EFFECTS OF CHOSEN VERSUS ASSIGNED JOBS ON THE WORK PERFORMANCE OF PERSONS WITH SEVERE HANDICAPS

We evaluated the effects of several choice-related variables on the work performance of adults with severe handicaps. After assessing client work preferences, three choice-related situations were presented: (a) providing clients with the opportunity to choose a work task, (b) assigning a preferred task, and (c) assigning a nonpreferred task. Results indicated that clients attended to work tasks almost twice as much when they chose their tasks and when assigned to work on preferred tasks versus when assigned to work on nonpreferred tasks. Results are discussed regarding the need to assess systematically the effects of choice-related variables.     

Therapeutic tasks: what kind of help is sought in psychotherapeutic sessions?

One of the main conditions for a good psychotherapeutic alliance is the agreement on therapeutic tasks and goals. This article explores the kind of help that clients expect from therapeutic sessions. By means of a written questionnaire, the clients of a private psychotherapy center, prior to the sessions, expressed their priorities regarding the work to be carried out in them. The assessment of 873 questionnaires showed that clients prefer to participate in therapeutic work that helps them plan actions, understand what is happening, and assess possibilities for change. Also important are therapeutic tasks that help clients evaluate their own actions, both past and planned. The importance that clients attach to different kinds of help varies above all according to how near they feel to resolving their problems. Nine different kinds of psychotherapeutic tasks are identified, which cover the possible requests a client can make of his/her therapist. This article discusses the clinical application of this model as a basis for planning and classifying psychotherapeutic interventions.     

Assessing mood with affect-sensitive tasks

It is hypothesized that when an individual experiences a change in mood there are concomitant changes in performance at cognitive and psychomotor tasks. The present study attempts to identify tasks which are mood-sensitive. The nature of affect-sensitive tasks will yield information about how mood influences behavior. Further, to the extent that relationships between mood and affect-sensitive tasks are found, clients may be motivated to change their mood by a knowledge of expectable improvements in performance. Ten tasks and a mood-adjective checklist were administered to 106 subjects. Four of the tasks showed statistically significant relationships with self-reported mood. Results were promising for further investigations of affect-sensitive tasks.     

Structural Determinants of Boredom Among the Clients of Psychosocial and Vocational Rehabilitation Centers

In psychosocial rehabilitation programs, clients are encouraged to counter boredom by occupying their time in more structured, meaningful, and enjoyable ways. Several means by which the structure of service organizations reduces feelings of boredom were explored. Hypotheses were tested using data from a sample of clients of Flemish rehabilitation centers for people with chronic mental health problems. Results show that in larger, more heterogeneous centers, boredom is reduced by offering clients a wider range of more routinized activities; in small homogeneous centers, the same effect is obtained by enhancing the intrinsic value of the tasks and by providing more opportunities for task communication. Rehabilitation centers seem to adapt their rehabilitation technology according to their organizational structure.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Experiences of Christian clients in secular psychotherapy: a mixed-methods investigation

Eleven Christian former clients were sampled to uncover factors contributing to positive versus negative experiences in secular psychotherapy. The qualitative results indicated that although many participants felt hesitant to discuss their faith due to uncertainty about their therapists' reactions, positive experiences were reportedly facilitated by therapists' openness to understanding clients' faith and giving clients control over how much, when, and how to discuss their religious beliefs and practices. Dissatisfied clients reported that their therapists expressed opposing religious views or avoided discussing religious or spiritual issues. Participants' self-reports of the working alliance and of their therapists' expertness, attractiveness, and trustworthiness were largely consistent with the narrative data, but the alliance scores were somewhat more sensitive to participants' positive versus negative evaluations of their therapy experience. That is, several participants rated their therapists' personal characteristics quite favorably but indicated poor agreement with their therapists on the goals or tasks of treatment.     

