Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.     

Stress Management with Law Enforcement Personnel: A Controlled Outcome Study of EMDR Versus a Traditional Stress Management Program

Eye Movement Desensitization and Reprocessing (EMDR) has been shown to be effective for treating posttraumatic stress disorder, but its efficacy as a stress management tool for normal individuals in highly stressful occupations has not been demonstrated. Sixty-two police officers were randomly assigned to either EMDR or a standard stress management program (SMP), each consisting of 6 hours of individualized contact. At completion, officers in the EMDR condition provided lower ratings on measures of PTSD symptoms, subjective distress, job stress, and anger; and higher marital satisfaction ratings than those in SMP. The effects of EMDR were maintained at the 6-month follow-up, indicating enduring gains from a relatively brief treatment regimen for this subclinical sample of officers who were experiencing some level of stress from their job.     

Functional Magnetic Resonance Imaging of Language in Epilepsy

Functional magnetic resonance imaging (fMRI) has revolutionized our understanding of functional networks and cerebral organization in both normal and pathological brains. In the present review, we describe the use of fMRI for mapping language in epilepsy patients prior to surgical intervention including a discussion of methodological issues and task design, comparisons between fMRI and the intracarotid sodium amobarbital test, fMRI studies of language reorganization, and the use of fMRI laterality indexes to predict outcome after anterior temporal lobectomy.     

Can research influence clinical practice?1

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

The efficacy of teaching psychology students exposure and response prevention for obsessive-compulsive disorder

The aim of the study was to investigate whether inexperienced student therapists could successfully learn exposure and response prevention for obsessive-compulsive disorder. Twenty out of 21 outpatients completed treatment as delivered by ten psychology students. A total of 60 hours group supervision and approximately 30 hours with individual supervision was given to the students over the course of three semesters. Large effect sizes were observed for measures of symptoms and depression. Sixty-two percent ( N = 13) of the intent to treat group achieved clinical significant change and 81% no longer met the diagnosis criteria ( N = 17). The treatment effects observed at the 6 month follow-up period were promising. The results are encouraging for training students in evidence based treatment for specific disorders.     

Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study

Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients’ (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants’ autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients’ consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.     

公费教育政策满意度对师范生教师职业认同的影响—社会认知因素的影响

采用问卷法,以839名公费师范生为研究对象,探究公费师范生政策满意度对师范生教师职业认同的影响,考察公费教育政策满意度、职业决策自我效能感、职业结果预期以及教师职业认同的关系。结果发现：（1）公费教育政策满意度显著正向预测教师职业认同;（2）职业决策自我效能感和职业结果预期在政策满意度和教师职业认同的关系中起中介作用,完全中介支持性政策满意度与教师职业认同的关系,部分中介限制性政策满意度与教师职业认同的关系。本研究通过社会认知职业理论解释了公费教育政策满意度与教师职业认同的关系路径,为提升公费师范生的教师职业认同提供了参考和借鉴。     

Interpersonal process in psychotherapy through the lens of the structural analysis of social behavior

As psychotherapy research focuses more and more on mechanisms of therapeutic change, increased attention has naturally been directed at therapy process. Over the past several decades, a variety of researchers have successfully applied Benjamin's 1974 Structural Analysis of Social Behavior (SASB) to the study of in-session psychotherapy events. This system for conceptualizing and analyzing interpersonal and intrapsychic processes has been shown to provide theoretically rigorous and empirically tractable instantiations of both helpful and hindering therapeutic exchanges. In this article the therapeutic alliance is conceived in terms of interpersonal processes as demarcated according to the SASB. This article also provides a review of SASB's wide-ranging applications to observing and studying the therapeutic relationship, therapy process, and client outcome. Also discussed are several data analytic and methodological considerations related to the SASB model and several new ancillary measures based on the SASB. Finally, the applied and clinical utility of the SASB system is discussed in light of a variety of contemporary empirical findings.