Predictors of Client Attrition in a University-Based Community Counseling Clinic

The purpose of this study was to investigate how symptom distress, social role, interpersonal relationships, gender, age, number of supports, and education level predict client attrition in a community sample. Using binary logistic regression and cross-sectional data, the authors examined the predictive impact of 8 variables on adult client attrition in a university-based community counseling clinic. Results indicated that education level, interpersonal relationships, and number of supports significantly predicted attrition. In this sample, gender, age, symptom distress, social role, and race did not significantly predict attrition. Implications for clinical assessment and counseling practice are discussed.     

Mapping differential responses to cognitive training using machine learning

We used two simple unsupervised machine learning techniques to identify differential trajectories of change in children who undergo intensive working memory (WM) training. We used self‐organizing maps (SOMs)—a type of simple artificial neural network—to represent multivariate cognitive training data, and then tested whether the way tasks are represented changed as a result of training. The patterns of change we observed in the SOM weight matrices implied that the processes drawn upon to perform WM tasks changed following training. This was then combined with K‐means clustering to identify distinct groups of children who respond to the training in different ways. Firstly, the K‐means clustering was applied to an independent large sample (N = 616, M_age = 9.16 years, range = 5.16–17.91 years) to identify subgroups. We then allocated children who had been through cognitive training (N = 179, M_age = 9.00 years, range = 7.08–11.50 years) to these same four subgroups, both before and after their training. In doing so, we were able to map their improvement trajectories. Scores on a separate measure of fluid intelligence were predictive of a child's improvement trajectory. This paper provides an alternative approach to analysing cognitive training data that go beyond considering changes in individual tasks. This proof‐of‐principle demonstrates a potentially powerful way of distinguishing task‐specific from domain‐general changes following training and of establishing different profiles of response to training.     

Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

Masked priming of prefixes and the influence of spelling-meaning consistency

Two experiments are reported which examined whether a prefixed word can be primed by a word sharing only the prefix letters in a masked priming paradigm. In addition the studies examined whether the size of the priming effect is influenced by the consistency with which a prefix letter pattern appears in real prefixed words. The ratio of real prefixed words to all words containing a prefix letter pattern was calculated and used to identify high-consistency prefixes, which are frequently used as prefixes (e.g., UN in UNHAPPY) and rarely appear as pseudoprefixes (e.g., UNCLE), and low-consistency prefixes, which appear in many pseudoprefixed words (e.g., DE in DESERT) but fewer truly prefixed words (e.g., DECODE). In Experiment 1, decision latencies for both types of prefixes were facilitated when real prefixed target words were preceded by real prefixed prime words in a short SOA masked priming paradigm, although the size of the priming effect for low-consistency prefixes was similar in size to that for orthographic controls. In Experiment 2, real prefixed target words were preceded by pseudoprefixed prime words. Facilitation in performance remained for high-consistency prefixes but was absent for low-consistency prefixes. These results support models of morphological processing that are sensitive to the statistical nature of the relationships between orthographic and semantic representations in a language.     

Fabry disease in genetic counseling practice: recommendations of the National Society of Genetic Counselors

The objective of this document is to provide health care professionals with recommendations for genetic counseling and testing of individuals with a suspected or confirmed diagnosis of Fabry disease, with a family history of Fabry disease, and those identified as female carriers of Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as an individual with Fabry disease who is a founder of a Fabry disease patient advocacy group in the United States. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing and interpretation of results, psychosocial considerations, and references for professional and patient resources. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a healthcare provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

Attachment to the Missing Object: Infidelity and Obsessive Love

In an object relations study on infidelity and obsessive love, the author observes that in relationships marked by chronic, repetitive infidelity and obsession, the lover is enamored with that which they can not have and that the psychological development of such individuals may have been traumatized by early attachment disturbances in the primary dyad. Tenacious, unsatisfying love-attachments as seen in sexual addictions and obsessional love may result from the internalization of an absent or intermittent object relationship—a morbid attachment to the missing object of infancy. Such patients often demonstrate depressive/addictive traits and schizoid defenses and typically have difficulty forming an attachment bond with the analyst, perceiving the analyst as a dangerous, rejecting agent who will recapitulate the original trauma. In the clinical case of Gretchen, the author uses Winnicott's (1960) concept of holding to create a progressive therapeutic bond, as toxic resistant forces are gradually resolved.     

How do speakers avoid ambiguous linguistic expressions?

Three experiments assessed how speakers avoid linguistically and nonlinguistically ambiguous expressions. Speakers described target objects (a flying mammal, bat) in contexts including foil objects that caused linguistic (a baseball bat) and nonlinguistic (a larger flying mammal) ambiguity. Speakers sometimes avoided linguistic-ambiguity, and they did so equally regardless of whether they also were about to describe foils. This suggests that comprehension processes can sometimes detect linguistic-ambiguity before producing it. However, once produced, speakers consistently avoided using the same linguistically ambiguous expression again for a different meaning. This suggests that production processes can successfully detect linguistic-ambiguity after-the-fact. Speakers almost always avoided nonlinguistic-ambiguity. Thus, production processes are especially sensitive to nonlinguistic- but not linguistic-ambiguity, with the latter avoided consistently only once it is already articulated.