Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

Perception of genetic risk among genetic counselors

A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

Relational Levels of the “Container-Contained” in Group Therapy

The cornerstone of W. R. Bion's theory of individual and group development is that thinking is a primary emotional need, and it matures in the context of social communication. Bion (1970) formulated the essential relationship between thinking and communicating in terms of the container-contained relationship. Bion (1970) described three types of communication, occurring on different levels of development: commensal, symbiotic, and parasitic. These patterns involve normal and pathological variations of the container-contained and call for different expressions of the therapist's subjectivity. In this paper, I describe each of these alterations as they apply to group therapy and to therapeutic activity. I include case examples of how I utilize the conceptual framework in my work.     

Health Focused Psychotherapy In Treating a Dual Diagnosed Patient

Health-focused psychotherapy offers a contemporary model used in assessment, treatment planning and evaluation in addressing patients with both medical and psychiatric diagnoses. Clinicians in the health and mental health disciplines must know and understand the importance of standards of care and models of intervention and evaluation in clinical practice for this type of patient. Examined is the use of a specific model providing a tailored orientation to patient education, along with the development and use of a clinical algorithm and care pathway for clinical practice. Provided is a case study for applying the development and use of a clinical algorithm and care pathway for a dual diagnosed patient receiving health-focused psychotherapy.     

Treating Hypochondriasis with Interpersonal Psychotherapy

The treatment of hypochondriacal patients can be conceptualized as taking one of three approaches. These typically address one of the following questions: 1) “Should the patient be preoccupied?” 2) “Why is the patient preoccupied?” 3) “What are the interpersonal consequences of being preoccupied?” Interpersonal Psychotherapy (IPT) is specifically designed to address the last of these questions. IPT focuses on understanding the patient’s real distress, exploring the patient’s maladaptive communications, and modifying those communications so that others are more able to meet the patient’s attachment needs. With a focus on communication in a time-limited frame, fostered by a strong collaborative relationship, IPT appears to be an effective method of reducing hypochondriacal behavior.     

Logotherapy-Enhanced REBT: An Integration of Discovery and Reason

Viktor Frankls Logotherapy and Albert Elliss Rational Emotive Behavior Therapy (REBT) are at seemingly opposite ends of the psychotherapeutic spectrum. However, a close review of the assumptions and philosophy of each school of therapy reveals that these two systems are compatible. We propose that a Logotherapy-enhanced REBT can increase human achievement and happiness by balancing the individual discovery of meaning with the pursuit of reason. This integrated and enhanced therapy will help human beings participate in positive life experiences and take greater responsibility for change. Fruitful and beneficial aspects of a Logotherapy enhanced-REBT are explored with respect to cognitions, emotions, and the reduction of rumination. Conclusions are drawn, limitations are discussed, and future recommendations are outlined.     

Contemporary Psychotherapy: Promoting Personal Responsibility for Therapeutic Change

An assortment of factors in modern society can be involved in the etiology and treatment of mental illness. Theories about etiology usually underlie, and therefore guide, most strategies for treatment. Although a comprehensive bio-psycho-social approach to mental illness can help to foster the collaboration of an interdisciplinary treatment team, a heavy emphasis on biological factors or cultural deprivation may reduce the client's feelings of personal responsibility for change. Contemporary psychotherapy can help clients reduce their tendency to attribute blame to biological predispositions or external societal factors. Instead, it is more helpful to cultivate attributions for personal responsibility for change, growth, and maturation.     

Effectiveness Research: Transporting Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) From the Lab to School-Based Health Clinics

This paper describes the process of modifying and transporting an evidence-based treatment, Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), from a university setting to school-based health clinics. It addresses conceptual issues involved in the shift from efficacy to effectiveness research as well as operational issues specific to the transport of IPT-A into school-based health clinics. Consideration is given to the rationale for an IPT-A effectiveness study, methodological concerns, and the timing of the move from the lab to the community. The authors identify challenges and barriers to initiating effectiveness and transportability research and provide suggestions for overcoming these barriers. Recommendations for conducting research in school-based practice settings are provided.