Who's using treatment manuals? A national survey of practicing therapists

Treatment manuals are currently the most common way treatments are disseminated to practicing clinicians, although little is known about the rates with which practicing therapists incorporate these manuals into their practice. In light of a widely acknowledged research-practice gap, understanding how often therapists are using manuals is important for shaping future dissemination efforts. This study collected data on rates of manual use among a national sample of mental health clinicians representative of those likely to be targeted in dissemination efforts (N = 756), as well as predictors of use. Results indicated that few clinicians (<10%) routinely incorporated manuals into their practice, although most employed them to some degree. Predictors of manual use included greater openness to new treatments, younger age, and a cognitive-behavioral treatment orientation (ps < .05). Implications for future dissemination efforts are discussed.     

What Must You Know and Do to Get Good Outcomes With DBT?

Because little research has been conducted on which therapist-client interactions lead to intermediate and end-point improvements in Dialectical Behavior Therapy (DBT), we have a small evidence-base from which to specify what therapists must know and do in order to obtain good outcomes using DBT. As with other evidence-based practices, dissemination of DBT has defaulted to assumptions and methods from the “psychotherapy technology model,” which emphasizes transfer of the validated treatment package from the research clinic to routine settings with high fidelity (Morgenstern & McKay, 2007). However, serious limitations of the psychotherapy technology model require pursuit of alternative complementary models to guide dissemination. One complementary approach is to use well-designed practice-based training research. In this approach, therapists learn modular competencies linked to a highly structured yet flexible clinical decision-making framework. Modular training of therapist competencies emphasizes the continuity of the component therapist strategies across evidence-based protocols rather than emphasizing the packages or manuals as separate and distinct. Key hypotheses about the change processes responsible for client change and the associated treatment strategies used to influence these change processes should be specified and measured at the level of client, therapist, and service delivery setting. Adopting this approach may offer advantages that apply to the dissemination and implementation of DBT and other evidence-based practices (EBPs).     

Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes

ObjectiveThe U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.MethodTherapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).ResultsThree-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = ?20.3, p < 0.001. Quality of life scores also increased.ConclusionsTraining in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Computer-assisted intervention for children with low numeracy skills

We present results of a computer-assisted intervention (CAI) study on number skills in kindergarten children. Children with low numeracy skill (n = 30) were randomly allocated to two treatment groups. The first group played a computer game (The Number Race) which emphasized numerical comparison and was designed to train number sense, while the other group played a game (Graphogame-Math) which emphasized small sets of exact numerosities by training matching of verbal labels to visual patterns and number symbols. Both groups participated in a daily intervention session for three weeks. Children's performance in verbal counting, number comparison, object counting, arithmetic, and a control task (rapid serial naming) were measured before and after the intervention. Both interventions improved children's skills in number comparison, compared to a group of typically performing children (n = 30), but not in other areas of number skills. These findings, together with a review of earlier computer-assisted intervention studies, provide guidance for future work on CAI aiming to boost numeracy development of low performing children.     

Individual differences in willingness to become an organ donor: A decision tree approach to reasoned action

The promotion of organ donation requires a better understanding of the attributes associated with willingness to donate. This entails revealing complex interactions among personality attributes related to intentions and behaviors. In the present study, survey data from young adults (N = 367) were analyzed using decision tree algorithms to identify these interactions within the reasoned action framework. Within this structure, donation attitudes, intentions, and behaviors were examined in relation to individual differences such as conscientiousness, empathy, time orientation, religiosity, and interpersonal trust.     

Therapist Self-as-Context and the Curative Relationship

This article discusses how the way the therapist relates to his or her personal responses to client material during the session contributes to making the relationship with the client an effective tool for treatment. Ideas from third wave behavior therapy are used to describe aspects of therapist involvement in the relationship and modes of therapist awareness of inner responses. In two vignettes, negative client reactions to an intervention bring problematic therapist material to the fore. Both cases highlight how the stories the therapists spun about themselves as professionals and persons could easily have limited their effectiveness in responding to the material. The vignettes also illustrate how clinicians can overcome personal meanings and judgments to access a more productive mode of interacting with the feelings a critical incident in the relationship evokes in them. It is argued that observing their own content from a psychological distance makes it possible for clinicians to use their feelings without getting caught up in them. These same feelings may then help the therapist perceive how the incident relates to the client’s daily life problems. The therapist’s engagement in a sense of self-as-context is described as a therapeutic stance that provides the psychological distance needed to help overcome alliance ruptures and other potential gridlocks and which may transform the therapist’s inner response to client content into a tool for addressing important client issues.     

