Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client‐centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE‐OM (Clinical Outcomes in Routine Evaluation‐Outcome Measure). The discourses drawn upon by clients (n=4) and therapists (n=4) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client‐centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top‐down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

Choosing Assessment Instruments for Depression Outcome Research With School‐Age Youth

Using effect size results from Erford et al.'s (2011) meta‐analysis for treatment of depression in school‐age youth, the authors analyzed 6 commonly used instruments for practical and technical strengths and weaknesses. Effect size estimates from these 6 instruments were compared to indicate likely results when used in future depression outcome research.     

Changes in Distress Intolerance and Treatment Outcome in a Partial Hospital Setting

Despite the well-established role of distress intolerance (DI) in a wide range of psychological disorders, few studies have examined whether DI improves during treatment and whether these changes are associated with symptom outcomes. Patients (N = 626) enrolled in a brief cognitive-behavioral partial hospital program completed pre- and posttreatment measures of DI. Results indicated that DI decreased significantly during treatment, with more than 30% of the sample exhibiting a reduction of more than 2 standard deviations from the sample mean. Women reported higher DI than men at baseline; however, there were no gender differences in changes in DI over time. Participants also completed a pre- and posttreatment measure of depression and a subset completed a measure of anxiety (n = 167). DI was associated with more severe depression and anxiety at pre- and posttreatment, with participants who reported a decrease in DI also reporting lower depression and anxiety symptoms at post-treatment. These results further highlight the transdiagnostic relevance of DI and suggest that DI may be a relevant factor in treatment outcome for depression and anxiety.     

Relationship between therapist empathy and client-perceived working alliance in China: A multilevel modelling analysis

This naturalistic study examined the relationship between two types of therapist empathy, intellectual empathy and empathic emotion, and client-perceived working alliance (WA) in China. The study adopted the definitions and assessment methods of empathy recommended by Duan and Hill and used the theory of WA by Bordin and WA Inventory-Short by Tracey and Kokotovic. Eighty-six clients and 43 therapists from a university counselling centre at a comprehensive university in China participated in the study. Therapist intellectual empathy and empathic emotion and client-reported WA measured in six consecutive sessions from the second through the seventh session were assessed for each session. The results of multilevel modelling analyses showed that client-perceived WA increased significantly session after session, and therapist empathic emotion significantly predicted Tasks of WA. Moreover, there was significant therapist effect associated with Bond. In the context of empathy and WA research findings reported in the USA, some of the non-significant results of this study were intriguing. We discuss the study results with particular attention to the Chinese cultural context and present suggestions for future research.     

An investigation into the psychometric properties of the CORE‐OM in patients with eating disorders

Aim: The current study aimed to explore the psychometric properties of the CORE‐OM (Clinical Outcomes in Routine Evaluation – Outcome Measure) when used in an eating disorder sample. Method: The CORE‐OM was administered at assessment to 360 individuals referred to an eating disorders service. Principal component analysis was conducted to look at the psychometric structure of the CORE‐OM, and psychometric properties were investigated using analyses of reliability and validity. Results: Analyses of the psychometric structure suggested a three‐component solution reflecting negatively worded, positively worded and risk items. The CORE‐OM showed good acceptability, acceptable internal and test‐retest reliabilities, as well as good convergent and known groups validity. Conclusions: The results of the current study support the CORE‐OM as a reliable and valid measure for assessing psychological distress in eating disorders.     

Psychotherapy training in Europe: similarities and differences

This paper gives a brief overview of the survey of European Psychotherapy training that was carried out by a team of European researchers. It sketches the current situation in each country and provides a brief quote from informants in each country, giving the flavour of the problems each is struggling with.     

Outcome of psychodynamic child psychotherapy in routine practice

The aim of the present naturalistic study was to explore the effectiveness of psychodynamic child psychotherapy in routine practice. The sample comprised 207 psychotherapies with children 4–12?years of age with a broad range of mental health problems. Data on two measures, children’s global assessment scale (CGAS) and strength and difficulties questionnaire (SDQ), were collected pre-post therapy. Within-group changes were analysed using repeated measures mixed-models ANOVA. Individual changes were examined by means of clinical significance. The analyses revealed improvement in general functioning, decrease in problem severity and problem impact on the child’s everyday life, as well as an increase in prosocial behaviour. For CGAS, an interaction effect was discovered suggesting a larger improvement for younger children (4–6?years) than for older children (10–12?years). After therapy, 38% (n 76) achieved clinically significant improvement. Time-limited psychotherapy proved favourable for children assigned to that particular treatment modality. The study generated similar results as previous well-controlled trials, revealing statistically significant results in a large sample and in spite the use of non-specific outcome measures. The study provides everyday evidence to the effectiveness of child psychodynamic treatment with parallel parental work for a broad range of child mental health problems.     

The CORE‐10: A short measure of psychological distress for routine use in the psychological therapies

Background: There is a need for a generic, short, and easy‐to‐use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE‐10 in response to this need. Method: Items were drawn from the CORE‐OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE‐OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow‐up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE‐10 in its standalone format. Results: The internal reliability (alpha) of the CORE‐10 was .90 and the score for the CORE‐10 correlated with the CORE‐OM at .94 in a clinical sample and .92 in a non‐clinical sample. The clinical cut‐off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut‐off score for the CORE‐10 was 13 and yielded sensitivity and specificity values of .92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE‐10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings.