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.     

The 'storied' helper: narrative ideas and practices in counselling and psychotherapy

This paper is intended as an introduction to the use of narrative ideas, languages and practices in counselling and psychotherapy. It explores the skills and knowledges that are involved in narrative ways of working for bothpractitioners and those who consult them. Counselling is understood as comprising a social process within a ‘storied world’. These ideas are illustrated through one particular ‘shortstory’. A narrative perspective enables us to consider the stories that are hidden as well as the stories that are privileged within the both contemporary cultural discourse and the professional discourses of counselling and psychotherapy.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

Freud

The author explores the evidence-base and selection criteria for a short-term supportive dynamic approach for patients whose psychological mindedness and quality of object relationships is low. Illustrating this approach with a case example he outlines the central features of Supportive Dynamic Therapy. He describes a psychodynamic conceptual and developmental framework that can be used to guide the therapist's interventions and responses, and modulate the patient's anxiety. A dynamic focus presented in the form of a central issue is shown to have a significant function both in containing the patient's anxiety, and in giving shape to the therapist's efforts to support the patient's ego-strengths and adaptive abilities. The therapeutic work can be seen to result in an alteration in the trajectory or reiterating pattern of the patient's life.     

The self in the couple relationship: part 2

Part 1 of this paper examined some of the ways in which individual therapy, by assisting in the development of a more cohesive sense of self in the individual, inevitably has an impact on the individual's relationships, especially their relationship with a partner. This paper approaches the topic of the significance of ‘the self’ in the couple relationship from an alternative direction. It focuses on the significance of ‘the self’ for couples therapy, and argues that couples therapy may sometimes need to include therapeutic work with one partner to facilitate change in the relationship. In both parts of the paper, a conceptualization of the couple relationship as ‘a transitional space’ is central.     

Narrating attachment: Some lessons learned from Charles Dickens' novel ‘Little Dorrit’

In this paper the author aims to explore the way in which contemporary society is informed by the values of technology, and how this ‘technological milieu’ influences the practice of counselling and therapy. The philosopher Albert Borgmann identifies some of the values of technology as efficiency, speed of results and ease of availability. While acknowledging technology's undoubted benefits, Borgmann warns that allowing these values to dictate ever more aspects of life threatens to impoverish us. In contrast with technological devices, the ‘focal’ experiences which give our lives meaning are rich and complex, as much to do with the journey as with reaching a goal. In this paper, the author argues that it is important to try and preserve counselling and psychotherapy as focal experiences, despite increasing pressure to conform to a more technological approach. In the light of this, the drive towards evidence-based treatments, the promotion of time-limited focused approaches to treatment and current trends such as the interest in neuropsychological approaches to attachment theory are examined.     

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.     

What Must You Know and Do to Get Good Outcomes With DBT?

Because little research has been conducted on which therapist-client interactions lead to intermediate and end-point improvements in Dialectical Behavior Therapy (DBT), we have a small evidence-base from which to specify what therapists must know and do in order to obtain good outcomes using DBT. As with other evidence-based practices, dissemination of DBT has defaulted to assumptions and methods from the “psychotherapy technology model,” which emphasizes transfer of the validated treatment package from the research clinic to routine settings with high fidelity (Morgenstern & McKay, 2007). However, serious limitations of the psychotherapy technology model require pursuit of alternative complementary models to guide dissemination. One complementary approach is to use well-designed practice-based training research. In this approach, therapists learn modular competencies linked to a highly structured yet flexible clinical decision-making framework. Modular training of therapist competencies emphasizes the continuity of the component therapist strategies across evidence-based protocols rather than emphasizing the packages or manuals as separate and distinct. Key hypotheses about the change processes responsible for client change and the associated treatment strategies used to influence these change processes should be specified and measured at the level of client, therapist, and service delivery setting. Adopting this approach may offer advantages that apply to the dissemination and implementation of DBT and other evidence-based practices (EBPs).