The effectiveness of therapeutic assessment with an adult client: a single-case study using a time-series design

This article presents the therapeutic assessment (TA; Finn, 2007) of a traumatized young woman named Claire. Claire reported feeling debilitated by academic demands and the expectations of her parents, and was finding it nearly impossible to progress in her studies. She was also finding it difficult to develop and sustain intimate relationships. The emotional aspects of close relationships were extremely difficult for her and she routinely blamed herself for her struggles in this arena. The assessor utilized the TA model for adults, with the exception of not including an optional intervention session. The steps of TA, particularly the extended inquiry and the discussion of test findings along the way, cultivated a supportive and empathic atmosphere with Claire. By employing the single-case time-series experimental design used in previous TA studies (e.g., Smith, Handler, & Nash, 2010; Smith, Wolf, Handler, & Nash, 2009), the authors demonstrated that Claire experienced statistically significant improvement correlated with the onset of TA. Results indicated that participation in TA coincided with a positive shift in the trajectory of her reported symptoms and with recognizing the affection she held for others in her life. This case illustrates the successful application of case-based time-series methodology in the evaluation of an adult TA. The potential implications for future study are discussed.     

Memory aids in reality orientation: a single-case study

A single-case study of retraining both verbal and behavioural orientation in an 84-yr-old patient with senile dementia is described. In contrast to the traditional approach of employing RO sessions in which verbal learning and subsequent free recall is employed, the patient was provided with a watch and a diary containing personalized information and a daily behavioural itinerary. Results suggest that such memory aids can increase orientation and when effective use of these aids becomes the target of a specific behavioural training then purposive behaviour can be engineered.     

The impact of ordinate scaling on the visual analysis of single-case data

Visual analysis is the primary method for detecting the presence of treatment effects in graphically displayed single-case data and it is often referred to as the “gold standard.” Although researchers have developed standards for the application of visual analysis (e.g., Horner et al., 2005), over- and underestimation of effect size magnitude is not uncommon among analysts. Several characteristics have been identified as potential contributors to these errors; however, researchers have largely focused on characteristics of the data itself (e.g., autocorrelation), paying less attention to characteristics of the graphic display which are largely in control of the analyst (e.g., ordinate scaling). The current study investigated the impact that differences in ordinate scaling, a graphic display characteristic, had on experts' accuracy in judgments regarding the magnitude of effect present in single-case percentage data. 32 participants were asked to evaluate eight ABAB data sets (2 each presenting null, small, moderate, and large effects) along with three iterations of each (32 graphs in total) in which only the ordinate scale was manipulated. Results suggest that raters are less accurate in their detection of treatment effects as the ordinate scale is constricted. Additionally, raters were more likely to overestimate the size of a treatment effect when the ordinate scale was constricted.     

Marching to the beat of a different drummer: Examining the impact of pacing congruence

In this article, we develop theory predicting the impact of being in (and out) of sync with the general pace of the social environment at work. We examine how fit and misfit between individual and aggregate work group hurriedness impact satisfaction, psychological strain, and helping behavior. The hypotheses are tested in a manufacturing organization using a combination of polynomial regression and hierarchical linear modeling. Response surface graphs indicate that fit with the hurriedness of the work group generally maximizes satisfaction and helping behavior. A more complex relationship determines strain. In comparing misfit situations, individuals are less strained and less satisfied when they exceed the work group’s pace versus when work group pace exceeds theirs.     

Specificity of learning in reality-orientation sessions: a single-case study

A single-case study of retraining of verbal orientation in a 68-year-old patient with Korsa-koff's psychosis is described. In order to test the specificity of learning three different lists of verbalorientation items were taught in separate phases of a multiple-baseline design. Learning did occur mainly in the appropriate phases, with little generalization across phases being apparent. The results support the presence of a relearning component in the Reality-Orientation approach. In addition they emphasize that it is desirable for treatment programmes to focus on particular target areas of functioning.     

A developmental view of therapeutic bonding in the family: treatment of the disconnected family

Data from an ongoing research study have been used to identify a subgroup of families of severely ill, young adults who present formidable treatment challenges to the family therapist. The disconnected family is characterized by disturbances in attachment between one or both parents and the patient. In many cases, disturbances in attachment and caretaking in the family of origin are reported for the parents in these families. Disconnected families that also have intense emotional styles of relating are particularly difficult to treat. A treatment model that focuses on intergenerational attachment issues is described.     

Examining the potential exploitation of UNOS policies

The United Network for Organ Sharing (UNOS) waiting list was designed as a just and equitable system through which the limited number of organs is allocated to the millions of Americans in need of a transplant. People have trusted the system because of the belief that everyone on the list has an equal opportunity to receive an organ and also that allocation is blind to matters of financial standing, celebrity or political power. Recent events have revealed that certain practices and policies have the potential to be exploited. The policies addressed in this paper enable those on the list with the proper resources to gain an advantage over other less fortunate members, creating a system that benefits not the individual most in medical need, but the one with the best resources. These policies are not only unethical but threaten the balance and success of the entire UNOS system. This paper proposes one possible solution, which seeks to balance the concepts of justice and utility.     

The presence of a calling and academic satisfaction: Examining potential mediators

The present study examined the relation of calling and academic satisfaction with a diverse sample of 312 undergraduate students. The presence of a calling was moderately correlated with academic satisfaction, and a multiple mediation model was utilized to test three potential mediators to this relation: career decision self-efficacy, work hope, and meaning in life. Using bootstrapping techniques, significant indirect effects were found for two of the three mediators, career decision self-efficacy, and work hope. After including the mediators in the model, the relation of calling and academic satisfaction was non-significant. These results indicate that calling relates to greater satisfaction in the academic domain in part because of increased career decision self-efficacy and work hope. Directions for future research are discussed.     

