Improving peer supervisor ratings of therapist performance in dialectical behavior therapy: An Internet-based training system.

The present study involved the development of an Internet-based training system (ITS) to help train peer supervisors. The system, which was piloted with Dialectical Behavior Therapy (Linehan, 1993) using mock sessions, demonstrates how Internet-based technology can facilitate training protocols to support the ongoing training and supervision of therapists efficiently. Participant evaluation of the system was very positive, with over 90% of respondents reporting that they believed that the ITS was very useful or extremely useful for therapist training. Possible uses of the system include: (a) helping therapists to learn to discriminate more effective from less effective interventions to provide better feedback to supervisees and peers on their sessions, (b) helping therapists to improve their own ability to monitor and deliver a treatment effectively, and (c) helping to structure therapist training and supervision activities. The system could also be used to help with real-world supervision of therapists, assuming that legal and ethical issues associated with the use of the Internet for clinical supervision are addressed adequately. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disrupting defensive family interactions in family therapy with delinquent adolescents.

This study compared the immediate impact of therapist reframing, reflection, and elicit-structure interventions on family-member defensive communications in the initial session of family therapy with a delinquent adolescent. Defensive statements included family-member statements that criticized, blamed, or disagreed with other family members. Sequences of behaviors following defensive family-member statements were examined to determine which therapist interventions were the most effective in disrupting defensive family interactions. Thus, every sequence included a defensive family-member behavior, a therapist intervention, and a family-member response (sequence: family defensive → therapist intervention → family response). Results indicated that therapist reframing is more effective than other therapist interventions in reducing family-members' defensive statements. Moreover, adolescents responded more favorably to reframes than did fathers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. 29 depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression, Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of change for multisystemic therapy with juvenile sexual offenders.

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months postrecruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their caregivers. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months postrecruitment, and 12 months postrecruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youth’s bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems.

This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of adherence predicted the largest declines in internalizing behaviors, with high and low adherence predicting smaller improvements (curvilinear effect). Therapist competence did not predict outcome and did not moderate adherence-outcome relations; however, competence findings are tentative due to relatively low interrater reliability for the competence ratings. Clinical and research implications for attending to both linear and curvilinear adherence effects in manualized treatments for behavior disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early disruptive behavior, poor school achievement, delinquent behavior, and delinquent personality: Longitudinal analyses.

Three alternative models concerning the causal links between early disruptive behavior, poor school achievement, and delinquent behavior or antisocial personality were tested with linear structural equation modeling. Ss were boys and girls followed from 1st grade to age 14 yrs. Disruptive behavior was assessed in Grade 1; school achievement was assessed in Grades 1 and 4; delinquent behavior and antisocial personality were assessed at age 14 yrs. With regard to self-reported delinquent behavior at age 14 yrs, results indicate that the best model for boys was a direct causal link between Grade 1 disruptive behavior and delinquent behavior. Poor school achievement was not a necessary causal factor. For girls, none of the tested models were a good fit to the delinquent behavior data. As for delinquent personality, results indicate that, for boys and girls, poor school achievement was a necessary component of the causal path between Grade 1 disruptive behavior and age 14 delinquent personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent and therapist evaluation of behavior therapy in a child psychological clinic.

Obtained evaluations from the parents of 70 children who were treated by psychological interns being trained in behavior therapy. Therapist ratings of specific problem improvement were obtained at close of therapy. Improvement ratings of the same specific problems were obtained from parents approximately 6 mo later. Classification of an S as improved or unimproved depended on the averages of both the therapist and parent ratings of the presenting problems. This procedure indicated overall improvement in 87 and 90% of the cases, based on therapist and parent averages, respectively. Therapists rated 80% of all specific problems improved at termination, as compared to 77% of problems improved as rated by parents at follow-up. Correlation between the improvement ratings of each problem by parent and therapist was highly significant (r = .51). 96% of the parents liked their therapists, and personal characteristics most frequently noted by the parents were warmth, understanding, and sincere interest in the S. The high improvement rates reported by therapists and parents are discussed in regard to previous therapy outcome studies with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy.

This study examined whether (a) therapist behaviors thought to enhance family treatment predicted caregiver in-session responses, and (b) caregiver race, racial match between caregiver and therapist, and family financial hardship moderated the relationships between therapist and caregiver behavior. Observers coded caregiver and therapist behavior during one session of multisystemic therapy for substance abusing adolescents. Therapist teaching, focusing on strengths, making reinforcing statements, problem solving, and dealing with practical family needs predicted caregiver engagement and/or positive response, regardless of race, racial match, or financial hardship. Caregiver race, financial hardship, and therapist–caregiver racial match occasionally moderated the relationship between other therapist and caregiver behaviors. Findings suggest both commonalities and differences in how therapist behavior may function to engage caregivers in family treatment, depending on diversity-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sustaining engagement: A change event in family therapy.

