Mediators of behavior change in two tailored physical activity interventions for adolescent girls

ObjectivesIt has been suggested that the lack of knowledge regarding the mechanisms responsible for behavior change may be responsible for the low levels of effectiveness in physical activity interventions among youth. While it is common for physical activity interventions to cite a theoretical framework, few test the validity of their constructs using an established mediation analysis technique. The purpose of this study was to identify mediators of physical activity behavior change in two tailored interventions for adolescent girls.DesignThis study involved an experimental design.MethodsParticipants (N=161) were randomly allocated to a control (CON) group, an intervention based on the Health Promotion (HP) Model or an intervention developed from the HP Model that included two processes from the Transtheoretical Model (THP). Both interventions included school-based education sessions, individual counseling sessions, and two physical activity sessions completed with the participants' mothers. Measures were assessed prior to the intervention, at post-intervention and at a 6-month follow-up. The following constructs were included in the mediation analyses: perceived benefits, perceived barriers, self-efficacy, exposure to models, social support, interpersonal norms, planning, stimulus control, and counterconditioning.ResultsPerceived benefits, perceived barriers, self-efficacy, and commitment to planning satisfied the criteria for mediation in the THP intervention. Self-efficacy and commitment to planning were identified as mediators in the HP intervention.ConclusionThe results of this study provide evidence that both interventions were successful in increasing physical activity through changes in the theoretical constructs.     

The Initial Psychotherapy Interview with Adolescent Clients

Initial psychotherapy sessions with adolescents can be very challenging due to the need to balance assessment, relationship building, caretaker/parent management, and case formulation with a client population that sometimes has little motivation for psychotherapy. This article combines empirical evidence, theoretical knowledge, and clinical experience to describe strategies for how psychotherapists can prepare themselves for initial psychotherapy sessions and manage tasks associated with five stages of the clinical interview: (a) the introduction, (b) the opening, (c) the body, (d) the closing, and (e) termination. Using case vignettes and short examples, there is an emphasis on how psychotherapists can develop and maintain a strong therapeutic alliance while simultaneously helping adolescent clients focus on psychotherapy tasks and goals. The overall goal of this article is to help psychotherapists smoothly navigate the potentially stormy stages of the initial clinical interview with adolescents.     

Implicit philosophies and therapeutic theories: How theoretical constructs conceal phenomena*

Abstract

This article is an attempt to respond to the question, “What lessons do philosophers have for psychotherapists?” The author approached the question by examining the role an implicit philosophical anthropology (Cartesian) played in the formation of a specific therapeutic construct. In particular, he explored how theoretical constructs conceal phenomena. The example employed was “projective identification.” It is shown that this construct which cradled a Cartesian philosophy actually hindered the psychotherapist who used it from accurately perceiving the experience of his client.     

Counsellor interpretations and the occurrence of in-session client change moments in non-dynamic psychotherapies

This study explored the relationship between therapist interpretations and optimal in-session client processes in 20 sessions conducted by exemplary psychotherapists of three different theoretical orientations: Client-Centred Therapy (CCT), Rational-Emotive Behaviour Therapy (REBT), and Gestalt/Existential Therapy (GT). The results indicated that interpretations were used with similar frequency across therapeutic approaches, but they were neither superior nor inferior to other interventions in relation to the occurrence of optimal in-session client processes. The results support the notion that interpretation is a commonly used therapist intervention and that different therapies accentuate different aspects of interpretation. Implications for psychotherapy integration are offered and the findings are discussed with reference to theory and clinical practice.     

Modes of Interaction in Psychodynamic Psychotherapy with Borderline and Non-Borderline Clients

Abstract

Individual variation in the use of symbolic aspects of the treatment situation has been theorized across client groups of varying developmental profiles. In particular, the use of metaphor is thought to be different in the therapies with Borderline clients. The present study involved an intensive qualitative analysis of metaphor-ic expressions from Borderline and non-Borderline psychotherapy sessions. Open-ended interviews were conducted with 2 therapists and 4 clients (2 Borderline; 2 non-Borderline) following single sessions from psychoanalyticaily oriented long term psychotherapies. The analysis of data found significant differences in the therapeutic interaction which led to the major core categories of (a) Literal Mode of Interaction and (b) Representational Mode of Interaction, representing the Borderline and non-Borderline sessions respectively. The characteristics of these two modes underscored the differences found in the use of metaphor between the two client groups. Implications for clinical practice are discussed.     

