The behavioral treatment of neurodermatitis through habit-reversal

Azrin and Nunn's habit-reversal technique (1973, 1977) was used to treat four clients with neurodermatitis. Following a single treatment session, scratching associated with this skin condition was markedly reduced for three clients, whereas this reduction occurred for the fourth client 4 days following treatment. Results at 6-month follow-ups showed that scratching was eliminated for the client with the mildest case, whereas this behavior remained at low levels for the other three clients.     

Oral behavioral patterns in facial pain, headache and non-headache populations

Patterns of oral behavior have been suggested as factors leading to head and facial pain. The present study evaluated the frequency with which certain oral habits were self-reported by five groups of Ss: Facial Pain. Tension Headache, Migraine Headache, Combined Migraine and Tension Headache and No Pain. Four oral behavior patterns were found to be significantly different among groups. These were diurnal bruxism. thrusting the jaw forward, cupping the chin in the hand and resting the hand on the side of the face. When Ss were reclassified into those reporting no facial pain, temporomandibular joint (TMJ) pain, or a combination of TMJ and jaw muscle pain, the variables of diurnal bruxism and resting the hand on the side of the face were found to predict significantly both pain groups. However, the resting the hand factor was negatively weighted for the TMJ Pain group only. One other factor, nocturnal bruxism. was found to be self-reported at a significantly higher frequency in the Combined Facial Pain group compared to the No Facial Pain and TMJ Pain groups. Discussion focuses on the implications of the present findings on research in the facial pain and headache areas.     

THE USE OF AN ENHANCED SIMPLIFIED HABIT-REVERSAL PROCEDURE TO REDUCE DISRUPTIVE OUTBURSTS DURING ATHLETIC PERFORMANCE

An enhanced simplified habit-reversal procedure was used with a 14-year-old boy who presented with a long history of disruptive, angry outbursts during tennis matches. Initial treatment involved simplified habit-reversal procedures delivered in a multiple baseline design across settings. Modest results led to additional supporting contingencies, including response cost. Results showed elimination of disruptive outbursts during both nontournament and tournament matches and highlight the importance of adding additional supporting contingencies to simplified habit reversal for some self-control problems.     

SEQUENTIAL APPLICATION OF MAJOR HABIT-REVERSAL COMPONENTS TO TREAT MOTOR TICS IN CHILDREN

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training; (b) awareness training and self-monitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.     

Spirituality of Chronic Orofacial Pain Patients: Case–Control Study

The objective of this study was to investigate spirituality and blood parameters associated with stress in patients with facial musculoskeletal pain. Twenty-four women with chronic facial musculoskeletal pain (CFMP) and 24 healthy women were evaluated with a protocol for orofacial characteristics, research diagnostic criteria for temporomandibular disorders and the Spiritual Perspective Scale. Blood samples were collected to analyze blood count, cortisol, ACTH, C3, C4, thyroid hormones, total immunoglobulin, C-reactive protein and rheumatoid factor. The study group was more spiritualized than control group. Individuals with a high score of spirituality had less myofascial pain, less bruxism and fewer complaints. They also had lower levels of ACTH and IgE. Spirituality was higher in the study group and can be considered an important tool for coping with CFMP.     

AUGMENTING SIMPLIFIED HABIT REVERSAL WITH AN AWARENESS ENHANCEMENT DEVICE: PRELIMINARY FINDINGS

The chronic hair pulling of a 36-year-old woman with moderate mental retardation was initially treated with a simplified habit-reversal (SHR) procedure that consisted of awareness training, competing response training, and social support. When SHR did not produce large and sustained reductions in hair pulling, an awareness enhancement device was added, and it reduced hair pulling to near-zero levels in two settings. The results are discussed, and directions for future research with this device are provided.     

