In defence of loose ends: Psychotherapy process research in the real world

Understanding what transpires in therapeutic conversations is as complex as the humans who are engaged in them. Inspired by the natural sciences, mainstream research in psychotherapy has taken up a positivist epistemology and strives for quantification and verification to produce evidence of the effectiveness of an approach. This paper explores an alternative foundation for therapeutic practices which has implications for how we do research. First, we present some ideas from process philosophy and dialogical perspectives.. In particular we return to the ideas of Henri Bergson who understood change as consisting of interpenetrated continuous and shifting states. In a next step we briefly look into how such ideas have influenced what is referred to as dialogical practices. Such dialogical practices operate through facilitating polyphonic, diverse perspectives that may mediate change in and through an intersubjective process of becoming. Based on this we take another step and make some suggestions for how we may develop research that enables ways of exploring therapeutic conversations as a multi-voiced, interactional and unfinalized process. We offer by way of example a method by which we attempt to integrate a linguistic theory (Systemic functional linguistics) with the dialogical framework and the ideas of Bergson. This paper considers how process philosophy may offer an alternative to the seeking of certainty that occurs in both psychotherapy research and practice, and ideas for making space for the ‘loose ends’ of the inconsistent and the unknown.     

Small theory and the strategic choices of prevention research

Our comments on the discussion of mediational screening for prevention research highlight two issues: (a) There are advantages to giving a high priority to theory in a strategic sequence of prevention research studies. (b) Screening to identify a subgroup that is experiencing problems on processes the program is designed to change may be useful in accomplishing specific goals within an overall strategy of prevention research studies.     

Clinical interventions and prevention for Asian American children and families: Current status and needed research

The current status of clinical interventions and prevention for Asian American children and/or adolescents and their families was assessed through a review of the literature on conceptual frameworks, cultural variables and related issues, and empirical studies. Five proposed approaches to treatment or prevention were examined. Some factors that might account for the slow progress of treatment research in this area were also discussed. These included conceptual and methodological issues; the paucity of data on psychopathology in this population; their low service-utilization rates; and societal images, values, and needs. Some needed directions for future research are suggested.     

Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs.

Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team.

Results: In complex interventions, effects are produced not only by the intervention, but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies.

Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.     

Parenting programs during adolescence: Outcomes from universal and targeted interventions offered in real‐world settings

The aim of this naturalistic study was to explore short and long‐term outcomes of five different group‐based parenting programs offered to parents of 10 to 17‐year‐olds. Three hundred and fifteen parents (277 mothers and 38 fathers) who had enrolled in a parenting program (universal: Active Parenting, COPE ; Connect; targeted: COMET ; Leadership training for parents of teenagers [LFT ]) answered questionnaires at three measurement waves (baseline, post‐measurement, and one‐year follow‐up). The questions concerned parenting style, parental mental health, family climate and adolescent mental health. Results revealed small to moderate changes in almost all outcome variables and in all parenting programs. Overall, parents in COMET reported the largest short and long‐term changes. No substantial differences in change were seen between the other programs. The results support the general effectiveness of parenting programs for parents of adolescents.     

The process of enabling change: a study of therapist interventions in family therapy

We describe the application of discursive analysis to the task of researching family therapy process. Through the analysis of a central theme in two family therapy treatments, we found that individual family members move to using a wider range of discourses on the central theme by the end of therapy. Using the example of one family's therapy sessions, we examine how the therapist contributes to the new meanings and views that emerge, and present our analysis of the therapists' interventions in relation to the 'production' of these alternative meanings. It is argued that discourse analysis can fruitfully be applied to family therapy process research and could contribute to theoretical concepts of change and therapeutic competence.     

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.     

Adolescent pregnancy: implications for prevention strategies in educational settings

Over 1 million teenagers become pregnant each year in the U.S. The most alarming increases have occurred among adolescents who are younger than 15 years of age. Variables strongly associated with teen pregnancy include minority status, low socioeconomic status, low academic achievement and occupational aspirations, and growing up in a single- parent household. A majority of teenage pregnancies are unintended, and pregnancy is the largest contributor to school dropout rate for U.S. adolescent females. During pregnancy, adolescent mothers suffer higher rates of health complications, and after childbirth they receive less education, have more children, and are more likely to be dependent on welfare. Psychologists employed in educational settings are in a unique position to be involved in adolescent pregnancy prevention efforts, and schools are increasingly considered to be appropriate environments for this purpose. Progressive school-based family planning programs have been established by the St. Paul/Ramsey Medical Center in St. Paul, Minnesota, and by the Johns Hopkins University Medical Center in Baltimore, Maryland. Both programs emphasize the distribution of contraceptives. An increasing number of school programs focus their efforts on helping adolescents become more responsible in their approach to sexual relationships, though they do not distribute contraceptives. A number of innovative community-based programs have also been formed that utilize multiple strategies to provide positive alternatives to pregnancy. Before setting up teen pregnancy prevention programs, school psychologists should try to learn from the lessons offered by established programs. They should also consult with teachers, administrators, students, and parents, and they should decide what instructional approaches are appropriate for their own situations.     

