The psychotherapy adaptation and modification framework: application to Asian Americans

Although effective treatments for many mental disorders have been developed, little research has been conducted to determine whether these interventions are effective in treating those from diverse backgrounds. Recent reports have suggested that ethnic minorities are less likely to receive quality health services and that they evidence worse treatment outcomes when compared with other groups. To improve care for those from diverse backgrounds, Western-developed psychotherapies may need to be culturally modified or adapted to become more effective in treating ethnic minorities. This article addresses the need for adapting psychotherapy and provides a conceptual framework for making such modifications. The psychotherapy adaptation and modification framework model is applied to recent Asian American immigrants as an illustrative example. However, it may also serve as a point of departure to adapt therapies for other ethnocultural groups.     

Can counselling/psychotherapy be helpful in reducing barriers to learning for the person with specific learning difficulties?

This paper explores the relative helpfulness of counselling/psychotherapy to individuals experiencing specific learning difficulties, as a means of reducing barriers to learning by allowing the individual to return to learning from experience. Highlighting earlier studies which indicate the positive impact of psychological therapy on educational attainment and inhibiting factors such as stress, this research investigates the experience of counselling from the perspective of the person with specific learning disabilities. Using Empirical Phenomenological Research, the study explores their understandings of the circumstances and factors by which therapy is found to be helpful or unhelpful, seeking to contribute to debate on whether psychological interventions that are ‘specialist’ in orientation are potentially more helpful than ‘generalist’ therapeutic approaches. The findings point both to the potential value of psychological therapies for persons with special educational needs as a complement to other interventions and also to the importance of considering the experiences of the client in addition to diagnostic assessments.     

Therapeutic Interventions

This article has two aims. One is addressed to practitioners, to say to them that too big a distinction is being drawn between interpretations and other interventions, and in particular that the term directive is being wrongly used. This militates against important moves toward the integration of different therapies. The other is addressed to researchers, to say to them that their research will be inadequate to the extent that they ignore many of the interventions used in therapy. Both of these aims are eventually served by the provision of a list of interventions running the whole continuum from non-directive to more directive. By looking at this list, we can become more aware of the range of what is possible in psychotherapy, and also of where the standard types of interpretations come in the scheme of things. It seems as though the wide range of interventions available in psychotherapy represents one of the ways in which it differs from counseling.     

Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.     

Mentalisierungsbasierte Psychotherapie bei schizophrenen Psychosen

Recently, there has been growing interest in new methods of psychotherapeutic interventions for schizophrenic patients. Social cognition, social functioning and quality of life are central objectives. Mentalization-based therapy (MBT) is a specific psychodynamic method developed from the fundament of attachment theory and empirical psychotherapy research for the treatment of borderline personality disorder, particularly focusing on attachment relationships, mentalizing capacity and affect regulation. Studies have shown that MBT is able to ameliorate interpersonal experience and social life. The latest neuroscientific findings support this view and encourage the application of a modified form of MBT in the treatment of schizophrenic patients. The authors present a concept for disorder-specific interventions in schizophrenia, including psychoeducational aspects and mentalizing exercises which step-by-step lead to a more reflective work in mentalization-based group psychotherapy.     

Transference focused psychotherapy: overview and update

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.     

Research Developments on the Therapeutic Alliance in Psychodynamic Psychotherapy

Research on psychotherapy in general, and psychodynamic therapy in particular, has consistently found that the quality of the alliance predicts the outcome of treatment. Little empirical support exists for the notion that the alliance sets the stage for techniques to be most effective, although adequate studies of this interaction between techniques and alliance are scarce. Research suggests that that the alliance is influenced in part by preexisting patient characteristics and in part by the quality of therapist interventions. Limitations of the empirical literature on the alliance are presented and some suggestions for future research are given.     

Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.     

Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives

Individuals with mental illness and addiction comprise at least half of the patients in most mental health treatment systems. This combination results in increased risk for frequent psychiatric relapses, poor medication compliance, violence, suicide, legal problems, and high utilization of the emergency room or inpatient services. Traditional mental health and addiction treatments have not adequately addressed these co-occurring disorders due to clinical interventions, programs, and system flaws that have not addressed the individual's needs. Integrated treatment requires both an understanding of mental illness and addiction and the means to integrate and modify the traditional treatment approaches in both the mental health and addiction treatment fields. There is strong evidence to support the efficacy and effectiveness of integrated treatment in this population. All mental health clinicians should become experienced and skilled in the core psychotherapy approaches to treating substance use disorders, including motivational enhancement therapy, relapse prevention (cognitive-behavioral therapy), and 12-step facilitation. In addition, integrated treatment includes integrating medications for both addiction and mental illness with the behavioral therapies and other psychosocial interventions. This article reviews the clinical intervention, program, and system components of integrated treatment and specific clinical interventions for this population.     

Culturally Informed and Flexible Family-Based Treatment for Adolescents: A Tailored and Integrative Treatment for Hispanic Youth

The increasing utilization of evidence-based treatments has highlighted the need for treatment development efforts that can craft interventions that are effective with Hispanic substance abusing youth and their families. The list of evidence-based treatments is extremely limited in its inclusion of interventions that are explicitly responsive to the unique characteristics and treatment needs of young Hispanics and that have been rigorously tested with this population. Some treatments that have been tested with Hispanics do not articulate the manner in which cultural characteristics and therapy processes interact. Other treatments have emphasized the important role of culture but have not been tested rigorously. The value of well designed interventions built upon an appreciation for unique patient characteristics was highlighted by Beutler et al. (1996) when they argued that "psychotherapy is comprised of a set of complex tasks, and practitioners need comprehensive knowledge of how different processes used in psychotherapy interact with patient characteristics in order to make treatment decisions that will maximize and optimize therapeutic power" (p. 30). A focus on how treatment processes interact with patient characteristics is particularly relevant in the Hispanic population because of the considerable heterogeneity beneath the Hispanic umbrella. Our new program of clinical research focuses on articulating how the varied profiles with regard to immigration stressors, acculturation processes, values clashes, sense of belonging to the community, discrimination, and knowledge about issues important to adolescent health can be more effectively addressed by a culturally informed treatment.     

A case series of attention modification in clinically anxious youths

Research in the last fifteen years suggests that anxious individuals selectively attend towards threatening information. Attention modification interventions for internalizing adults have been developed to target cognition at this basic level; these programs have demonstrated initial efficacy in attention bias and anxiety symptom reduction. To date, there have been no published studies of attention modification in youths with clinical levels of anxiety. The current case series examined the initial efficacy of a four-week (12 sessions) attention modification program (AMP) designed to train attention away from threat in 16 children and adolescents (ages 10 to 17) diagnosed with DSM-IV anxiety disorders. Overall, youths experienced a significant decrease in anxiety and depression symptoms, and 12 of 16 youths no longer met criteria for any anxiety diagnosis at post-treatment. AMP was feasible with youths, and all youths and parents deemed the program acceptable. These findings provide support for further research on the use of cognitive bias modification interventions with clinically anxious youths.     

A Clinician's Guide to PTSD Treatments for Returning Veterans

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and Veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of non-exposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections.     

Complementary and alternative therapies for cerebral palsy

The optimal practice of medicine includes integrating individual clinical expertise with the best available clinical evidence from systematic research. This article reviews nine treatment modalities used for children who have cerebral palsy (CP), including hyperbaric oxygen, the Adeli Suit, patterning, electrical stimulation, conductive education, equine-assisted therapy, craniosacral therapy, Feldenkrais therapy, and acupuncture. Unfortunately, these modalities have different degrees of published evidence to support or refute their effectiveness. Uncontrolled and controlled trials of hippotherapy have shown beneficial effects on body structures and functioning. Studies of acupuncture are promising, but more studies are required before specific recommendations can be made. Most studies of patterning have been negative and its use cannot be recommended. However, for the other interventions, such as hyperbaric oxygen, more evidence is required before recommendations can be made. The individual with CP and his or her family have a right to full disclosure of all possible treatment options and whatever knowledge currently is available regarding these therapies.     

