Being transformed: Delivering a psychotherapeutic group intervention targeting repeat suicide attempts

Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.     

The relation of children's everyday nonsocial peer play behavior to their emotionality, regulation, and social functioning

The relations of children's nonsocial behavior to their emotionality, regulation, and social functioning were examined in a short-term longitudinal study. Parents (primarily mothers) and teachers rated children's effortful regulation, emotionality, asocial behaviors, problem behaviors, and social acceptance, and children's nonsocial play behaviors were observed for two semesters. Peers also rated likability. Children's observed reticent activities were related to adults' ratings of high regulation, low externalizing problems, and high asocial behavior, as well as to low anger and low positive emotion. On the other hand, solitary play was associated with low positive emotion and low regulation over time and with high asocial behavior and high peer exclusion. Peer rejection mediated the relation of internalizing emotions (anxiety, low positive emotion) and regulation to solitary play later in the school year, and asocial play mediated the relation of internalizing emotions to both solitary and reticent play behavior.     

Group Treatment with French-Speaking African Survivors of Torture and Its Effects on Clinical Engagement: Can Hope Be Operationalized?

This study examines the clinical engagement of French-speaking African survivors of torture by measuring how often they utilize adjunctive programmatic services (i.e., mental health, social, and legal services) in relation to their involvement with the Francophone support group. Thirty-two clients who attended at least five Francophone group therapy sessions were identified and matched with their counterparts who never attended the Francophone group. We compared the number of services the clients in the Francophone group and the control group utilized, controlling for the number of services the clients utilized before attending the Francophone group. We found that the Francophone group showed significantly greater overall programmatic engagement. For the types of services utilized, the Francophone group sought out more mental health services, but there was no significant difference in social and legal services. These findings suggest that involvement with the Francophone group can be linked to increased levels of programmatic engagement.     

Offender engagement in group programs and associations with offender characteristics and treatment factors: A review

The aim of this review is to establish how offender engagement within group programs has been conceptualized, defined or assessed, and the factors that are associated with it. Existing models describe determinants of engagement and the process of behavioral change, but there is little in the way of theory explaining the process of engagement in treatment and change. Forty-seven studies were reviewed and revealed inconsistent definitions and assessments of engagement as well as inconsistent use of measures which contributes to confusion about the scope of engagement and reflects the lack of theory. Attendance, completion or dropout rates were frequently relied upon, but may not reliably infer engagement. Participation and out of session behaviors in conjunction with one another, reflecting a series of active responses to treatment, may more reliably reflect engagement in treatment and change. A model for offender engagement is presented which might help clarify the role of engagement variables. Offender demographics appeared to be of little value in predicting engagement, with only a small number of psychosocial factors (hostility, impulsivity) predicting low levels of engagement and most others (anger, anxiety) having little influence. Treatment factors (therapeutic relationship, program objectives) were more consistently related to engagement, but are under-researched.     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

Therapieverläufe von Sexualstraftätern

Throughout the past decades evaluation studies on sexual offender treatment have led to controversies. While numerous studies examined the effectiveness of different interventions, the possible underlying mediating mechanisms have largely been neglected. This study took a multimethod approach to investigate the measurability of change processes in sexual offenders serving a sentence in the social therapeutic institution (SothA) of the detention center in Tegel, Germany (n?=?105). A longitudinal design with three groups (i.e. waiting group, treatment group and day release group) from four perspectives on change processes (i.e. external criminal prognostic assessment, therapists’ view, staff observation and clients’ perspective) was employed. Most criminal prognostic risk and protective factors improved over the course of treatment and this effect was smallest in the waiting group. While therapists reported increased therapeutic constraints in the course of treatment, they were more favorable in the criminal prognosis and detected more differentiated patterns of needs and resources of clients as conceptualized by the primary and secondary assets of the good lives model (GLM). In contrast, during the course of treatment the sexual offenders showed an increased awareness of the criminogenically relevant problems in the sexual domain. Nonetheless, the overall number of problems they identified as criminogenically relevant decreased. The internal problem attribution in the sense of internal causes (“It is my fault”) and capability of change (“Only I can solve the problem”) was increased. The stronger the clients’ perception of own problems in the sexual context increased over the course of treatment, the more positive the change in the staff’s view of their behavior became and the more their dynamic risk factors improved. Overall, this study found strong evidence that change processes in SothA might already be detectable during ongoing social treatment. It is currently uncertain whether these changes influence future recidivism. A comparison with recidivism data is necessary and in planning.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Latent profiles of work motivation in adolescents in relation to work expectations,goal engagement,and changes in work experiences

