Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.     

Using MCMC chain outputs to efficiently estimate Bayes factors

One of the most important methodological problems in psychological research is assessing the reasonableness of null models, which typically constrain a parameter to a specific value such as zero. Bayes factor has been recently advocated in the statistical and psychological literature as a principled means of measuring the evidence in data for various models, including those where parameters are set to specific values. Yet, it is rarely adopted in substantive research, perhaps because of the difficulties in computation. Fortunately, for this problem, the Savage–Dickey density ratio (Dickey & Lientz, 1970) provides a conceptually simple approach to computing Bayes factor. Here, we review methods for computing the Savage–Dickey density ratio, and highlight an improved method, originally suggested by Gelfand and Smith (1990) and advocated by Chib (1995), that outperforms those currently discussed in the psychological literature. The improved method is based on conditional quantities, which may be integrated by Markov chain Monte Carlo sampling to estimate Bayes factors. These conditional quantities efficiently utilize all the information in the MCMC chains, leading to accurate estimation of Bayes factors. We demonstrate the method by computing Bayes factors in one-sample and one-way designs, and show how it may be implemented in WinBUGS.     

Rhetorical theory and family therapy practice

The study found that a connection exists between rhetoric and therapy because both fields are interested in using language as a tool for generating change. Persuasion is viewed as inherent in human communication, even though people do not necessarily intentionally attempt to persuade others. Following a brief (but detailed) explanation of the theoretical stance which informs the implementation of rhetorical techniques in therapy, three pragmatic exemplars are offered to demonstrate the employment of two classical rhetorical concepts, the parastasis catalogue and syncrisis.The authors are grateful to Sandra Kodner, MS for her participation in the development of this project.     

Attributions related to wife abuse: A comparison of the perceptions of volunteer advocate-counselors and marriage and family therapists

Attributions related to wife abuse held by advocate-counselors working in women's shelter home settings and marriage and family therapists were compared. The major finding was that the two groups were surprisingly similar in their attributions even though their theoretical backgrounds and training were considerably different. Implications for practice and training are presented.     

The need for developing standardized family pedigree nomenclature

To assess the variation in usage of symbols used in recording a genetic family history, full members of the National Society of Genetic Counselors were surveyed by questionnaire. The questionnaire return rate was 55.3% and genetic counselors from a broad range of clinical experience, genetic counseling training programs and geographic regions responded. There was striking variation in symbols used for recording routine medical information in a genetic family history (i.e., pregnancy, spontaneous abortion, termination of pregnancy). There was even less consensus in recording situations representing new reproductive technologies (i.e., artificial insemination by donor semen, donor ovum, surrogate motherhood). The results of this survey document the need for developing standardized nomenclature in recording genetic family histories as a quality assurance measure in the delivery of genetic services. Such standardization will reduce the chance of incorrect interpretation of patient and family medical and genetic information.     

Attending to the shame: Working with addicted populations

Shame is a potent emotion that plays a major role in the life of addicted individuals. Shame's ability to penetrate and skew major motivational systems may play a part in the formation of addicted lifestyles. The shame-based or shame-prone individual, such as the addicted client, poses unique problems for the therapist. This paper explicates the processes and consequences of shame and offers guidelines to help clinicians work with addicted clients.Mitchell B. Young, MS, is a third-year doctoral student in the department of counseling and development at Purdue University.The author wishes to express appreciation to Kate Kerr, PhD, for her fine editorial work.     

Coparenting and Toddler's Interactive Styles in Family Coalitions

The current study examined the coparenting and toddler's interactive styles in family coalitions. According to structural family theory, boundaries between generations are clear in alliances, but disturbed in coalitions: the parents look to the child to regulate their conflictual relationship and the child attempts to meet this need. In a normative sample studied longitudinally during the Lausanne Trilogue Play situation (LTP, N=38), 15 coalition cases were detected. Styles of coparenting and of child's interactions were determined and compared in coalition and alliance cases at 18 months. Findings confirm the structural family model by showing the specific ways in which the coparenting and the toddler's interactive styles are associated in 3 different patterns of coalitions: binding, detouring, and triangulation. They illustrate how the child's triangular capacity, or her ability to simultaneously communicate with both parents, is used to regulate the parents' relationship. They suggest that the LTP observational paradigm is a promising assessment method of early family interactions. They point to the importance of assessing early the child's contribution to family coalitions.     

Expertise for upright faces improves the precision but not the capacity of visual working memory

Considerable research has focused on how basic visual features are maintained in working memory, but little is currently known about the precision or capacity of visual working memory for complex objects. How precisely can an object be remembered, and to what extent might familiarity or perceptual expertise contribute to working memory performance? To address these questions, we developed a set of computer-generated face stimuli that varied continuously along the dimensions of age and gender, and we probed participants’ memories using a method-of-adjustment reporting procedure. This paradigm allowed us to separately estimate the precision and capacity of working memory for individual faces, on the basis of the assumptions of a discrete capacity model, and to assess the impact of face inversion on memory performance. We found that observers could maintain up to four to five items on average, with equally good memory capacity for upright and upside-down faces. In contrast, memory precision was significantly impaired by face inversion at every set size tested. Our results demonstrate that the precision of visual working memory for a complex stimulus is not strictly fixed but, instead, can be modified by learning and experience. We find that perceptual expertise for upright faces leads to significant improvements in visual precision, without modifying the capacity of working memory.     

Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline

We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008–2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST‐trained counselors. Few significant changes in ASIST‐trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST‐related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.