Initiation of evidence-based psychotherapies in Veterans with posttraumatic stress disorder

The Department of Veterans Affairs (VA) requires that all VA hospitals and clinics provide access to evidence-based psychotherapies (EBPs). Despite these widespread dissemination efforts, only a minority of Veterans receive EBP services. Reasons for these low rates of EBP utilization are largely unknown. This study examined the characteristics of Veterans with posttraumatic stress disorder (PTSD) who did (Initiation group) and did not (No-Initiation group) initiate a VA-approved EBP after participating in an information session. Veterans chose their preferred treatment from a menu of EBPs. Results demonstrated that Veterans in the No-Initiation group had longer periods of time between their referral and first EBP visit. Among Veterans in the Initiation group, the majority (68%) initiated a trauma-focused EBP as their first or second treatment, suggesting that providing a range of treatment options did not negatively impact their willingness to engage in PTSD treatment. Results are discussed in terms of VA initiatives to improve access to and initiation of mental health care for Veterans.     

Symptomatic distress and effectiveness of psychological treatments delivered at a nationwide student counseling service

The aim of this study is to investigate the effectiveness of student counseling in Denmark and to compare the symptomatic distress among student counseling clients with that of Danish outpatients. The pre-intervention level of self-reported symptomatic distress among 1256 students closely paralleled that of psychiatric outpatients. Participants in the intervention study were the 739 student clients with two or more counseling sessions. For the 530 (71.7%) participants with both pre- and post-measurements, the mean pre–post Cohen’s d effect size (ES) was .76 on the Global Severity Index of the Symptom Check List-90-Revised. An intention-to-treat analysis of all 739 clients resulted in an ES of .59. The number of recovered clients according to the Jacobson and Truax criteria was 295 (68.8%) of the 429 (80.9%) clients above the clinical cut-off at pre-intervention, while 66 (12.5%) of the 530 clients reliably deteriorated. The mean number of sessions was 5.0. Individual counseling, number of sessions, and ending counseling in agreement predicted better outcome. In line with results from other countries, this study may indicate that in Denmark student counseling is an effective intervention for a highly needy clientele, even though a high proportion of clients deteriorated (12.5%) or dropped out (31.7%).     

国外自杀心理学研究与理论评介

以自杀致病理论、自杀评估理论、自杀治疗理论为线索,回顾与总结了国外近十年来的自杀心理学理论与研究概况,同时重点介绍了致病理论中的应激—易感模型、逃避自我理论、杀死自我理论;自杀评估理论中的SSF评估、四阶段过程模式;自杀治疗理论中的SATIR理论和荣格艺术治疗理论等,并做了简短评论     

心理治疗中的循证实践及其哲学思考

心理治疗中的循证实践是指治疗者根据个体已有的临床技能与经验,利用最佳的研究证据,在考虑病人人格、文化及偏好等因素的情况下进行的心理治疗实践。通过描述心理治疗中循证实践运动发展的两个阶段,考察其哲学基础及存在的问题,对其发展趋势及对整个心理学发展的意义进行了展望。     

What does it take to let go? An investigation into the facilitating and obstructing factors of forgiveness–the therapist's perspective

The phenomenon of forgiveness, initially neglected by psychotherapists due to its religious connotation, is finding increasing recognition as a transformative process involving the injured party in a profound way. This thesis is based on therapists’ experiences with clients who have been emotionally wounded. However, its content may be of relevance also for those who are struggling to forgive as well as those who are in a position to help others undergoing this process. Fifteen practitioners, most of them highly experienced, from eleven different countries on four different continents, have shared their observations and experiences by filling in an e-mail administered in-depth questionnaire. The topic has been approached with the following study objectives: the nature of forgiveness, intrapersonal and interpersonal factors affecting forgiveness, and the role of the therapist in the client's process of letting go. A qualitative research design has been applied for the data analysis, to identify the major themes of each research question, representing the facilitating and obstructing conditions relevant for forgiveness. Since the danger of premature forgiveness emerged as a recurrent concern, a “forgiveness chart” has been developed, assigning the analysed data to relevant categories: A reference tool designed to support a genuine process of letting go.     

Can counselling/psychotherapy be helpful in reducing barriers to learning for the person with specific learning difficulties?

This paper explores the relative helpfulness of counselling/psychotherapy to individuals experiencing specific learning difficulties, as a means of reducing barriers to learning by allowing the individual to return to learning from experience. Highlighting earlier studies which indicate the positive impact of psychological therapy on educational attainment and inhibiting factors such as stress, this research investigates the experience of counselling from the perspective of the person with specific learning disabilities. Using Empirical Phenomenological Research, the study explores their understandings of the circumstances and factors by which therapy is found to be helpful or unhelpful, seeking to contribute to debate on whether psychological interventions that are ‘specialist’ in orientation are potentially more helpful than ‘generalist’ therapeutic approaches. The findings point both to the potential value of psychological therapies for persons with special educational needs as a complement to other interventions and also to the importance of considering the experiences of the client in addition to diagnostic assessments.     

心理治疗效果评定量表（简式）在中、德应用的心理测量学研究

419名中国和德国被试参加了本研究,并回答了若干简式心理健康量表。所选的这套量表能对心理治疗不同阶段的效果（Howard’s阶段模型：重新认识期-转变期-康复期）进行测查。本研究目的在于考察这些简式量表能否用于认知-行为治疗跨文化培训项目中的质量管理。结果显示,这些量表在中德两种文化背景下都有很高的信度和效度（聚合效度和敏感性）。尽管项目间的高相关似乎提示心理健康模型只有一个维度,但探索性因素和理论分析则更支持心理健康是一个分为8个亚维度的模型,其中每个亚维度或者与基础情绪、或者与社会性情感相连关联。本文最后就研究结果及其对心理治疗质量控制的意义进行了详细讨论     

Previews of a Paradigm Shift in Psychotherapy: An Interview with Alvin Mahrer

The main purpose of the interview was to explore Alvin Mahrer’s views on an uncommon issue, namely the possibility of a paradigm shift in the field of psychotherapy. The interview covers (a) a way to help bring about a revolutionary paradigm shift, and (b) preview possibilities for an across-the-board, comprehensive paradigm shift in the field of psychotherapy. Grateful appreciation is extended to the reviewers whose comments were helpful and constructive in enabling a substantial improvement in the earlier draft of the interview.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

'Dialectical process' and 'constructive method': micro-analysis of relational process in an example from parent-infant psychotherapy

Jung defined experience that takes place between therapist and patient as 'dialectical process', achieved through 'constructive method'. Perspectives from attachment theory, neurobiology, cognitive science, systems thinking and infancy research confirm and extend his view of the centrality of relational process in the development of self. Interactional experiences are embedded within the history of the primary parent-infant relationship and structure within the mind implicit patterns of relating. These patterns influence capacities for managing a whole lifetime of affective relational experience within the self and with others. This paper shows how parent-infant psychotherapy seeks to intervene during the formation of disturbed relational patterns. I offer detailed micro-analysis of the moment-to-moment 'dialectical process' that a mother, her four-month-old infant and myself 'constructed' together.