Common errors in psychotherapy with Chicanos: Extrapolations from research and clinical experience.

Explicates errors that lead to the underutilization of psychotherapy by Chicanos and errors that therapists are likely to make in working with Chicano patients. Underutilization of psychotherapy is related to the erroneous judgment that the Chicano culture and psychotherapy are incompatible and to the error of looking to the patient variable rather than to the therapist variable as a major factor. The errors in treatment of Chicanos include a tendency to overdiagnose psychopathology, a misunderstanding of the cultural differences relating to formality and personalization of professional relationships, confusion about differences in coping styles, a superficial grasp of the concept of machismo, the misperception of Chicanos as a homogeneous group, and anxiety on the part of the Anglo therapists about topics such as dependency, competition, and sexism. Ways to reduce the errors are offered. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist status, patient diagnosis, and psychotherapy outcome in a psychiatric outpatient population.

Previous research generally has supported the hypothesis that A therapists obtain better therapy outcomes with schizophrenics, while B therapists do better with neurotics. Based on recent evidence, a 2nd hypothesis (super A) has been advanced which predicts that A therapists do at least as well with neurotic patients as do B therapists and that As obtain significantly more positive outcomes with schizophrenics. To examine these hypotheses, the therapy outcomes of 7 A and 4 B therapists, differentiated by their scores on the 23-item Whitehorn and Betz (1957) A-B scale, with their 18 schizophrenic and 18 neurotic patients were examined. A multivariate ANOVA computed for the 2 outcome measures, therapists' ratings of patient improvement and number of therapy sessions, clearly supported the super-A hypothesis. Separate ANOVAs demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support with number of sessions attended as the dependent measure. Of considerable importance was the fact that the addition of ataractic medication to the treatment of schizophrenics did not attenuate the effect of the A-B therapist distinction on therapeutic outcome. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder.

The relationship between therapists and treatment outcome was examined in 14 highly trained therapists who participated in the Multicenter Collaborative Study for the Treatment of Panic Disorder. Overall, therapists yielded positive outcomes in their caseloads; yet, therapists significantly differed in the magnitude of change among caseloads. Effect sizes for therapist impact on outcome measures varied from 0% to 18%. Overall experience in conducting psychotherapy was related to outcome on some measures, whereas age, gender, gender match, and experience with cognitive-behavioral therapy (CBT) were not. Therapists with above- and below-average outcomes were rated similarly on measures of adherence and competency. The results suggest that therapists make a contribution to outcome in CBT for panic disorder, even when patients are relatively uniform, treatment is structured, and outcome is positive. Implications for future clinical outcome studies and for training clinicians are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cotherapists versus single therapists and immediate versus delayed treatment in behavioral marital therapy.

Evaluated the overall effectiveness of behavioral marital therapy (BMT) in aiding distressed couples, and explored the relative effectiveness of (a) cotherapists vs single therapists and (b) immediate treatment vs delayed treatment, which resulted from placing couples on a waiting list. 30 maritally distressed couples (aged 19–59 yrs) were randomly assigned to 1 of 6 treatment conditions, with 5 couples per condition: (a) immediate treatment by Therapist A; (b) immediate treatment by Therapist B; (c) immediate treatment by Therapists A and B as a cotherapy team; (d) delayed treatment by Therapist A; (e) delayed treatment by Therapist B; or (f) delayed treatment by Therapists A and B as a cotherapy team. Ss were administered a battery of tests that included the Marital Adjustment Test and Areas-of-Change Questionnaire. Results indicate that BMT was more effective than no treatment on both self-report measures and 1 of 2 behavioral measures, thus affirming the overall effectiveness of the treatment. A cotherapy team and single therapists were equally effective in producing treatment changes. In addition, overall there were no significant differences between couples receiving therapy immediately and couples treated after a 10-wk waiting period. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erratum to Matthews and Burkhart.

Reports an error in the article "A-B Therapist Status, Patient Diagnosis, and Psychotherapy Outcome in a Psychiatric Outpatient Population" by Jerry G. Matthews and Barry R. Burkhart (Journal of Consulting and Clinical Psychology, 1977, Vol. 45, No. 3, pp. 47S-482), the next to last sentence of the abstract is incorrect. The sentence reads: "Separate analyses of variance demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support, with number of sessions as the dependent measure." The sentence should read: "Separate analyses of variance demonstrated further support for the super-A hypothesis with number of sessions attended as the dependent measure, whereas the interaction hypothesis received support, with therapists' ratings as the dependent variable." (The following abstract originally appeared in record 1978-03783-001) Previous research generally has supported the hypothesis that A therapists obtain better therapy outcomes with schizophrenics, while B therapists do better with neurotics. Based on recent evidence, a 2nd hypothesis (super A) has been advanced which predicts that A therapists do at least as well with neurotic patients as do B therapists and that As obtain significantly more positive outcomes with schizophrenics. To examine these hypotheses, the therapy outcomes of 7 A and 4 B therapists, differentiated by their scores on the 23-item Whitehorn and Betz (1957) A-sub( scale, with their 18 schizophrenic and 18 neurotic patients were examined. A multivariate ANOVA computed for the 2 outcome measures, therapists' ratings of patient improvement and number of therapy sessions, clearly supported the super-A hypothesis. Separate ANOVAs demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support with number of sessions attended as the dependent measure. Of considerable importance was the fact that the addition of ataractic medication to the treatment of schizophrenics did not attenuate the effect of the A-sub( therapist distinction on therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential effects of experiential and problem-solving interventions in resolving marital conflict.

