Family treatment of an obsessive-compulsive child: a case report

This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.     

Characterizing variation in the functional connectome: promise and pitfalls

The functional MRI (fMRI) community has zealously embraced resting state or intrinsic functional connectivity approaches to mapping brain organization. Having demonstrated their utility for charting the large-scale functional architecture of the brain, the field is now leveraging task-independent methods for the investigation of phenotypic variation and the identification of biomarkers for clinical conditions. Enthusiasm aside, questions regarding the significance and validity of intrinsic brain phenomena remain. Here, we discuss these challenges and outline current developments that, in moving the field toward discovery science, permit a shift from cartography toward a mechanistic understanding of the neural bases of variation in cognition, emotion and behavior.     

Prompting a consumer behavior for pollution control

A field application of behavior modification studied the relative effectiveness of different prompting procedures for increasing the probability that customers entering a grocery store would select their soft drinks in returnable rather than nonreturnable containers. Six different 2-hr experimental conditions during which bottle purchases were recorded were (1) No Prompt (i.e., control), (2) one student gave incoming customers a handbill urging the purchase of soft drinks in returnable bottles, (3) distribution of the handbill by one student and public charting of each customer's bottle purchases by another student, (4) handbill distribution and charting by a five-member group, (5) handbills distributed and purchases charted by three females. The variant prompting techniques were equally effective, and in general increased the percentage of returnable-bottle customers by an average of 25%.     

New problems and results in behavior therapy

What is presently observed is not only a rapid increase in the number of publications, but also a major change in the theoretical principles of behavior therapy. The former onesidedness of a form of behavior therapy theoretically substantiated by classical conditioning only may be regarded as having been completely overcome. For example, this is evident from new approaches to behavior diagnosis as an essential prerequisite of differentiated therapy planning. Recent concepts of the theoretical substantiation of the effectiveness of behavior therapy lead to an increasing consideration of both cognitive and motivational aspects and also take into account the complexity of the patient's social relations. This, in turn, results in the availability of a wide range of indication-specific methods of behavior therapy.     

Clients' experiences of online therapy in the early stages of a COVID-19 world: A scoping review

The emergence of the COVID-19 pandemic in 2019 forced an abrupt shift in the modality through which psychotherapy was delivered and online therapy became the only viable option for clients. Research regarding experiences of online therapy during the early stages of the COVID-19 pandemic is minimal, however, and has largely focussed on therapists' experiences of delivering online treatment, as opposed to clients' experiences of receiving it. A scoping review was undertaken to establish what is known from the existing literature about clients' experiences of online therapy during the initial stages of the COVID-19 pandemic and identify gaps in the current knowledge. Searches were conducted across four academic databases: Scopus, EBSCO CINAHL Complete, EBSCO MEDLINE and OVID PsycInfo; the literature was excluded based on established PICOS criteria. Data were summarised through data charting and synthesised by way of inductive content analysis. A total of five articles were identified. All articles focussed on online therapy using video or audio conferencing, and four of the five studies examined clients with eating disorders. Inductive content analysis identified seven categories, as follows: preference for face-to-face therapy; appreciation of accessibility and convenience; online format hindered connection; positive experience of online therapy; individual client differences impacted experience; strong therapeutic alliance indicative of positive experience; and gratitude for continuation of treatment. Future research could explore clients' experiences of online therapy in a “post-pandemic” world and include a broader range of client populations and online therapy approaches in the COVID-19 context.     

Personal management of growth: productivity, decision-making, emotion, and social behavior in my senior year.

The writer used self-recording and charting of his own behavior as a way to observe and manage changes during his senior year at high school. The method used has implications for the application of behavior modification technology to self-management, and to behaviors that occur inside an organism's skin. The results have implications for study of the Senior Slump", for college and career planning in high school, for clarifying interpersonal attitudes, and for keeping track of one's emotional well-being.     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy's comparable efficacy to other empirically supported approaches.     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.     

