Does Maintenance Treatment Matter?

This study examined the effects of a two-year maintenance treatment assessed at 1 and 2 years following Parent–child Interaction Therapy (PCIT). Sixty-one of 100 clinic-referred children (M age?=?4 years, 4 months) originally diagnosed with oppositional defiant disorder (ODD) completed the standard treatment and were then randomized to PCIT maintenance treatment (MT) or to an assessment-only follow-up condition (AO). Rating scale and observational measures from fathers, mothers, and children were collected before and after standard treatment and at one- and two-year follow-up assessments. Maintenance treatment involved monthly telephone contacts from the original therapist focused on relapse prevention based on principles of PCIT. At the two-year follow-up, MT families showed few changes from post-treatment, as expected. However, the expected decrements for AO control families were not seen. Few differences between MT and AO were found at either follow-up assessment, and there were no significant differences in the rates of change during follow-up. The maintenance of gains among AO families may have resulted from the continuous enhancement of standard treatment or from inadvertent reinforcement for maintenance provided by the assessments of change alone.     

Self and Talent—Treatment Considerations

The clinical pursuit of patients' experiences of talent, in their current life and in their developmental years, has broadened the clinical field considerably and provided more lanes and latitude in the “royal road to the unconscious.” Interest in patients' talents has been experienced as an invitation to bring in their created works, not just as a display of aesthetic interest but, much more importantly, as another pathway through which the analyst can access an understanding of the deepest and most meaningful levels of selfexperience. This article explores some of the meanings of talent for the self and suggests that there is a developmental line for the maturation of one's relationship to one's talent. I provide discussion that illustrates the coextensiveness of the inner experience of talent with the selfobject surround throughout growth and maturation. Finally, I provide illustrations of how talent can be experienced and how exploration of experiences of talent can play a quintessential role in psychoanalytic treatment.     

Do Health Care Workplaces Affect Treatment Environments?

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, but the potential effect of health care workplaces on the treatment environment has been little studied. Building on a model proposed by Schaefer and Moos (1993), we propose that the workplace factors of supervisory work environment (e.g. support from supervisors, managerial control) and programme philosophical orientation (e.g. disease model of addiction, psychosocial learning model of addiction) predict four treatment environment elements: patient autonomy, staff control, staff sensitivity, and patient alienation. Multiple regression analysis of data drawn from a survey (response rate = 86%) of 327 staff members at 15 Veterans Affairs (VA) inpatient substance abuse treatment programmes revealed that greater managerial control over staff predicted greater patient alienation, lower staff sensitivity towards patients, and greater staff control over patients. Stronger disease model programme orientations predicted less patient alienation and greater staff sensitivity, whereas stronger psychosocial model programme orientations predicted less staff control. These results suggest that health care workplaces may influence treatment environments. Implications for further research and practice are discussed. © 1997 John Wiley & Sons, Ltd.     

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.     

Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

Psychoanalytic Treatment: Thick Soup or Thin Gruel?

One way to evaluate a psychoanalytic theory is to picture a therapist with that theory in his mind and imagine what happens when we fold him into the basic soup of psychoanalytic procedure. Because the background forces of analytic treatment are so influential, the practical outcome cannot be predicted from the details or the validity of the theory alone. Thus, we should not assume that newly discovered items of neurophysiology and infant observation are ever what is actually being dealt with in psychoanalysis. To illustrate this principle, I select two recent theories derived from observational studies, and explore the likely effects that a therapist's belief in them would have on seven dimensions of the psychoanalytic situation. Theories set the therapist's attitude, the attitude affects the background forces, and the total effect of all of that constitutes the significance of the theories for psychoanalytic treatment.     

Cultural and Telehealth Considerations for Trauma‐Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement

Given that trauma exposure among youth, particularly those from communities of color, is high, there is a dire need to improve trauma-focused treatment for young people of color. Growing research has documented that integrating cultural and telehealth considerations into trauma-focused treatment can enhance treatment engagement and lead to positive treatment outcomes. Therefore, the purpose of this paper is to demonstrate how to incorporate cultural and telehealth considerations concurrently to enhance treatment engagement for Latinx youth and their caregivers. Specifically, we describe the process of delivering Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to three trauma-exposed Latinx youths through the use of telehealth technology. Clinical recommendations are discussed to improve treatment engagement of Latinx youth and other young people of color.     

