Predicting patient dropout in psychotherapy.

Examined patient dropout on the basis of social class, congruence of patient and therapist attitudes, patient's perception of therapist qualities, and practical issues interfering with coming to treatment. 93 patients seen at intake at an outpatient mental health clinic completed the Barrett-Lennard Relationship Inventory (BLRI). 31 Ss met criteria for dropping out, and 24 met criteria for remaining in therapy. The other Ss could not be categorized as either. A t-test between the 2 groups on BLRI scores revealed only a trend for dropouts to see their therapists more negatively (i.e., less warm, empathic, and genuine) following intake than did nondropouts. Education, therapist–patient congruence, and practical problems did not predict dropout. Early levels of rapport between patient and therapist, it is concluded, are clearly related to patients deciding to remain in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family experience of barriers to treatment and premature termination from child therapy.

Barriers to participation in treatment were proposed as a basis for dropping out of treatment among children seen in outpatient therapy. Families (N?=? 242) of children referred for treatment for oppositional, aggressive, and antisocial behavior participated. The main findings were that (a) barriers to participation in treatment contributed significantly to dropping out of therapy; (b) perceived barriers to treatment were not explained by family, parent, and child characteristics that also predicted dropping out; and (c) among families at high risk for dropping out of treatment, the perception of few barriers attenuated risk. Parent perceptions of the difficulties of participating in treatment (including stressors and obstacles associated with treatment, perceptions that treatment is not very relevant, and a poor relationship with the therapist) influenced who dropped out. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on Miller and Hester's "Inpatient alcoholism treatment: Who benefits?"

W. R. Miller and R. K. Hester (see record 1986-28253-001) conclude that inpatient treatment of alcoholism is no more effective than outpatient treatment of alcoholism for most individuals. However, they fail to adequately distinguish between alcohol abuse and alcohol dependence, draw their conclusions from admittedly methodologically weak studies, and appear to prefer outpatient treatment because it is cheaper. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy with depressed elderly patients: Research considerations.

There is general agreement that depression is the most common functional psychiatric disorder among the elderly, affecting 7–21% of the population. Since so many of the elderly, especially the depressed elderly, suffer from physical disorders that complicate or contraindicate drug therapy, psychotherapy is potentially a highly desirable treatment modality for many depressed persons in the upper age groups. And yet, elderly people are generally excluded from psychotherapy studies for a variety of methodologial, practical, and ethical reasons. As psychotherapy researchers begin to turn their attention to the treatment of the elderly patient, a number of ethical issues and problems of design and implementation of research with this population must be addressed. The present article explores the issues of patient homogeneity, external validity, internal validity, choosing and implementing specific treatment modalities, therapist experience and attitudes, therapist age, reliability and validity of measures, and problems obtaining follow-up information when studying treatment of depressed elderly patients. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of cocaine abusers: Support for a Type A–Type B distinction.

The dysfunction and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A–Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent chemical dependence: Assessment, treatment, and management.

Presents the Comprehensive Assessment and Treatment Model for the assessment, treatment, and management of chemically dependent adolescents (CDAs). This model is based on the assumption that as the chemical dependence increases, functioning in all areas of life decreases. Outcome studies and follow-up questionnaires can be keyed to the domains of functioning contained in the model. The goals of therapeutic intervention with CDAs are abstinence followed by a sober state of mind with nonchemical coping skills. Achievement of these goals requires a continuum of care from inpatient structured treatment centers to outpatient private practice. The therapist should be able to use the appropriate level of care as indicated by the CDA's behavior. The therapist should also use individual and group psychotherapy, urine drug screens, and family therapy to achieve the goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The etiology of alcoholism: A prospective viewpoint.

Reviews previous prospective studies of alcoholism and analyzes data from a new 33-yr prospective study of 456 nondelinquent controls from a delinquency study (S. Glueck and E. Glueck, 1968). Data suggest that presence or absence of South European ethnicity (perhaps as a result of attitudes toward alcohol use and abuse) and the number of alcoholic relatives (perhaps more due to heredity rather than environment) accounted for most of the variance in adult alcoholism explained by childhood variables. Premorbid antisocial behavior also added significantly to the risk of alcoholism. When ethnicity and heredity were controlled, childhood emotional problems and multiproblem family membership explained no additional variance. Thus, the etiological hypotheses that view alcoholism primarily as a symptom of psychological instability may be illusions based on retrospective study. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overlap of clusters of psychiatric symptoms among clients of a comprehensive addiction treatment service.