The Effects of Strategic and Behavioral Family Therapies on Child Behavior and Depression

The efficacy of behavioral and strategic approaches to child-focused family therapy for child behavior and depressive symptomatology was investigated. Participants were 49 clinic-referred families who were randomly assigned to either behavioral or strategic family therapy for 8 to 12 weeks and assessed at pre- and post-test. Results showed that both forms of therapy were equally effective in reducing parent-reported behavior problems and depression in children. In addition, the relationship between child and maternal depression was explored. Significant relationships were found between pre-test levels of depression in children as reported by mothers and mothers' self-reported depression, psychological stress and level of interpersonal discomfort. The results support a relationship between child and maternal depression. The findings also suggest that child-focused family therapy can be effective for both behavioral and depressive symptoms.     

Musiktherapie

Music therapeutic treatment targets the development of the perception, experience, symbolization and relationship abilities of an individual. The reception, production and reproduction of music induce intrapsychic and interpersonal processes. The processing of musical material provides a suitable means for reflective insight and recognition. With the help of music therapy resources are activated and individually significant associations of experiences are substantiated. Music therapy methods follow psychoodynamic, behavior therapeutic, learning theoretical, systemic, anthropological and holistic humanistic approaches. The scientific-based and evaluated special therapy focuses the expression of treatment diversity as well as theory formulation and immanent evaluation of treatment approaches.     

Strategy Choice in Sociocultural Context

Historically, research on strategy development has focused on charting changes in modal strategy use associated with age and experience. In recent years, however, researchers have begun to document the variety of strategies children have in their repertoires at different ages and with different degrees of experience on tasks. Of growing importance is understanding the processes by which children choose among available approaches. In this paper, I review evidence that sociocultural influences play a powerful role in shaping both the repertoires of strategies individuals have available to solve problems, and the choices they make among those strategies.     

Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders

The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well established for the treatment of eating disorders. Attention is given to inclusion and exclusion criteria, how the program differs from standard treatments for eating disorders, and the application of specific DBT treatment components for multidiagnostic clients with eating disorders.     

Toward a Developmentally Informed Narrative Therapy

Narrative approaches to psychotherapy emphasize the impact of the stories or narratives we construct on our reality and behavior. However, little effort has been made to elucidate how individuals' differential capacities for meaning-making influence the process of re-storying lives. The present article introduces to family therapy a model of the changing nature of individuals' ability to create meaning. The model, referred to as developmental-constructivism ( 10 ), suggests that, in addition to contextual factors, individual differences in the capacity for organizing experience will influence therapeutic efforts to generate new and more adaptive narratives. The model is also presented as a heuristic for comparing and integrating two influential approaches to narrative therapy: the externalizing approach of Michael White and the solution-focused approach of Steve de Shazer.     

THE EPISTEMIC APPROACH IN COGNITIVE THERAPY

A theory of epistemic behavior is applied to the problem of cognitive therapy. The theory addresses the process whereby all knowledge is acquired and modified. The task of cognitive therapy is to modify some types of knowledge, those with aversive consequences to the individual. Any knowledge is assumed to be inevitably biased, selective and tentative. It is assumed to be affected by three epistemically relevant motivations: the need of structure, the fear of invalidity and the need of conclusional contents. Such motivations can be appropriately enlisted in the aid of uprooting the patient's dysfunctional beliefs or “frustrative hypotheses” concerning his/her failures to attain important goals. Unlike major alternative approaches, the present one: (1) disputes the dysfunctional misconception hypothesis whereby neurotic inferences are distorted or biased as compared to normal inferences, (2) questions the value of constructing a priori lists, or taxonomies of dysfunctional beliefs, and (3) qualifies the suggestion that own behavior or personal experience is a superior vehicle of belief-induction. Instead, the persuasive value of behavior or experience is assumed to be restricted to cases in which the individual trusts his own ability to interpret the events at hand.     

