Multiply Victimized Women: How Do They Change?

Recent studies have demonstrated that women are frequently victims of several types of violent actions via different agents throughout their life spans. Furthermore, multiple victimizations have been associated with psychological difficulties. The present study aimed to understand the change processes, in a self-directed way, of 19 female victims of multiple violent actions during their lifetimes. The women were evaluated for one year using a depression scale and a qualitative interview. The interviews were analyzed using the innovative moments (IMs) model. The results evidenced three groups, according to the evolution of their depressive symptoms during the one-year evaluation period. There were two unchanged groups, one being the symptomatic group (N = 6), which continuously presented symptoms at a clinical level, and the other the asymptomatic group (N = 7), which did not report depressive symptoms at any assessment moment. The change group (N = 6) exhibited a reliable decrease in clinically significant symptoms. Regarding IMs, the majority of the women were able to develop innovative moments regarding the dominant problem over a one-year evaluation period. Those women mobilized alternative ways to address multiple victimization experiences primarily through reflection IMs. Although there were several exceptions to the problematic narratives during the one-year assessment, the change group had a higher proportion and diversity of IM types—namely, a higher reconceptualization and reflection subtype II—compared with the unchanged groups. Moreover, reconceptualization differentiated the change group from the other two groups. These latter IMs may reflect the concept of “postvictimization growth” and the positive changes that arise from experiences of victimization.     

Intrusive and non-intrusive memories in a non-clinical sample: the effects of mood and affect on imagery vividness

We studied the number, valence, and vividness of intrusive and non-intrusive memories in two groups (N = 20) of pre-screened non-depressed mood and depressed mood undergraduate participants. They were asked to generate as many intrusive memories (IMs) as possible from the prior 2 weeks, together with pleasant and unpleasant non-intrusive memories from the same period. They subsequently formed images of these memories and rated them on measures of vividness, valence, arousal, and overall affect, while having their heart rate, skin conductance, and electromyogram monitored. IMs were common, with participants generating a mean of 1.15 pleasant IMs and 1.60 unpleasant IMs, and there was some evidence that they were mood-congruent. IMs were more vivid than non-intrusive memories, a difference not due to either valence or arousal. We conclude that IMs are a general feature of human memory rather than just a symptom of certain clinical disorders.     

Intrusive and non‐intrusive memories in a non‐clinical sample: The effects of mood and affect on imagery vividness

We studied the number, valence, and vividness of intrusive and non‐intrusive memories in two groups (N = 20) of pre‐screened non‐depressed mood and depressed mood undergraduate participants. They were asked to generate as many intrusive memories (IMs) as possible from the prior 2 weeks, together with pleasant and unpleasant non‐intrusive memories from the same period. They subsequently formed images of these memories and rated them on measures of vividness, valence, arousal, and overall affect, while having their heart rate, skin conductance, and electromyogram monitored. IMs were common, with participants generating a mean of 1.15 pleasant IMs and 1.60 unpleasant IMs, and there was some evidence that they were mood‐congruent. IMs were more vivid than non‐intrusive memories, a difference not due to either valence or arousal. We conclude that IMs are a general feature of human memory rather than just a symptom of certain clinical disorders.     

Effectiveness of error management training: a meta-analysis

Error management training (EMT) is a training method that involves active exploration as well as explicit encouragement for learners to make errors during training and to learn from them. Past evaluation studies, which compared skill-based training outcomes of EMT with those of proceduralized erroravoidant training or of exploratory training without error encouragement, have yielded considerable variation in effect sizes. The present meta-analysis compiles the results of the existing studies and seeks to explain this variation. Although the mean effect of EMT across all 24 identified studies (N = 2,183) was positive and significant (Cohen's d = 0.44), there were several moderators. Moderator analyses showed effect sizes to be larger (a) for posttraining transfer (d = 0.56) than for within-training performance and (b) for performance tasks that were structurally distinct (adaptive transfer; d = 0.80) than for tasks that were similar to training (analogical transfer). In addition, both active exploration and error encouragement were identified as effective elements in EMT. Results suggest that EMT may be better suited than error-avoidant training methods for promotion of transfer to novel tasks.     

Meaning Coconstruction in Group Counseling: The Development of Innovative Moments

This study discusses a model of group counseling, the narrative mediation path (NMP), which is a unique narrative, multimodal approach that combines four narrative modes (metaphoric, iconographic, writing, and bodily) and the narrative group. The purpose of the NMP is to foster reflexive processes with underachieving university students and to improve their academic performance. The study analyzes a single case of group counseling for seven underachieving economics students at an Italian university and the process of meaning construction among NMP narrative modes and the follow-up session. It applies the innovative moments coding system, a reliable method for studying change by tracking narrative innovations in sessions. More specifically, we focus on how innovative moments (IMs: action, reflection, protest, and reconceptualization) evolve during the four different narrative modes and the follow-up session. The findings suggest that the NMP fosters narrative innovations, mainly of a reflexive nature (reflection and reconceptualization). Moreover, during counseling and the follow-up session, the pattern of change is primarily characterized by reconceptualization IMs, the most complex form of narrative innovation.     