Compared the relative effectiveness of 2 interventions in the treatment of marital discord: a cognitive-behavioral intervention that focused on teaching problem-solving skills and an experiential intervention that focused on emotional experiences underlying interaction patterns. 45 couples seeking therapy were randomly assigned to 1 of these treatments or to a wait-list control group. Each treatment was administered in 8 sessions by 6 experienced therapists whose interventions were monitored and rated to ensure treatment fidelity. Assessment measures included the Dyadic Adjustment Scale; Couples Therapy Alliance Scale; and tests of emotional style, target complaints, goal attainment, and intimacy. Results indicate that the perceived strength of the working alliance between couples and therapists and of general therapists effectiveness were equivalent across treatment groups and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. The effects of the emotionally focused treatment were superior to those of the problem-solving treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the emotionally focused group were still significantly higher than those in the problem-solving group. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common methodological problems in research on the addictions.

Among the common methodological problems in research on the addictions are (a) selective, incomplete, or biased reviews of prior research; (b) reliance on inadequate or incomplete diagnostic criteria in choosing Ss; (c) choice of inappropriate comparison groups; (d) use of inadequate alcoholic analogs when alcoholic Ss are unavailable; (e) failure to adequately account for treatment dropouts; (f) unwarranted choice of single-S over group designs and vice versa; (g) failure to ensure that comparably trained, equivalently committed therapists provide both experimental and control treatments; (h) failure to ensure that patients in both experimental and control treatments receive treatments as therapist- and time-intensive; (i) failure to follow patients for adequate lengths of time posttreatment; (j) failure to provide for adequate, multidimensional treatment outcome measures tapping a full range of patient behavior; (k) failure to exercise restraint, scientific modesty, and criticality in reporting results of one's own research; and (l) failure to recognize differences between statistical and clinical significance. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of effective therapists: Further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient treatment of depression to take longer than did moderately and less effective therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) as a measure of treatment effectiveness in an outpatient training clinic.

This study evaluated the validity of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER), a system that identifies target problems and monitors treatment outcomes. Pre- and posttreatment data were obtained from 78 clients and their therapists in an outpatient training clinic. CASPER scales were significantly correlated with the Brief Symptom Inventory (BSI) and with therapist ratings on the Global Assessment Scale (GAS) at both intake and posttreatment. These measures also showed significant pre- to posttreatment changes. The largest effect sizes were found on CASPER individualized outcome measures. Residual change scores and posttreatment improvement ratings derived from CASPER were significantly correlated with BSI and GAS change scores. There was moderate agreement between clients' and therapists' ratings; clients tended to rate their functioning higher than did therapists on several CASPER scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term, team implemented behaviour modification of speech in a young boy.

Gave a 31/2 yr old male 121/2-hr behavior therapy sessions over a 6-wk period to overcome his lack of verbal communication. Pre- and post-treatment measures of verbalization indicate that treatment increased S's use of clear speech and reduced his use of non-words. The substantial therapeutic gains achieved in such a short-term "crash" program with a team of therapists suggests that the procedure, rather than a single patient-therapist relationship, was responsible for the improvements. Differential reinforcement, as opposed to contingency reversals, was used to demonstrate that the results were due to the treatment. (French summary) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Formation of a therapeutic relationship: Experiences during the initial phase of psychotherapy as predictors of treatment duration and outcome.

Studied the formation of a psychotherapy relationship using self-reports of clients and therapists. Items designed as measures of a set of dimensions considered salient to the process of therapy were incorporated into client and therapist report forms. These were completed separately by clients and therapists immediately following each of the initial 10 sessions. It was hypothesized that report-form dimension scores early in treatment would predict persistence in treatment, duration of treatment, and retrospective evaluations of outcome. Subjects were 91 students (36 males, 55 females) attending a large urban unversity and 19 therapists (10 females, 9 males) on the staff of the university student counseling service. A number of client and therapist dimensions predicted persistence in treatment as early as the 3rd session. Dimension scores failed to predict duration of treatment for remainers, however. A greater number of dimension scores correlated with therapist outcome ratings than with client outcome ratings. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic Treatment: A Meta-Analysis of Outcome Studies.

Multisystemic treatment (MST) is a family- and home-based therapeutic approach that has been found to be effective in treating antisocial youths and that has recently been applied to youths with serious emotional disturbances. In light of the increasing dissemination of MST, this review examines the effectiveness of MST by quantifying and summarizing the magnitude of effects (treatment outcomes) across all eligible MST outcome studies. Included in a meta-analysis were 7 primary outcome studies and 4 secondary studies involving a total of 708 participants. Results indicated that across different presenting problems and samples, the average effect of MST was d = .55; following treatment, youths and their families treated with MST were functioning better than 70% of youths and families treated alternatively. Results also showed that the average effect of MST was larger in studies involving graduate student therapists (i.e., efficacy studies; d = .81) than in studies with therapists from the community (i.e., effectiveness studies; d = .26). In addition, MST demonstrated larger effects on measures of family relations than on measures of individual adjustment or peer relations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders and response to group-oriented evening treatment.

