The clinical representativeness of couple therapy outcome research

The clinical representativeness of outcome studies is defined as the generalizability of recruitment processes, assessment/diagnostic procedures, treatment protocols, and therapeutic results from research settings to naturalistic treatment settings. The main goal of the present study was to examine the clinical representativeness of couple therapy in outcome studies. The data set was formed by 50 published clinical trials, including 34 couple therapy outcome studies for marital distress (CTMD) and 16 couple therapy outcome studies for comorbid relational and mental disorders (CTMD + C). The present findings showed that, overall, the clinical representativeness of couple therapy outcome studies is only fair (i.e., the mean global score is slightly lower than the midpoint of the rating scale used to assess representativeness). CTMD + C studies fared better than CTMD studies on many dimensions of clinical relevance. Studies in which pretherapy training was less intensive (for CTMD studies only), treatment was less structured, and therapists were more experienced showed larger effect sizes than those in which such was not the case.     

Rising verbal intelligence scores: implications for research and clinical practice

Evidence suggests that scores on various intelligence tests have been rising at a fast rate. To find out whether performance on the Wechsler Adult Intelligence Scale (WAIS) Vocabulary subtest has also been rising, the authors searched major psychology journals for investigations involving healthy younger and older adult participants and collected the reported WAIS Vocabulary scores. The meta-analysis shows that WAIS Vocabulary scores have been rising at the rate of 0.117/year (corresponding to 1.52 IQ points/decade) for younger adults and 0.367/year (corresponding to 4.79 IQ points/decade) for older adults.     

Prevalence of mood symptoms and depressions during pregnancy: implications for clinical practice and research

A review of the literature demonstrates that the incidence of new mental disorders and their prevalence during pregnancy is similar to the 12-month incidence of mental disorders in women during other periods of their lives. The prevalence of severe mood, behavior, and cognitive symptoms during pregnancy is rather high. Severe mental symptoms during pregnancy have been reported to be associated with an increased rate of complications during pregnancy and delivery, preterm deliveries, low birth weight, a higher rate of postpartum depression, and a longer-term impact on the offspring's development. Several pre-pregnancy risk factors to develop dysphoric symptoms have been reported, but their utility for primiparous women with no previous history of mental disorders is unclear. The association of mental symptoms with general symptoms and biological changes during pregnancy is also unclear. Given the short- and long-term impact of dysphoric symptoms and stress during pregnancy on mother and child, efficacious, efficient, and safe prevention and treatment modalities are essential and achievable. Clarification of the nature and phenotyping of mental and general symptoms during pregnancy is an important step for the development of effective interventions.     

Evidence-based approaches to assessing couple distress

This article describes a conceptual framework for couple-based assessment strategies grounded in empirical findings linking couple distress to a broad range of both individual and relationship characteristics. These characteristics can contribute to, exacerbate, or result from relationship problems. On the basis of these findings, the authors articulate specific targets of clinical inquiry reflecting relationship behaviors, cognitions, and affect as well as features of individual distress. Guided by this framework, empirically supported assessment strategies and techniques emphasizing relationship functioning across diverse methods are proposed, including the clinical interview, analog behavioral observation, and both self- and other-report measures. Discussion concludes with specific recommendations regarding clinical assessment of couple distress and directions for further research.     

Emotional sequelae of abortion: implications for clinical practice

For women in therapy who have had abortions, an exploration of the context and aftermath of each abortion has been suggested. This inquiry should include: characteristics of the woman herself before and at the time of the abortion, the nature of the interpersonal and cultural milieu at the time, characteristics of the medical environment and procedure, and any events subsequent to the abortion that may evoke regrets about the earlier decision.
Whether or not such an inquiry results in the identification of unresolved issues surrounding the abortion, it is likely to enhance one's general understanding of the client. Exploring a woman's decision to have an abortion can bring into relief developmental and family issues, relationship conflicts, and her aspirations for education, work, and family. A woman's approach to establishing and asserting her priorities and values in making difficult personal decisions becomes clear as does her ability to tolerate and resolve the ambivalence inherent in making difficult decisions.
In psychotherapy, it is important to understand and address those aspects of experience that women have difficulty resolving. Hence, the emphasis on categories of experience that may have a negative impact on a woman's emotional well-being after abortion. Nevertheless, the clinician should remember that even women who report negative post-abortion sequelae overwhelmingly report that they feel that the decision was the right one for them. Having ambivalent feelings to resolve does not necessarily mean that one has made a wrong choice, only that one has made an emotionally significant choice with far-reaching personal implications, in a sociocultural environment that reinforces the ambivalence inherent in such decisions.     