In response to the call for researchers to identify components of family treatment that are common across theoretical approaches (e.g., A. S. Gurman, 1988), a qualitative analysis was undertaken of an important change event in family treatment: sustaining engagement (SE). Using R. C. Bogdan and S. K. Biklen's (1992) modified analytic induction method, a sample was identified of successful SE events, that is, therapeutic episodes in which family members move from disengagement with each other to sustained engagement on a problem-solving task. Videotapes of 33 sessions were scrutinized to develop and refine the operational definitions of disengagement and sustained engagement. After 2 reviewers independently verified the selection of 8 SE events, a qualitative comparison was conducted of the interpersonal dynamics in the 4 successful vs the 4 unsuccessful events. The resulting conceptual model of the SE change process is described, followed by suggestions for continued research on this therapeutic event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis.

Cognitive-behavioral psychotherapies (CBT) are among the first-line interventions for major depressive disorder (MDD), and a significant number of studies indicate their efficacy in the treatment of this disorder. However, differential effects of various forms of CBT have seldom been analyzed in the same experimental design. On the basis of data collected in a randomized clinical trial comparing the efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy (SSRI) in the treatment of MDD, the present article investigates the theory of change advanced by REBT and CT. Measures included to test the two theories of change assess three classes of cognitions: (a) automatic thoughts, (b) dysfunctional attitudes, and (c) irrational beliefs. The results indicate that REBT and CT (and also pharmacotherapy) indiscriminately affect the three classes of cognitions. On the long term (follow-up), a change in implicit demandingness seems more strongly associated with reduced depression and relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence process research in family therapy: A rationale and some practical guidelines.

Suggests that treatment adherence research has recently established a permanent niche in psychotherapy outcome research as a means for testing whether interventions have been implemented as intended. Advanced-level adherence methods allow investigators to move beyond treatment integrity questions regarding model fidelity and toward treatment process questions regarding therapeutic technique and intervention dosage. Though still in the developmental stage, treatment adherence process procedures appear to be congruent with the methods, goals, and theoretical framework that characterize contemporary psychotherapy process research. Because adherence process research is virtually absent from the family therapy research literature, practical guidelines are presented for conducting observational-based adherence research on family therapy models, using the example of Multidimensional Family Therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing peer praise of socially rejected delinquent youth: Effects on cooperation and acceptance.

This study assessed the effects of positive peer reporting (PPR) on the cooperative behaviors and peer acceptance of 3 socially rejected, delinquent youths (2 males and 1 female) in residential care. PPR involved rewarding classroom peers with token points for publicly praising the social behavior of target students. A nonconcurrent multiple baseline was used to assess the effects of the procedure. Results indicated that PPR increased the use of cooperative statements made to peers. For all 3 students, PPR also led to increases in their peer status. Social validity measures indicated high treatment acceptability and a match between the amount of cooperative behavior emitted by participants and randomly selected classmates. Findings support the use of peers as sources of reinforcement for a rejected youth's prosocial behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Standing up for a change: Reducing bias through interpersonal confrontation.

Three experiments examined the effectiveness of interpersonal confrontations as a means for decreasing stereotypic responding. After making stereotypic inferences about Black individuals, participants were confronted and reactions were measured across various intrapersonal and interpersonal response domains. Confrontations varied in level of hostility (Experiment 1) and whether they were expressed by a Black or White person (Experiment 2). Results indicate that although confrontations (and particularly hostile ones) elicited negative emotions and evaluations toward the confronter, participants also experienced negative self-directed affect. Furthermore, regardless of who did the confronting or how much hostility was expressed, confronted participants subsequently were less likely to provide stereotypic responses (Experiments 1-2), and the effect of the confrontation generalized to reporting less prejudiced attitudes (Experiment 3). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Rational emotive behavior therapy: A therapist’s guide.

Reviews the book, Rational emotive behavior therapy: A therapist’s guide by Albert Ellis and Catharine MacLaren (see record 1998-06395-000). In this book, the authors first provide an overview of the history and theory of Rational Emotive Behavior Therapy (REBT). They review the philosophical and personality theory foundations of REBT and outline the theory's explanations of personality disturbance and change. Next, the authors turn to the specific intervention techniques used as part of REBT treatment. They present cognitive, experiential, and behavioral techniques, and include specific case examples of each. Finally, the authors discuss the integration of REBT with other systems of therapy and include an Appendix regarding maintaining and enhancing therapy gains. The strength of the book is in the second set of chapters, which provide an overview of specific therapeutic techniques. These chapters were clear and engaging and offer the therapist-reader concrete strategies which can be easily implemented. The earlier chapters, which provide an overview of the theory of REBT, do not work quite as well as those on treatment techniques. The organization is somewhat confusing and there appears to be some redundancy to the material presented. However, this volume would likely work well as either an introduction to REBT or as a quick, easily readable review for those familiar with the approach. It would also be appropriate for students in clinical training, who will find the hands-on techniques particularly useful. Those who use this book as an introduction to REBT, and who find the approach fits their style and philosophy, will likely want to do more in-depth reading on the subject. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on adherence, behavior change, and mental health: A workshop overview.