The Obstacle is the Path: Overcoming Blocks to Homework Assignments in a Complex Presentation of Depression

There is increasing evidence to demonstrate that clients who complete homework assignments have a better outcome in cognitive therapy (Kazantzis, Deane, & Ronan, 2000). Most clinicians recognize that enabling clients to effectively utilize homework can be a major task in itself, particularly with disorders such as depression, where individuals find even the simplest daily tasks daunting. This article begins by highlighting the problem of changing any pattern of activity, and then explores the difficulties of engaging clients in homework when they present with persistent depression with secondary anxiety features.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

A SUPERVISORY STRATEGY TO IMPROVE WORK PERFORMANCE FOR LOWER FUNCTIONING RETARDED CLIENTS IN A SHELTERED WORKSHOP

A multiple component strategy was investigated for aiding staff responsible for supervising production of lower functioning retarded clients on contract tasks in an institution-based sheltered workshop. The strategy was assessed in a combined multi-element, multiple baseline across groups design with a reversal component. Production performance increased during the production supervisory strategy with all 16 clients, with the range of increase varying from a few percentage points to 150% of baseline production. Both the clients and staff (responsible for conducting the research) preferred working under experimental conditions rather than under baseline conditions which approximated those found in “typical” sheltered workshops.     

Influence of stuttering therapy on clinicians'' disfluencies: Effects of client modeling

This study investigated whether student clinicians working with stutterers subsequently produce more disfluencies than student clinicians providing therapy to clients with other speech and language disorders. Seventeen graduate students working in a 6-wk summer camp setting were divided into two groups: eight who provided treatment for stutterers (group 1) and nine who provided therapy for clients with other communication disorders (group 2). All student clinicians were recorded during spontaneous speaking and oral reading tasks prior to camper arrival and following camper departure. An eight-category classification system was used to determine disfluency types. Findings revealed that Group 1 clinicians significantly decreased their total disfluencies between pre- and post-camp recordings on the spontaneous speaking task. Unexpectedly, this same group also substantially increased part-word repetitions and sound prolongations. The possibilities of incidental learning, reverse modeling, and overidentification with stuttering clients are discussed.     

Influence of Therapist and Client Behaviors on Therapy Alliance

This study considers the combined effect of therapist behaviors and couples interaction dynamics on therapeutic alliance because it seems to be a significant predictor of successful therapy outcomes. We measured therapeutic alliance using the Working Alliance Inventory, Observer Version (WAI-O), which includes three subscales: goals, tasks, and bond. We investigated the combined effect of therapist behaviors and couples interactions on therapeutic alliance. There were three significant findings: (1) the models better predicted therapeutic alliance for men clients than women clients; (2) combined consideration of partner behaviors and therapist behaviors provided the stronger prediction of therapeutic alliance; and (3) different variables predicted alliance for women clients versus men clients.     

Behavior Treatment: General Considerations

The principal goal of behavior treatment for retarded clients is that of modifying behavior as it occurs in a given environment in such a manner that it becomes more appropriate to that environment. The therapeutic or change agents can involve a variety of persons other than the counselor, teacher, and client--this may include parents, peers, work supervisors and others who can provide supportive influences. Education and rehabilitation programs should be tailored to the occupational and social environment of the retarded client and designed to teach those behavior patterns that are relevant to that environment. Additionally, the work tasks for which retarded clients are trained should be highly structured and routine. Excessive demand for adaptability or decision making is a major cause of training failure for retarded clients.     

Evidence-based training in cognitive-behavioural coaching: can personal development bring less distress and better performance?

Coaching has become during the past years an emergent guidance profession. Cognitive-behavioural coaching (CBC) emphasises the importance of enhancing the emotion–regulation abilities of clients and replacing their non-productive behaviours. Qualified professionals are needed in order to effectively facilitate the desired changes in their clients. We aimed to investigate the effectiveness of the personal development component within a training programme in CBC. Pre- to post-training comparisons showed a reduction in the participants’ level of depressed mood, as well as an improvement in their work performance. The active components were the emotion–regulation skills acquired and the quality of their homework tasks. Implications are discussed underlying the use of an evidence-based approach for training professionals in the field of CBC.     

Harnessing the river of time: a theoretical framework of time use efficiency with suggestions for counselors

Some individuals have difficulty using their time efficiently and, subsequently, completing tasks in an allotted amount of time. This article offers an operational definition and a theoretical framework of time use efficiency. Suggestions are offered for counselors working with clients who have difficulties using their time efficiently.     