The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!

Abstract

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.     

The effectiveness of a proactive coping intervention targeting self-management in diabetes patients

Objective: The study’s aim was to investigate psychological, behavioral and medical long-term outcomes of an existing self-management intervention targeting the development of proactive coping skills (e.g. goal setting and identifying barriers) in type 2 diabetes patients. The study aimed to replicate prior research showing the intervention’s effectiveness, and to extend it by (a) adding booster sessions and (b) prolonging the period of follow-up measurement to capture long-term effects.

Design/outcome measures: A total of 141 type 2 diabetes patients were included in the intervention. The intervention employed a 5-step approach to target proactive coping skills. Psychological (e.g. proactive coping and self-efficacy) and behavioural variables (e.g. self-care, diet and physical activity) were assessed at baseline (T1), after the initial phase of the intervention (T2), after the booster phase (T3) and at follow-up (T4), comprising a total period of 15 months. Medical variables were assessed at T1 and T4.

Results: Employing piecewise Latent Growth Curve Modelling, results showed that participants improved on all psychological and behavioural variables during the initial phase and maintained these improvements over 12 months. The booster phase yielded no further improvements. Mixed findings were obtained on medical outcomes.

Conclusion: The original intervention is effective, but the added value of the booster sessions is uncertain.     

Attachment in Psychotherapy

Abstract

Basic psychotherapy techniques are necessary for trauma intervention, including the terrorist attacks that occurred on September 11, 2001. The importance of these techniques is reviewed within various settings in the New York City area immediately following the World Trade Center disaster. The purpose included debriefing of practitioners, as well as the education of trauma symptoms and assessment for client intervention. Perhaps most importantly was the therapeutic technique modeled by the social work leader in these vignettes, since she and other practitioners simultaneously experienced symptoms of trauma. The practice of creating and maintaining a therapeutic atmosphere at this time was an essential challenge for all.     

Feasibility and acceptability of an exergame intervention for schizophrenia

ObjectivesTo evaluate the feasibility and acceptability of an exergame intervention as a tool to promote physical activity in outpatients with schizophrenia.DesignFeasibility/Acceptability Study and Quasi-Experimental Trial.MethodSixteen outpatients with schizophrenia received treatment as usual and they all completed an 8-week exergame intervention using Microsoft Kinect^® (20 min sessions, biweekly). Participants completed pre and post treatment assessments regarding functional mobility (Timed Up and Go Test), functional fitness performance (Senior Fitness Test), motor neurological soft signs (Brief Motor Scale), hand grip strength (digital dynamometer), static balance (force plate), speed of processing (Trail Making Test), schizophrenia-related symptoms (Positive and Negative Syndrome Scale) and functioning (Personal and Social Performance Scale). The EG group completed an acceptability questionnaire after the intervention.ResultsAttrition rate was 18.75% and 69.23% of the participants completed the intervention within the proposed schedule. Baseline clinical traits were not related to game performance indicators. Over 90% of the participants rated the intervention as satisfactory and interactive. Most participants (76.9%) agreed that this intervention promotes healthier lifestyles and is an acceptable alternative to perform physical activity. Repeated-measures MANOVA analyses found no significant multivariate effects for combined outcomes.ConclusionThis study established the feasibility and acceptability of an exergame intervention for outpatients with schizophrenia. The intervention proved to be an appealing alternative to physical activity. Future trials should include larger sample sizes, explore patients' adherence to home-based exergames and consider greater intervention dosage (length, session duration, and/or frequency) in order to achieve potential effects.     

Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial

ObjectiveTo examine the effectiveness of an individualized problem-solving intervention provided to family caregivers of women living with severe disabilities.DesignFamily caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.ParticipantsFamily caregivers (64 women, 17 men) and their care recipients (81 women with various disabilities) consented to participate.Main outcome measuresCaregivers completed the Social Problem-Solving Inventory – Revised, the Center for Epidemiological Studies Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in three additional assessments throughout the year.ResultsMultilevel modeling was used to conduct intent-to-treat analyses of change trajectories for each outcome variable. Caregivers who received PST reported a significant linear decrease in depression over time; no effects were observed for caregiver health or life satisfaction. Caregivers who received PST also displayed an increase in constructive problem-solving styles over the year.ConclusionsPST may benefit community-residing family caregivers of women with disabilities, and it may be effectively provided in home-based sessions that include face-to-face visits and telephone sessions.     

Validity of the Global Assessment of Relational Functioning (GARF) When Used By Community-Based Therapists

Construct validity of the Global Assessment of Relational Functioning (GARF) was assessed using a health services research approach, a mode of study that captures the naturalistic practice of health service providers. A sample of 395 couple/family cases with GARF scores assigned pre- and post-therapy by 222 community-based marriage and family therapists yielded these results: 1) pretreatment GARF scores were negatively correlated with severity of client problems; 2) GARF change scores were positively correlated with client reported changes in functioning; 3) GARF change scores were positively correlated with therapist-reported client change; 4) GARF change scores were positively correlated with client satisfaction; 5) pretreatment GARF scores were negatively correlated with number of therapy sessions; and 6) pretreatment GARF scores and client diagnoses showed no relationship. Given these results the GARF appears to have construct validity in community settings, and is a promising brief assessment tool for relational functioning.     

Traumatic Incident Reduction

Abstract

Traumatic Incident Reduction (TIR) is a person-centered, yet intensely focused approach to trauma resolution, based on the principle that the very act of trying to repress painful memories is what holds them in place and gives them power over the individual. TIR consists of a safe and structured method for reviewing the contents of a past trauma repeatedly at a pace and with a degree of exposure determined by the client. By applying the TIR technique to a traumatic memory in a one-on-one setting with a trained facilitator, the client can discover what he or she needs to know in order to achieve a permanent reduction or elimination of the memory's traumatic aftereffects.     

Some Aspects of Empathy in the Process of Psychotherapy: Learning from Indian Tradition

This article focuses on some practices in Indian tradition as interventions for enhancing empathy among aspiring psychotherapists. In this venture, author after briefly looking into the evolution of pro-social behavior, it defines basic nature of bond formation between therapist and client, and then summarizes findings of studies on Eastern meditational practices in the context of empathy. Since there is not much convincing evidence that meditational practices enhanced empathy in psychotherapists, the suggestion is to explore other processes in the Indian tradition. Intuition (pratibha) and holistic learning (vyutpatti) are among those processes, respectively, for journeys into the inner world and interventions at community level. They are pragmatic ways to sensitize the aspiring psychotherapists.     

Effet de la thérapie des schémas sur la dépression de la personne âgée institutionnalisée : 3 études de cas uniques de type AB en lignes de bases multiples

IntroductionSchema therapy has confirmed its effectiveness in caring for depression. However, few studies have evaluated its effectiveness of an institutionalized elderly population.ObjectiveThe aim of this pilot study is to evaluate the efficiency of this therapy for the treatment of depression in 3 elderly people, with no neurocognitive disease, living in a nursing home.MethodClinician conducted a single case experimental protocol AB with multiple baseline for 3 participants who were experiencing depressive symptoms. Participants were randomized in 3 baselines and performed respectively 8, 7, and 6 intervention sessions.ResultsThe results highlight progressive effectiveness for two of the three residents. From baseline to the end of the therapeutic sessions (11 weeks), the improvement was significant and clinically observable for the activation of the schemas (–1.4 and –2 points on average) as well as for the level of depression (–8 and –9 points to the GDS).ConclusionThis pilot study indicates the effectiveness and replicability of schema therapy as therapeutic intervention for depression in elderly people.     