The National Institute of Mental Health sponsored a research workshop in 1999 to examine the potential of various theoretical approaches for enhancing adherence and behavior change, with special attention to mental disorders as mediators and outcomes. Complementary, multiple levels of analysis—including individual, small-group, community, and cultural perspectives—were considered. Working groups identified problems and gaps in knowledge that if addressed would transform adherence and behavior change from overlooked or nuisance variables to critical variables in research on mental and medical disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude change through reward of verbal behavior.

"72 Ss were induced to engage in debates on 3 different issues, taking sides opposite to those which they had indicated as their own in an opinion pretest. Half of the Ss were rewarded, in a predetermined order, by a purported vote which proclaimed them the better debators, while the other half were punished by presumably losing the debate. Posttests of Ss' opinions showed a tendency of the 'winners' to change their opinions in the direction of their debates, while the 'losers' did not change significantly. A control group of nondebators likewise showed no significant change in opinions." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of peer support and therapist contact on long-term weight loss.

This study evaluated the effectiveness of two posttreatment programs designed to enhance the maintenance of weight loss. Eighty-five obese clients were randomly assigned to either (a) behavior therapy plus a peer-support maintenance program, (b) behavior therapy plus a therapist-contact maintenance program, or (c) behavior therapy only. At a 7-month follow-up session, the therapist-contact program resulted in significantly greater maintenance of weight loss compared with the peer support and behavior therapy only conditions. However, by the time of an 18-month follow-up assessment, overall relapse rates were equivalent across conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management.

Adherence of therapists to behaviors specified in cognitive-behavior therapy, interpersonal therapy, and clinical management manuals was studied. Raters used the Collaborative Study Psychotherapy Rating Scale (CSPRS) to rate therapist adherence in each of 4 sessions from 180 patients in the treatment phase of the National Institute of Mental Health Treatment of Depression Collaboration Research Program. Results indicate that therapists exhibited more behaviors appropriate to their own respective treatment approaches than to other treatment approaches. In fact, the 3 treatments could be discriminated almost perfectly using the CSPRS. Analysis of the psychometric properties of the CSPRS revealed high interrater reliability and high internal consistency. However, a 5-component structure extracted from the intercorrelations of the CSPRS items was substantially different from a 5-factor structure found in an earlier study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist adherence in brief strategic family therapy for adolescent drug abusers.

Objective: Therapist adherence has been shown to predict clinical outcomes in family therapy. In prior studies, adherence has been represented broadly by core principles and a consistent family (vs. individual) focus. To date, these studies have not captured the range of clinical skills that are represented in complex family-based approaches or examined how variations in these skills predict different clinically relevant outcomes over the course of treatment. In this study, the authors examined the reliability and validity of an observational adherence measure and the relationship between adherence and outcome in a sample of drug-using adolescents who received brief strategic family therapy within a multisite effectiveness study. Method: Participants were 480 adolescents (age 12–17) and their family members, who were randomized to the Brief Strategic Family Therapist treatment condition (J. Szapocznik, U. Hervis, & S. Schwartz, 2003) or treatment as usual. The adolescents were mostly male (377 vs. 103 female) and Hispanic (213), whereas 148 were White, and 110 were Black. Therapists were also randomly assigned to treatment condition within agencies. Results: Results supported the proposed factor structure of the adherence measure, providing evidence that it is possible to capture and discriminate between distinct dimensions of family therapy. Analyses demonstrated that the mean levels of the factors varied over time in theoretically and clinically relevant ways and that therapist adherence was associated with engagement and retention in treatment, improvements in family functioning, and reductions in adolescent drug use. Conclusions: Clinical implications and future research directions are discussed, including the relevance of these findings on training therapists and studies focusing on mechanisms of action in family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School functioning in early adolescence: Gender-linked responses to peer victimization.

Research indicates that peer victimization contributes to poor school functioning in childhood and adolescence, yet the processes by which victimization interferes with school functioning are unclear. This study examined internalizing and externalizing problems as domain-specific mediators of the association between subtypes of peer victimization (relational, physical) and school functioning (engagement, achievement) with a cross-sectional sample of 337 early adolescents. School engagement was examined further as a proximal process that intervenes in the associations between internalizing and externalizing problems and achievement. Gender differences in these associations were assessed. As expected, internalizing problems showed stronger links with relational than with physical victimization and partially mediated the influence of both on engagement for girls but not boys. Externalizing problems partially mediated the influence of both subtypes of victimization on school functioning for girls and physical victimization for boys. Notably, engagement was a robust mediator of the contributions of internalizing problems and physical victimization to achievement for girls and externalizing problems to achievement for girls and boys. Findings also suggest that physical (but not relational) victimization partially mediates the link between internalizing and externalizing problems and school functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)