Narrative and Clinical Change in Cognitive-Behavior Therapy: A Comparison of Two Recovered Cases

Psychotherapy research suggests that therapeutic change is associated with the emergence and development of innovative moments (IMs)—that is, exceptions to the problematic self-narrative that brought the client to therapy. This study compares two recovered cases of major depression, according to symptom measures, that presented contrasting profiles of evolution of IMs: one typical of successful therapy (Barbara), and another typical of unsuccessful therapy (Claudia). The core conflictual relationship theme (CCRT) was used to study narrative change independently of the innovative moments coding system (IMCS). The results suggest a high congruence between the IMCS and the CCRT profiles. Although Barbara presented changes in the IMCS and the CCRT in a similar way, Claudia's self-narratives (IMs and CCRT), despite symptom change, did not change. The results are discussed, considering the importance of narrative changes in recovery from depression and the maintenance of therapeutic gains.     

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a client's presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each client's functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.     

A comparison of the quality of intrusive memories in post-traumatic stress disorder and depression

As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.     

A comparison of individual and group cognitive-behavioural treatment for female pathological gambling

The current study aimed to determine the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered in individual and group format. Fifty-six female pathological gamblers with electronic gaming machine gambling problems were randomly assigned to the control (waiting list) group or one of the treatment groups (individual or group treatment). Treatment comprised a 12-session program including financial limit setting, alternative activity planning, cognitive correction, problem solving, communication training, relapse prevention, and imaginal desensitisation. Treatment outcome was evaluated with conceptually related measures within the areas of gambling behaviour and psychological functioning. While individual and group treatment formats generally produced comparable outcomes in terms of gambling behaviour and psychological functioning, group treatment failed to produce superior outcomes to the control group in relation to several measures of psychological functioning. Moreover, by the completion of the six-month follow-up, 92% of the gamblers allocated to individual treatment compared with 60% allocated to group treatment no longer satisfied the diagnostic criteria for pathological gambling. These findings suggest that some caution should be employed when delivering cognitive-behavioural treatment in a group format until further research is conducted to establish its efficacy.     

Meta-analysis for single-case consultation outcomes: Applications to research and practice

The application of meta-analysis holds much appeal for single-case consultation outcome research. We review a meta-analytic method for using within-study treatment effect sizes in reporting consultation outcomes. The strengths and limitations of traditional group design meta-analysis are examined. Various methods for analyzing single-case outcomes are discussed briefly, followed by an examination of the use of meta-analysis in single-case reviews across independent studies. Within-study meta-analytic results are presented that were derived from treatments implemented in consultations in natural settings. To conclude the article, an illustration is offered of a single-case data analysis display that incorporates meta-analytic results along with other indices of treatment outcome. Recommendations are provided for using meta-analytic methods to evaluate outcomes of single-case consultation treatment.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

An experimental investigation of the impact of the Lidcombe Program on early stuttering

Preliminary Phase I and II trials for the Lidcombe Program of early stuttering intervention have found favorable outcomes and that the treatment is safe. Although speech-language pathologists (SLPs) often need to intervene with pre-schoolers' early stuttering, many of these children will recover at some time in the future without such intervention. Consequently, they need to know whether the Lidcombe Program's effect on stuttering is greater than that of natural recovery. Participants were 23 pre-school children who were randomly assigned to either a control group or a treatment group that received the Lidcombe Program for 12 weeks. A repeated measures ANOVA showed no main effect on stuttering for the group (control/treatment), a significant main effect for the measurement occasion (at the start and at the end of the treatment period), and a significant interaction between group and measurement occasion. Stuttering in the treatment group reduced twice as much as in the control group. These results are interpreted to mean that the introduction of the Lidcombe Program has a positive impact on stuttering rate, which exceeds that attributable to natural recovery.     

Exploring the Relationship Between Conduct Disorder and Residential Treatment Outcomes

We examined the differential outcomes in residential treatment for youths with conduct disorder (CD)—with special attention paid to interactions with age and gender—in a sample of children and adolescents in 50 residential treatment centers and group homes across Illinois. Multi-disciplinary teams rated youths ages 6–20 (N = 457) on measures of mental health and other factors within 30 days of admission, about 7 months after admission, and at discharge. While both groups initially responded similarly to treatment, the CD group performed better relative to the non-CD group over the full course of treatment, showing healthier relative change on five outcomes variables and more significant improvement. Age range moderated the relationship between CD group membership and change in work/school performance. There were significant between groups differences within the youngest age group (6–11 years) in which the CD group worsened relative to the non-CD group.     