A Brief Motivational Intervention for Treatment‐Refusing OCD Patients

Cognitive behavioral therapy involving exposure and response prevention (ERP) is the psychosocial treatment of choice for obsessive‐compulsive disorder (OCD). Despite this, ERP is not widely used by mental health practitioners, and so dissemination of ERP and other empirically supported treatment (ESTs) has become a priority. Even so, utilization of ESTs such as ERP remains below 50% even among therapists who self‐identify as having a cognitive behavioral orientation. Barriers to the acceptance of ERP include practical obstacles such as lack of training and the cost of treatment, but also patient variables such as treatment refusal. It has been estimated that approximately 25% of OCD patients refuse ERP. This paper describes a brief, 4‐session readiness intervention (RI) designed to decrease ERP refusal among patients with OCD. In this study, 12 patients with OCD who had refused ERP were randomized to RI or wait‐list (WL). 86% of participants in the RI condition and 20% of participants in WL condition agreed to begin ERP following the 4‐week period. ERP following RI, but not WL, was associated with a decrease in OCD symptoms comparable to that observed in OCD patients who did not refuse ERP. However, ERP following RI was associated with a high drop‐out rate (50%), a figure that exceeds that typically seen in OCD treatment studies. Techniques to reduce drop‐out as well as directions for future research are discussed.     

Parents' Involvement in ASD Treatment: What Is Their Role?

The rising prevalence of autism spectrum disorders (ASD) warrants a greater level of clinical attention to best treat those with ASD. The characteristics of ASD lead to impairment for both the child with the disorder and his/her family. To effectively treat children with ASD, parents need to be included in intervention efforts. Research suggests that parental involvement in treatment improves the generalizability of skills and increases the amount of intervention the child receives. Numerous benefits have been found in child and parent outcomes when parents are included in treatment. The purpose of this paper is to discuss the impact ASD can have on the parent-child relationship, the factors that influence treatment outcome, and the advantages of including parents in treatment. The different roles parents can have in treatment will also be discussed along with providing clinicians guidance on practical ways to involve parents in the treatment of children with ASD.     

Parent–Child Informant Discrepancy is Associated with Poorer Treatment Outcome

In child clinical psychology, parent and child reports are typically used to make treatment decisions and determine the effectiveness of treatment. However, there are often moderate to large discrepancies between parent and child reports, and these discrepancies may reflect meaningful information about the parent, the child, and the parent–child relationship. Additionally, parent–child discrepancy may predict treatment outcome. This study examined parent–child discrepancy in a sample of 62 children (10.15±1.26 years old) with prominent social competence deficits and mixed diagnoses who were treated with a resilience-based, cognitive–behavioral group therapy program (the Resilience Builder Program) in a private clinical setting. Further analyses were conducted to investigate whether parent–child discrepancy related to treatment outcome. Consistent with the literature, prominent parent–child discrepancy was found across domains, with parents generally reporting more severe symptomatology. Treatment with the Resilience Builder Program resulted in significant improvement in parent report of multiple domains of functioning, including resilience, social skills, and emotion and behavior regulation. Importantly, larger parent–child discrepancy at the start of therapy was predictive of poorer overall treatment response. Given its impact on therapeutic effectiveness, these results suggest that parent–child disagreement regarding the child’s impairment at the onset of therapy is worthy of assessment prior to treatment, and may itself be a topic worthy of targeting in treatment.     

The Silent Treatment? Changes in patient emotional expression after silence

Psychotherapy can be an emotionally laden conversation, where both verbal and nonverbal interventions may impact the therapeutic process. Prior research has postulated mixed results regarding how clients emotionally react following a silence after the therapist is finished talking, potentially due to studying a limited range of silences with primarily qualitative and self-report methodologies. A quantitative exploration may illuminate new findings. Utilising research and automatic data processing from the field of linguistics, we analysed the full range of silence lengths (0.2–24.01 s), and measures of emotional expression—vocally encoded arousal and emotional valence from the works spoken—of 84 audio recordings of Motivational Interviewing sessions. We hypothesised that both the level and the variance of client emotional expression would change as a function of silence length; however, due to the mixed results in the literature, the direction of emotional change was unclear. We conducted a multilevel linear regression to examine how the level of client emotional expression changed across silence length, and an ANOVA to examine the variability of client emotional expression across silence lengths. Results of both analyses indicated that as silence length increased, emotional expression largely remained the same. Broadly, we demonstrated a weak connection between silence length and emotional expression, indicating no persuasive evidence that silence leads to client emotional processing and expression.     

