The Theory-Practice Gap in Cognitive-Behavior Therapy

This special series is devoted to understanding the theory-practice gap in cognitive-behavior therapy (CBT). Although CBT enjoys considerable empirical support, and is widely recognized as an efficacious approach to a diversity of psychiatric disorders and includes many different forms of treatment, it is unclear whether clinicians are familiar with the underlying theories of the treatments they are practicing. Moreover, it is unclear to what degree an understanding of the theory is necessary for effective practice. Gaining clarity on the role of understanding underlying theory and identifying potential disparities between theory and practice may have implications for the way graduate training programs are structured and current professionals approach continuing education. A brief exploration of these implications will be offered by introducing issues related to the scientist-practitioner model and dissemination of efficacious treatments, in addition to an outline of potential advantages and disadvantages of knowing underlying theory. This special series will then feature several major approaches to treatment wherein the role of theory and practice are discussed.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

Postural Balance Following Aerobic Fatigue Tests: A Longitudinal Study Among Young Athletes

General fatigue can cause aggravation of postural balance, with increased risk for injuries. The present longitudinal study aimed to evaluate the postural balance of young athletes following field aerobic tests throughout 1 year of training. Thirty children from a sports center in Nazareth, participating in a 3 times/week training program (specific to basketball, soccer, or athletic training), were assessed. Postural balance parameters were taken before, immediately after, and 10 min after a 20 m shuttle-run aerobic test, at 3 time points during 1 training year (Start/Y, Mid/Y, and End/Y). Fitness improved at the Mid/Y and End/Y compared to Start/Y. Postural balance significantly deteriorated immediately after the aerobic test and improved significantly in the 10-min testing in all 3 time points, with significant deterioration in the End/Y compared with the Start/Y. In conclusions, postural balance deteriorates immediately after aerobic exercises, and at the end of the year. To better practice drills related to postural balance and possibly to prevent injuries, it is best for young athletes to properly rest immediately following aerobic exercises and to practice postural balance mainly at the beginning and at the middle of the training year.     

Can Visual Illusions Be Used to Facilitate Sport Skill Learning?

Recently it has been reported that practicing putting with visual illusions that make the hole appear larger than it actually is leads to longer-lasting performance improvements. Interestingly, from a motor control and learning perspective, it may be possible to actually predict the opposite to occur, as facing a smaller appearing target should enforce performers to be more precise. To test this idea the authors invited participants to practice an aiming task (i.e., a marble-shooting task) with either a visual illusion that made the target appear larger or a visual illusion that made the target appear smaller. They applied a pre–post test design, included a control group training without any illusory effects and increased the amount of practice to 450 trials. In contrast to earlier reports, the results revealed that the group that trained with the visual illusion that made the target look smaller improved performance from pre- to posttest, whereas the group practicing with visual illusions that made the target appear larger did not show any improvements. Notably, also the control group improved from pre- to posttest. The authors conclude that more research is needed to improve our understanding of whether and how visual illusions may be useful training tools for sport skill learning.     

Scheduling Scaffolding: The Extent and Arrangement of Assistance During Training Impacts Test Performance

Various kinds of assistance, including prompts, worked examples, direct instruction, and modeling, are widely provided to learners across educational and training programs. Yet, the effectiveness of assistance during training on long-term learning is widely debated. The authors examined how the extent and schedule of assistance during training on a novel mouse movement task impacted unassisted test performance. Learners received different schedules of assistance during training, including constant assistance, no assistance, probabilistic assistance, alternating assistance, and faded assistance. Constant assistance led to better performance during training than no assistance. However, constant assistance during training resulted in the worst unassisted test performance. Faded assistance during training resulted in the best test performance. This suggests that fading may allow learners to create an internal model of the assistance without depending on the assistance in a manner that impedes successful transfer to unassisted circumstances.     

Correspondence

Dorothy Judd: Give Sorrow Words: working with a dying child. Published by Free Association Books, 1989. £12.95.

Clifford Yorke, Stanley Wiseberg, Thomas Freeman: Development and Psychopathology — Studies in Psychoanalytic Psychiatry. Published by Yale University Press. £22.50.

Otto Weininger: Children's Phantasies. The Shaping of Relationships. Published by Karnac Books, 1989. £14.95.

Lynn Barnett: Enriching Day Care, 1989. Anna Freud Nursery, 1988. Buddle Lane, 1987. Available from Concorde Video Films Council Ltd., 201 Felixstowe Road, Ipswich, IP3 9BJ. Price £10 to hire, £30 + p.p. &; V.A.T. to buy.     

Children in psychodynamic psychotherapy: changes in global functioning

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.