Visual search in the real world: evidence for the formation of distractor representations

Visual search in the real world often requires that we search the same environment a number of times for different targets. What is the fate of information about fixated distractor objects during these searches? Here, participants searched the same array of real objects on a tabletop twice for two different targets successively whilst wearing a head-mounted eye-tracker. We found that fixating an object when it was a distractor in the first search facilitated search for that same object when it became the target in the second search. The results suggest that the location and identity of fixated distractor objects are represented to a level that guides subsequent searches, even when this information is not required at the time of fixation.     

Understanding the role of gender in body image research settings: Participant gender preferences for researchers and co-participants in interviews,focus groups and interventions

Participant gender preferences for body image researchers, interventionists and focus group and intervention co-participants have been largely ignored, despite recognition that such characteristics can influence the nature and quality of data collected and intervention effects. To address this, Australian women (n = 505) and men (n = 220) completed a questionnaire about their preferences for interviewers and focus group facilitators, for teachers delivering school-based interventions, and for co-participants in these settings. Women predominantly preferred female interviewers and teachers, and mixed-sex co-participants, but most had no preference for focus group facilitators. Body dissatisfied women were more likely to prefer female researchers and single-sex co-participants. Most men did not have specific preferences, however, body dissatisfied men were more likely to report a gender preference for interviewers and teachers. Professional capabilities, personal qualities and appearance were regarded as important researcher characteristics. These findings have important implications for body image research, particularly among high-risk groups.     

When change in the self is mistaken for change in the world

The authors examined whether and when changes in the self lead to mistaken assessments that the world has changed. Survey data revealed that: personal changes in respondents (e.g., parenthood, financial change) were positively correlated with their assessments of various social changes (e.g., crime rates, freedom). Experimental data provided converging evidence. Experimentally induced change in knowledge influenced participants' perceptions of change in an author's writing style from one decade to the next (Study 3). Bringing self-change to participants' attention attenuated their judgments of change in the world when they had sufficient cognitive resources to consider how such self-changes might affect their perceptions (Studies 4-6). Discussion highlights how such misattributions of change contribute to the pervasive belief in societal decline.     

Writing consumer research: the world according to Belk

• Writing is a core scholarly competence. Not only is it a skill that every academic must acquire, regardless of their methodological, philosophical or empirical affiliations, but also it is ‘a substantial differentiating characteristic of eminent researchers’. This article offers an analysis of the writing style of one of the field's most eminent researchers, Russell W. Belk. It identifies five literary devices that help Belk's writing stand out from the crowd and, while the article does not claim to contain the secret of writing success, it considers the crucial part writing plays in the consumer research process.

Copyright © 2007 John Wiley & Sons, Ltd.     

A demonstration of a token economy for the real world

Token economies are rarely used in real-world psychiatric settings because of barriers to their implementation, such an institutional constraints and insufficient collegial support. The line-level treatment team at Elgin Mental Health Center was able to overcome these contraints and develop a user-friendly token economy. This article describes Elgin's simple yet effective token economy and the process used to develop it.     

Formation and use of covariation assessments in the real world

In this study we examined covariation assessments made using real‐world information held by individual participants about an important preventive health behaviour: receiving an influenza vaccine (‘flu shot’). Four hundred and seventy‐seven healthy adult participants completed a questionnaire, indicating both their personal experience and vicarious experience (knowledge of other people's experiences) with the flu shot and the flu. Additionally, participants provided a covariation assessment by indicating how effective they thought the flu shot is in preventing the flu. We examined whether the experience information was related to the covariation assessment, and whether it in turn was related to the decision to receive a flu shot. Our results indicated that people use a simple intuitive strategy to combine their personal experience information. For vicarious experience information, we found evidence for use of a normative strategy, as well as simpler intuitive strategies. Consistent with our hypothesis, both types of experience information were associated with the effectiveness judgement, which was subsequently related to the decision to obtain a flu shot. Practical applications of these findings are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

A demonstration of a token economy for the real world

Token economies are rarely used in real-world psychiatric settings because of barriers to their implementation, such an institutional constraints and insufficient collegial support. The line-level treatment team at Elgin Mental Health Center was able to overcome these contraints and develop a user-friendly token economy. This article describes Elgin's simple yet effective token economy and the process used to develop it.