Understanding alliances. How can research inform user‐friendly practice?

'User-friendliness' is described as a therapist stance which involves attentiveness to the quality of the 'therapeutic relationship', both between therapist and family and between service providers and their public. This article draws on research published in the last seven years from within and outside the family therapy field which can help improve this relationship. I will argue that the issues which challenge user-friendly practice need to be related to the theories which inform family therapy and to the traditional tension within the research field between focusing on measurable outcomes or on user satisfaction. The urgency for a clear analysis of what can make family therapy practice more sensitive to its public comes partly from the relative state of maturity which family therapy has now reached and its need actively to work alongside other approaches. Other crucial influences considered are a greater public demand for choice and improvements in public services, and social policy trends towards greater efficiency and accountability within the helping services.     

The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder

This is the first study that explores whether early maladaptive schemas are related to treatment outcome for patients with obsessive-compulsive disorder (OCD). The sample consisted of 88 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory and Young Schema Questionnaire – Short Form were administered before and after treatment. Regression analyses using post-treatment Y-BOCS as the dependent variable indicated that higher scores on the abandonment schema at pre-treatment were related to poor outcome and explained 7% of the variance in symptoms at post-treatment. Higher scores on the self-sacrifice schema at pre-treatment were related to good outcome and explained 6% of the variance in obsessive-compulsive symptoms at post-treatment. During treatment, only changes in the failure schema were significantly related to good outcome and explained 18% of the variance in symptoms at post-treatment.     

USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a prerecorded message of “stop”). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.     

USING PARENTS AS THERAPISTS TO EVALUATE APPROPRIATE BEHAVIOR OF THEIR CHILDREN: APPLICATION TO A TERTIARY DIAGNOSTIC CLINIC

We conducted a preliminary analysis of maintaining variables for children with conduct disorders in an outpatient clinic. Eight children of normal intelligence between the ages of 4 and 9 years were evaluated during 90-min sessions. The children's parents conducted the assessments by varying task demands (easy and difficult) and parental attention (attention and no attention) within a multielement design. The assessment focused on appropriate child behavior and was conducted to formulate hypotheses regarding maintaining contingencies. Results demonstrated that the children's appropriate behavior varied across assessment conditions and, for 7 of the 8 children, occurred at a higher rate during one condition than during other conditions. In addition, treatment integrity data demonstrated that parents were able to implement the procedures as intended. The recommended treatments were rated as being both effective and acceptable to parents for up to 6 months following the evaluation. Our results extend previous studies of functional analytic procedures conducted by trained experimenters with severely handicapped children in more controlled settings.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

Women and Aging: Insights for Care from a Clinical Perspective

The purpose of this article is to generate pastoral clinical insights from the life experiences of three women entering the fourth quarter of life. The author considers how both physical, emotional, and spiritual resources as well as challenges can either enhance or disturb well-being. The author concludes that each of the women, having been in counseling for at least one year, has experienced an enhanced personal sense of well-being. Emerging from the clinical analysis, the author makes suggestions for helpful congregational pastoral care.     

What's the difference between children and adults? Conflict,cooperation and indifference in relationships between adult and children's therapeutic services

Children's and adult mental health services come from different traditions and have for long tended to work in ignorance of, or in conflict with, each other. This has led to many opportunities for a joined‐up approach to family difficulties being missed. Family therapy as a method is in a good position to make links between these separate silos and tackle the divisiveness of tribal professional thinking through the development of a crossover practice that draws on the best in both traditions.     

Family therapy by default: developing useful fall‐back positions for therapists

This article looks at some of the effects on practitioners of the increasing complexity and variety of ideas within the family therapy field. In adopting the currently popular notion of ‘default position’ from information technology, I argue that therapists can easily feel that their work has a random quality to it. I examine how our own default positions can be based on force of habit, a quest for novelty or the effects of stress. Some suggestions are offered for how we can more accurately go about choosing ideas that will be of help to the families with which we work and to ourselves.