Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Bayley‐III: Cultural differences and language scale validity in a Danish sample

The purpose of this study was to investigate cultural differences between Danish and American children at 2 and 3 years as measured with the developmental test Bayley‐III, and to investigate the Bayley‐III Language Scale validity. The Danish children (N = 43) were tested with the Bayley‐III and their parents completed an additional language questionnaire (the MacArthur‐Bates CDI). Results showed that scores from the Danish children did not differ significantly from the American norms on the Cognitive or Motor Scale, but the Danish sample scored significantly higher on the Language Scale. A comparison of the Bayley‐III Language subtests with the CDI showed that the two measures correlated significantly, but the percentile score from the CDI was significantly higher than the percentile score from the Bayley‐III Language subtests. This could be because the two instruments measure slightly different areas of language development, or because the Bayley‐III overestimates language development in Danish children. However, due to the limitations of the current study, further research is needed to clarify this issue.     

Facial Affect Recognition and Psychopathy: A Signal Detection Theory Perspective

Though emotional processing deficits are often conceptualized as a core feature of psychopathy, the common assessment of these deficits using the percentage correct (or hit rate) on affect recognition tasks may not provide a full or accurate picture of facial affect recognition in psychopathic individuals. Signal detection theory (SDT) provides a more informative statistical approach by providing independent measures of perceptual sensitivity (d’) and willingness to report perceiving a signal or response criterion (c). The current study employed signal detection methods to test the predictions of the integrated emotion systems and hostile attribution bias perspectives, two theoretical perspectives that make specific predictions regarding facial affect recognition. These perspectives were tested in a sample of 280 adult male incarcerated offenders who were assessed for psychopathy using the Psychopathy Checklist-Revised and who completed a novel test of facial affect recognition presenting 324 digital morphs of faces reflecting systematic combinations of pixels from neutral and affective face images (displaying six different types of emotion) as expressed by four different actors. The findings were generally not consistent with either of these perspectives. Psychopathy was negatively associated with d` for anger. Results also indicated an effect of psychopathy on response criterion for fear and effects of psychopathy on response criterion for anger and surprise that were evident only for some actors. The implications of these findings are considered through the lenses of several theoretical perspectives, and theoretical and methodological limitations of the current study are considered.

     

Family Functioning and Social Support in Men and Women Diagnosed with Depression in China

Previous research has demonstrated the association between family functioning and depression. This study evaluated family functioning and perceived social support in men and women in Shanghai who had received a diagnosis of a major depressive disorder (N = 100), including sixty-six women and thirty-four men. The relationship between family functioning and social support of outpatients with major depressive disorders was explored using the Chinese Family Assessment Device and the Multidimensional Scale of Perceived Social Support. The scores from all dimensions of family functioning for both men and women indicated that depressed men and women all reported experiencing unhealthy family functioning. The clinical implications of these findings for the developing practice of family therapy in China are discussed.     

Infertility and Adjustment in Women: The Effects of Attachment Style and Social Support

The moderating effects of two psychological resources—attachment style and perceived social support—on adjustment were studied in 109 infertile women, examining the effects of duration of infertility and of primary (the woman has no child of her own) versus secondary (the woman already has a child of her own) infertility. Subjects were administered questionnaires measuring marital adjustment, psychological distress, and well-being. A model viewing attachment style and social support as moderators between stress psychological well-being was explored. The results showed that among the objective characteristics, only duration of infertility had any impact on the psychological measures. Furthermore, the psychological resources were highly associated with the adjustment scores in general. A hierarchical regression analysis showed that attachment style and social support both were related to marital quality and to psychological well-being and that these two resources function as stress moderators. It was concluded that attachment style and social support are important resources for individuals in times of stress, as exemplified in the infertility situation.     

One size does not fit all: face emotion processing impairments in semantic dementia, behavioural-variant frontotemporal dementia and Alzheimer's disease are mediated by distinct cognitive deficits

Patients with frontotemporal dementia (both behavioural variant [bvFTD] and semantic dementia [SD]) as well as those with Alzheimer's disease (AD) show deficits on tests of face emotion processing, yet the mechanisms underlying these deficits have rarely been explored. We compared groups of patients with bvFTD (n = 17), SD (n = 12) or AD (n = 20) to an age- and education-matched group of healthy control subjects (n = 36) on three face emotion processing tasks (Ekman 60, Emotion Matching and Emotion Selection) and found that all three patient groups were similarly impaired. Analyses of covariance employed to partial out the influences of language and perceptual impairments, which frequently co-occur in these patients, provided evidence of different underlying cognitive mechanisms. These analyses revealed that language impairments explained the original poor scores obtained by the SD patients on the Ekman 60 and Emotion Selection tasks, which involve verbal labels. Perceptual deficits contributed to Emotion Matching performance in the bvFTD and AD patients. Importantly, all groups remained impaired on one task or more following these analyses, denoting a primary emotion processing disturbance in these dementia syndromes. These findings highlight the multifactorial nature of emotion processing deficits in patients with dementia.