A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes

This paper critically examines the historical conceptualization of cognitive behavioral psychotherapy approaches (CBT) as a direct clinical counterpart of the cognitive revolution. The main “second wave” cognitive psychotherapies, either standard cognitive therapy (CT) or constructivist, in spite of their differences, share a common conceptualization of psychopathological factors as superordinate structural cognitive content belonging to the self: self-beliefs, self-schemata, personality organizations and so on. On the other hand, rational emotive behavior therapy (REBT) is an exception given that in REBT self-knowledge is not the core psychopathological tenet, being rather a derivate mechanism. Moreover, in non clinical cognitive science cognition is conceived as a regulatory function that operates retroactively and not in a hierarchically super- ordered fashion centered on the self. A historical review suggests that in both CT and constructivist model the structuralistic model of self-centered cognition may have emerged for both cultural and scientific reasons: self-centered cognitive models may be more readily understandable to clinicians as they allow for a straightforward identification of operationalizable self-beliefs. The emergence of new “third wave” process-centered CBT approaches may represent a comeback to functionalism, where cognition is considered again a regulatory function and not a structure. In addition, REBT’s interest in dysfunctional evaluations not focused on the self presaged this clinical and scientific turning point toward functionalism.     

In search of meaning: values in modern clinical behavior analysis

Skinner described behavior analysis as the field of values and purpose. However, he defined these concepts in terms of a history of reinforcement and failed to specify whether and how human and nonhuman values might differ. Human values have been seen as theoretically central within a number of nonbehavioral traditions in psychology, including humanism and positive psychology. However, these approaches have failed to provide explanations of the behavior-environment relations involved in valuing that might allow prediction and influence with respect to this phenomenon. Modern clinical behavior analysis in the form of acceptance and commitment therapy (ACT), however, succeeds in providing a functional definition of human values that meets this latter criterion. ACT is rooted in behavior analysis and relational frame theory (RFT) and defines values in terms of verbally established motivation. ACT empirical research into values has begun to blossom in recent years, and ACT-RFT researchers are currently investigating the concept at the most basic empirical level as well as in the applied clinical arena, heralding new interest in and insight into values within clinical behavioral psychology.     

Bayesian data analysis as a tool for behavior analysts

Bayesian approaches to data analysis are considered within the context of behavior analysis. The paper distinguishes between Bayesian inference, the use of Bayes Factors, and Bayesian data analysis using specialized tools. Given the importance of prior beliefs to these approaches, the review addresses those situations in which priors have a big effect on the outcome (Bayes Factors) versus a smaller effect (parameter estimation). Although there are many advantages to Bayesian data analysis from a philosophical perspective, in many cases a behavior analyst can be reasonably well‐served by the adoption of traditional statistical tools as long as the focus is on parameter estimation and model comparison, not null hypothesis significance testing. A strong case for Bayesian analysis exists under specific conditions: When prior beliefs can help narrow parameter estimates (an especially important issue given the small sample sizes common in behavior analysis) and when an analysis cannot easily be conducted using traditional approaches (e.g., repeated measures censored regression).     

Strengthening Connections: Functional Connectivity and Brain Plasticity

The ascendancy of functional neuroimaging has facilitated the addition of network-based approaches to the neuropsychologist’s toolbox for evaluating the sequelae of brain insult. In particular, intrinsic functional connectivity (iFC) mapping of resting state fMRI (R-fMRI) data constitutes an ideal approach to measuring macro-scale networks in the human brain. Beyond the value of iFC mapping for charting how the functional topography of the brain is altered by insult and injury, iFC analyses can provide insights into experience-dependent plasticity at the macro level of large-scale functional networks. Such insights are foundational to the design of training and remediation interventions that will best facilitate recovery of function. In this review, we consider what is currently known about the origin and function of iFC in the brain, and how this knowledge is informative in neuropsychological settings. We then summarize studies that have examined experience-driven plasticity of iFC in healthy control participants, and frame these findings in terms of a schema that may aid in the interpretation of results and the generation of hypotheses for rehabilitative studies. Finally, we outline some caveats to the R-fMRI approach, as well as some current developments that are likely to bolster the utility of the iFC paradigm for neuropsychology.     

Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior Problems and Drug Abuse

This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.