The Incongruity of Congruence

SUMMARY

This paper examines Satires concept of congruence and the possibility of a “Tao of communication” in historical, social, and cultural context. The author then suggests alternative strategies for facilitating mutual understanding among couples     

Water Mist Punishment for Two Classes of Problem Behaviour

A study with multiple baseline design across situations and response-classes was used to evaluate the effects of a water mist procedure used for punishment of two classes of problem behaviour in a 50-year-old woman with severe mental retardation. Problem behaviour was reduced to less than 5% of baseline. After 19 months the problem behaviour was still reduced, and had stabilized at a level below 10% of baseline. Due to financial economies the local community authorities terminated the treatment, which resulted in a marked increase in the rate of problem behaviour.     

Experiences of Patients in Cognitive Behavioural Group Therapy: A Qualitative Study of Eating Disorders

The aim of this study was to investigate whether there was a difference in skin conductance response between 2 groups of military personnel when exposed to emotionally neutral and charged stimuli. The 2 groups were a combat experience group (n?=?10) with prior experience of emotionally charged war situations and a comparison group (n?=?10) with no such experience. Results showed that the comparison group reacted more strongly to exposure to both charged and neutral pictures than did the combat experience group, regardless of exposure time. The results are discussed in terms of emotional numbing and differences in anxiety state between the 2 groups.     

Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes

ObjectiveThe U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.MethodTherapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).ResultsThree-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = ?20.3, p < 0.001. Quality of life scores also increased.ConclusionsTraining in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Family Process 1962-1969

This is a personal recollection of the first 8 years of Family Process, the volumes published under the first Editor, Jay Haley, and strongly influenced by the Mental Research Institute at Palo Alto, of which Haley was a member. The later influence of the group's "double bind" hypothesis of schizophrenia is explored. Some ideas about the influence of theory on practice are suggested. Several examples of experiments in the social setting of family work are picked out of these volumes because of their influence on later programs. Finally, the essay offers a retrospective appreciation of the influence of Gregory Bateson on the mood of "revolution" forecast in the opening years of Family Process.     

Couple Therapy Research and the Practice of Couple Therapy: Can We Talk?

As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.     

Frustration Intolerance as a Multidimensional Concept

The Rational Emotive Behavior Therapy (REBT) concept of frustration intolerance is briefly reviewed and placed in historical context. It is argued that this concept includes a wide range of belief content, and is best considered as a multidimensional construct. A multidimensional model is presented, and the implications for theory and practice discussed.     

A Combined- Constructionist Therapeutic Approach To Couples Experiencing Erectile Dysfunction: Part I

Marked changes have occurred in the conceptualization and treatment of Erectile Dysfunction (ED) in the past two decades. Emphasis has shifted to the role of biomedical and organic factors using medical and surgical interventions in the etiology of sexual dysfunction, deemphasizing the quality of the overall couple relationship. However, by using only a medical approach, the couple is left with balancing the positive and negative facets of a considerably different relationship with sex now in their lives and their relationship. This paper is Part I of a two part article on erectile dysfunction. Part I presents information on the bio-medical factors that may be related to ED and the medical model treatment approaches. Part II presents information on the psychological and systemic issues that may be related to erectile dysfunction, encouraging the use of a combined-constructionist framework.     

What Does It Mean to Be Relational? A Framework for Assessment and Practice

The authors begin with a question regarding how to better draw upon relational thinking in making case assessments and treatment plans. They first address issues regarding the cultural construction of self and relationships, integrating women's psychology, family systems, and collectivist culture literatures within a discussion of power. Then they present a heuristic framework for how individuals orient themselves within relationships that includes two dimensions--focus and power--and evolves out of the social context. From these two dimensions, a typology of four basic relational orientations is presented: position directed, rule directed, independence directed, and relationship directed. Case examples from couple's therapy and suggestions for practice are provided.