The role of therapy productiveness on MFT clients’ intentions to persist in therapy

Many clients drop out of therapy before reaching their goals (Bohart &; Wade, 2013 Bohart, A. C., &; Wade, A. M. (2013). The client variables in psychotherapy. In M. Lambert (Ed.) Bergin &; Garfield’s Handbook of psychotherapy and behavior change. (p. 219–257). New York: Wiley. [Google Scholar]), though being in therapy produces more change than not being in therapy (Lambert, 1992 Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross &; M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books. [Google Scholar]). To investigate the factors that affect clients’ decisions to persist in therapy, we surveyed a convenience sample of 72 clients of MFTs in individual, couple or family therapy currently in treatment in a community-based therapy center. We tested moderation using regression analysis to determine the extent to which productiveness moderates the relationship between therapeutic alliance and intended persistence. Results showed that productiveness moderated the relationship between therapeutic alliance and intended persistence. Specifically, higher levels of therapy productiveness strengthened the relationship between therapeutic alliance and therapy persistence. Implications for future research and practice are presented and discussed.     

生殖系基因治疗的技术和伦理问题

生殖系基因治疗是通过对生殖系细胞的基因修饰,给该细胞发育而来的整个有机体及其后代带来永久性的遗传纠正。本文着重对生殖系治疗的现有技术条件,存在技术问题及各种观点作一归纳,主要试图反映生殖系基因治疗的科学背景及当代人的思考,希望有助于人们的思考。     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.     

The development of a culturally informed, family-focused treatment for schizophrenia

With the changing demographics in the United States, there is an increasing need for psychotherapy interventions that have been tailored for and empirically evaluated with culturally diverse groups. This article discusses the development and evaluation of a family-focused, culturally informed therapy for schizophrenia (CIT-S) that is currently being pilot tested at the University of Miami. Case examples of CIT-S with participating families are provided, along with a discussion of interesting and challenging cultural issues that we have encountered during the pilot phase of this treatment study.     

A Video Recall Study of In‐session Changes in Sentiment Override

This study examines in‐session changes in sentiment override over the first three sessions of couple therapy. Couples viewed a video recording of therapy sessions immediately after each of the first three sessions and continuously rated their level of sentiment override. Ninety‐eight changes were randomly chosen for analysis. Three talk turns prior to each change was coded using the Family Relational Communication Control Coding System. Results show that changes in sentiment override occur frequently. Repeated incidents of communication control were related to negative change in sentiment override for females. Repeated incidents of being left out of the conversation were related to negative changes in sentiment override for females and positive changes for males.     

Mental Health Utilization Among Diverse Parenting Young Couples

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social–personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor–Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow‐up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse’s influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.     

Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

Depressive Symptoms,Criticism, and Counter‐Criticism in Marital Interactions

Although people with depressive symptoms face criticism, hostility, and rejection in their close relationships, we do not know how they respond. Following interpersonal theories of depression, it might be expected that depressive symptoms would be associated with a tendency to receive and also to express criticism toward one's spouse, and that at least some of this criticism would be a contingent response to criticism received (i.e., “counter‐criticism”). However, other research has determined that depressive symptoms/behaviors suppress partner criticism, suggesting that depressed people might respond to partner criticism similarly, by subsequently expressing less criticism. In a sample of 112 married couples, partial correlations, regressions, and Actor‐Partner Interdependence Modeling indicated that lower criticism and counter‐criticism expression during a laboratory marital interaction task was associated with higher depressive symptoms, especially when such individuals were clinically depressed. Furthermore, during a separate and private Five‐Minute Speech Sample, lower criticism by partners was associated with higher depressive symptoms, especially when those who chose the interaction topic were also clinically depressed. All analyses controlled for relationship adjustment. These results suggest that spouses with higher depressive symptoms and clinical depression diagnoses may be suppressing otherwise ordinary criticism expression toward their nondepressed partners; furthermore, nondepressed partners of depressed people are especially likely to display less criticism toward their spouse in a private task.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.