment can be carried out by means of a Gamma Knife or a Linear Accelerator. The Linear Accelerator may be either a single-purpose appliance, exclusively employed in radiosurgery, or an adapted appliance, which is used primarily for fractioned radiotherapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a "dedicated Linac", the latter as an "adapted Linac". Cost accounting data for these alternatives will be discussed under three main categories: investment costs, operating costs, and finally staffing costs. Costs are only considered to the extent that this is necessary to facilitate a comprehensive cost comparison. Factors for which the costs remain the same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or special administration, diagnosis, and image processing. The results and conclusions of this study therefore cannot be employed immediately in the evaluation of cost reimbursement schemes of the type carried out by agencies responsible for social insurance. Here, appropriate complete cost analyses especially for this purpose are required. The final comprehensive cost comparison reveals that the adapted Linac is the most favourable alternative with small annual quantities of patients. With larger numbers of patients the Gamma Knife represents the most favourable from a cost accounting angle. The dedicated Linac accordingly does not have a cost advantage for any of the examined numbers of patients. Clearly the lowest treatment costs per patient can be achieved by employing a Gamma Knife and using it to capacity.     

Contemporary psychotherapists: A national survey of characteristics, practices, orientations, and attitudes.

Surveyed a representative sample of American psychologists engaged in psychotherapy concerning their characteristics, activities, affiliations, theories, and selected attitudes. 410 members (aged 24–79 yrs) of Division 29 (Psychotherapy) of the American Psychological Association responded to an 82-item questionnaire. Survey results are described and compared to the findings of a similar survey by J. C. Norcross and J. O. Prochaska (e.g., see record 1982-21987-001) of American clinical psychologists (Division 12 members). Among the most salient findings were that (1) over 80% of Ss have had personal therapy and highly value these experiences as preparation for providing therapy; (2) individual therapy is the most popular therapeutic modality, but over one-half of the Ss engage in marital and family therapy; (3) while therapists spend relatively small percentages of their time doing research, they do as a group publish and present papers; (4) private practice is the modal affiliation of the Ss and may be the most equitable employment setting; and (5) psychodynamic orientations have experienced renewed preference with eclecticism declining, suggesting a need for more integrative models of therapy. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward comprehensive case conceptualizations in counseling: A visual integrative technique.

Presents a visual method designed to assist counseling practitioners in the development of client problem conceptualizations. A visual display of 9 information categories essential for counseling conceptualization is introduced. The categories are described and conceptual relationships between them are cited, discussed, and displayed using a 2nd visual technique with a case example of a test-anxious female undergraduates. Suggestions are included for use of the technique at prepracticum, beginning practicum, and advanced levels of training. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of housing costs on polydrug abuse patterns: A comparison of heroin, cocaine, and alcohol abusers.

This study evaluated how price of housing affects hypothetical purchasing decisions. Participants (26 heroin, 28 cocaine, and 15 alcohol abusers, and 25 controls) were exposed to 4 conditions in which they "purchased" drugs, food, housing, and entertainment. Whereas income remained constant, housing prices varied across conditions. Except for 23% of heroin abusers, participants purchased housing regardless of cost, so that income increased as housing cost decreased. Demand for food was income inelastic, whereas demand for entertainment was income elastic. Each group showed income elastic demand for their drug of choice. Hypothetical choices were reliable; drug choices were correlated with urinalysis results, and willingness to forgo housing in the simulation was correlated with time spent homeless in real life. This study shows that changes in housing prices may affect choices for drug and nondrug reinforcers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative study of experts' conceptualizations of supervisee reflectivity.

Reflectivity in its most basic sense is focused contemplation and has been touted as an important skill for professionals in practice. As part of an effort to form an integrated theory of reflectivity as it occurs in clinical supervision, 5 experts in practitioner development were interviewed about the attributes of supervisee reflectivity. Respondents' statements from initial interviews were categorized and presented to respondents for discussion in a 2nd set of interviews. Grounded theory analysis (A. Strauss & J. Corbin, 1990) was used to derive a set of final categories. These categories included (a) causal conditions of new information and uncertainty; (b) intervening conditions of supervisee personality, supervisee cognitive capacity, and supervision environment; (c) the process of the supervisee's search for understanding of phenomena in the counseling session; and (d) change in the supervisee's perception, behavior, or long-term growth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic outcome and reduction in medical utilization: A cautionary tale.

Studied the relationship between the offset effect and psychotherapeutic intervention. 22 psychotherapy groups studied were found to be finally composed of 32 therapy dropouts, 10 low changers, and 41 high changers. The total of visits to the health center and the cost of these visits were computed for each S. The data imply that dropouts—patients who might be considered as having the worst psychotherapeutic outcomes—also have the best medical offset outcomes. It is suggested that a single session or a limited number of sessions may have been enough to allow the dropout Ss to at least begin recovery. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions for terroristic trauma: Symptoms, syndromes, and treatment strategies.

Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of the clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and manmade disasters, war and political violence, workplace homicide, and school shootings. This article reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attacks. The article describes the psychological syndromes resulting from terrorism and discusses crisis intervention, individual therapy, and family therapy modalities for treating victims of terror. Last, the role of mental health clinicians in the larger national and international response to terroristic trauma is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of fast-rate, slow-rate, and silent previewing interventions on reading performance

Researchers investigated the effects of three different previewing interventions on the oral reading rates of 12 junior and senior high school students with learning disabilities. Under fast-rate listening previewing (FRLP), students were instructed to follow silently as experimenters read from a text at an average rate that was 77.7% faster than the students' current oral reading rate. During slow-rate listening previewing (SRLP), students followed along as experimenters read at an average rate that was 22.5% faster than the students' reading rate. Students were instructed to read passages silently under silent previewing (SP). Immediately following each previewing intervention, students read the same passage aloud. The number of words read correctly per minute and the number of errors per minute served as dependent variables. The results showed statistically significant decreases in error rates under SRLP and SP. The results also showed that SRLP resulted in statistically significantly fewer errors per minute than FRLP. These results suggest that orally reading while students follow along at a rate much higher than their current reading rates may not be as beneficial as reading aloud at slower rates.     

Clinicians' theoretical orientations: Selection, utilization, and efficacy.

479 clinical psychologists were surveyed regarding their use of and satisfaction with their theoretical orientations, reasons for the selection of their orientations, and the relative influence of their chosen orientations on psychotherapy practice. Contrary to suggestions that clinicians select an orientation largely on inexplicable or accidental grounds, adoption of an orientation was attributed to personal, deliberate choices primarily predicated on clinical experience, personal values, and graduate training. Of 18 possible influences on therapeutic practice, theoretical orientation was rated the most influential and theory of pathology/personality the 2nd most influential, which suggests that clinical psychologists perceive their orientations as pervasive and efficacious therapeutic variables. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental divorce, parent–child bonds, and adult attachment orientations among college students: A comparison of three racial/ethnic groups.

Despite evidence indicating that race/ethnicity and parental divorce may respectively affect perceptions of family and other intimate relationships, the conjoint influences of these sociodemographic variables on self-reports of both early (parent–child) and current (intimate adult) attachment relationships have not been investigated. In the present study, the authors examined (a) the contributions of parental marital status and race/ethnicity to scores on these measures and (b) the relative abilities of parental bonds to predict adult attachment orientations among students from different family backgrounds (i.e., intact and divorced) and from different racial/ethnic groups (i.e., White, Black, and Hispanic/Latino). Results indicated that race/ethnicity and parents' marital status had significant effects on the attachment measures, and that the extent to which parental bonds predicted adult attachment orientations varied among students with different family backgrounds and race/ethnicity. Implications of these findings to the conceptualization of college students' psychosocial development are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing relapse among former smokers: A comparison of minimal interventions through telephone and mail.

This study compared 2 minimal interventions for reducing relapse in ex-smokers. One intervention involved 12-month access to a telephone hot line. In the other intervention, 8 relapse-prevention booklets were mailed to participants over 1 year. The 2 interventions were crossed in a 2?×?2 factorial design, yielding control, hot-line-only, mailings-only, and combined conditions. The criterion of at least 1 week of abstinence at baseline was met by 584 participants, 446 of whom also completed a 12-month assessment. Repeated mailings, but not the hot line, reduced relapse for those participants who had been abstinent for less than 3 months at baseline. At follow-up, 12% of those in the mailings conditions were smoking again compared with 35% in the nonmailings conditions. As predicted, both interventions were effective at attenuating the association between depressive symptoms and poor outcome found in the control condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating children with early-onset conduct problems: A comparison of child and parent training interventions.

Families of 97 children with early-onset conduct problems, 4–8 yrs old, were randomly assigned to 1 of 4 conditions: a parent training treatment group (PT), a child training group (CT), a combined child and parent training group (CT?+?PT), or a waiting-list control group (CON). Posttreatment assessments indicated that all 3 conditions had resulted in significant improvements in comparison with controls. Comparisons of the 3 treatment conditions indicated that CT and CT?+?PT children showed significant improvements in problem solving as well as conflict management skills, as measured by observations of their interactions with a best friend; differences among treatments on these measures consistently favored the CT over the PT condition. As for parent and child behavior at home, PT and CT?+?PT parents and children had significantly more positive interactions, compared with CT parents and children. One-yr follow-up assessments indicated that all the significant changes noted immediately posttreatment had been maintained over time. Moreover, child conduct problems at home had lessened over time. Analyses of the clinical significance of the results suggested that the combined CT?+?PT condition produced the most significant improvements in child behavior at 1-yr follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions.

The relative efficacy of professional and paraprofessional therapists in providing group cognitive-behavioral therapy (CBT) and mutual support group therapy (MSG) was examined. Depressed outpatients (N?=?98) were randomly assigned to CBT or MSG led by either 2 professional or 2 paraprofessional therapists. Results suggest that nonprofessionals were as effective as professionals in reducing depressive symptoms and that clients in the CBT and MSG conditions improved equally. Clinically significant improvement was demonstrated for both conditions. However, following treatment, more patients in the professionally led CBT groups were classified as nondepressed and alleviated than in the paraprofessionally led CBT groups. Additionally, therapist adherence to manual-based treatments was associated with greater improvement in clinician-rated depressive symptoms in both conditions and skills in cognitive restructuring were associated with greater improvement among clients in CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)