Psychotherapy with Low-Income Patients: Lessons Learned from Treatment Studies

Psychotherapy with low-income patients presents a variety of challenges for the clinician. This paper discusses some of those challenges, including the barriers that poor individuals face in obtaining treatment, as well as issues of stigma, mistrust of authority, and potential cultural differences and differing expectations between mental health providers from higher socioeconomic backgrounds and lower-income individuals in need of care. We review some of the findings reported in treatment studies with low-income, frequently minority, samples that shed light on the types of adaptations to treatment that have proven successful. Finally, we discuss some of the clinical research that has been conducted with low-income, predominantly minority women through the department of psychiatry at Georgetown University over the past several years, concluding with some of the lessons we have learned in developing and conducting psychotherapeutic treatments with this population.     

Lessons Learned from Two Peer-Led Mutual Support Groups

Abstract

This case report and analysis describe the formation of two peer-led mutual support groups conducted within the context of a Veterans Administration Medical Center. Based on our assessment of the success of one of these groups and the failure of the other, we offer several recommendations and suggestions to help promote this modality. More specifically, we hypothesize that such groups are more likely to be successful (1) if participants are transferred en masse from another group, (2) that, at least initially, housing the group in the same context as formal clinician-led groups or overlapping clinician-led and peer-led groups may help smooth the transition from authority-led treatment to a mutual peer support format, and finally, (3) that prior experiences in interpersonal process groups may promote the skills and cohesion to promote successful transition to mutual support.     

Evaluating Single-Subject Treatment Research: Lessons Learned from the Aphasia Literature

The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however, it has been difficult to discern the relative potency of these treatments in a standardized manner. In this paper we describe an approach to quantify treatment outcomes for single-subject research studies using effect sizes. These values provide a means to compare treatment outcomes within and between individuals, as well as to compare the relative strength of various treatments. Effect sizes also can be aggregated in order to conduct meta-analyses of specific treatment approaches. Consideration is given to optimizing research designs and providing adequate data so that the value of treatment research is maximized.     

Medical Humanities and Cultural Studies: Lessons Learned from an NEH Institute

In this essay, the directors of an NEH Institute on Medicine, Literature, and Culture consider the lessons they learned by bringing humanities scholars to a teaching hospital for a month-long institute that mingled seminar discussions, outside speakers and clinical observations. In an exchange of letters, they discuss the productive tensions inherent in approaching medicine from multiple perspectives, and they argue the case for a broader conception of medical humanities that incorporates the methodologies of cultural studies.     

Cognitive-Behavioral Therapy for Offender Hopelessness: Lessons from Treatment of Forensic Inpatients

Patients remanded to forensic hospitals often experience a marked situational depression once initial psychotic symptoms subside and the reality of their legal situation becomes evident. Individual psychotherapy is not often used with this population due to a generally high level of impairment. It is suggested, that with modifications, the cognitive-behavioral therapy manual by Michael Thase (in: VanHasselt, Hersen (eds) Sourcebook of psychological treatment manuals for adult disorders, 1996) designed to treat depression in psychiatric inpatients can be used to treat situational depression in forensic inpatients. Modifications include the use of increased behavioral techniques, the addition of a group component, and lengthening of time limits for each treatment phase. Case examples from a first attempt to implement the new treatment program are presented.     

Identifying the Effects of Unjustified Confidence versus Overconfidence: Lessons Learned from Two Analytic Methods

One of the most common findings in behavioral decision research is that people have unrealistic beliefs about how much they know. However, demonstrating that misplaced confidence exists does not necessarily mean that there are costs to it. This paper contrasts two approaches toward answering whether misplaced confidence is good or bad, which we have labeled the overconfidence and unjustified confidence approach. We first consider conceptual and analytic issues distinguishing these approaches. Then, we provide findings from a set of simulations designed to determine when the approaches produce different conclusions across a range of possible confidence–knowledge–outcome relationships. Finally, we illustrate the main findings from the simulations with three empirical examples drawn from our own data. We conclude that the unjustified confidence approach is typically the preferred approach, both because it is appropriate for testing a larger set of psychological mechanisms as well as for methodological reasons. Copyright © 2013 John Wiley & Sons, Ltd.     

