Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

Interobserver agreement and procedural fidelity: An odd asymmetry

We examined articles with experiments published in the Journal of Applied Behavior Analysis and in Behavior Analysis in Practice from 2017 through 2021 to determine how frequently procedural fidelity was assessed. When procedural fidelity was assessed, we determined how often a measure of interobserver agreement for those fidelity data was provided. We also determined how often a measure of interobserver agreement for participants' behavior was provided. Across both journals and all years, 54.7% of relevant articles provided a measure of procedural fidelity. Of them, 17.7% provided a measure of interobserver agreement for procedural fidelity. In marked contrast, 96.4% provided interobserver agreement data for participants' behavior. It is unfortunate that applied behavior analysts frequently fail to provide procedural fidelity data and, when they do, often fail to provide interobserver agreement data for the fidelity data. Reviewers for, and editors of, behavior-analytic journals are encouraged to strongly consider the relative value of procedural fidelity and agreement on procedural fidelity measures when rendering recommendations on the suitability of a given submission.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Race in the Space: Clinical Considerations for Addressing Race in Treatment

During a period of intense racial unrest in the nation, we were working as clinicians delivering a manualized protocol to LGBTQ adults of varying racial and ethnic backgrounds. Intrigued by the differences in our modes of engagement with clients, we, a Black, cis female therapist and White, cis male therapist, set out to further explore how our positionalities informed our communications with, and expectations of, White and non-White clients during this time. In this paper, we reflect on these differences when delivering therapy in cross-racial and same-race dyads. We highlight where our experiences overlap as clinicians trained in the same program and where they diverge due to our respective worldviews. We conclude with considerations for practitioners to engage with race in psychotherapeutic treatment.     

On the longevity of behavioral interventions for challenging behavior

The capacity for a treatment to maintain its effects over time may be the most critical component of behavioral interventions for challenging behavior as treatments that fail to persist are likely to be of little value to society. We reviewed the quality and quantity of different types of post-intervention data for the treatment of challenging behavior in studies published over the last 7 years. We found that for the majority of participants at least one measure of maintenance, fading, or follow-up was reported but with limited information regarding the quality of those measures. Reports of secondary variables related to post-intervention data (e.g., latency to measurement) were also uncommon. We discuss possible explanations for the paucity of post-intervention data, barriers to obtaining post-intervention data, strategies for obtaining these data, and implications for the external validity of behavioral interventions for challenging behavior. We provide recommendations for increasing the probability that post-intervention data are included in applied research on challenging behavior.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.     

Parental assessment of the adjustment of children following abduction by the other parent

We present a multiple regression model that explores post-return adjustment of school-age children who experienced abduction by a parent. The model includes: a) child and family characteristics preceding abduction, b) characteristics of the abduction experience, and c) child and family characteristics following return. Overall, the model accounts for 21% of the variance in post-return adjustment of children (p.05). The most salient finding is that post-return adjustment of children was best explained by characteristics of the child and family before the abduction occurred. Domestic violence perpetrated by one or both parents was the most significant factor.     

INCREASING CALORIE CONSUMPTION IN CHILDREN WITH CYSTIC FIBROSIS: REPLICATION WITH 2-YEAR FOLLOW-UP

Three mildly malnourished children with cystic fibrosis and their parents participated in a behavioral group-treatment program that focused on promoting and maintaining increased calorie consumption. Treatment included nutritional education, gradually increasing calorie goals, contingency management, and relaxation training, and was evaluated in a multiple baseline design across four meals. Children's calorie intake increased across meals, and total calorie intake was 32% to 60% above baseline at posttreatment. Increased calorie consumption was maintained at the 96-week follow-up (2 years posttreatment). The children's growth rates in weight and height were greater during the 2 years following treatment than the year prior to treatment. Increases in pace of eating and calories consumed per minute were also observed 1 year posttreatment. These findings replicated and extended earlier research supporting the efficacy of behavioral intervention in the treatment of malnutrition in children with cystic fibrosis.     

EFFECTS OF CHOSEN VERSUS ASSIGNED JOBS ON THE WORK PERFORMANCE OF PERSONS WITH SEVERE HANDICAPS

We evaluated the effects of several choice-related variables on the work performance of adults with severe handicaps. After assessing client work preferences, three choice-related situations were presented: (a) providing clients with the opportunity to choose a work task, (b) assigning a preferred task, and (c) assigning a nonpreferred task. Results indicated that clients attended to work tasks almost twice as much when they chose their tasks and when assigned to work on preferred tasks versus when assigned to work on nonpreferred tasks. Results are discussed regarding the need to assess systematically the effects of choice-related variables.