This article describes the prevalence and overlap of psychiatric symptoms among 2,784 clients of the outpatient programs at a comprehensive addictions treatment facility. The psychiatric symptoms were assessed by a computer-based questionnaire, and the analysis focused on the overlap of symptom clusters (multimorbidity) and their relation to selected intake variables known to be predictors of treatment outcome. Of all clients, 27.4% scored positive for 1, 18.9% for 2, and 22.3% for 3 or more clusters, the most frequent being depression, anxiety, and history of conduct disorder. Multimorbidity was significantly correlated with female gender, unemployment, less social support, cannabis problems, fewer legal problems, and increased treatment engagement. Clients with more substance use disorders presented more psychiatric symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client–therapist value similarity and psychotherapy outcome: A microscopic analysis.

Examined the association between patient–therapist pretreatment value similarity and subsequent improvement in 45 nonpsychotic psychiatric outpatients (aged 19–54 yrs) who were randomly assigned to 22 therapists. Pre-assignment assessment of similarity in 36 value dimensions on the Rokeach Value Survey was investigated to determine how the dimensions influenced symptomatic and global changes in the therapy process. Treatment outcome was assessed both by patient and therapist reports, and the SCL-90 was used to evaluate pre- to posttreatment symptom change on 9 symptom dimensions. In addition, therapists were asked to complete a subjective rating of improvement at the end of treatment. The results indicate that a complex pattern of similarity and differences in specific values promoted maximal improvement. Moreover, specific improvement measures were influenced differently by various patient–therapist value patterns. Generally, therapist ratings of outcome were enhanced by pretreatment dissimilarities in value placed on social ascendance and achievement and similar value emphasis being placed on humanistic and philosophical concerns. Patient ratings of outcome were also enhanced if patient and therapist shared philosophical and humanistic concerns, but were further facilitated if values relating to social attachment and independence were ranked differently for patient and therapist. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of motivational interviewing on participation and outcome in residential alcoholism treatment.

Tested motivational interviewing (a strategy to increase motivation for change) as a preparation for residential alcoholism treatment. 28 consecutive alcoholism admissions to a psychiatric hospital were assigned alternately to receive or not to receive a 2-session motivational assessment and interview shortly after intake, in addition to standard evaluation and treatment procedures. Patients who received the motivational interview participated more fully in treatment (as evidenced by therapist ratings) and showed significantly lower alcohol consumption at a 3-mo follow-up interview. The beneficial effects of motivational interviewing on outcome were mediated by increased participation in treatment. The extent to which the received treatment outcome conformed to patients' pretreatment expectations was predictive of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude similarity, topic importance, and psychotherapeutic attraction.

Studied the effect of attitude similarity and topic importance on attraction in a natural setting by exposing 75 prison inmates, incarcerated for public intoxication, to varying attitudes of a psychotherapist prior to hearing him in a taped therapy session. The therapist's attitudes were either similar or dissimilar to the S's and pertained to either alcoholism (important) or general (unimportant) issues. Attraction was assessed using the Client's Personal Reaction Questionnaire developed by J. D. Ashby et al. A group of control Ss received no attitudinal information. Ss were more attracted to the therapist after receiving alcohol items regardless of degree of similarity expressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude variables associated with patient response to hospitalization.

Administered the CPH Factor Attitude Scale to 51 male veterans before and after treatment in a psychiatric ward, to assess the effects of patient attitudes toward hospitilization. A direct relationship was found between negative attitude and length of hospitalization. However, Ss' attitudes did not (a) change from admission to discharge, (b) predict response to treatment as measured by therapist ratings, or (c) correlate with educational level. In addition, Ss viewed the hospital as more authoritarian than ward personnel. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy.

This investigation examined the relationship between gender (client, therapist, and client/therapist dyad) and various psychotherapy-related variables for clients with mood and/or anxiety disorders. In several instances, both client and therapist gender predicted treatment retention and psychological symptom changes during 3 months of therapy. In general, female clients were more likely to advance beyond the initial intake assessment and also complete 3 months of therapy. Conversely, male clients were more likely to withdraw from therapy after the initial intake assessment. Specific client/therapist gender pairing predicted treatment retention in the mood disorder subsample and trait anxiety symptom severity in the anxiety disorder subsample. Some findings should be interpreted with caution, as there were small group samples in a few of the analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relative roles of bipolar disorder and psychomotor agitation in substance dependence.