REDUCING SEVERE DIURNAL BRUXISM IN TWO PROFOUNDLY RETARDED FEMALES

Several diurnal audible teeth grinding (bruxism) was found to affect 21.5% of a profoundly retarded population. However, no previous research has treated bruxism in retarded individuals. In the current study a multiple baseline across subjects design was used to assess the effectiveness of contingent “icing,” brief contingent tactile applications of ice, as a treatment for bruxism. Three 15-minute treatment periods and two 5-minute generalization periods were conducted 5 days per week. One resident displayed a 95% reduction in the percentage of intervals during which bruxism occurred during treatment periods and a 67 % reduction during generalization periods. The other resident displayed a 94% reduction in the percentage of intervals during which bruxism occurred during treatment periods and a 53% reduction during generalization periods.     

The relationship between frontalis muscle activity and self-reports of headache pain

The relationship between levels of frontalis muscle activity and self-reports of pain was evaluated in two studies. In Study I frontalis muscle activity and self-reports of pain collected during biofeedback treatment of muscular contraction headache clients were correlated. In Study II frontalis EMG activity was increased and decreased using biofeedback techniques while concurrent reports of headache pain were recorded. The results of Study I indicated a significant relationship between EMG activity and reported headache pain for only two of the five subjects studied. The biofeedback procedures in Study II were associated with reliable increases and decreases in EMG activity. Concordance between EMG and pain reports occurred only during the EMG increase condition. Overall correlations were significant for one of the 2 subjects. The results suggest that EMG activity may not be sufficient to account for pain reports in all chronic headache clients, and variables other than EMG activity may be influencing reports of pain in some patients.     

Death of a Clinician: The Personal, Practical and Clinical Implications of Therapist Mortality

Death is inevitable and yet in US culture the discussion of death is somewhat taboo. Marriage and Family therapists are trained in the implications of grief and loss for clients who lose loved ones and yet examination of the impact of therapist mortality on clients is lacking in the clinical literature. This article examines ways that private practice therapists can both protect their client’s confidentiality and mitigate the impact of therapist sudden death on their clients with planning and forethought. In addition, the factors influencing the lack of empirical research on this topic is discussed in the context of social mores on death and how therapists’ own denial of mortality may impact their ability to connect with clients through the pain of grief and loss. Recommendations are made for therapists to evaluate their own attitudes towards mortality and develop a plan for client care in the event of their death.     

Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

Contemporary Psychotherapy: Moving Beyond a Therapeutic Dialogue

Psychotherapy was developed as a means of using words to heal emotional pain. Although a therapeutic dialogue can be helpful to many clients, some people need a more action-based intervention. Psychotherapy may be enhanced by adapting several therapeutic procedures that have been found effective in physical therapy. Where physical therapy can help clients learn to manage chronic physical pain, psychotherapy can help clients learn to manage chronic emotional pain. Both physical therapy and psychotherapy can help to facilitate awareness, flexibility, strength and endurance in order to maximize the clients functional ability.     

Changes in the incidence of nocturnal bruxism in college students: 1966-1989

The frequency of self-reported nocturnal bruxism in three large samples of college undergraduates was compared as a means of assessing change in the incidence of this disorder since 1966. We found the incidence of nocturnal bruxism had increased from 5.1% to 20.5% in college students over the period covered by these studies.     

Client as Expert: Incorporating Spirituality Using the Tree Ring Technique

Addressing spirituality with clients from diverse spiritual backgrounds is a facet of culturally competent and ethical practice, yet various obstacles contribute to spirituality being overlooked. This article features a counseling technique used with clients who are experiencing difficulty with issues of a spiritual nature. Based on constructivist principles, the tree ring technique provides a context and process for examining clients’ spiritual conflicts, whereby the client is the expert and the counselor adopts a not‐knowing stance.     

Fading vs systematic desensitization in the treatment of snake and spider phobia

Fading, a new technique for the treatment of phobias, was compared to systematic desensitization and a waiting-list control group for clients with snake and spider phobia. The fading technique used slides of the phobic stimulus instead of imagery, and slides of positive scenes capable of arousing a calm positive feeling as anxiety-antagonists. The clients were assessed on different self-report, behavioural and physiological measures before and after treatment. The clients were treated individually and received eight sessions, one per week. The within-group comparisons showed that both the fading and the desensitization group changed significantly on most, of the dependent measures, but the control group did not. The between-group comparisons yielded fewer significancies but on four of the 12 dependent measures both treatment groups were significantly better than the control group, while there were no differences between the fading and desensitization groups.     

