Less Directiveness by Therapists Improves Drinking Outcomes of Reactant Clients in Alcoholism Treatment.

In this study, the authors examined the impact of the interaction between clients' trait reactance and therapists' directiveness on the effectiveness of psychotherapy treatment for alcoholism. Ratings of videotaped treatment sessions were used to measure clients' reactance (N = 141) and therapists' directiveness. Models tested for the interaction as a predictor of 1-year posttreatment drinking quantity and frequency. Results indicate that directiveness had a negative impact on outcomes for clients at medium and high levels of reactance but did not affect drinking among clients low in reactance. Increased therapist use of interpretation, confrontation, and introduction of topics was most predictive of more frequent and larger quantities of drinking among reactant clients. This study suggests that research on treatment process can yield significant theoretical and clinical benefits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled comparison of psychiatric day treatment and inpatient hospitalization.

59 seriously ill, female, 16-72 yr old psychiatric patients were randomly assigned, after 2-6 wks of inpatient evaluation, to an inpatient or day service where they were evaluated, along with a control group of 34 "usual" day hospital patients, for up to 24 mo. Data from the Psychiatric Status Schedule, Psychiatric Evaluation Form, Dynamic Assessment Scale, and other similar measures indicate that for the range of patients studied, day treatment is, on the whole, superior to inpatient treatment in 5 distinct areas: subjective distress, community functioning, family burden, total hospital cost, and days of attachment to the hospital program. The findings of other controlled studies are confirmed and extended to include previously unreported outcome dimensions and a broader socioeconomic population. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of usual and experimental patients in a psychiatric day center.

In a previously reported study by the authors (see record 1976-28530-001) of inpatient and day hospitalization, 59 seriously ill female psychiatric patients were randomly assigned to an inpatient or a day hospital setting. The present study compared the 29 seriously ill patients randomly assigned to the day hospital with a control group of 34 "usual" day patients. Ss were assessed on 14 outcome measures, some of which were derived from the Psychiatric Status Schedules and the Psychiatric Evaluation Form. The experimental group showed significantly more improvement from baseline to subsequent time periods in 3 distinct areas: global mental status, subjective distress, and family adjustment. The controls, on the other hand, spent fewer nights in the hospital, used the hospital facilities significantly less during the 1st 3 mo, and incurred a significantly lower cost for the same period. Two measures—number of social work contacts and amount of time spent in the treatment milieu—indicated that experimentals initially required more staff effort than controls, but at later time periods the reverse was true. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)