Expanding the single-case study: a proposed psychoanalytic research program

This paper offers a proposed program of research using single-case time-series methods that can be used by practicing clinicians. The paper is written for psychodynamically oriented clinicians who want to get involved in psychotherapy research and make contributions to the scientific literature. How to measure treatment outcomes and psychodynamic constructs are discussed. With few exceptions, conducting single-case time-series research using psychodynamic psychotherapy has far more advantages than disadvantages.     

A combined therapeutic approach in a family setting

Combined treatment approaches, co-therapy and family work are three concepts which are under much discussion in psychiatry. This paper describes the systematic use of an integrated treatment approach used by co-therapists working with families in which a child was the referred patient. The rationale behind this approach together with its advantages and disadvantages are discussed. The authors conclude that the approach is sufficiently promising to merit formal evaluation.     

'Holding' as a therapeutic manoeuvre in family therapy

This paper describes the use of planned parental physical 'holding' as part of family therapy in a Child and Family Guidance Clinic. It is used when the child is overactive or out of parental control, or is not attached to its parents. Direct or indirect suggestions that parents hold their children are made by the therapist.     

Consistency in individual and family theoretical orientation from assessment to therapy: Its impact on the effectiveness of therapy

Abstract

The effect of consistency in theoretical orientation, whether individual or family, from assessment to therapy on the effectiveness of psychotherapy was examined in archival data. All identified patients (N=131) were ages 5-18 and comprised four groups according to the orientation of their assessment and therapy: the individual-individual (n=49) and family-family (n=49) groups and the individual-family (n=21) and family-individual (n=12) groups. Theoretical consistency was positively associated with therapy duration and participation, as well as with outcome. This association was attributable to the significant relation between family assessment prior to family therapy and the dependent variables of continuation in therapy, percent of sessions attended, nature of termination, and percent of missed sessions. Results support the theoretical position of family therapists that family assessment is the assessment method of choice.     

Examining the role of parental self-regulation in family physical activity: A mixed-methods approach

Physical activity (PA) is essential for good health. However, parents risk becoming less active because of the demands of parenting. This has consequences for children as parents are role models. The present study used a mixed-methods approach to explore parental self-regulation associated with PA. Data were collected from 36 parents with preschool-aged children. They were interviewed about their PA and their family’s PA. Parents also completed PA and self-regulation questionnaires and wore an accelerometer for five days. Qualitative data were examined using an inductive approach to thematic analysis. It showed that parents felt that they had limited time for personal PA. Mothers’ self-regulation was driven by an ethic of care and subjective norms, whereas fathers’ self-regulation was driven by beliefs about the importance of autonomy. Nevertheless, both parents saw caring for their children as the main priority. Quantitative data were examined using multiple regression analyses. Results showed that different self-regulatory behaviours predicted the PA of mothers and fathers. Which predictors were significant depended on the type of activity and how it was measured. The findings warrant longitudinal research that would enable the effect of family dynamics on self-regulation associated with PA to be assessed.     

A family therapy workshop: a review of a two-year experiment in a Social Services Department

As family therapy ceases to be regarded as a passing fashion, and becomes recognized as a real therapeutic force, the need for new forms of support and supervision is becoming ever more apparent. This paper describes and evaluates the supervisory system for family therapy set up by an Area Group in a Local Authority Social Services Department and plans to do so in a way which has practical application for workers in a variety of settings.     

Observing the therapeutic alliance in family therapy: associations with participants' perceptions and therapeutic outcomes

Positive and negative alliance‐related behaviours of thirty‐seven families seen in brief family therapy were rated from videotapes using the System for Observing Family Therapy Alliances ( Friedlander et al., 2006b ). Positive associations were found between in‐session behaviour and participants' perceptions of the alliance and improvement so far both early (session 3) and later in therapy (session 6). Binary logistic regression showed that successful outcomes (defined as consensus by therapist and all family members on general improvement and reduced problem severity) were significantly predicted by positive individual behaviour (Engagement in the Therapeutic Process, Emotional Connection with the Therapist, Safety within the Therapeutic System) in session 3 and productive within‐family collaboration (Shared Sense of Purpose within the Family) in session 6. Shared Sense of Purpose was the alliance indicator most consistently associated with clients' and therapists' perceptions of therapeutic progress; moreover, it was the only alliance indicator to improve significantly over time in treatment.     

The impact of contextual family risks on prisoners' children's behavioural outcomes and the potential protective role of family functioning moderators

Abstract

Research suggests that children of prisoners have an increased risk for behavioural and emotional problems. However, in a resilience approach, one should expect heterogeneous outcomes and thus apply a contextualized perspective. As this is rarely acknowledged in empirical research, the present study sought to fill this gap using data from the Fragile Families and Child Wellbeing study on 801 children of imprisoned fathers. We explored the extent to which cumulative family risks measured during the first year of life (e.g., poverty and mental health problems) predicted behavioural outcomes at age 9 and whether potentially protective aspects of family functioning moderated the impact of these risk factors. Cumulative risk significantly predicted behavioural outcomes, but the associations were weak. No strong evidence of moderation was found. At low risk, mother–child closeness moderated behavioural outcomes. There was also some evidence of moderation by accumulated protective factors. Potential implications for policy and practice and challenges for further research are discussed.