Commentary on reviews of “outcome” studies of family and marital psychotherapy

Reviews of the outcome literature in family and marital therapy are critically evaluated. The literature is equivocal in regard to the effectiveness of family therapy, particularly in comparison to alternative forms of treatment, so that statements to the effect that family therapy has demonstrated its general efficacy would not appear to be justified. Problems are identified which require solution before the efficacy of family therapy can be demonstrated.Paper presented at the 45th annual conference of the American Association for Marriage and Family Therapy, Chicago, Illinois, October 31, 1987.     

Intuition in family therapy: A short manual on post-modern witchcraft

Intuition is an important part of a mature clinician's work. Yet, it is a component of clinical work which is looked upon with suspicion, due in part to the Middle-Age's association between intuition and the work of witches. This paper describes a tenuous link between intuition, witches, and Carl Whitaker. Patterns for including intuition in family therapy are discussed.     

Suicidal ideation in adolescent psychiatric inpatients as associated with depression and attachment relationships

Examined suicidal ideation in adolescent psychiatric inpatients as associated with depressive symptoms and attachment to mother, father, and peers. Fifty-nine adolescent psychiatric inpatients (25 male, 34 female) completed self-report measures of suicidal ideation, depressive symptoms, and attachment. Attachment to mother accounted for significant variation in levels of depressive symptoms and suicidal ideation. In addition, attachment to peers accounted for significant variation in suicidal ideation and girls' (but not boys') depressive symptoms. However, after adjusting for depressive symptoms, attachment variables failed to contribute additional variance in suicidal ideation. Self-reported depressive symptomatology remained the strongest predictor of suicidal ideation, regardless of its order in the regression analyses. Prevention and treatment efforts may focus on mother-adolescent attachment and peer attachment (particularly in girls) to reduce risk for depression and suicidal ideation.     

The Contribution of Neuroimaging to the Study of Language and Aphasia

New structural and functional imaging methods continue to be developed at a rapid pace. In the last 25 years, advanced imaging techniques have provided insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Imaging studies have also yielded new information regarding how individuals recover language after stroke. We briefly review the strengths and weaknesses of the various radiological methods currently used to study language and aphasia.     

Effectiveness of training in organizations: a meta-analysis of design and evaluation features

The authors used meta-analytic procedures to examine the relationship between specified training design and evaluation features and the effectiveness of training in organizations. Results of the meta-analysis revealed training effectiveness sample-weighted mean ds of 0.60 (k = 15, N = 936) for reaction criteria, 0.63 (k = 234, N = 15,014) for learning criteria, 0.62 (k = 122, N = 15,627) for behavioral criteria, and 0.62 (k = 26, N = 1,748) for results criteria. These results suggest a medium to large effect size for organizational training. In addition, the training method used, the skill or task characteristic trained, and the choice of evaluation criteria were related to the effectiveness of training programs. Limitations of the study along with suggestions for future research are discussed.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

Cognitive-Behavioral Treatment of Panic Disorder: Confronting Situational Precipitants

Panic Disorder is a common, debilitating psychological problem which is often effectively treated through cognitive behavioral approaches. Cognitive-behavioral treatment incorporates education, relaxation training, cognitive therapy, behavioral exposure, and relapse prevention treatment strategies. A case illustration demonstrates how cognitive-behavioral treatment facilitated a client's ability to identify and confront situational precipitants to panic in a gradual and systematic manner. A therapeutic and collaborative relationship provided the foundation for treatment, while education helped the client to understand the vicious cycle between somatic symptoms, catastrophic thoughts, and anxiety. Passive relaxation training incorporated deep breathing, muscle relaxation, and positive imagery generated from the client's own experience. Cognitive restructuring involved identifying automatic thoughts related to panic, challenging dysfunctional beliefs associated with the client's depression and low self-esteem, and generating alternative ways of thinking. Behavioral exposure (e.g., imaginal exposure, behavioral rehearsal, in vivo techniques) helped the client gain a greater sense of mastery over panic attacks triggered by his fear of hypodermic needles. Over the course of treatment, the frequency and intensity of the client's panic attacks decreased. Furthermore, the client's sense of mastery over panic had beneficial effects on his mood and self-esteem. Treatment gains were maintained at one-year follow-up.