The treatment of patients with personality disorders remains a challenging endeavor. The influence of paranoid, borderline, and dependent personality disorders on 154 patients' responses to an intensive group-oriented evening treatment program was investigated. Possible mediating effects of patient psychological mindedness and work were also investigated. Postsessional work ratings were provided by patients, therapists, and other patients for a small insight-oriented group. Benefit was assessed by using general impressions of overall usefulness, provided by patients and therapists. Results indicated that psychological mindedness had a differential influence on work and outcome for the 3 disorders, but work was related to outcome regardless of the disorders. Implications and limitations of the study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subject characteristics and preferences for different approaches to psychotherapy: A multivariate study.

Examined selected personality variables, sex, age, interpersonal values, and educational level, as antecedents to preferences for a nondirective (Carl Rogers) or directive (Albert Ellis) therapist. Ss were 77 hospitalized psychiatric patients and 77 normal undergraduates. Individual films of the same patient being separately interviewed by the therapists were shown to the Ss on separate days. The Barrett-Lennard Relationship Inventory and an expression of preference for therapists were dependent measures. Ss who preferred the Ellis presentation proved to be more dogmatic (Rokeach Dogmatism Scale, Form E) and externalized (Rotter's Internal–External Locus of Control Scale) than Ss preferring the Rogers presentation. Trait anxiety (Taylor Manifest Anxiety Scale) was only related to therapy preference for the patients. The variables differed in discriminability between preferences, although patients and students were similar in their relative preferences for the 2 therapist orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo controls in psychotherapy research: A sine qua non or a placebo for research problems?

Contends that efforts to transpose to psychotherapy research the definition and the pejorative meanings associated with the medical concept of placebo are inappropriate. Problems in implementing placebo controls in psychotherapy are described, including the difficulty of ensuring that under nonblind design conditions, therapists and their patients will view both the experimental and placebo treatments as comparably credible. Six research issues are reviewed that stem from the definitional requirement that the placebo control for the critical and specific components characteristic of the experimental treatment. These issues are (1) lack of standardization of placebos, (2) lack of standardization of psychotherapies, (3) the problem of viewing psychotherapy as a set of techniques, (4) the difficulty in differentiating placebos from alternative forms of treatment, (5) insensitivity of measures, and (6) limits of generalization. A research strategy is proposed that is more likely than the placebo control model to facilitate the accumulation of knowledge regarding effective elements of psychotherapy. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals.

The effects of 3 90-min eye movement desensitization and reprocessing (EMDR) treatment sessions on traumatic memories of 80 participants were studied. Participants were randomly assigned to treatment or delayed-treatment conditions and to 1 of 5 licensed therapists trained in EMDR. Participants receiving EMDR showed decreases in presenting complaints and in anxiety and increases in positive cognition. Participants in the delayed-treatment condition showed no improvement on any of these measures across the 30 days before treatment, but after treatment participants in the delayed-treatment condition showed similar effects on all measures. The effects were maintained at 90-day follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a theoretical conceptualization of the Whitehorn-Betz A-B scale.

Administered the Whitehorn-Betz A-B scale, the Sundland and Barker Therapist Orientation Questionnaire, and a biographical information blank to 30 male doctoral level counselors. Results of analyses indicate that (a) the therapist's orientation was independent of his A-B disposition; and (b) A therapists were socially dependent conforming, while B therapists were socially independent nonconforming. It is suggested that the results support a complementary hypothesis in which "the counselor is able to model the interpersonal and intrapersonal skills the client lacks." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing play therapists for disaster response: Principles and procedures.

In the wake of numerous recent natural disasters such as the 2004 tsunami and 2005 hurricanes, play therapists have been asked to provide disaster response. However, the role of disaster response interventionists is vastly different from the typical role of play therapists. In order for play therapists to be prepared for disaster response, an explanation of disaster response principles and procedures is needed. This article will help educate play therapists about how to use their play therapy skills and knowledge in a disaster response environment. Specifically, this article will (a) explain basic principles such as following the Incident Command Structure; (b) discuss the play therapist's role in disaster response in light of the phase of disaster; and (c) recommend disaster response procedures. Examples from APT members' response to the tsunami and Hurricane Katrina are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client initial disturbance and outcome in psychotherapy.

Evaluated 34 clients seen by 19 therapists in a counseling center by 6 different criteria of outcome, including pre- and posttherapy MMPI difference scores, and ratings by clients, therapists, and supervisors completed at the end of therapy. Measures of initial disturbance consisted of self-report inventories and ratings by therapists, supervisors, and judges. It was found that in general, none of the measures of rated disturbance were related to outcome criteria, but small to modest inverse relationships were obtained between the measures of subjective disturbance and global ratings of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)