A critical review of psychotherapy outcome studies with adolescents: 1978-1988

Although interest in identifying effective psychotherapies for adolescent mental health problems has increased dramatically in the last decade, there have been few attempts to summarize and integrate the recent empirical literature on psychotherapy outcomes with adolescents. The present paper reviews the methods and findings of adolescent psychotherapy outcome studies published from 1978 to 1988. Evaluations of individual psychotherapy with adolescents generally reveal positive short-term outcomes, but long-term outcomes are still to be determined. Evaluations of systemic therapies (especially family therapy) with adolescents often reveal positive outcomes that are maintained over extended follow-up periods. Recommendations are presented for improving the methodology of future psychotherapy outcome studies with adolescents.     

Gender differences in autonomous and social achievement orientations

This research examined gender differences in orientations toward autonomous and social achievement. Three independent samples of subjects (total N= 359 males and 574 females) completed measures of achievement orientation (including Strumpfer's [1975] Autonomous Achievement Values and Social Achievement Values scales) and relevant cognitive, affective, and behavioral variables. Correlational and factor analyses clearly identified distinct autonomous and social achievement factors for both men and women in each of the samples. Examination of the correlates of achievement orientation indicated that whereas an autonomous achievement orientation is similarly expressed in males and females, there are considerable sex differences in the expression of an orientation toward social achievement. In particular, a social achievement orientation was associated with concerns over social approval and responsiveness to social influence among males, but was generally unrelated to these factors among females. Findings are discussed in terms of several recent hypotheses concerning the effects of sex role norms on the development and expression of achievement needs in men and women.     

Patterns of interocular transfer of visuomotor coordination reveal differences in the representation of visual space

Acquisition and interocular transfer of adaptation to optical transformations of input were examined in strabismic and orthotropic subjects. Distinct patterns of behavior were displayed by three groups: strabismic alternating suppressors, strabismic and orthotropic constant suppressors, and orthotropes with normal binocularity of vision. It is suggested that these behaviors result from the way in which visual space is represented in each group, an outcome of the pattern of use of the eyes during early development. The conditions for modification of the representation of visual space appear to parallel those for initial acquisition.     

Efficacy and social validity of procedures for improving conversational skills of college students with autism

Better conversational skills correspond to a higher quality of life for adults diagnosed with autism spectrum disorder (ASD). In this study, we taught vocal–verbal responses discriminated by compound arrangements of concealed conversation partner mands to two college students with ASD. Participants learned to engage in self-questioning about their conversation partner's behavior and to reinforce three concealed mands for termination of an aversive conversation scenario. We assessed generalization to conversation probes with trained confederates and to interactions with untrained conversational partners (e.g., peers, professors). Finally, we collected peer ratings of the social validity of changes in conversational behavior as well as participants' ratings of study goals, procedures, and outcomes.     

Sketching while narrating as a tool to detect deceit

In none of the deception studies that used drawings to date, was the effect of sketching on both speech content and drawing content examined, making it unclear what the full potential is of the use of drawings as a lie detection tool. A total of 122 truth tellers and liars took part in the study who did or did not sketch while narrating their allegedly experienced event. We formulated hypotheses about the total amount of information and number of complications reported and about various features of the drawings. Participants in the Sketch-present condition provided more information than participants in the Sketch-absent condition, and truth tellers reported more details than liars, but only in the Sketch-present condition. In contrast to previous research, no Veracity differences occurred regarding the content of the drawings, perhaps because sketching was introduced as a tool that facilitated verbal recall and not as a stand-alone tool.     

Contrast effects do not underlie effects of preceding liquids on stop-consonant identification by humans

These experiments explored the claim by A. Lotto and K. Kluender (1998) that frequency contrast explains listeners' compensations for coarticulation in the case of liquid consonants coarticulating with following stops. Evidence of frequency contrast in experiments that tested for it directly was not found, but Lotto and Kluender's finding that high- and low-frequency precursor tones can produce contrastive effects on stop-consonant judgments were replicated. The effect depends on the amplitude relation of the tones to the third formant (F3) of the stops. This implies that the tones mask F3 information in the stop consonants. It is unknown whether liquids and following stops in natural speech are in an appropriate intensity relation for masking of the stop. A final experiment, exploiting the McGurk effect, showed compensation for coarticulation by listeners when neither frequency contrast nor masking can be the source of the compensations.     

Affirmation of personal values buffers neuroendocrine and psychological stress responses

Stress is implicated in the development and progression of a broad array of mental and physical health disorders. Theory and research on the self suggest that self-affirming activities may buffer these adverse effects. This study experimentally investigated whether affirmations of personal values attenuate physiological and psychological stress responses. Eighty-five participants completed either a value-affirmation task or a control task prior to participating in a laboratory stress challenge. Participants who affirmed their values had significantly lower cortisol responses to stress, compared with control participants. Dispositional self-resources (e.g., trait self-esteem and optimism) moderated the relation between value affirmation and psychological stress responses, such that participants who had high self-resources and had affirmed personal values reported the least stress. These findings suggest that reflecting on personal values can keep neuroendocrine and psychological responses to stress at low levels. Implications for research on the self, stress processes, health, and interventions are discussed.     

High-lethality status in patients with borderline personality disorder

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.     

The formation of the therapeutic alliance in couple therapy

This study examines the predictive validity of several clinical variables--including marital distress, individual symptomatology, and family-of-origin experiences--on the formation of the alliance in couple therapy. Eighty people who were treated with a naturalistic course of integrative conjoint psychotherapy at a large midwestern outpatient clinic were assessed on the clinical variables before session 1. They also completed ratings of the therapeutic alliance after sessions 1 and 8. Individual symptomatology did not predict alliance formation at either treatment stage. Higher levels of marital distress predicted poorer alliances to treatment between partners at session 1. Marital distress also predicted therapeutic alliance quality for men and women at session 8. Family-of-origin distress predicted alliance quality for men at session 1, and for women at session 8. Family-of-origin distress for men and women predicted split alliances early in treatment, and marital distress predicted split alliances for women at session 8. Clinical implications for the assessment and treatment of couples are discussed.