心理咨询中的突然获益：工作同盟及初始症状的影响

对82位当事人在咨询中的症状改变过程进行纵向研究,检验突然获益模式（Sudden Gain, SG）的发生及其与咨询效果的联系,并探索初始症状水平、工作同盟对SG的影响。结果表明,24.93%的当事人经历了SG,咨询效果显著好于其他当事人;SG组与对照组在初始症状水平和总体工作同盟水平上差异显著。结论：SG出现于本土心理咨询中,经历SG的当事人取得了更好的咨询效果,工作同盟与初始症状水平与SG的发生相关。     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

Anger management therapy with young male offenders: An evaluation of treatment outcome

The aim of the present study was to assess the effectiveness of a brief group‐based anger management intervention with young male offenders. Eighty‐seven prisoners were assessed as suitable for the intervention. Fifty of these made up the experimental group and 37 the control. Prior to intervention prisoners completed a self‐report anger questionnaire (Anger Management Assessment questionnaire: AMA). Prisoners were also assessed by officers on a checklist addressing angry behaviour (Wing Behaviour Checklist: WBC). Both measures were completed approximately two weeks before the date of the intervention and eight weeks after the intervention (and while the control group remained on the waiting list). It was predicted that the experimental group would show significant improvements in both measures following intervention and that no such change would be observed in the control group. This hypothesis was supported, with significant improvements observed in the experimental group and no change observed in the control. Aggr. Behav. 30:174–185, 2004. © 2004 Wiley‐Liss, Inc.     

Outcome of aggression affects processing and can legitimise subsequent aggression: Influence of trait aggressiveness

The present study investigated differences in processing times between positive and negative outcomes to an aggressive reaction to provocation. The effects of outcome, sex, trait aggressiveness and current mood on subsequent subject‐generated material were also examined. Fifty subjects read stories line by line on a computer screen. Reading time for the key sentence describing a positive or negative outcome to an aggressive reaction to provocation was recorded and subjects wrote a continuing sentence to half the stories. Subjects took less time to process the negative outcome. The positive outcome resulted in more subject‐generated aggression than the negative outcome. There were few sex differences but men wrote more aggressive endings than women for the stories containing physical aggression. Trait aggressiveness was correlated with producing more aggressive content in the continuing sentence for both outcomes. Feeling peaceful was correlated with producing prosocial material to neutral stories. Subjects therefore expect a negative outcome to aggressive behaviour. Reading stories which present a positive outcome to aggression increases the accessibility of aggressive cognitions. Subjects high in trait aggressiveness are not inhibited by a negative outcome. Aggr. Behav. 30:284–297, 2004. © 2004 Wiley‐Liss, Inc.     

The Adult Attachment Interview and psychoanalytic outcome studies

During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies.     

Locomotion, assessment, and regulatory fit: Value transfer from “how” to “what”

Regulatory fit is experienced when people pursue a goal in a manner that sustains their regulatory orientation. Previous research on promotion and prevention orientations has found that regulatory fit increases people’s perception that a decision they made was “right,” which in turn transfers value to the decision outcome, including being willing to pay more for a product than those who chose the same product without regulatory fit (Higgins, 2000; Higgins et al., in press). We predicted that the effect of regulatory fit on monetary value could be generalized to locomotion and assessment orientations. Participants were willing to pay over 40% more for the same book-light when it was chosen with a strategy that fit their regulatory orientation (assessment/“full evaluation”; locomotion/“progressive elimination”) than when it was chosen with a non-fit strategy.     

The Role of Fidelity and Feedback in the Wraparound Approach

Wraparound approaches are being implemented with children in many mental health systems around the country. Evidence for the effectiveness of the wraparound approach, however, is limited. In addition, the degree to which wraparound interventions adhere to the principles of wraparound has rarely been assessed. We examined the influence of adherence to wraparound principles and outcome feedback within the wraparound approach. Children participating in family team meetings were enrolled in a feedback or no feedback condition. Teams receiving feedback were given a brief report regarding outcome progress four times over a three-month period. In addition, adherence to wraparound principles was assessed in the initial team meeting and examined in relationship to outcome at three months and nine months. Although youth in both feedback and non-feedback groups improved with intervention, there were few differences between the groups based on outcome feedback. Similarly, adherence was uniformly high and did not influence the outcome for individual cases. Although the wraparound approach was helpful for youth in our sample, outcome feedback and adherence to wraparound principles had limited influence on these effects.     

Limited Information Goodness-of-fit Testing in Multidimensional Contingency Tables

We introduce a family of goodness-of-fit statistics for testing composite null hypotheses in multidimensional contingency tables. These statistics are quadratic forms in marginal residuals up to order r. They are asymptotically chi-square under the null hypothesis when parameters are estimated using any asymptotically normal consistent estimator. For a widely used item response model, when r is small and multidimensional tables are sparse, the proposed statistics have accurate empirical Type I errors, unlike Pearson's X ². For this model in nonsparse situations, the proposed statistics are also more powerful than X ². In addition, the proposed statistics are asymptotically chi-square when applied to subtables, and can be used for a piecewise goodness-of-fit assessment to determine the source of misfit in poorly fitting models. This research has been supported by the Department of Universities, Research, and Information Society (DURSI) of the Catalan Government, by grant BSO2003-08507 of the Spanish Ministry of Science and Technology, and an NSERC Canada grant. We are grateful to the referees for comments leading to improvements.     

An investigation into the client at the heart of therapy

This paper reports on an exploration of the experience of the client at the heart of therapy. A grounded theory analysis of clients' experiences of therapy provided through a voluntary sector counselling service was undertaken, and generated four main categories: permission, engagement, transparency and restructuring. The results of the study are presented in a way that hopefully retains much of the richness of what people have reported about their experience of counselling. The findings of the study are discussed in terms of the idea that counselling can provide a setting where people can have common therapeutic requirements met.     

Use of the CAFAS to Evaluate Outcome for Youths with Severe Emotional Disturbance Served by Public Mental Health

Outcomes are reported for youths with serious emotional disturbance receiving customary services from community mental health service providers who receive state mental health funds. Various outcome indicators for the Child and Adolescent Functional Assessment Scale (CAFAS) are described, as well as a procedure for categorizing youths into client types based on the CAFAS subscale scores. The youth's intake assessment was compared to the last CAFAS evaluation that the youth received. A statistically significant reduction in mean CAFAS total score was observed for the entire sample and for each client type. In addition, the mean number of subscales on which the youth was rated as severely impaired significantly decreased for the total sample and for each client type. The proportion of youths who experienced a clinically meaningful improvement in functioning was 58.6%. For the subset of youths who were rated as severely impaired on one or more subscales at intake, 53.1% left services without any severe impairments. The pattern of outcome results differed for subgroups based on type and extent of impairment. Implications of these findings and suggestions for using outcome monitoring to improve services in the public mental health sector are discussed.