Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.     

Claiming Subjectivity: Re-Storying Clinical Psychology and Myself

This article explores becoming a clinical psychologist later in life. Drawing on the author’s experience as a developmental psychologist who becomes a clinical respecialization student, it traces shifts in narratives of identity, belongingness, perspectives on psychology, and ways of knowing that both influence and construct her perspective on age and midlife. The paradigm shifts of going from professor, to student and intern, and philosophical shifts, transitioning from a stance of objectivity, to one informed by deep subjectivity, are considered. The ways that age matters is pondered as an artifact of the larger social construction of aging. The article proposes that a rich later-in-life perspective often includes the capacity to utilize self-knowledge and affective interpretation that nurtures subjectivity. The capacity to summon subjectivity facilitates rich authentic empathic connection with patients in clinical practice. The author explores the process of learning and re-storying herself in a manner that draws on self-reflection, clinical subjectivities, the life-learned ability to be humble, and a theory-informed lens of clinical psychology that is truly different from developmental psychology. The promise for future contributions to both clinical work and the greater field by “new” clinicians at midlife is explored.     

Does Lack of “Genetic-Relative Family Health History” Represent a Potentially Avoidable Health Disparity for Adoptees?

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as (for older adopted children) language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history (GRFHx). Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx.     

当代中国临床医学伦理准则建设论纲

我国当代临床医学伦理准则亟待出台，建设时机现已水到渠成，为积极参与这项重要的建设工程，本文提出了找准现实生长点为根本课题的基本建设思路，并以病人中心准则为核心探索性地设计出了准则体系。     

Transgenerational patterns of abusive parenting: Analog and clinical tests

Two studies were conducted to determine whether there was an association between punitive childhood histories and abusive parenting. In the first experiment, undergraduate students who reported more punitive childhood histories and undergraduates who reported mild or nonpunishing childhoods were tested with an Analog Parenting Task. The task used photographic stimuli to depict child behaviors and to elicit disciplinary choices in response to children's transgressions. Persons from the more punitive backgrounds were significantly more likely to endorse potentially injurious disciplinary responses. Additionally, in a post-hoc analysis, women with mild punishment backgrounds were more likely to indicate they were annoyed by the depicted child behaviors than women with the severe punishment backgrounds and men with both punishment histories. In the second experiment, childhood histories of parents of children seen at a psychiatric clinic were assessed. The data indicated an association between severely punitive backgrounds of parents and the probability that the referred child had been physically abused. Also, the punishment histories of the parents were associated with the presence of antisocial and aggressive presenting problems displayed by the referred child. The two experiments together were considered to provide support for a modified version of the trans-generational hypothesis of abuse.     

What do clinical supervision research reviews tell us? Surveying the last 25 years

What do clinical supervision research reviews across the last 25 years tell us? That question is subsequently examined. Based on database and literature searches, 20 reviews appearing from 1995 through 2019 were identified for survey examination; consistencies, inconsistencies and other defining features were determined across reviews; and the survey findings and their implications are considered. Primary findings are as follows: (a) ‘proof’ for supervision appears to be more ‘proof by association’ than otherwise, being primarily a product of ex post facto, cross‐sectional, correlational study; (b) evidence supporting supervision impact of any type is weak at best, especially so for worker and client outcomes; (c) supervision models generally lack empirical foundation; (d) evidence‐based supervision appears to be more a hope and dream than supervision‐based reality at present; and (e) the primary methodological problems that plagued supervision research in the 1990s are still all too frequent in modern research. Some questions to entertain about supervision going forward, and some remedies for improving its research, are proposed.     

"It's led me astray": How Cognitive Behavioural Therapists experience personal therapy in clinical practice

Personal therapy is considered to be an essential component of most psychotherapeutic training programmes. However, it remains peripheral to cognitive behavioural therapy (CBT) training courses. We present a subsection of results from a qualitative study that examines how CBT therapists use personal therapy in their clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Participants were asked about how they used personal therapy in their clinical practice and their accounts were analysed using interpretative phenomenological analysis (IPA) to identify common themes. This article presents the results of the first master theme, “Personal therapy creates conflict”, which explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol‐led CBT. Results show that participants found personal therapy created considerable internal conflict, where their use of technical evidence‐based treatment protocols as practitioners was experienced in tension with the relationally oriented therapy they had received as clients. We discuss results in the context of Gabriel Marcel's philosophical insights on the dehumanising effects of technology on human relationships. We conclude with a brief consideration of the current political climate that increasingly privileges short‐term technical solutions to psychological distress.     

Independently Licensed Counselors' Work Values

Prospective clinical mental health counseling students need to know if their work values align with those of independently licensed counselors before investing their time and accumulating debt. Analyzing the work values of 463 independently licensed counselors in the United States, we found 89% expressing social (altruistic) work values and 22% expressing intrinsic work values. Independently licensed counselors want to help clients become fully functioning and self-actualized by maintaining unconditional positive regard, being congruent, and providing empathy. Clarifying these work values and their interaction can help prospective and current clinical mental health counseling students determine their future job role.