The effect of affective bibliotherapy on clients' functioning in group therapy

Abstract The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients' functioning in therapy and their session impression. Three small groups totaling twenty-five in-patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In-therapy behaviors were assessed through the Client Behavior System (CBS; Hill & O'Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients' impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.     

The relationship between therapeutic engagement,cognitive errors,and coping action patterns: An exploratory study

Aim: This exploratory study examined the relationship between clients’ involvement in therapy and their cognitive errors (CE) and coping action patterns (CAP). Method: Therapy sessions from N = 26 clients were rated for CE and CP using the CE and CAP methods. Client involvement was measured with the Positive and Negative Affect Schedule, as well as the . Results: The CEs’ ‘magnification of the negative or minimisation of the positive’ and ‘labelling’ were associated with measures of affective therapeutic engagement. The coping styles ‘negotiation’, ‘opposition’, ‘submission’, ‘isolation’, ‘support seeking’, ‘information seeking’, ‘delegation’, and ‘escape’ were found to be associated with affective and behavioural dimensions of therapeutic involvement. Conclusions: These findings provide preliminary supporting evidence that CE and CP are related to the extent to which clients engage in the work of therapy. Implications for researchers and therapists are discussed.     

Treating mothers of aggressive children: a research study

In this empirical investigation, three conditions in the group therapy of aggressive children were compared: Child only treatment, Mother + Child treatment, and a notreatment control. The 75 participating children, all Druze from two cities in Israel, were assigned equally and randomly to the three conditions, 25 children in each. In addition, the mothers of these children participated in the study, with 25 of them treated in groups. A semi-structured treatment program using bibliotherapy was conducted, with some modifications, in the two therapy conditions. Results indicated that, compared to the control group, both treatment conditions were effective in reducing aggression, although the Mother + Child condition showed significantly greater gains on the children's self-report measure. With regard to maternal coping, gains were greater in the Mother + Child treatment group than in the Child treatment group on four of six subscales. Finally, three associations were found between reductions in children's aggression and changes in maternal coping.     

Can mindfulness modify your thoughts? A study in the context of social phobia

IntroductionSocial phobia is said to be the commonest anxiety disorder (Furmark, 2002). Cognitive Behavior Therapy appears to be the most recommended form of psychological treatment for this condition (Federoff & Taylor, 2001; Willutzki et al., 2012). Dismantling studies have raised doubts regarding the utility of cognitive restructuring in bringing about decrease in symptoms (Barrera et al., 2016; Pompoli et al., 2018). Mindfulness, a ‘third-wave’ concept, seems to contradict the philosophy of ‘restructuring’ with its apparent stress on non-judgmental observation (Hayes, 2004). This approach postulates that acceptance of cognitions and emotions as therapeutic in contrast to traditional cognitive behavior therapy approach, which advocates restructuring and modifications of cognitions.ObjectiveThe current study attempted to study the ‘restructuring’ effects of mindfulness in persons with social phobia.MethodThirty-nine clients with a primary diagnosis of social phobia (ICD – 10) participated in the Mindfulness Integrated Cognitive Behavior Therapy (MICBT) program, which consisted of eight sessions. MINI International Neuropsychiatry Interview Plus, Liebowitz Social Anxiety Scale, Fear of Negative Evaluation, Meta Cognitions Questionnaire and Five-Facet Mindfulness Questionnaire were administered pre and post of the therapeutic program.ResultsThe results demonstrated that MICBT had a significant effect on reducing the scores on fear of negative evaluation and bringing about changes in metacognitions.ConclusionMindfulness could be sufficient as a therapeutic strategy to bring about changes in the cognitions of clients with social phobia without using cognitive restructuring.     

Therapeutic Factors in Adolescents’ Groups With and Without Movies

ABSTRACT

The study explores the therapeutic factors in two types of group interventions–-film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13–14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents’ engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent–adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship–climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.     

Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors)

ABSTRACT

Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition–change were more prevalent in group treatment.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

Mapping Good Therapy Sessions: A Pilot Study of Within-Session Client Affect

The purpose of the present study was to measure client affect over small timescales within therapy sessions, in order to identify affective patterns that might distinguish good versus poor sessions. Toward this end, patterns of affect were observed across 15-s intervals throughout one therapy session for each of four different clients being treated for generalized anxiety disorder using cognitive-behavioral therapy. The primary hypothesis was that during “good” therapy sessions (as defined by high session alliance scores and good therapy outcomes), clients would exhibit a pattern of positive–negative–positive (PNP) affect during the course of the session, reflecting prolonged periods of negative affect consistent with productive therapeutic work, situated between periods of positive feeling. Clients in “poor” sessions were not expected to show this pattern. The findings were consistent with predictions. There was also a non-significant trend suggesting that clients in good sessions demonstrated a greater frequency of very small PNPs—as brief as 45 s—suggesting a potentially greater number of “micro-episodes” of therapeutic work. Implications of the findings are discussed.     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

Operational Sequence in Group Therapy with Young Offenders

Abstract

Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an individual’s prior interactions with attachment figures develop into templates that will guide the way they form connections and perceive their relationships with others. This study examined clients’ ratings of their relationship with the therapist as well as their ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a primarily group-based day-treatment program for childhood interpersonal trauma, at Women’s College Hospital in Toronto, Ontario, Canada. Results demonstrated that clients’ perceptions of relationships in group therapy varied as a function of attachment classification.     

心理治疗的会谈间体验对治疗效果的影响——来自追踪研究的证据

采用多层线性分析方法,在短程心理咨询的连续会谈中检验来访者的会谈间体验对咨询效果的影响。以36名个案、151次会谈为样本,结果发现,来访者的症状总体呈线性下降趋势;不同来访者症状变化的速率存在个体差异,会谈间体验的情绪因子能解释症状变化速率总变异的40.79%。结论：在短程心理咨询中,来访者想起咨询会谈或/和咨询师时的情绪体验能显著预测咨询效果。     

The Influence of Individual Attachment Styles on Group Members’ Experience of Therapist Transitions

Abstract

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients’ attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group. This discussion will elucidate how knowledge of attachment theory and an understanding of clients’ individual attachment styles can be useful in predicting responses to therapist-initiated terminations and transitions.     

Predicting Dropout in Counseling Using Affect Coding of the Therapeutic Relationship: An Empirical Analysis

This study used an observational research method to examine affective counselor–client exchanges during the initial session of counseling for clients who dropped out of counseling and clients who remained in counseling. Results confirmed significant differences in the affect codes of clients and counselors between the 2 groups. Discriminant function analyses classified 77% of counselors and clients in the correct groups and correctly classified over 94% of clients who returned for 4 or more sessions.     

Psychological counseling as an adjunct to stuttering treatment: Clients’ experiences and perceptions

PurposeStuttering can trigger anxiety and other psychological and emotional reactions, and limit participation in society. It is possible that psychological counseling could enhance stuttering treatment outcomes; however, little is known about how clients view such counseling. The purpose of this study was to gain an understanding of clients’ experiences with, and perceptions of, a psychological counseling service that was offered as an optional adjunct to speech therapy for stuttering.MethodNine individuals who stutter (13-38 years old) participated in semi-structured interviews. Six participants had taken part in psychological counseling; three participants did not do so. Interview data were analyzed using grounded theory as a guiding framework.ResultsFour thematic clusters emerged from participants’ accounts: insights into personal decision-making, why others may not participate in counseling, psychological counseling as a worthwhile part of therapy, and counseling as a necessary component in a stuttering treatment program.ConclusionIn addition to experiencing barriers and facilitators to help-seeking that are reported in related fields, participants accounts also revealed novel facilitators (i.e., a ‘why not’ mentality and the importance of having a pre-existing relationship with the clinician who offered the service) and barriers (i.e., viewing the service as a ‘limited resource,’ and, the overwhelming nature of intensive stuttering treatment programs). Findings suggest that clients value the option to access psychological counseling with trained mental health professionals to support the stuttering treatment provided by speech-language pathologists. Participants made recommendations for the integration of psychological counseling into stuttering treatment programs.     

The effect of manual movements on stuttering in individuals with down syndrome

PurposeStuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients’ needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.MethodEighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.ResultsThe experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.ConclusionIndividual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.     

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Interventions in everyday lives: How clients use psychotherapy outside their sessions

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.     

Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Therapist empathy,homework compliance,and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients’ subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist–client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients’ ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist’s caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.