Motivation plays a key role in successful entry into working life. Based on a cross-sectional and a one-year longitudinal study, we used a person-centered approach to explore work-related motivation (i.e., autonomous goals, positive affect, and occupational self-efficacy) among 577 students in 8th grade (Study 1) and 949 adolescents in vocational training (Study 2). Based on latent profile analysis, in both studies we identified four groups that were characterized by different levels of overall motivation and one group characterized by low positive affect and mean levels in autonomous goals and self-efficacy. Profiles characterized by high levels of motivation showed the highest levels of positive work expectations and goal engagement and the lowest levels of negative work expectations in Study 1 and the highest levels of person-job fit, work engagement, and job satisfaction in Study 2. Moreover, latent difference score analysis showed that motivational profiles predicted changes in person-job fit and work engagement across one year but not in job satisfaction. The results imply that career counselors should be aware of characteristic motivational patterns of clients that may require specific counseling approaches.     

Self‐monitoring and the propensity for risk

Apart from earlier research on sexual behavior, little is known about associations between self‐monitoring and engagement in risk behaviors. Our research verified that one component of self‐monitoring, public performing, is related to a range of risk behaviors. We then tested whether the greater engagement of high compared to low self‐monitoring individuals in risk behaviors could be attributed to: (a) greater discrepancies between perceptions of risk and reported risk behaviors for the high‐scoring group; or (b) higher levels of sensation seeking among high versus low self‐monitoring individuals. Data from a sample of 452 college students supported the second of these two explanations. Implications for self‐monitoring theory and measurement, as well as for adolescent and young adult risk behaviors, are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Exploring the Experiences of Individuals With Serious Mental Illness in a Modified Treatment Mall: Centralized Off-Unit Programing With Extended Hours,a Mixed Methods Study

Abstract

Centralized Off-Unit Programing With Extended hours (COPE) is a recovery-oriented model of service that aims to address limited occupational engagement and social isolation among inpatient clients with serious mental illness. This study explored the self-reported outcomes of 12 clients using semi-structured interviews and pre- and post- administration of the Personal Recovery Outcome Measure. These outcomes were supported by significant improvements in personal recovery and included sense of choice, occupational engagement, socialization, change in environment, skill learning, and improved sense of wellness. These findings provide preliminary evidence on the COPE model of service and its potential role in promoting personal recovery.     

An intra‐individual test of the demands‐control model: A weekly diary study of psychological strain in portfolio workers

Twenty‐five years of research on Karasek's job strain model has produced evidence that jobs involving high demands, low control and low social support may produce psychological strain. The present study takes this research in a new direction by using a time‐sampling methodology with a group of portfolio workers (self‐employed individuals who work for multiple clients) to examine whether working weeks that involve more of these characteristics are associated with greater psychological strain. The study also examines whether workers' optimism moderates the intra‐individual relationship between job characteristics and strain. Every week for 26 weeks, 65 portfolio workers completed a diary containing measures of work demands, job control, social support and strain. Multi‐level analyses supported the additive but not the interactive form of the job strain model. However, differences in portfolio workers' optimism moderated an interactive effect of weekly demands and control on anxiety and depression, such that the highest levels of strain were experienced by pessimists under conditions of low control and high demands. The results suggest that psychological strain can vary with temporal variations in job characteristics and that a person‐situation approach is appropriate for understanding these dynamics.     

