Total Recall: Treating Chronic Mental Illness as a Memory

The ideas outlined in this paper developed from three separate strands of my work as a therapist treating older people. Firstly, I was concerned with reducing the number of patients not benefiting from therapy. In keeping with Pinquart et al.'s (Am J Psychiatry 163:1493–1501, 2006) recent meta-analytic survey concerning the use of psychotherapy and medication, 50% of the depressed patients treated by my team failed to respond adequately. Secondly, the ideas grew out of my attempts to determine why different therapies with older people have often been shown to have equivocal beneficial impacts (Davies and Collerton, J Ment Health 6:335–344, 1997). Thirdly, I was interested in integrating the relevant neuropsychological features, particularly memory, into my therapeutic work. These three strands have led me to propose a pan-theoretical model of distress based on memory functioning and existing information processing perspectives (Teasdale and Barnard, Affect, cognition and change: Remodelling depressive thought, 1993; Power and Dalgleish, Behav Cogn Psychother, 27:129–142, 1996).     

Participating From the Comfort of Your Living Room: Feasibility of a Group Videoconferencing Intervention to Reduce Distress in Parents of Children With a Serious Illness or Injury

ABSTRACT

This study explored the feasibility and potential effectiveness of a videoconferencing group intervention for parents of children with a life-threatening illness. Parent functioning was assessed at pre, post, and 6-month follow-up (N?=?13). Semistructured interviews explored parent experiences of the program and clinicians’ experiences were systematically recorded. Attendance was high (92%) and parents reported comfort with the online delivery. Quantitative data revealed significant reductions on three of the nine measures examined (parent guilt/worry; unresolved sorrow/anger; lack of psychological flexibility). Clinician data are described and highlights the skills and program modifications required to adapt to the videoconferencing modality. A randomized controlled trial is now underway.     

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us—when confronted with family secrecy in clinical practice—to carefully consider the potential destructive and life‐giving aspects of the silence.     

Third‐Order Thinking in Family Therapy: Addressing Social Justice Across Family Therapy Practice

We contend that the field of family therapy is undergoing a notable shift from second‐ to third‐order thinking. We offer theoretical support and examples to demonstrate how third‐order thinking provides a framework for integrating heightened sociocultural attunement into family therapy practice. We discuss the importance of third‐order thinking relative to being prepared to invite families into third‐order change. Finally, we offer a case example to show specific guidelines for third‐order practice.     

The Impact of Treatment Components Suggested by the Psychological Flexibility Model: A Meta-Analysis of Laboratory-Based Component Studies

An important aspect of psychotherapy research is the examination of the theoretical models underlying intervention approaches. Laboratory-based component research is one useful methodology for this endeavor as it provides an experimental means of testing questions related to intervention components and the change process they engage with a high level of control and precision. A meta-analysis was conducted of 66 laboratory-based component studies evaluating treatment elements and processes that are suggested by the psychological flexibility model that underlies Acceptance and Commitment Therapy (acceptance, defusion, self as context, committed action, values, and present moment), but also touches on a variety of contextual forms of cognitive behavior therapy. Significant positive effect sizes were observed for acceptance, defusion, present moment, values, mixed mindfulness components, and values plus mindfulness component conditions compared to inactive comparison conditions. Additional analyses provided further support for the psychological flexibility model, finding larger effect sizes for theoretically specified outcomes, expected differences between theoretically distinct interventions, and larger effect sizes for component conditions that included experiential methods (e.g., metaphors, exercises) than those with a rationale alone. Effect sizes did not differ between at-risk/distressed and convenience samples. Limitations with the meta-analysis and future directions for laboratory-based component research are discussed.     

Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes

Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differential levels of symptom improvement. Sessions were sampled from a randomized trial comparing different consultation conditions in training therapists new to CPT. Among 69 patients, one session from Sessions 1–3 and one session from Sessions 4–7 were reliably rated for adherence and competence using the CPT Therapist Adherence and Competence Scale, and for therapeutic alliance using the Working Alliance Inventory-Observer scale. Mixed models, including detrending using a fixed effect of session, predicted self-reported Posttraumatic Stress Disorder Checklist (PCL-IV) scores in one session using process scores from the previous session. The statistical interaction between fidelity and alliance scores to predict outcome was also examined. Alliance had significant, positive correlations (rs = 0.18–0.21) with same-session adherence and competence. Higher competence scores and higher therapeutic alliance scores in one session were independently associated with lower PCL-IV scores in the subsequent session. Adherence scores, which tended to be very high with relatively less variability, did not significantly relate to subsequent-session PCL-IV scores. Competence significantly interacted with alliance, such that sessions high in both competence and alliance predicted especially lower subsequent-session PCL-IV scores. A strong therapeutic alliance may have a synergistic, salutary effect with the competent delivery of CPT.     

Client Versus Clinicians’ Standards of Clinically Meaningful Change and the Effects of Treatment Expectations on Therapeutic Outcomes in Individuals With Posttraumatic Stress Disorder

There is limited research on the concordance between client perceptions and clinician standards of the degree of symptom change required to achieve meaningful therapeutic improvement. This was investigated in an adult sample (N = 147) who received trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD). We examined whether clients’ benchmarks of change were related to actual outcomes and the relationship between client expectations and their treatment outcomes. Clients completed measures indexing the level of symptom reduction required (in their view) to reflect a benefit or recovery from treatment and treatment expectations. Actual PTSD severity was indexed pre- and posttreatment via self-report and clinician-administered interview. Results demonstrated that the amount of change clients said they required to experience a benefit or recovery was significantly larger than typical clinical research standards. Nonetheless, the majority of client benchmarks of change (79.7–81.8%) were consistent with clinical research standards of what constitutes benefit or recovery. Client benchmarks were generally positively correlated with their actual outcomes. Clients’ belief that treatment would be successful was associated with greater reductions in PTSD symptoms. These findings provide preliminary evidence that the standards used to determine clinically significant change are somewhat consistent with clients’ own perceptions of required symptom change.     

Applications of Collaborative Helping Maps: Supporting Professional Development,Supervision and Work Teams in Family‐Centered Practice

Collaborative, family‐centered practice has become an influential approach in helping efforts across a broad spectrum of human services. This article draws from previous work that presented a principle‐based, practice framework of Collaborative Helping and highlighted the use of Collaborative Helping maps as a tool both to help workers think their way through complex situations and to provide a guideline for constructive conversations between families and helpers about challenging issues. It builds on that work to examine ways to utilize Collaborative Helping maps at worker, supervisory, and organizational levels to enhance and sustain collaborative, family‐centered practice and weave its core values and principles into the everyday fabric of organizational cultures in human service agencies and government agencies that serve poor and marginalized families and communities.     

Intervenciones psicológicas para cuidadores con síntomas depresivos: revisión sistemática y metanálisis

It has been well determined that nonprofessional caregiving, which is a fundamental component of care to dependent persons, may lead to an increased risk for mental disorders in caregivers, especially depression. This paper sought to conduct a systematic review and meta-analysis to determine the efficacy of psychological interventions to reduce depressive symptoms aimed at nonprofessional caregivers. A comprehensive search of studies published from 1980 to 2013 was conducted in Medline and PsycInfo databases, as well as in the references of other reviews, meta-analysis and relevant book chapters, thereby shortlisting 13 papers. Although most of the interventions reached positive results in decreasing depressive symptomatology, their effects in general were moderate (ES = −0.49, 95% CI [−0.62, −0.36]). Important advances have been produced regarding the quality of the studies, but some limitations are still found which restrict the scope of their findings. It is necessary to conduct further studies that meet excellence standards and, more concretely, regarding indicated prevention of depression.