Verbal fluency and creativity: General and specific contributions of broad retrieval ability (Gr) factors to divergent thinking

The Cattell–Horn–Carroll (CHC) model of intelligence views creativity as a first-level factor within the second-level factor of broad retrieval ability (Gr), alongside other first-level abilities such as ideational fluency and word fluency. Traditional methods of measuring creativity, however, confound idea quality with idea quantity, which might exaggerate the relationship between creativity scores and verbal fluency factors. Participants (n = 131 adults) completed two divergent thinking tasks (unusual uses for a rope and a box), which were scored using newer methods that effectively separate creativity (scored via subjective ratings) and fluency (scored as number of responses). They then completed 16 verbal fluency tasks that assessed six lower-order Gr factors: word fluency, associational fluency, associative flexibility, ideational fluency, letter fluency, and dissociative ability. Viewed singly, many of the lower-order factors significantly predicted creative quality and fluency. General Gr had substantial effects on creative quality (standardized β = .443) and fluency (β = .339) in a higher-order model as well as in a bifactor model (quality β = .380, fluency β = .327). Moreover, general Gr was the only significant predictor in the bifactor model, suggesting that it, not the specific factors, was most important. All effects were essentially the same after controlling for typing speed and vocabulary knowledge. The findings thus support the CHC view of creativity/originality as a lower-order component of Gr, illuminate the relationships between creativity and first-level Gr factors, extend the study of creativity and intelligence beyond fluid intelligence, and further indicate that creativity is more closely tied to cognitive abilities than creativity research has yet recognized.     

The Use of Communication Technology in Private Practice: Ethical Implications and Boundary Dilemmas in Therapy

This study investigates the use of communication technology (CT) by therapists in private practice. CT has exploded in the last decade and therapists have begun to implement this technology in their work. It is important to understand better the types of technology therapists are using and how they decide which devices are most useful for clinical practice. Additionally, the availability of the therapist has long been debated and CT provides media to make therapists readily available. Results show that therapists have boundary concerns and ethical dilemmas regarding CT and often feel unprepared to handle inappropriate out-of-session contacts when they occur.     

Aberrant neural mediation of verbal fluency in autism spectrum disorders

Objective

Contrasts of verbal fluency and automatic speech provide an opportunity to evaluate the neural underpinnings of generativity and flexibility in autism spectrum disorders (ASD).

Method

We used functional magnetic resonance imaging (fMRI) to contrast brain activity in high functioning ASD (n = 17, mean verbal IQ = 117) and neurotypical (NT; n = 20, mean verbal IQ = 112) adolescent and young adult males (12–23 years). Participants responded to three word generation conditions: automatic speech (reciting months), category fluency, and letter fluency.

Results

Our paradigm closely mirrored behavioral fluency tasks by requiring overt, free recall word generation while controlling for differences in verbal output between the groups and systematically increasing the task demand. The ASD group showed reduced neural response compared to the NT participants during fluency tasks in multiple regions of left anterior and posterior cortices, and sub-cortical structures. Six of these regions fell in cortico-striatal circuits previously linked to repetitive behaviors (Langen, Durston, Kas, van Engeland, & Staal, 2011), and activity in two of them (putamen and thalamus) was negatively correlated with autism repetitive behavior symptoms in the ASD group. In addition, response in left inferior frontal gyrus was differentially modulated in the ASD, relative to the NT, group as a function of task demand.

Conclusions

These data indicate a specific, atypical brain response in ASD to demanding generativity tasks that may have relevance to repetitive behavior symptoms in ASD as well as to difficulties generating original verbal responses.     

