Clinical Supervision of Couple and Family Therapy during COVID-19

This paper addresses the need for a swift transition from in-person clinical supervision to telesupervision during the time of the COVID-19 global pandemic. Five specific areas will be discussed in the effort to enhance the quality of clinical supervision provided to couple and family therapists in training at this time including the following: (1) COVID-19 and the structural changes and technological adaptation of supervision; (2) culturally and contextually sensitive guidelines for clinical supervision during COVID-19; (3) the supervisee’s competence and the clinical supervisory process; (4) the new set of boundaries and the supervisory role; (5) and the supervisory alliance and supervisees’ vulnerabilities in the face of COVID-19.     

Safety equipment use and crash involvement among cyclists – Behavioral adaptation,precaution or learning?

The present study has investigated relationships between cyclists’ safety equipment use, crash involvement, and other safety relevant behavior. The main focus is on relationships that indicate either behavioral adaptation (safety equipment use leads to riskier behavior) or precautionary behavior (safety equipment is used for cycling in risky situations). Three consecutive surveys were conducted in 2015, 2016, and 2017 years among 650 Norwegian cyclists. Most items were dichotomized and analyzed with logistic regression models. In contrast to the behavioral adaptation hypothesis, regular use of safety equipment (bicycle lights, high-visibility clothing, and helmets) was found to be negatively related to some types of high-risk behavior (listening to music and taking chances while cycling). Regular use of bicycle lights and high-visibility clothing is also negatively related to collision involvement. Safety equipment use was found to be positively related to regular winter cycling and cycling in mixed traffic (not on sidewalks), and it is most likely used as a precautionary measure in such situations. Some cyclists learn from crash involvement by starting to use safety equipment after a crash, but the results do not indicate that crash involvement deters from cycling. The main conclusion from the study is that recommending, promoting or even mandating safety equipment for cyclists can be expected to improve safety and that behavioral adaptation is not likely to occur, at least not to an extent that will outweigh the positive safety effects. The results do not support reservations against the use of “sporty” (well-equipped) models in campaigns for promoting cycling.     

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.     

The Harvard Pigeon Lab under Herrnstein

The history of the Harvard Pigeon Lab is a history of two periods of remarkable productivity, the first under Skinner's leadership and the second under Herrnstein's. In each period, graduate students flocked to the leader and then began stimulating one another. Chance favored Herrnstein's leadership, too, because an unusually large number of graduate students were admitted in the fall of 1962. In each period, productivity declined as the leader lost interest in the laboratory and withdrew. Directly and indirectly, the laboratory finally died as a result of the cognitive "revolution." Skinner and his students saw the possibility of a natural science of behavior and set about establishing that science based on concepts such as response rate, stimulus control, and schedules of reinforcement. Herrnstein and his students saw that the science could be quantitative and set about making it so, with relative response rate, the matching law, and the psychophysics of choice (analogous to S. S. Stevens' psychophysics). The history might provide a golden research opportunity for someone interested in the impact of such self-organizing research groups on the progress of science.     

Sustained efficacy of dialectical behaviour therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is considered one of the most promising treatments for borderline personality disorder (BPD). Recently, we reported significantly positive effects of 12 months DBT on parasuicidal behaviour and impulsivity in a mixed group of female BPD patients with and without substance abuse. Fifty-eight women with BPD were randomly assigned to either 52 weeks of DBT or treatment as usual (TAU). Follow-up assessment took place at 78 weeks, i.e., 6 months after discontinuation of DBT. Participants were clinical referrals from addiction treatment and psychiatric services. Outcome measures included parasuicidal behaviour, impulsivity and substance abuse. Six months after treatment discontinuation, the benefits of DBT over TAU in terms of lower levels of parasuicidal and impulsive behaviours, and in alcohol use, sustained. No differences between the treatment conditions were found for drug abuse. In conclusion, DBT seems to have a sustained effect on some of the core symptoms of BPD and on alcohol problems in a mixed population of female borderline patients with and without substance abuse problems.     

Measurement Structure of the Turkish Translation of the Child Behavior Checklist Using Confirmatory Factor Analytic Approaches to Validation of Syndromal Constructs

The new correlated 8-factor measurement structure of the Child Behavior Checklist for ages 6-18 (CBCL/6-18; T. M. Achenbach & L. A. Rescorla, 2001) derived from an American sample was used as a benchmark to evaluate its generalizability to Turkish general population (N = 5,195) and clinical (N = 963) samples. Item-level confirmatory factor analysis (CFA) was used to evaluate the adequacy of the correlated 8-factor model across 3 sample conditions (general population, clinical, and combined sample whose Total Problems scores were above the Turkish national median). The results supported the generalizability of the overall measurement structure of the CBCL to the Turkish population.     

The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

Science and Human Behavior: a tutorial in behavior analysis

B. F. Skinner's Science and Human Behavior (1953) became the main source of my understanding of behavior during my first semester as a college professor in 1955 at Kansas University. It has continued to exert a major influence throughout my career as the basis for a completely deterministic science of behavior, as a handbook to be consulted as a first step in dealing with any issue in behavior analysis, and as a tutorial in behavioral interpretive analysis--in the use of a small number of behavioral concepts and principles to understand behavior of all degrees of complexity. I describe four general interpretive orientations or maxims that are of broad significance for behavior analysis, and also two underappreciated major theoretical contributions.     

Demographic characteristics,social competence,and behavior problems in children with gender identity disorder: a cross-national,cross-clinic comparative analysis

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study—the first cross-national, cross-clinic comparative analysis of children with gender identity disorder—found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.     

Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.