Bridging the Gap between Explicative and Treatment Research: A Model and Practical Implications

The recent move toward the recognition of empirically supported treatments (ESTs) within numerous facets of the field of clinical psychology has been met with general enthusiasm. The EST movement would not have been possible without the efforts of earlier treatment researchers. Paradoxically, this is also a time when some of the leaders in clinical psychology are recognizing that there is a paucity of experimental treatment research being conducted today relative to the high volume of correlationally based, explicative research, which examines the associations among variables. In this paper we present numerous reasons for the relative excess of explicative research and the paucity of treatment outcome research. Clinical practice is used to exemplify how assessment-oriented, explicative activities and the design of treatment can be integrated. A research-based example in which explicative research is used directly to inform the design of the intervention in treatment outcome research is presented as one model for emulation. Specific recommendations are made to help guide professionals and students entering the field who wish to conduct treatment research. An expansion on some of the themes highlighted in this paper can be found in the chapter from which it was in part derived (Blount, Bunke, & Zaff, 1999).     

Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers’ experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers’ belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.     

Empirically validated treatments—What now?

Progress in the identification of empirically supported psychological interventions is described, along with possible mechanisms for training in such treatments. Obstacles to training established clinicians, including time, cost, and geographic barriers are also discussed.     

The Future of Psychotherapy: Visions and Recommendations

Using a roundtable discussion format, the editor and new members of the editorial board for the Journal of Contemporary Psychotherapy exchange ideas about how they envision the future of psychotherapy, anticipate likely positive and negative outcomes, identify key issues to be confronted today in order to maximize future success, and clarify the role of the individual psychotherapist in protecting psychotherapy as a viable field of study and practice. The discussion closes with recommendations for the next generation of psychotherapists and general conclusions about the future of psychotherapy.     

Gender congruence and body satisfaction in nonbinary transgender people: A case control study

Abstract

Background: Binary transgender people access gender affirming medical interventions to alleviate gender incongruence and increase body satisfaction. Despite the increase in nonbinary transgender people, this population are less likely to access transgender health services compared to binary transgender people. No research has yet understood why by exploring levels of gender congruence and body satisfaction in nonbinary transgender people.

Objective: The aim of this study was to compare levels of gender congruence and body satisfaction in nonbinary transgender people to controls [binary transgender people and cisgender (nontrans) people].

Method: In total, 526 people from a community sample in the UK took part in the study (97 nonbinary, 91 binary, and 338 cisgender identifying people). Participants were asked to complete an online survey about gender congruence and body satisfaction.

Results: There were differences in gender congruence and body satisfaction between nonbinary and binary transgender people. On sex-specific parts of the body (i.e., chest, genitalia, and secondary sex characteristics), nonbinary transgender people reported significantly higher levels of gender and body satisfaction compared to binary transgender people. However, there was no difference in congruence and satisfaction with social gender role between the two transgender groups (nonbinary and binary). Cisgender people reported significantly higher levels of gender congruence and body satisfaction compared to transgender people (nonbinary and binary).

Conclusions: There are differences in gender congruence and body satisfaction between nonbinary and binary transgender people. Nonbinary individuals may be less likely to access transgender health services due to experiencing less gender incongruence and more body satisfaction compared to binary transgender people. Transgender health services need to be more inclusive of nonbinary transgender people and their support and treatment needs, which may differ from those who identify within the binary gender system.     

Real-world inpatient programs: Shedding some light-A critique

This critique is a response to an article by Morisse, Batra, Hess, Silverman, and Corrigan (1996), in which “a token economy for the real world” is promulgated as an alternative to the comprehensive social-learning program and assessment technology presented by Paul and Lentz (1977). The article misrepresents the treatment-and-assessment procedures that have been empirically validated as the most effective and cost-efficient for inpatient programs. The article also inappropriately cites the results of prior reports as support for an oversimplified approach to the development and implementation of inpatient programs. The promoted approach is in direct opposition to the widely recognized need for empirically validated interventions and evaluations in mental health services. Not only are data lacking to support assertions of effectiveness for the resulting program but illustrative examples demonstrate technically unsound procedures as well as an ethically questionable emphasis on staff desires to the exclusion of patient needs. We attempt to correct Morisse et al.'s inaccuracies and misconceptions regarding the work of Paul and colleagues, note the major problems with their perfunctory approach, and provide recommendations for implementation and maintenance of empirically validated procedures for inpatients.     

Cognitive-Behavioral Therapy in the Digital Age: Presidential Address

Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field’s challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.     

Bridging the Theory-Practice Gap by Getting Even Bolder With the Boulder Model

Cognitive behavioral therapy is an effective treatment for virtually all psychiatric disorders. However, very few patients have access to it and few therapists are trained in the theory and practice of cognitive behavioral therapy. Based on the existing evidence and the articles of this series, the following recommendations are made: (a) all mental health care providers (including Psy.D. and social workers) need to be trained in the practice and theories of empirically supported treatments, specifically cognitive behavioral therapy; (b) clinical practice also needs to be based on theory, not just treatment manuals; and (c) psychological treatments have to move beyond the DSM boundaries.     

INTERACTION EFFECTS IN MULTIELEMENT DESIGNS: INEVITABLE,DESIRABLE, AND IGNORABLE

A single-subject design often used to compare the effectiveness of two or more independent variables (like treatment programs) is the multielement (alternating treatments or simultaneous treatments) design. Variants of this design approximate the concurrent comparison of the effects of two or more variables (or levels of variables) by programming the variables (or levels) in rapid alternation, typically across or within daily sessions. Properly combined with conventional reversal designs, these designs can also display a variety of interaction effects, some of them worrisome, others highly desirable for the future development of the field. A worrisome model is the possibility that when Treatment B alternates rapidly with Treatment C, the effects of each will not be the same as when each is the only treatment used. A desirable model is the use of the multielement design as a fast-paced component of an otherwise conventional reversal design examining contextual control of some relationship: the possibility that some behavior responds differently to Controlling Variables A and B in Context X than in Context Y. This second possibility opens single-subject designs to the more efficient examination of all interactive effects and is highly desirable, considering the prevalence and importance of interactions in determining the limits and the generality of currently understood behavioral phenomena.     

OVERVIEW OF SUPPORTED EMPLOYMENT

This article traces the emergence of supported employment as a result of philosophical changes in expectations for persons with disabilities, based on scientific developments that challenged traditional service-delivery models. Supported employment program characteristics also are reviewed, and the influence of applied behavior analysis is outlined. Finally, areas for future research in supported employment are discussed.