Interpersonal factors and perinatal depressive symptomatology in a low-income Latina sample

Interpersonal factors are among the risk factors that predispose women to experiencing mood disturbances during the childbearing years. This study investigates the trajectory of change in depressive symptomatology over the course of the perinatal period as related to interpersonal risk factors (marital quality and social support) in a sample of 69 low-income, mostly immigrant Latina mothers at high and low risk for depression. We found a significant linear change in depressive symptomatology from baseline (pregnancy) through the postpartum period. This decline was steeper for high-risk women who reported high levels of social support compared with those who reported low levels of social support. In addition, a greater decline in depressive symptom scores was found for women who reported better postnatal marital quality, irrespective of risk group status. The results suggest the importance of considering marital quality and social support in estimations of risk for depression. These findings also have implications for targeting social support and marital quality in preventive interventions for perinatal depression in Latinas.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

The relationship of clients’ social class to early therapeutic impressions

Using case vignettes that differed in the presentation of the client's social class, the influence of social class on therapeutic impressions was studied in the context of just-world beliefs. Results suggested that (1) participants with higher levels of belief in a just world saw poor and working-class clients as more unpleasant to work with and more dysfunctional and (2) working-class vignettes were associated with the lowest predictions of session depth and smoothness. The findings suggest that counselors may respond differently to clients based on their social class, and in a way that negatively predisposes them toward work with poor and working-class clients.     

Client attractiveness as related to the concept of engagement in therapy

The study examined the relationship between client attractiveness and return for a second appointment using 163 clients and their 10 therapists. Clients rated as more attractive were more likely to return after intake. A further investigation showed that both therapists with a history of higher percentages of returning clients and more-attractive clients have a facilitative effect on therapeutic involvement or engagement.     

The relationship of academic self-efficacy to class participation and exam performance

This study examined the relationship of academic self-efficacy to engagement in class discussion and performance on major course exams among students (N = 165) in an undergraduate human development course. Cluster analysis was used to identify three levels of academic self-efficacy: high (n = 34), medium (n = 91), and low (n = 40). Results indicated that high, medium, and low academic self-efficacy all significantly predicted levels of student participation and exam performance, but the directionality of group placement on the academic measures was different for students at the high self-efficacy level versus those at the low and mid self-efficacy levels. Cluster analysis was also used to divide students into high, medium, and low grade-point average (GPA). These groups did not differ significantly on either self-efficacy or class participation but did differ on exam performance. Within GPA levels, self-efficacy was most strongly related to class participation and exam performance at the highest level of GPA and least related at the lowest level of GPA.     

The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder

The authors describe a new cognitive-behavioral systems-based group treatment for outpatients diagnosed with borderline personality disorder (BPD). The program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving. The STEPPS program was developed to address the cognitive distortions and behavioral dyscontrol typical of clients with BPD, and combines this with skills training and a systems component. The latter involves clients with BPD and those in their system including family members, significant others, and health care professionals. The program is fully manualized, and involves 20 two-hour weekly group meetings; specific goals (or lessons) are identified for each session. Preliminary data from the US and the Netherlands have shown that the group achieves high levels of acceptance from clients and therapists and that the model may be effective in helping to relieve the symptoms associated with BPD. Work is now underway to confirm the effectiveness of the model through a randomized controlled trial.     

A signal detection analysis of gist-based discrimination of genetic breast cancer risk

Pervasive biases in probability judgment render the probability scale a poor response mode for assessing risk judgments. By applying fuzzy trace theory, we used ordinal gist categories as a response mode, coupled with a signal detection model to assess risk judgments. The signal detection model is an extension of the familiar model used in binary choice paradigms. It provides three measures of discriminability—low versus medium risk, medium versus high risk, and low versus high risk—and two measures of response bias. We used the model to assess the effectiveness of BRCA Gist, an intelligent tutoring system designed to improve women’s judgments and understanding of genetic risk for breast cancer. Participants were randomly assigned to the BRCA Gist intelligent tutoring system, the National Cancer Institute (NCI) Web pages, or a control group, and then they rated cases that had been developed using the Pedigree Assessment Tool and also vetted by medical experts. BRCA Gist participants demonstrated increased discriminability for all three risk categories, relative to the control group; the NCI group showed increased discriminability for two of the three levels. This result suggests that BRCA Gist best improved discriminability among genetic risk categories, and both BRCA Gist and the NCI website improved participants’ ability to discriminate, rather than simply shifting their decision criterion. A spreadsheet that fits the model and compares parameters across the conditions can be downloaded from the Behavior Research Methods website and used in any research involving categorical responses.