Development and validation of a measure of an individual’s lateness attitude

The authors developed and validated a measure of employees’ attitudes toward lateness at work. Analyses provided clear evidence of the reliability and validity of the new measure. Specifically, high reliabilities were observed in both student (α = .82) and employee (α = .84) samples. Using objective lateness data from organizations, the measure significantly predicted two lateness behaviors, lateness frequency (r = .25, p < .01) and duration (r = .24, p. < .01), over a six-month period. Most importantly, lateness attitude improved prediction of lateness behavior above and beyond prediction made with only general job attitudes and conscientiousness.     

To be in touch

This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.     

Measuring implicit attitudes of 4-year-olds: the preschool implicit association test

The Preschool Implicit Association Test (PSIAT) is an adaptation of an established social cognition measure (IAT) for use with preschool children. Two studies with 4-year-olds found that the PSIAT was effective in evaluating (a) attitudes toward commonly liked objects (flowers = good) and (b) gender attitudes (girl = good or boy = good). The gender attitude PSIAT was positively correlated with corresponding explicit attitude measures and also children’s actual sex. The new implicit and explicit measures of gender attitudes demonstrated discriminant validity; each predicted variance in children’s gendered play activities beyond that predicted by the other. Discussion describes potential uses of the PSIAT to investigate development of societally significant attitudes and stereotypes at younger ages than are achievable with currently available methods.     

Antecedents and consequences of retirement planning and decision-making: A meta-analysis and model

In this study, meta-analytic procedures were used to examine the relationships between retirement planning, retirement decision and their antecedent and consequences. Our review of the literature generated 341 independent samples obtained from 99 primary studies with 188,222 participants. A small effect size (ES) for antecedents of retirement planning (poor health, negative working conditions and positive attitudes toward retirement) was obtained (ranging from r = .05 to r = .19), whereas a medium ES was obtained for work involvement and job satisfaction (r = −.31 and r = −.34). Regarding retirement decision, lower effect sizes were obtained. Effect sizes for the relationships with consequences were medium for retirement planning and bridge employment (r = .28), for retirement decision-volunteer work (r = .26), and for retirement decision-retirement satisfaction (r = .26). Structural equation analysis using the pooled correlation matrix allowed us to test a more complex model. Potential moderator variables were examined, and it was found that they explained only a small percentage of variability of primary studies. Results are discussed, and theoretical and empirical implications are suggested.     

Technology-Assisted Psychotherapy (TAP): Adapting Computerized Treatments into Traditional Psychotherapy for Depression

Technology may be changing the process of psychotherapy. Unfortunately, some therapists lack the computer skills or financial resources needed for the newest technology. The literature is reviewed for journal articles on the treatment of depression published during the past 7 years in which treatments have been guided by technology. Six findings are summarized that may be helpful when therapists lack skills or resources for advanced technology. (1) The assessment of depression can be facilitated by technology, whether using standardized questionnaires or simple ratings of mood submitted each day. (2) Technology tools can be used to send daily reminders to help clients develop more adaptive habits in thoughts or actions. (3) Clients can confront their problems through therapeutic dialogue, whether conducted in person, over the telephone, or via videoconference. (4) Depressed clients can confront their negative attitudes, often triggered by some form of loss, failure, or rejection, whether real, imagined, or anticipated. (5) Clients can use writing assignments to identify, label, explore and express their thoughts and feelings. These writing assignments can be conducted via email, or internet forms. (6) Clients value rapport with a therapist, and this bond seems important to ensure participation and adherence with treatment. Therapists can strengthen the treatment of depression using basic technology tools to extend, or supplement traditional sessions. However, it is important to protect the rapport needed for sustained participation in psychotherapy sessions.     