Group Creativity Training for Children: Lessons Learned from Two Award‐Winning Teams

The development of group creativity can be challenging for both young students and their teachers. This study examined the processes and learning outcomes of group creativity training from the perspectives of elementary school students and teachers while identifying critical factors that contributed to the success of the training. Data were collected from two Korean elementary school teams that won the gold (1st) and a special medal at the 2011 Destination Imagination global competition. Both individual and group interviews were carried out with 13 students and two teachers to investigate their perspectives of group creativity training. The analysis of the interview data revealed three major factors and subthemes: group dynamics (conflict and play), individual characteristics of the students (personality and motivation), and teachers’ roles (training strategies, training style, and commitment). In addition, a semi‐longitudinal survey conducted a year after the interviews examined nine skill or competency domains (self‐management, creativity, leadership, interpersonal relationship, patience, cooperation, information processing, communication, and presentation) to evaluate effects of the group creativity training on student learning. Synthesizing the analyses, we addressed the following three topics that arose from the discussions: the Safe Nest Effect, teachers’ training style, and multiple learning experiences derived from group creativity training.     

Biopolitics: Lessons from history

Biopolitics is an emerging subdiscipline within the field of political science. The essay examines historical antecedents and delineates three categories of such works: 1) metaphor, 2) evolutionary/genetic influences on behavior, and 3) public policy implications. A number of problems with these works are noted. Finally, suggestions for the current interest in biopolitics are outlined, based upon the historical analysis.     

A General Structure of Job Performance: Evidence from Two Studies

Purpose  

The purpose of this study is to test alternative models of job performance based on competing categorization criteria.     

Manualized Treatment of Panic Disorder in a Medical Setting: Two Illustrative Case Studies

People who experience panic attacks (PAs) typically present to medical settings, concerned that their symptoms signify a life-threatening condition. Despite the efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD), medical practitioners seldom provide this type of treatment. Physicians may lack the time or expertise to impart such behavioral medicine interventions, while patients may find group or individual CBT too costly even when available. Researchers have begun investigating manualized CBT as a cost-effective alternative when traditional forms of this intervention are prohibited. This article describes two case studies in which women presenting to a medical clinic with PD were treated with 6 weeks of manualized CBT after pharmacotherapy was unsuccessful or unpalatable. Both patients exhibited reductions in panic and depressive symptomatology over baseline levels, along with increases in self-efficacy regarding their ability to manage future PAs. Improvements were maintained over 12 months, supporting continued use of manualized CBT as a supplement or alternative to pharmacological methods of treating PD in the medical setting.     

浅谈外科手术在重度肥胖治疗中的作用

目前在重度肥胖治疗中存在着孤立地,片面地看待疾病,对主要矛盾注意不够的问题,且过度依赖内科治疗。而外科手术对病态肥胖有着良好的效果,是去除代谢综合征(MS)主要致病因素的有效手段。但由于人们观念陈旧,临床上很少有人接受手术治疗。因此转变人们的观念是提高重度肥胖治疗效果的关键和必需的一步。     

浅谈外科手术在重度肥胖治疗中的作用

目前在重度肥胖治疗中存在着孤立地,片面地看待疾病,对主要矛盾注意不够的问题,且过度依赖内科治疗.而外科手术对病态肥胖有着良好的效果,是去除代谢综合征(MS)主要致病因素的有效手段.但由于人们观念陈旧,临床上很少有人接受手术治疗,因此转变人们的观念是提高重度肥胖治疗效果的关键和必需的一步.     

Applying Recommendations from the Literature on Stereotype Threat: Two Field Studies

Purpose  

The objective of these two studies was to apply recommendations from the literature on stereotype threat to reduce the magnitude of subgroup differences in an employment context.     

Lessons from Wittgenstein: Elucidating folk psychology

To the extent that psychologists are concerned to do more than collect raw data for possible interpretation, they cannot avoid interrogating the philosophical assumptions which inform their work. This paper argues that there is a vital need for conceptual clarification of many of the central topics studied by today's sciences of the mind. Yet, rather than offering a comprehensive survey of these, this paper focuses on one illustrative, high profile case: the way in which our everyday understanding of reasons for action has been wrongly categorized in terms of ‘theory of mind’ abilities. Focusing on this example I show how it is possible to elucidate topics in the philosophy of psychology by relinquishing certain powerful explanatory temptations and by attending more closely to our everyday practices and activities.