Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Live-In Family Counseling: An Integrated Approach

This article presents an integrated family counseling approach that utilizes observation and intervention in the home setting.     

An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents

Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.     

Virginia Satir: An Integrated, Humanistic Approach

This article traces professional and personal influences that helped Virginia Satir to shape her worldview. She was an integrative humanist who included body, mind, emotional, and spiritual processes to transform systems ranging from the molecular to the cosmic. Her theories and techniques offered a wellspring of hope and possibility to individuals as well as large assemblies. The presentation of a case with young, abused children demonstrates her use of self (through physical touch) by sensitively reframing the cycle of violence as an opportunity for safe, cooperative contact.     

The Psychosocial Development of Children and Adolescents in the People's Republic of China: An Eriksonian Approach

This exploratory study of Eriksonian psychosocial development in school-aged children in the People's Republic of China tested the feasibility of Erikson's model with 360 students from 6 primary and high schools. The 16 Content Analysis Scales of Psychosocial Maturity were applied to the transcribed verbalizations from an open-ended interview and the scale scores were analyzed with two factors, school grade and gender. The grade-related results indicated that the development of psychosocial maturity among these school students showed some consistency with Erikson's model in terms of stage-relevant experience. However, resolution of industry versus inferiority was the main focus of all the research participants. Identity versus identity diffusion was emerging among high school students. A high level of trust existed for all school grades, but grade 1 consistently scored higher than other grades for all aspects of psychosocial maturity. No significant gender difference was found for any stage experience. The implications for the findings and the limitations of the methodology have been discussed.     

Brief Behavioral Therapy for Pediatric Anxiety and Depression: Piloting an Integrated Treatment Approach

Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral therapy protocols for anxiety and depression to their core components and combine them into a brief, integrated treatment suitable for the broad population of internalizing youth seen in primary care. Specifically, we discuss: (a) the rationale for targeting anxiety and depression in pediatric primary care and the deployment-focused treatment development model; (b) the content of our behaviorally based treatment program; and (c) clinical outcomes of 2 sample cases with comorbid depression and anxiety.     

An Integrated Treatment Program for Psychogenic Pain

The family characteristics associated with the presence of recurrent abdominal pain are identified. The involvement on the pediatrician and the effects of this involvement on the patient, family, and perpetuation of the symptoms are described. A successful therapeutic program combining behavior modification and family therapy is elaborated. Changes in the structure and functioning of the family are vital to the outcome of therapy and the prevention of recurrence of symptoms.     

Integrated and Holistic Treatment Approach to PTSD and SUD: A Synergy

A review of the literature on integrated and holistic treatment approaches of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) diagnoses is presented. Perspectives on the etiology of PTSD‐SUD comorbidity and the inter‐relation of symptoms are explored.     

教育神经科学:探究人类认知与学习的一条整合式途径

教育神经科学是第二代认知科学对人的具身认知进行认识深化的必然产物,也是不同层面研究以整合态势来研究教育情境中人的认知过程及其发展的当然结果。在认知神经科学与教育已有的良好沟通下,教育神经科学就是要通过教育学家、心理学家、神经科学家等的合力,借助多种技术(包括脑成像技术),多视角、多层面地分析人的心理活动,以求最终达到科学改进教育理论及其做法的目的。不可否认,本研究领域还存在一些问题;但这并不会就此阻止教育学、心理学、神经科学加快合作与融合的步伐。     

Counselors and Physicians Providing Mental Health Services: An Integrated Approach

The authors argue that there is a clear link between mental and physical health issues. A wellness‐based approach to integrated health care, such as the one described in this article, may allow older clients to be empowered to make lifestyle changes that can improve the quality of their lives and reduce physical illness.     

Therapeutic Practices and Ethical Beliefs of Professionals Working With Adolescents in Residential Treatment

The authors investigated dual relationships between 2 groups of staff (direct care and professional) and adolescent clients in 2 residential treatment programs. Staff were surveyed on their behavior and corresponding ethical beliefs regarding interactions they believed to be acceptable with minor clients specifically at termination of the treatment program. Direct care staff were more likely than were professional staff to have inconsistencies in behaviors and ethical beliefs. The American Counseling Association's (1995) Code of Ethics would prohibit some of the staff beliefs regarding acceptable behavior. Both groups were uncertain about the ethical appropriateness of certain interactions with adolescent clients. Implications are discussed.     

