Caregiver Involvement in the Intensive Mental Health Program: Influence on Changes in Child Functioning

We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings also reflected increased therapists’ attempts to provide additional in-home services in cases where caregivers demonstrated a decline in their ability to provide for their children’s physical and material needs, or in which therapists discovered that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many of these findings.     

Book Club Groups to Aid Relational Connection and Trust among Addicted Trauma Survivors

This is a secondary analysis of qualitative data from a literacy study, which examines Book Clubs as a creative approach to engage female addicted trauma survivors in developing psychologically safe, trusting therapeutic relationships. This approach is respectful of the participants’ experiences of relational trauma and diverse cultural contexts, in part because book clubs are ‘normal’ experiences in which the client is better able to have control over the level of vulnerability she engages in within the therapeutic milieu. Themes indicating increasing levels of vulnerability and psychological safety include use of book club discussions to identify with text, plot, or characters; to discuss escape coping and aggressive coping; and to discuss self as a victim and as a survivor.     

暴力视频游戏对个体亲社会性的影响：一项元分析

暴力视频游戏是一种新兴的娱乐媒介, 是指含有描绘个体试图对其他个体造成伤害等内容的视频游戏。亲社会性是人类区别于动物的重要特征, 包括在人际交往中个体所表现出的利他、助人等一切使他人受益的认知、情感和行为。本文采用元分析的方法整合国内外已有研究, 分析暴力视频游戏对玩家亲社会性影响的主效应, 并重点考察各调节变量在暴力视频游戏与亲社会性的关系中产生的作用。通过文献检索, 纳入符合要求的文献24篇, 包含63个效应值(effect size), 总样本量18554人。研究结果显示：暴力视频游戏与亲社会性总效应值显著, 但相关较弱(r = -0.10)。调节效应分析表明, 暴力视频游戏与亲社会性的关系受到被试性别、被试类型、被试年龄、测量类型与亲社会性测量指标的调节。未来研究可以进一步采用一般攻击模型与一般学习模型等理论模型指导暴力视频游戏对亲社会行为影响研究, 同时优化实证研究中测量亲社会性的实验范式, 并且需要重点考察个体差异对暴力视频游戏与亲社会性关系的影响。     

Priming attachment security improves attitudes towards a range of therapies

We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non‐relational and distanced‐relational therapies for those with a fearful‐avoidant attachment orientation. For relational and distanced‐relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help‐seeking behaviour. Priming security may promote open‐minded decision‐making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.     

Considering boundaries when doing therapeutic work with people who are seeking asylum: a reflective case study

People who are seeking asylum often have lived experience of their personal boundaries and human rights being violated. For this reason, it is especially important that we consider the impact of boundaries in therapeutic work with this population. This paper explores work with a woman with a severe trauma history who was seeking asylum in England. Examples of perceived boundary crossings in the therapeutic relationship are examined. Considerations for other clinicians working with asylum seekers are discussed. These include: addressing socio-political factors; being sensitive to cultural differences; the importance of supervision and reflective practice; the personal impact of such work; and using critical thinking and warmth to manage boundaries rather than rigidly following rules.     

Therapist activities preceding therapy setbacks in a poor-outcome case

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

临床麻醉中常用中效肌肉松弛剂的比较

为了更准确在临床麻醉过程中使用中效肌肉松弛剂,用比较治疗学的理念及方法对目前国内报道的中效肌肉松弛剂阿曲库铵、顺式阿曲库铵、维库溴铵、罗库溴铵的应用方法进行比较和分析。结果发现：插管起效时间罗库溴铵最短,临床时效顺式阿曲库铵最长,阿曲库铵有组胺释放的作用,阿曲库铵和顺式阿曲库铵药物代谢主要是霍夫曼消除。比较治疗学方法有助于临床麻醉肌松剂的抉择。