Expanding the Limits of Bibliotherapy for Panic Disorder: Randomized Trial of Self-Help Without Support but With a Clear Deadline

Cognitive behavioral bibliotherapy for panic disorder has been found to be less effective without therapist support. In this study, participants were randomized to either unassisted bibliotherapy (n = 20) with a scheduled follow-up telephone interview or to a waiting list control group (n = 19). Following a structured psychiatric interview, participants in the treatment group were sent a self-help book consisting of 10 chapters based on cognitive behavioral strategies for the treatment of panic disorder. No therapist contact of any kind was provided during the treatment phase, which lasted for 10 weeks. Results showed that the treatment group had, in comparison to the control group, improved on all outcome measures at posttreatment and at 3-month follow-up. The tentative conclusion drawn from these results is that pure bibliotherapy with a clear deadline can be effective for people suffering from panic disorder with or without agoraphobia.     

Links between family gender socialization experiences in childhood and gendered occupational attainment in young adulthood

Gendered occupational segregation remains prevalent across the world. Although research has examined factors contributing to the low number of women in male-typed occupations – namely science, technology, engineering, and math – little longitudinal research has examined the role of childhood experiences in both young women's and men's later gendered occupational attainment. This study addressed this gap in the literature by examining family gender socialization experiences in middle childhood – namely parents' attitudes and work and family life – as contributors to the gender typicality of occupational attainment in young adulthood. Using data collected from mothers, fathers, and children over approximately 15 years, the results revealed that the associations between childhood socialization experiences (~ 10 years old) and occupational attainment (~ 26 years old) depended on the sex of the child. For sons but not daughters, mothers' more traditional attitudes toward women's roles predicted attaining more gender-typed occupations. In addition, spending more time with fathers in childhood predicted daughters attaining less and sons acquiring more gender-typed occupations in young adulthood. Overall, evidence supports the idea that childhood socialization experiences help to shape individuals' career attainment and thus contribute to gender segregation in the labor market.     

Tales of a Therapist

ABSTRACT

Historically, theorists and clinicians from various schools of family therapy have discussed therapist self-disclosure in terms of either helping or inhibiting therapeutic progress. Although postmodern language-based theorists and therapists accept and encourage its use, few clinical examples of therapist self-disclosure exist in the family therapy literature. In this paper, a postmodern family therapist working within the language-based tradition describes the use of self-disclosures with a couple. The therapist then reviews the effects of those self-disclosures through the eyes of husband, wife, and therapist.     

Examining the pathways between gratitude and self-rated physical health across adulthood

The current study examined whether dispositional gratitude predicts physical health among adults, and if so, whether this relationship occurs because grateful individuals lead healthier lives, either psychologically or physically. Specifically, we examined whether psychological health, healthy activities, and willingness to seek help for health concerns mediated the link between gratitude and self-reported physical health, as well as if these mediational pathways are moderated by age, in a broad sample of Swiss adults (N = 962, M_age = 52 years, age range: 19–84). Dispositional gratitude correlated positively with self-reported physical health, and this link was mediated by psychological health, healthy activities, and willingness to seek help for health concerns. However, the indirect effects for psychological health and healthy activities were stronger for older than younger adults. In other words, the mechanisms explaining why gratitude predicts health appear to differ across adulthood.     

The Fluency Amplification Model: Fluent stimuli show more intense but not evidently more positive evaluations

Processing fluency plays a large role in forming judgments, as research repeatedly shows. According to the Hedonic Fluency Model, more fluently processed stimuli are rated more affectively positive than less fluently processed stimuli. Most research documenting such findings uses neutral or positive stimuli with low complexity, thus any potential impact of initial stimulus valence cannot be tested. In the present study, 60 IAPS stimuli ranging from very negative to very positive valence were rated on liking by participants. Processing fluency was manipulated through perceptual priming (7 ms). Results of Experiment 1 (N = 35) support the prediction of the Hedonic Fluency Model, but only for stimuli with an initially positive valence. However, when negative stimuli were processed more fluently, they were rated as more negative than when processed less fluently. Experiment 2 (N = 39) showed that enhancing the accessibility of the stimulus content (via prolonging the prime duration to 100 ms) cannot account for the results of Experiment 1, since Experiment 2 failed to replicate the findings obtained in Experiment 1. Potential factors influencing affective evaluation of negative stimuli are discussed. A model is offered for the reinterpretation of processing fluency as an amplifying factor for evaluative judgment.