A Conceptual Model and Clinical Framework for Integrating Mindfulness into Family Therapy with Adolescents

Individual and group‐based psychotherapeutic interventions increasingly incorporate mindfulness‐based principles and practices. These practices include a versatile set of skills such as labeling and attending to present‐moment experiences, acting with awareness, and avoiding automatic reactivity. A primary motivation for integrating mindfulness into these therapies is compelling evidence that it enhances emotion regulation. Research also demonstrates that family relationships have a profound influence on emotion regulation capacities, which are central to family functioning and prosocial behavior more broadly. Despite this evidence, no framework exists to describe how mindfulness might integrate into family therapy. This paper describes the benefits of mindfulness‐based interventions, highlighting how and why informal mindfulness practices might enhance emotion regulation when integrated with family therapy. We provide a clinical framework for integrating mindfulness into family therapy, particularly as it applies to families with adolescents. A brief case example details sample methods showing how incorporating mindfulness practices into family therapy may enhance treatment outcomes. A range of assessment modalities from biological to behavioral demonstrates the breadth with which the benefits of a family‐based mindfulness intervention might be evaluated.     

Implications of research for the treatment of depressive disorders during childhood

Basic research into the prevalence, natural course, and phenomena of comorbidity of depressive disorders during childhood are reviewed and implications of this research for treating depressed youths are noted. Results of investigations into the biological aspects of depression are integrated into a multifactorial model of depressive disorders during childhood and the efficacy of pharmacological interventions is discussed. Cognitive theory is integrated with attachment theory to explain a possible avenue to the development of depressive disorders during childhood. Interpersonal therapy has emerged as a potentially effective intervention for depressed youths. Basic tenets of this treatment model are compared and contrasted to a cognitive-behavioral treatment model, and a hybrid treatment referred to as “cognitive therapy within the interpersonal context” is proposed.     

Integrated treatment: a conceptual framework for an evidence-based approach to the treatment of personality disorder

Evidence that various therapies are effective in treating personality disorder and that outcome does not differ substantially across treatments suggests that it is time replace concerns about the efficacy of specific therapies and which form of therapy to use with an evidence-based approach that combines methods that work from all therapies. A framework is proposed for selecting and combining eclectic treatment methods and delivering them in a coordinated way. The framework has two components: (1). a system for conceptualizing personality disorder based on empirical knowledge about the structure, etiology, development, and stability of personality pathology to use as a guide to selecting interventions and planning the sequence in which they will be used; and (2), a model of therapeutic change based on the general literature on psychotherapy outcome and specific studies of PD treatments. The framework proposes that integrated treatment be organized around general principles of therapeutic change common to all effective therapies supplemented with more specific treatment methods taken from the different therapies as needed to tailor treatment to individual patients and treat specific problems and psychopathology. The coordinated delivery of such a diverse array of interventions is achieved by using a phases of treatment scheme that proposes that treatment focus on specific symptoms and problems is a systematic and orderly way according to their stability and potential for change.     

WHO (OR WHAT) CAN DO PSYCHOTHERAPY:

Research suggests that paraprofessional therapists usually produce effects that are greater than effects for control conditions and comparable to those for professional therapist treatment Other nonprofessional psychological treatments, such as selfadmimstered materials and self-help groups, have also demonstrated positive effects Because of the promise of these nonprofessional treatments, their potential for low-cost service delivery, and the important theoretical questions that studies comparing them can answer, psychotherapy outcome research should shift away from comparisons of different professional therapies and instead compare nonprofessional therapies with professional therapy     

Couple Therapy Research and the Practice of Couple Therapy: Can We Talk?

As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.     

Training the Parents of Juvenile Offenders: State of the Art and Recommendations for Service Delivery

Parent training is consistently highlighted as one of the most effective means of preventing delinquency and treating young children with conduct problems, and it has proven to be one of the most cost-effective interventions for doing so. There is, however, far less evidence supporting the efficacy of parent-training programs with adolescents and juvenile offenders. Nonetheless, it still seems to be one of the more promising methods for treating the behavior problems of adolescent delinquents, especially when used in conjunction with other carefully selected program components. We begin with an overview of parent training, highlighting the key components of successful programs. Research on the efficacy of parent training in the treatment of behavior problems among children and adolescents is discussed, particularly the differential impact of parental-training programs with specific groups of youths and families. We then discuss the ways in which parent training has been combined with other interventions in the treatment of delinquency. We conclude with a discussion of the problems encountered in implementing parent training, including recommendations for meeting the unique challenges of effective program implementation. The findings and conclusions of the research reported here are those of the authors and do not reflect the official positions or policies of the National Institute of Justice, The Office of Justice Programs, or the U.S. Department of Justice.