Updating to the WAIS-III and WMS-III: considerations for research and clinical practice

The Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Wechsler Memory Scale-Revised (WMS-R) are the most commonly used intelligence and memory scales in both clinical and neuropsychology. In 1997, updated versions of these instruments (the WAIS-III and WMS-III) were published. Because of the extensive use of the WAIS-R and WMS-R in the field and the body of accumulated research, there is naturally some reluctance by clinicians and researchers to update to the new versions. It is sometimes difficult for clinicians who test individuals on repeated occasions to switch over to the new versions of the scales because of the difficulty of interpreting score discrepancy between the 2 versions. Researchers, especially those conducting longitudinal research, have a similar difficulty in changing measurement devices because of the possible threat of internal validity. This article reviews the substantive revisions of the scales and outlines those issues that users should take into consideration when updating to the new versions.     

Placebo effects in developmental disabilities: implications for research and practice

Recent clinical trials of secretin in children with autism showed robust placebo effects and no benefit of secretin over placebo. This article explores the reasons for the observed placebo effects, focusing on the heightening of positive expectancy by media attention and by the sensory experiences associated with intravenous injections. Comparisons are drawn with research involving other novel treatments and other clinical populations of children with developmental disabilities and neurobehavioral disorders. Research regarding mechanisms of placebo effects is reviewed, including patient and clinician attributes, expectancy effects, participation effects, changes in caregiver behavior, and conditioning. New evidence regarding the biological basis of placebo effects is briefly presented. Since placebo effects are ubiquitous and may operate by a variety of mechanisms, research design is critical in designing clinical trials and in evaluating other outcomes research. Measurement issues important for research in developmental disabilities are emphasized. Ethical concerns have been raised regarding the use of placebo in clinical research, but current analysis suggests that placebo controls are necessary and defensible on ethical grounds, if certain conditions are met. The study of placebo effects ("placebology") holds great promise as a new area of research in therapeutics. The author's research in the potential augmentation of stimulant effects in children with attention deficit/hyperactivity disorder (ADHD) by adding placebo in open label is briefly presented. The placebo has always been integral to the practice of medicine, but advances in scientific medicine and medical ethics have diminished the role and use of placebo in practice. An innovative approach to the ethical use of placebo is proposed.     

Fear of AIDS: Its meaning and implications for clinical practice

Clinical reports have appeared about patients who present for mental health treatment with the major symptom of fearing that they have AIDS. The clinical reports of patients who fear AIDS are similar to those made many years ago by patients who feared syphilis. As with the syphilophobia of years ago, the AIDS group represents a divergent set of patients. Some can be described as the worried well who have realistic concerns because of a recent history of high risk behavior; others have unrealistic fears that are secondary to a major mental disorder such as hypochondriasis, depression, or schizophrenia. Suggestions are made to psychotherapists who encounter patients presenting with the problem of fearing AIDS.The views expressed here do not necessarily represent those of the Pennsylvania Psychological Association     

Trust in leadership: meta-analytic findings and implications for research and practice

In this study, the authors examined the findings and implications of the research on trust in leadership that has been conducted during the past 4 decades. First, the study provides estimates of the primary relationships between trust in leadership and key outcomes, antecedents, and correlates (k = 106). Second, the study explores how specifying the construct with alternative leadership referents (direct leaders vs. organizational leadership) and definitions (types of trust) results in systematically different relationships between trust in leadership and outcomes and antecedents. Direct leaders (e.g., supervisors) appear to be a particularly important referent of trust. Last, a theoretical framework is offered to provide parsimony to the expansive literature and to clarify the different perspectives on the construct of trust in leadership and its operation.     

Racial microaggressions in everyday life: implications for clinical practice

Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. A taxonomy of racial microaggressions in everyday life was created through a review of the social psychological literature on aversive racism, from formulations regarding the manifestation and impact of everyday racism, and from reading numerous personal narratives of counselors (both White and those of color) on their racial/cultural awakening. Microaggressions seem to appear in three forms: microassault, microinsult, and microinvalidation. Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance. Suggestions regarding education and training and research in the helping professions are discussed.     

Effects of speech accents on interpersonal evaluations: implications for counseling practice and research

This article reviews literature from the fields of psycholinguistics, communications, and social psychology that has examined the effects of speech accents (i.e., regional, national, and international variations in same-language use) on interpersonal attitudes, casual attributions, and subsequent behaviors. The authors link selected findings from this literature to the field of counseling to show that these findings can inform service delivery, particularly counseling conducted with ethnic minority and immigrant populations in the United States. Implications for practice and ideas for future research in this area are also discussed.     

A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

The postmodern counsellor: Some implications for practice,theory, research and professionalism

What is postmodernism? What are the implications of the death of God, science and the subject for counselling? Further questions include: To what extent does postmodernism, show that behavioural, humanistic, existential, and most psychoanalytic theories are delusional in that they would have the clients/patients believe that they are the core, the centre, the subject? What are the dangers of seeing ‘others’ practically, theoretically and when conducting research as either enhancing our narcissism and/or the counselling order? In terms of an ethical practice, can the postmodern counsellor stop counselling from reverting to a technique orientated mechanism of professional vested interests, and instead find a better way for us all to put the other first?