Behavior treatment: General considerations

The principal goal of behavior treatment for retarded clients is that of modifying behavior as it occurs in a given environment in such a maner that it becomes more appropriate to that environment. The therapeutic or change agents can involve a variety of persons other than the counselor, teacher, and client—this may include parents, peers, work supervisors and others who can provide supportive influences. Education and rehabilitation programs should be tailored to the occupational and social environment of the retarded client and designed to teach those behavior patterns that are relevant to that environment. Additionally, the work tasks for which retarded clients are trained should be highly structured and routine. Excessive demand for adaptability or decision making is a major cause of training failure for retarded clients. Reprinted from Gardner, William I.Behavior Modification in Mental Retardation: The Education and Rehabilitation of the Mentally Retarded Adolescent and Adult. Aldine.     

Beyond beliefs: Challenging obsessive thoughts and compulsive behaviours within a collaborative counselling relationship

Three clients with obsessive‐compulsive disorder were studied using a multiple case study approach. Clients' experiences of cognitive‐behavioural therapy, in particular the impact of having their beliefs challenged, and their responses to self‐monitoring tasks and behavioural experiments were investigated. Data included case notes made during therapy, pre‐ and post‐therapy questionnaires, and post‐therapy semi‐structured interviews. Qualitative analysis of the data identified clients' obsessive beliefs, general negative beliefs and meta‐cognitive beliefs, and explored any post‐therapy changes in these beliefs. The results demonstrated similarities between cases in obsessive beliefs (e.g. inflated responsibility for harm), general negative beliefs (e.g. feelings of failure), meta‐cognitive beliefs (e.g. the need to control thoughts) and affect (e.g. guilt). Questionnaire data from all three clients suggested no clinically significant post‐therapy changes in general negative beliefs and meta‐cognitive beliefs. However, idiosyncratic changes in obsessive beliefs were reported during therapy and at post‐therapy interview, and clients reported improved functioning and decreased levels of distress during therapy and at interview. Responses to challenge were uniformly positive, but reactions to self‐monitoring and behavioural experiments varied across cases. The implications of these findings for the treatment of obsessive‐compulsive disorder using cognitive behavioural techniques are discussed.     

CBT for Grief: Clearing Cognitive Obstacles to Healing from Loss

There is tremendous variability in people’s ability to cope with, and adjust to, the death of someone close to them. One of the factors identified as significant in this regard is the constellation of beliefs that includes a mourner’s thoughts about the circumstances of the death, their feelings about the person who died, their reflections on the relationship with that person, and their assessment of their own ability to survive the loss. This paper considers the role of cognition in adaptation to loss, and demonstrates how maladaptive cognitions concerning the loss, the manner of death or the relationship with the deceased can interfere with adaptation and lead to complications in grief. Case examples illustrate the use of CBT with bereaved clients and the benefits of this approach as part of an overall strategy for helping grieving clients. The effectiveness of CBT with bereaved individuals is enhanced when clients understand the rationale of the treatment and are committed to carrying out the tasks specified in their treatment plan. The article presents a simple model for promoting client involvement and compliance.     

THE USE OF POSITIVE AND NEGATIVE REINFORCEMENT IN THE TREATMENT OF ESCAPE-MAINTAINED DESTRUCTIVE BEHAVIOR

We identified 3 clients whose destructive behavior was sensitive to negative reinforcement (break from tasks) and positive reinforcement (access to tangible items, attention, or both). In an instructional context, we then evaluated the effects of reinforcing compliance with one, two, or all of these consequences (a break, tangible items, attention) when destructive behavior produced a break and when it did not (escape extinction). For 2 clients, destructive behavior decreased and compliance increased when compliance produced access to tangible items, even though destructive behavior resulted in a break. For 1 client, extinction was necessary to reduce destructive behavior and to increase compliance. Subsequently, when the schedule of reinforcement for compliance was faded for all clients, destructive behavior was lower and fading proceeded more rapidly when compliance produced multiple functional reinforcers (i.e., a break plus tangible items or attention) and destructive behavior was on extinction. The results are discussed in terms of the effects of relative reinforcement value and extinction on concurrent operants.     

Psychological maturity of young, divorcing people

The present investigation was done to assess the psychological maturity of divorcing couples. A special questionnaire was formulated, using the conception of human development proposed by Erikson and Levinson as well as Hevighurst's conception of developmental tasks. 94 students of the VI-th year of medicine (47 women and 47 men) participated in constructing the questionnaire. Then 15 women and 15 men, who were clients of the Consulting and Diagnostic Family Center, ages 23 to 32 years were tested. Analysis shows lower scores for women than for men, especially on subscales of personal and interpersonal relations and adaptation to the parent's role.