Negotiating for Improved Reimbursement for Dialectical Behavior Therapy: A Successful Project

Dialectical Behavior Therapy (DBT) is an evidence-based treatment for borderline personality disorder that has been widely disseminated to many outpatient treatment settings. Many practitioners depend on third-party payers to fund treatment delivery. DBT requires additional clinical services not often included in outpatient therapy, including a weekly skills group led by 2 clinicians, and the requirement for clinicians to attend weekly consultation team and provide intersession contact for coaching. Standard outpatient insurance rates for individual and group sessions do not provide adequate reimbursement for the additional services of DBT. This paper describes how 2 DBT team leaders collaborated to obtain improved reimbursement for their programs. The 2 teams met with insurers, educated them about DBT, and showed outcomes from their programs to achieve large increases in reimbursement rates. The paper includes client outcome data from both programs.     

The IQ: A Reply

Approach vs. be approached behavioral measures of personal space were taken on 102 fifth and sixth grade children, each of whom was assigned to one of three groups: (a) Model-Close condition, (b) Model Far condition, and (c) No-Model Control group. A male peer served as model (M), and a 41-year-old female served as the object person. Results revealed a strong modeling tendency with both girls and boys tending to stay close or far from the object person as a function of M behavior. Boys and girls tended to behave similarly in the Close and Far modeling groups, but girls used more space in the No-Model Control condition. These findings suggest that modeling had an attenuating effect on sex differences in use of space. It was concluded that modeling theory is a viable conceptual tool for use in personal space research.     

Dimensions of temperament and depressive symptoms: Replicating a three-way interaction

High negative emotionality (NE), low positive emotionality (PE), and low self-regulatory capacity (i.e., effortful control or EC) are related to depressive symptoms and furthermore, may moderate one another’s relations to such symptoms. Indeed, preliminary evidence suggests they may operate in a three-way interaction (Dinovo & Vasey, 2011), but the replicability of that finding remains unknown. Therefore, we tested this NE × PE × EC interaction in association with depressive symptoms in 5 independent samples. This interaction was significant in 4 of the 5 samples and a combined sample and approached significance in the fifth sample. In contrast, the NE × PE × EC interaction was unrelated to general anxious symptoms and thus may be specific to symptoms of depression. Implications, directions for future research, and limitations are discussed.     

Repelled by virtue? The dark triad and eudaimonic narratives

ABSTRACT

We propose that the dark triad of personality predicts how recipients respond to eudaimonic narratives (stories dealing with purpose in life, the human condition, and human virtue). Matched eudaimonic or noneudaimonic videos were presented via random assignment. The more individuals lack empathy and organize their world around self-promotion—reflected in the so-called dark triad of narcissism, Machiavellianism, and psychopathy—the more they perceived the eudaimonic stories (vs. control) to be inauthentic and corny (perceived corniness). This effect translated to a more negative overall evaluation of the eudaimonic videos (moderated mediation). Self-reported feelings of being touched, moved, and inspired (meaningful affect) were largely unaffected by the dark triad, suggesting that these personality factors do not disable emotional responses to eudaimonic narratives.     

Girls’ Spatial Skills and Arithmetic Strategies in First Grade as Predictors of Fifth-Grade Analytical Math Reasoning

This study investigated longitudinal pathways leading from early spatial skills in first-grade girls to their fifth-grade analytical math reasoning abilities (N = 138). First-grade assessments included spatial skills, verbal skills, addition/subtraction skills, and frequency of choice of a decomposition or retrieval strategy on the addition/subtraction problems. In fifth grade, girls were given an arithmetic fluency test, a mental rotation spatial task, and a numeric and algebra math reasoning test. Using structural equation modeling, the estimated path model accounted for 87% of the variance in math reasoning. First-grade spatial skills had a direct pathway to fifth-grade math reasoning as well as an indirect pathway through first-grade decomposition strategy use. The total effect of first-grade spatial skills was significantly higher in predicting fifth-grade math reasoning than all other predictors. First-grade decomposition strategy use had the second strongest total effect, while retrieval strategy use did not predict fifth-grade math reasoning. It was first-grade spatial skills (not fifth-grade) that directly predicted fifth-grade math reasoning. Consequently, the results support the importance of early spatial skills in predicting later math. As expected, decomposition strategy use in first grade was linked to fifth-grade math reasoning indirectly through first-grade arithmetic accuracy and fifth-grade arithmetic fluency. However, frequency of first-grade decomposition use also showed a direct pathway to fifth-grade arithmetic reasoning, again stressing the importance of these early cognitive processes on later math reasoning.     

Altruism and Boundary Violation

ABSTRACT

The desire to help others is a common motivation for becoming a therapist, and boundary crossings are an expectable part of psychotherapeutic work. However, progression to boundary violation is rare. The concept of an altruistic boundary violation is presented and illustrated with detailed clinical material drawn from the analysis of Mrs. A,¹ a generally ethical therapist, whose violation of the therapist/patient boundary with her patient, M, began as an altruistically motivated enactment and boundary crossing. In Mrs. A’s case, and arguably in all similar altruistic boundary violations, a specific fit existed between patient and therapist. The intense need to rescue this particular patient was fueled by Mrs. A’s history of early physical and abandonment trauma, which increased her vulnerability to overidentification with her traumatized patient. The stress of relocation to another city and closing her practice further magnified her susceptibility. The complex clinical, professional, ethical, and legal issues inherent in consulting on such a case are discussed. I describe my countertransference and my parallel enactment, an initial crossing of the boundary between the roles of supervisor and therapist.     

Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship?

In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time. However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders. In the current investigation, we examined avoidant coping as a moderator of the association between heart rate reactivity to a trauma monologue measured shortly after a traumatic event and severity of posttraumatic stress disorder (PTSD) symptoms measured several months later. Fifty-five female survivors of assault completed PTSD diagnostic interviews and a self-report coping measure and participated in a trauma monologue procedure that included continuous heart rate measurement. These procedures were completed within 1 month of the assault and again 3 months postassault. After we controlled for the effect of initial symptom levels, the interaction of heart rate reactivity to the trauma monologue and avoidant coping measured at Time 1 was associated with PTSD symptom severity at Time 2. Individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the first few months following the trauma. These findings may help inform early intervention efforts for survivors of traumatic events.     

Relations among early adolescents' parent-adolescent attachment, perceived social competence, and friendship quality

To assess whether the relation between attachment and friendship quality may be explained by social competence, 113 students in Grades 7 and 8 from the Baltimore metropolitan area completed self-report questionnaires on the variables of interest. In hierarchical regression analyses, both maternal Affective Quality of Attachment and the interaction of School with paternal Affective Quality of Attachment predicted social competence. Also, the interaction of School with paternal Affective Quality of Attachment predicted negative friendship features, whereas social competence predicted positive friendship features. These findings provide support for a pathway between adolescents' attachment to both parents and adolescents' perceived social competence and, in turn, their friendship quality.