An Evaluation of a Summer Treatment Program for Adolescents With ADHD

Although adolescents with attention-deficit/hyperactivity disorder (ADHD) experience serious life impairment (Molina et al., 2009; Wolraich et al., 2005), very few effective psychosocial interventions exist to treat this population (Pelham & Fabiano, 2008; Smith, Waschbusch, Willoughby, & Evans, 2000). Intensive child-directed interventions are an important component in the treatment of childhood ADHD (Pelham et al., 2005), yet no study exists that fully evaluates an intensive adolescent-directed intervention. The current investigation is a pilot study of 19 adolescents with ADHD (age range: 11-16) who participated in an 8-week intensive Summer Treatment Program–Adolescent (STP-A) during the summer of 2009. The program was developed to address specific difficulties associated with ADHD in adolescence. As such, the program was designed to be ecologically valid, age appropriate, and parent-involved. Results suggest that almost all adolescents who attended the STP-A benefitted from the program according to parent, self, and staff ratings and objective measures. These ratings also indicated that participants showed moderate improvement in each of the 6 domains targeted by treatment (i.e., conduct problems, adult-directed defiance, social functioning, inattention/disorganization, mood/well-being, and academic skills). All parents indicated that both they and their children benefitted from the program and all but 1 parent indicated that the STP-A was more effective than the treatments they had utilized in the past. A case example is presented to illustrate typical improvement patterns during the STP-A. Discussion addresses the role of the STP-A in the treatment of ADHD in adolescence.     

An Integrative Brief Treatment Approach for Obsessive-Compulsive Disorder

This article reports on the integrated application of cognitive therapy, transactional analysis techniques, and the behavioral technique of response prevention using self-instructional training and behavioral substitution in a brief therapy approach. These methods were applied in the case of a young man who presented with compulsions to perform repetitive and ordering rituals with the belief that it would prevent his girlfriend from becoming pregnant. A 21-year-old white male who had performed 3 to 5 hours of rituals daily for several years was able to eliminate the majority of his compulsive behaviors and reduce his level of anxiety after eight clinical therapy sessions. Results were maintained at 6-month follow-up. The clear precipitating factors and the unusual maintaining variables for the disorder in the client are described. The author discusses the case in light of current theoretical, therapeutic, and biomedical understandings of the disorder.     

Relational Financial Therapy: An Innovative and Collaborative Treatment Approach

An intervention model for couples reporting both relationship and financial stress was developed and evaluated. The model utilized co-therapy teams of marriage and family therapists and financial planners who employed a five-session treatment approach in working with 12 couples. Findings demonstrated numerous benefits of this collaborative model. A recommendation was made that academic programs and professionals in MFT and Financial Planning develop similar interdisciplinary collaborative efforts.     

The Development and Role of the Therapeutic Alliance in Supportive Psychotherapy with Adolescents

The formation of a therapeutic alliance is considered a central issue in therapy, and particularly crucial and challenging in work with adolescents. The relational and technical components of the therapeutic alliance were examined from the perspective of the adolescent client. 40 emotionally disturbed adolescent girls, aged 13 to 16 years, received brief supportive psychotherapy in the school setting. The alliance was assessed at sessions 3, 6 and 9, and outcome was evaluated on measures of internalizing problems, self-esteem, adjustment and client satisfaction. The results indicated the stability of the alliance between sessions 3 and 6, followed by significant linear increases between sessions 6 and 9. The strength of the alliance was most consistently related to reductions in internalising problems and client estimates of change. The implications for training and clinical practice with adolescent clients are discussed and future research avenues outlined.     

The Therapeutic Alliance: Implications for Therapeutic Process and Therapeutic Goals

Interest in the importance of the therapeutic alliance to the psychotherapeutic process has recently grown across theoretical domains. Through a case example the author demonstrates that in some cases a familiar pattern of relating with the therapist may be more important for the client in terms of treatment success than positive regard early in treatment. Also, charting shifts in the quality of the relationship rather than quantitative changes in the alliance may help the therapist navigate the recursive emergent properties of relationship, goals of treatment and choice and timing of interventions. Finally, the author suggests that the therapist’s internalization of the client may represent a significant leap in the relationship, and help reduce some of the “sloppiness” that is inherent in the therapeutic process.