Does the Traditional Treatment of Enthymemes Rest on a Mistake?

In many actual arguments, the conclusion seems intuitively to follow from the premisses, even though we cannot show that it follows logically. The traditional approach to evaluating such arguments is to suppose that they have an unstated premiss whose explicit addition will produce an argument where the conclusion does follow logically. But there are good reasons for doubting that people so frequently leave the premisses of their arguments unstated. The inclination to suppose that they do stems from the belief that the only way in which an argument's conclusion can follow definitely from its premisses is to follow logically. I argue that this belief is mistaken. I propose a revision of the current generic conception of logical consequence, and its variant specifications, to avoid the paradoxes of strict implication. The revised conception can then be naturally extended to include also what we might call 'enthymematic consequence'. This concept is a kind of consequence, whose properties merit investigation.     

Cognitive Appraisal Therapy: A Treatment Plan for “Silvia”

The principles and procedures of Cognitive Appraisal Therapy (CAT) are applied to the case of Silvia. The assessment plan focuses on affective, behavioral, and cognitive aspects of personality. The patient evidences self-pity and anger, and rebellion and withdrawal in her interpersonal relations. Key interventions include encouraging positive methods for comforting her feelings, building self-respect by doing what she deems morally right, eliminating self-defined victim status by active pursuit of her goals, and correcting cognitive distortion of self-image and pessimistic forecasts. Other characteristic CAT interventions are also discussed and illustrated.     

Breathwork: An Additional Treatment Option for Depression and Anxiety?

Breathwork is an increasingly popular experiential approach to psychotherapy based on the use of a specific breathing technique, however, claims of positive mental health outcomes rely on anecdotal clinical evidence. To ascertain the likely efficacy of breathwork this review clarifies the approach and its theoretical assumptions and examines relevant empirical research relating to breathing inhibition, suppression of inner experience, and possible neurological and physiological effects. Additionally, research into mindfulness-based psychotherapy and yoga breathing-based interventions with comparable features to breathwork are examined. Findings suggest qualified support for the key theoretical assumptions of a three component breathwork model, referred to as Integrative Breathwork Therapy (IBT), and its possible utility in the treatment of anxiety and depression. Further research aimed at exploring specific efficacy of this approach for these disorders may yield a useful additional treatment option utilising a different process of change to existing treatments.     

Still an American? Mortality Salience and Treatment of Suspected Terrorists

In today's post‐9/11 world, it is important to consider the psychological factors related to beliefs about the proper treatment of those suspected of terrorist involvement. We report 2 experiments on the impact of mortality salience on people's willingness to deny procedural protections to terror suspects. Reminders of mortality led participants to extend more procedural protections to an American terrorism suspect, but fewer toward a Saudi Arabian. In Study 2, we replicated and extended the results of Study 1 by showing that support of extreme interrogation measures was specific to members of enemy out‐groups (e.g., Saudis), as opposed to non‐enemy out‐groups (e.g., Bulgarians). The results are discussed in terms of terror‐management theory.     

Where Is Group Treatment Going in the 21st Century?

The author contends that group psychotherapy can be a dynamic force for social change. He shows how group psychotherapists have developed tools that reach far beyond the limits of that particular profession; they deal with the basic interaction among all peoples everywhere in all societies. These tools can be demonstrated, taught, and experienced. In as much as they can be learned, group therapists have to start teaching them to people at the earliest levels of cognitive development. That means that it has to start in our school systems as part of the educational process. A particular kind of specialist has to be trained who can function within the system itself and yet think psychodynamically. The author maintains that this can be accomplished.     

Predicting Treatment and Follow-up Attrition in Parent–Child Interaction Therapy

Predictors of attrition from individual parent–child interaction therapy were examined for 99 families of preschoolers with disruptive behavior disorders. Seventy-one percent of treatment dropouts were identified by lower SES, more maternal negative talk, and less maternal total praise at pretreatment. Following PCIT, families were randomly assigned to an Assessment-Only or Maintenance Treatment condition. Higher maternal distress predicted 63% of dropouts in the Assessment-Only condition. Lower maternal intellectual functioning predicted 83% of dropouts from Maintenance Treatment. Findings highlight a continuing need for evidence-based retention strategies at various phases of engagement in PCIT. This study was funded by the National Institute of Mental Health (RO1 MH60632). We thank the members of the UF Child Study Laboratory for their contributions to this study.