Psychological Change in Everyday Life: An Exploratory Study

The innovative moments model was used in a pilot study that aimed to explore the change processes involved in everyday change outside psychotherapy. According to this model, the emergence and development of innovative moments (IMs) as exceptions to a problematic pattern are closely associated with psychological change. A longitudinal design covering 4 months of interviews was implemented with 13 adults who were coping with significant personal problems without clinical psychopathological complaints. Semistructured interviews were used to explore participants' personal accounts of their problems, and change was assessed using a scaling task at the end of the study. A total of 114 interviews were analyzed using the innovative moments coding system. A general linear model showed that higher levels of change were associated with higher proportions of complex IMs over time. Moreover, lower levels of change were associated with an increase in elementary IMs. These results support the idea that successful psychological change in everyday life shares similarities with the change pattern found in psychotherapy using the innovative moments model.     

Evaluating Group-Based Interventions When Control Participants Are Ungrouped

Individually randomized treatments are often administered within a group setting. As a consequence, outcomes for treated individuals may be correlated due to provider effects, common experiences within the group, and/or informal processes of socialization. In contrast, it is often reasonable to regard outcomes for control participants as independent, given that these individuals are not placed into groups. Although this kind of design is common in intervention research, the statistical models applied to evaluate the treatment effects are usually inconsistent with the resulting data structure, potentially leading to biased inferences. This article presents an alternative model that explicitly accounts for the fact that only treated participants are grouped. In addition to providing a useful test of the overall treatment effect, this approach also permits one to formally determine the extent to which treatment effects vary over treatment groups and whether there is evidence that individuals within treatment groups become similar to one another. This strategy is demonstrated with data from the Reconnecting Youth program for high school students at risk of school failure and behavioral disorders.     

‘Tied together feelings’ Group psychotherapy with latency children: the process of forming a cohesive group

In this paper we describe our experience of running a psychoanalytic psychotherapy group for six children, ranging in age from 4-8 years old. The group ran for a year, with sessions held weekly for an hour. The rationale for group work, selection criteria and the treatment setting are discussed. The paper charts the evolution within the children of the concept of an internal 'work group' (Bion, 1961), as opposed to a 'gang', as their self-awareness and capacity to relate to each other improved. This reflected a corresponding shift in their relationship to the two group leaders, moving from their initial perception of us as neglectful and in conflict with each other, towards recognizing us as a therapist couple who could work together thoughtfully for their benefit. The children's relationship to the group leaders, representing a 'parental couple' in the transference, was the focus of much of the work group. The positive outcomes for most of the children, resulting from this treatment, are reported.     

Asociality and engagement in adult offenders in substance abuse treatment

In therapeutic community models for drug treatment, individual recovery is principally structured around group meetings and positive peer influences. Research shows that asocial group members with resistant behaviors and attitudes are at risk for poor treatment outcomes and have the potential to adversely impact the therapeutic group. To gain a better understanding of the asocial client's role in the larger treatment process, in-prison treatment data were used: (1) to model and confirm a two-factor solution of asociality consistent with the literature, and (2) to examine the relationship between asocial clients and treatment engagement for validation of the two-factor model. Exploratory analysis resulted in a three-factor solution representing behavioral responsivity, cognitive distortion, and social disassociation dimensions. Nested ANOVA (i.e., clients nested within prison programs) demonstrated that asocial levels (low, medium, and high risk) predicted treatment engagement. Furthermore, comparisons among asocial risk levels indicated that high asocial clients reported significantly lower engagement levels when compared with low and medium asocial clients. Copyright ? 2012 John Wiley & Sons, Ltd.     

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.     

Does severity predict distress? The relationship between subjective and objective measures of appearance and psychological adjustment,during treatment for facial lipoatrophy

The intuitive or lay belief that the severity of a disfiguring condition predicts psychological distress is not demonstrated in clinical practice, nor in research studies. This within group study used standardised measures repeated at six month intervals, to investigate the relationship between subjective and objective measures of appearance and psychological adjustment in 51 patients undergoing treatment for facial lipoatrophy using a synthetic filler, Newfill^®. Results demonstrate a dissociation between objective and subjective measures with only subjective assessment predicting psychological outcomes. It is recommended that Moss's (2005) hypothesis of discrete group membership (normal/not normal) should be adapted to include an internal standard for comparison, and that all evaluations of treatment modifying disfigurement should include a standardised subjective measure of appearance.     

Studying psychotherapy change in narrative terms: The innovative moments method

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format.