Play in Supervision

Abstract

Clinical supervision is a fundamental component of counselor education training. Counselor Educators play an active and dynamic role in helping beginning practicum students conceptualize their work with clients. The use of expressive arts in counseling has been shown to be effective in creating a deeper level and meaning to counselor and client interactions. This article describes the use of a particular expressive art technique, a sandtray, based on Sandplay Therapy, with students enrolled in beginning practicum. Additionally, results from a pilot study comparing ratings of traditional supervision and ratings of sandtray supervision with students enrolled in a beginning practicum experience are provided. Results of the pilot study indicated some preliminary support for the viability of the application comparing ratings of traditional supervision sessions with ratings of supervision using sandtray.     

A difficulty with the functionally independent construction measure of cognitive differentiation

Abstract

Much effort has gone into development of measures of cognitive differentiation. One of the most frequently used measures is Landfield's Functionally Independent Construction (FIC). The present study of the personal constructs of psychotherapists raises issues regarding the validity of FIC. Forty therapists were administered a repertory grid (Rep Grid) assessing their construal of self, clients, and acquaintances on both elicited and supplied constructs. Ratings were completed using a seven-point Likert-type scale (? 3 to + 3). FIC was calculated separately for the parts of the Rep Grid involving acquaintance construal, client construal, the total elicited construct Rep Grid, and the total Rep Grid. These FIC scores were correlated with the number of zero ratings in the grids, producing correlations greater than .70. It is proposed that these results are largely due to the method of computing FIC.     

Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor–client interactions

Motivational Interviewing (MI) is a client-centered communication style with the aim to resolve client ambivalence within a change-related counseling. Its potential benefit for career counseling has been discussed by several scholars but no empirical research has investigated MI in this context so far. The current study used process measures from MI to investigate dynamic interactions within a career counseling intervention. Overall, we analyzed two videotaped sessions of 14 unique counselor–client dyads. Verbal behavior of counselors and clients were coded with two observational coding schemes from MI (one for counselors and one for clients, respectively). Behavior profiles of counselors were compared with benchmarks of good MI. Furthermore, client verbal ambivalence was compared between sessions. Finally, we conducted lag sequential analyses to analyze temporal dynamics between counselor behavior and immediate client verbal responses across N = 6883 behavioral events. Our results showed, first, behavior profiles of career counselors did significantly differ from recommended counseling benchmarks of good MI practice. Second, as assumed on the basis of past studies, client ambivalence decreased across sessions. Third, MI consistent counselor behaviors showed a positive sequential association with client positive career talk, whereas MI inconsistent counselor behaviors showed the reverse pattern. Our results suggest that counseling behaviors recommended from MI are facilitating career interventions. We discuss how trainings in MI could amend career counseling interventions and provide ethical implications when integrating MI into career counseling programs.     

Alliance rupture and repair processes in borderline personality disorder: A case study using dialogical sequence analysis

Objective: This study examined alliance rupture and repair processes in borderline personality disorder (BPD) and how the content of sessions interacts with the quality of the alliance.

Design: A mixed methods single case study design was employed incorporating quantitative and qualitative measures of process and outcome.

Methods: This case study examined a 22-year-old female with BPD who received 16 sessions of Cognitive Analytic Therapy. Measures of alliance, symptoms and global functioning were taken across multiple time-points. Selected sessions were analysed using dialogical sequence analysis (DSA), a theory-driven method of psychotherapy research that analyses utterances according to their author, addressee and referential object.

Results: Quantitative data indicated symptom reduction without functional improvement. DSA demonstrated that the first exchanges in therapy were reflective of key relational themes. The case suggests that, rather than simply negotiating tasks and goals, repairing ruptures involves systematically linking the manifest topic to the client’s core problems.

Conclusions: This case study points to the mediating role that the content of sessions has on alliance quality. Results underline the importance of the therapist stance, the need for a shared formulation to make sense of relational processes and the use of responsively timed interventions to decrease desperation and improve self-reflection.