Previous studies have shown that both bipolar disorder (BPD) and psychomotor agitation (PMA) are associated with substance dependence. These two findings have yet to be integrated, despite evidence that PMA is closely linked with the bipolar spectrum. Accordingly, the current study examined whether BPD and PMA had unique or overlapping associations with substance dependence disorders. Participants were 2,300 individuals seeking outpatient psychiatric treatment. Before treatment, participants were assessed using structured clinical interviews, which yielded DSM-IV psychiatric diagnoses and clinical ratings of mood symptoms. Current PMA and lifetime BPD were present in 483 and 172 (bipolar I, n = 71; bipolar II, n = 101) participants, respectively. Current PMA and lifetime BPD each were associated with increased prevalence of lifetime nicotine, alcohol, and drug dependence (ORs ≥ 1.52, ps ≤ .0004). These associations remained significant when controlling for demographic characteristics and comorbid psychiatric disorders, except the link between agitation and alcohol dependence, which was reduced to a trend (p = .058). Although BPD and PMA were associated with each other, these two factors demonstrated unique, nonoverlapping relationships to nicotine, alcohol, and drug dependence. Individuals with both PMA and BPD exhibited especially high rates of comorbid substance dependence. The present results replicate and extend previous findings documenting the relations of BPD and PMA to substance dependence. BPD and PMA may represent independent psychopathological correlates of substance dependence. Future research should explore the theoretical and clinical significance of these potentially distinct relations to substance dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric comorbidity with problematic alcohol use in high school students

OBJECTIVE: To delineate the degree to which various levels of problematic alcohol use are associated with psychiatric disorders in adolescents. METHOD: The lifetime occurrence of psychiatric disorders was examined in a community sample of 1,507 older adolescents (aged 14 through 18 years) who were categorized according to their alcohol use (i.e., abstainers, experimenters, social drinkers, problem drinkers, and abuse/dependence group). RESULTS: Increased alcohol use was associated with the increased lifetime occurrence of depressive disorders, disruptive behavior disorders, drug use disorders, and daily tobacco use. There was a trend for increased alcohol use in girls to be associated with anxiety disorders. More than 80% of adolescents with alcohol abuse/dependence had some other form of psychopathology. Alcohol disorders, in general, followed rather than preceded the onset of other psychiatric disorders. Comorbidity was associated with an earlier age of alcohol disorder onset and with greater likelihood of mental health treatment utilization. CONCLUSIONS: Rates of psychiatric comorbidity with problematic alcohol use in adolescents are striking and represent an important therapeutic challenge.     

Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: Role of treatment services.

This study examined the patient and treatment factors associated with 6-month outcome in 649 opiate-, alcohol-, and cocaine-dependent (male and female) adults, treated in inpatient and outpatient settings, in 22 publicly and privately funded programs. Outcomes were predicted by similar factors, regardless of the drug problem of the patient or the type of treatment setting or funding. Greater substance use at follow-up was predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Better social adjustment at follow-up was negatively predicted by more severe psychiatric, employment, and family problems at admission and positively predicted by more psychiatric, family, employment, and medical services provided during treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of Alcohol and Drug Use and Dependence From Adolescence to Adulthood: The Effects of Familial Alcoholism and Personality.

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivation for treatment: A review with special emphasis on alcoholism.

Provides an integrative review of research relating motivational variables and interventions to treatment entry, compliance, and outcome, emphasizing alcoholism and other addictive behaviors. Disadvantages of a trait model of motivation and perceptions of motivation, including agreement, self-label, desire for help, distress, and compliance/dependence, are discussed. Empirical evidence is considered regarding motivational interventions, including advice, feedback, goal setting, role playing, modeling, contingencies, continuity of care, voluntary choice, and modification of behavior attractiveness. Nonspecific aspects of motivation are addressed, including client characteristics (distress, self-esteem, locus of control, severity, conceptual level), environmental variables, and therapist characteristics (hostility, expectancy, empathy). A dynamic conceptualization of treatment motivation is proposed as an alternative to a trait model. (7 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist experience, general clinical ability, and treatment outcome in schizophrenia.

Knowledge of the effect of therapist training and experience on the outcome of treatment of schizophrenic patients is scanty. The present article presents data systematically collected in the course of a controlled comparison of the effects of 5 different treatment methods in schizophrenia (individual psychotherapy, ataractic drug treatment, individual psychotherapy and drug treatment, ECT, and "milieu" care) involving 228 1st-admission schizophrenics without significant prior treatment and 38 psychiatric residents or recently graduated psychiatrists. Among the 23 outcome variables studied (including the Menninger Health-Sickness Scale, the Camarillo Dynamic Assessment Scale, the MMPI, the Communication subscale of the MACC Behavioral Adjustment Scale, and the Clyde Mood Scale), there was not a single instance in which the effect of therapist experience and general clinical ability was significantly related to outcome. There appeared to be, however, differences among therapists' results that were not related to experience and general clinical ability, particularly in relation to the length of time that they kept their patients in hospital. Drug treatment tended to override but perhaps not entirely eliminate these effects. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)