Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.     

Visuospatial cueing by self-caused features: Orienting of attention and action–outcome associative learning

The effect of a salient visual feature in orienting spatial attention was examined as a function of the learned association between the visual feature and the observer’s action. During an initial acquisition phase, participants learned that two keypress actions consistently produced red and green visual cues. Next, in a test phase, participants’ actions continued to result in singletons, but their color could be either congruent or incongruent with the learned action–color associations. Furthermore, the color singletons now functioned as valid or invalid spatial cues in a visual search, in which participants looked for a tilted line (“/” or “\”) among distractors (“X”s). The results showed that an action-congruent color was more effective as a valid cue in the search task (increased benefit), but less effective as an invalid cue (reduced cost). We discuss our findings in terms of both an inhibition account and a preactivation account of action-driven sensory bias, and argue in favor of the preactivation account.     

Clinical Exchange: The Architectural Failure

The Clinical Exchange invites eminent clinicians of diverse persuasions to share, in ordinary language, their clinical formulations and treatment plans of the same psychotherapy patient—one not selected or nominated by those therapists—and then to discuss points of convergence and contention in their recommendations. This Exchange concerns a Mr. L, a 47-year-old, married man presenting for outpatient individual psychotherapy with chief complaints of depression, anxiety, and a lengthy history of vocational underachievement. Drs. Herbert Fensterheim, Leslie Greenberg, and Leigh McCullough, who anchor their practices in the cognitive-behavioral, experiential, and psychodynamic orientations, respectively, are the featured commentators. Finally, Dr. Jerold Gold, the case contributor and Mr. L's psychotherapist, provides a few closing comments.     

Resilient Response to Battering

Spouse abuse remains an important social problem. Recent research has begun to explore resiliency in a variety of areas: Why, despite harsh life circumstances, do some people survive and later thrive after experiencing trauma? What are the processes associated with a successful departure from abuse? The authors worked with a local shelter to identify three groups of women: (a) those currently at the shelter; (b) those who had been away from an abusive relationship for at least one year; and (c) those who were identified by shelter staff as having demonstrated a resilient response to battering, and compared experiences and recommendations between groups and discuss clinical and service implications.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

Concurrent and 2-Year Longitudinal Relations Between Executive Function and the Behavior of 1st and 2nd Grade Children

Concurrent and 2-year longitudinal relations were investigated between two indicators of children’s (n =60; mean age = years 11 months) executive function, inhibitory control and sequencing ability, and behavior problem symptomatology. Dependent measures were parent and teacher reported internalizing and externalizing behavior. Hierarchical multiple regression analyses demonstrated few significant concurrent associations between either inhibitory control or sequencing ability, and behavior problem symptoms. In contrast, baseline inhibitory control predicted decreased teacher reported externalizing, and parent reported externalizing and internalizing behavior problems over a 2-year period. Baseline sequencing ability also predicted decreased teacher reported externalizing and parent reported internalizing behavior over this same time period. Results suggest that some aspects of executive function in early elementary grade-school children may be more strongly associated with change in behavior over time than concurrent behavior. Implications of these findings for the prevention of behavior problems are discussed.     

Trends in Telehealth versus On-site Clinical Genetics Appointments in Manitoba: A Comparative Study

Telehealth involves the use of information and communications technology to deliver health services to patients over distance. Canada is well suited to benefit from telehealth since many individuals live in remote, rural and isolated locations. Manitoba is the easternmost prairie province and MBTelehealth is an active Canadian program that currently has 105 sites in 73 communities. Although studies of patient satisfaction comparing telehealth to on-site clinical visits have been conducted, a comparative study of the types of genetics patients seen via these two modalities has not been performed previously. In this study we: (1) examined the uptake of telehealth in Genetics in Manitoba; (2) contrasted telehealth usage in Genetics with other clinical programs; and (3) performed a comparative study of the types of Genetics referrals seen in 2008 on-site versus via telehealth. Results indicate the uptake of telehealth is increasing and has made genetics outreach clinics unnecessary. The Program of Genetics and Metabolism is consistently one of the top ten utilizers of telehealth within the province. With respect to discipline, chi square analysis revealed the trends were not significantly different for on-site and telehealth encounters, with prenatal referrals being the most common and Hereditary Breast and Ovarian Cancer referrals being the least common. Referrals within each discipline varied depending on the need for fetal assessment and physical examination. Telehealth was utilized regularly for test results sessions across all disciplines.     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.