An inaccurate-timing filter for reaction time measurement by JAVA applets implementing Internet-based experiments

JAVA applets are not accurate enough to measure reaction time unless precautions are taken. A response-filtering technique is introduced that identifies inaccurate measurements by testing whether the client-side JAVA implementation produces false measurements of a time interval of known length during the measured reaction time. Reaction times that indicate such inaccuracy are discarded to increase the reliability of the remaining data. Three studies provide illustrative data on the effectiveness of the new technique, using 11 different computer systems. Study 1 showed differences in the accuracy of different clients and higher variability of the obtained means with applets than with native programs. Study 2 showed sharply increased variability when additional loads were imposed on the clients during reaction time measurement. The response-filtering technique diminishes this variability. Study 3 indicated more accurate measurement, with the new technique being able to reveal even smaller differences in difficult technical conditions.     

Photovoice: Fulfilling the Call for Advocacy in the Counseling Field

Counselors are bound by ethical code to advocate at individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit the growth and development of clients. Photovoice is a participatory action research method that utilizes a specific photographic technique to capture an issue from the lens of those affected. The authors of this article propose that photovoice can be adapted to individual counseling with clients to fulfill our ethical call to advocate at the individual level to address barriers and promote growth. A case example is given to demonstrate how photovoice can be used in a counseling session to advocate for clients.     

Clients’ Experiences of Disengaged Moments in Psychotherapy: A Grounded Theory Analysis

The study offers an empirically derived model of clients’ experiences of disengaged moments, defined as moments when clients withdraw, distance, or lessen their intensity of involvement with therapy-relevant material or relationships. Interpersonal Process Recall (IPR) interviews were conducted with nine psychotherapy clients of therapists with varied orientations and experience. The interviews were transcribed verbatim and subjected to qualitative analysis using grounded theory analysis (Glaser and Strauss, The discovery of grounded theory: Strategies for qualitative research, 1967) methodology. The results suggested that clients use disengagement for protection from pain, strategic retreat, relationship management, self-through-other discovery, and self-betterment. The core category across all of the experiences of disengagement relates to communicating difficulties and experimenting within the therapy relationship toward self-change. Recommendations are offered for research and practice.     

Toward the re‐enchantment of psychotherapy: Stories as container

Abstract

Storytelling by a therapist to clients may serve to increase clients’ ability to bear pain, to increase self‐complexity, and expand clients’ senses of the allowable. A model delineating the therapeutic impact of therapist storytelling in psychotherapy is proposed. Stories may change clients’ selves so that they may accommodate traumatic experiences and internal complexity. Stories increase clients’ capacity to tolerate painful experience and therefore serve as a container of tragic life experiences. The artistry of therapeutic story selection is defined as choosing stories consonant with clients’ strengths, rather than with the nature of the trauma. The power of story‐listening to alter consciousness in pleasant ways (storystoned) increases its usefulness as an intervention that is neither anxiety provoking nor re‐traumatizing.     

Exploring Counselor-Client Agreement on Clients’ Work Capacity in Established and Consultative Dyads

Counselor-client agreement on the work capacity of clients living with serious mental illnesses informs the counseling relationship and facilitates accurate assessments of client eligibility for public programs. In this exploratory mixed-methods study, we assessed counselor-client agreement on clients’ work capacity in 61 established therapeutic dyads and compared it with 30 dyads involved in an initial assessment session. Intraclass correlation coefficients and mountain plots were used to examine counselor-client agreement. Results revealed moderate counselor-client agreement of work capacity for both dyads. Counselor interviews illuminated sources of discordance. These results have practical implications for assessing the work capacity of clients.