An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.     

Therapeutic outcomes in the Welsh Government's school‐based counselling strategy: An evaluation

Aims: The purpose of this study was to evaluate the outcomes of school‐based counselling, as delivered in the Welsh Government's School‐based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person's CORE (YP‐CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta‐analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP‐CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school‐based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.     

What Are You Really Saying? Associations between Shyness and Verbal Irony Comprehension

Verbal irony exploits the ambiguity inherent in language by using the discrepancy between a speaker's intended meaning and the literal meaning of his or her words to achieve social goals. Irony provides a window into children's developing pragmatic competence. Yet, little research exists on individual differences that may disrupt this understanding. For example, verbal irony may challenge shy children, who tend to interpret ambiguous stimuli as being threatening and who have difficulty mentalizing in social contexts. We examined whether shyness is related to the interpretation of ironic statements. Ninety‐nine children (8–12 year olds) listened to stories wherein one character made either a literal or ironic criticism or a literal or ironic compliment. Children appraised the speaker's belief and communicative intention. Shyness was assessed using self‐report measures of social anxiety symptoms and shy negative affect. Shyness was not related to children's comprehension of the counterfactual nature of ironic statements. However, shyness was related to children's ratings of speaker meanness for ironic statements. Thus, although not related to the understanding that speakers intended to communicate their true beliefs, shyness was related to children's construal of the social meaning of irony. Such subtle differences in language interpretation may underlie some of the social difficulties facing shy children. Copyright © 2012 John Wiley & Sons, Ltd.     

Intercultural Therapy with Latino Immigrants and White Partners

SUMMARY

Interethnic and interracial marriages of Latinos and White Americans are on the rise and will continue to reshape the identities of individuals, couples, families, and communities. Clinicians working with these intercultural couples find no systematic training to address what is becoming a significant segment of our society. Couple therapists, however, cannot be culturally competent and effective based solely on knowledge of some dimensions of a couple's cultural backgrounds. Using clinical and theoretical ideas, the author defines clinical work with these couples as an explicit intercultural exchange. Our task as clinicians requires a rethinking of our conversations with these couples. It involves a caring therapeutic approach that is sustained on relational and systemic levels, and intercultural conversational skills inspired by clinical and other literatures that are explicitly dedicated to work with cultural difference and the “other.”     

A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

Computerised Cognitive Behavioural Therapy in an Adult Mental Health Service: A Pilot Study of Outcomes and Alliance

This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.     

Identity and Emotional Competence as Mediators of the Relation between Childhood Psychological Maltreatment and Adult Love Relationships

This study tested whether identity formation and emotional competence mediated the relationship between childhood psychological maltreatment and adult attachment styles, and tested the differential long-term effects of psychological abuse and neglect. The sample included 187 undergraduates in romantic relationships. Measures assessed the extent of childhood trauma, family expressiveness, alexithymia, self-esteem, self-concept, and adult attachment style. Results of path analysis showed that emotional competence, but not self-identity, mediated the relationship between psychological maltreatment and adult attachment styles. Self-identity mediated the relationship between psychological maltreatment and emotional competence. Emotional abuse and neglect both were associated with lack of contentment, sense of worthiness and significance, alexithymia, and fearful adult attachment style. Results support the importance of emotional competence for forming adult romantic relationships.     

Managers’ selection preferences: The role of prejudice and multicultural personality traits in the assessment of native and immigrant job candidates

PresentationStatistics across European countries show that immigrants have a disproportionate lower employment probability than persons born in the host country (SOPEMI, 2010). Explanations to this phenomenon are complex.ObjectivesAn experiment was conducted to investigate the relationship between multicultural personality traits and managers’ selection preferences in the hiring of native vs. foreign-born job candidates. We proposed that this relationship was mediated by prejudice.MethodsNorwegian managers (n = 222) were presented with one Turkish immigrant job candidate and two Norwegian-born, less qualified job candidates. The managers completed the Multicultural Personality Questionnaire (MPQ) and the Blatant Prejudice Scale (SBPS).ResultsWe found that the threat and rejection blatant prejudice subscale and Emotional stability predicted the managers’ hiring preferences. Specifically, the higher threat and rejection subscale scores and the lower emotional stability scores, the more likely it is that the managers preferred to hire a native, less qualified candidate over the Turkish immigrant candidate. The effect of emotional stability on candidate preference was not mediated by prejudice.ConclusionsThe results suggest that managers’ feelings of threat due to foreign-born immigrants’ participation in the host society (political conservatism), and threat due to intercultural interactions, are significantly related to foreign-born immigrant job candidates’ chances of being hired.     

The integrative attitude–a personal journey

The origins of clinical psychotherapy date from the beginning of last century and the development of broadly four foundational schools–psychoanalytic, cognitive-behavioural, humanistic and transpersonal psychologies. The imperative to integrate these schools, however, is relatively recent and in the last 25 years a professional integration movement has developed, exemplified by the formation of SEPI and the UKAPI, and ‘integrative psychotherapist’ is now the most popular nomenclature used in the profession. This article gives a brief history of the integration movement, reviews some issues raised by developments so far, and discusses the personal dilemma that integration evokes in the would-be integrative practitioner. Using my own journey I espouse an integrative attitude that is based on the nature of integration as an evolving personal process rather than an ideal, fixed, profession-wide position. I describe three interweaving modalities of integration I call constructive, complicit and contiguous integration, which form a developmental framework that aims to encourage the individual activity of questioning, inventing, researching and interrogating the discipline within its philosophical, professional and social context. In concluding, this article exhorts the profession to see integration as a personal journey, as a way of being that is constantly becoming and unfolding in relation with the therapist's training, experience and interaction with peers and clients. The result is indefinable and unnameable, and perhaps represents the soul of integrative psychotherapy.     

Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.