Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).     

Introduction: Using Techniques via the Therapeutic Relationship

In this work, we have the opportunity to hear people’s most private concerns, worries, distress, and share in their hopes, aspirations, and dreams for the future. The work involved in the practice of cognitive behavior therapy; our knowledge, theories, techniques, and strategies are practically useless if we are unable to relate to our clients. Relational attributes were incorporated as part of the defining features essential to therapeutic change in the seminal guide for cognitive therapy (A. T. Beck, Rush, Shaw, & Emery, 1979). Conceptualizations of “collaboration” and “empiricism” have since been misconstrued with the construct of the working alliance in the past, although both have unique distinctions and implications for practice. This article presents an introduction to a special series in Cognitive and Behavioral Practice, which illustrates the vital role of collaborative empiricism within culturally responsive CBT, through the structure of the therapy session, cognitive case conceptualization, self-monitoring, interventions focused on cognitive change, and exposure to emotions and situations. We invite you to join with us in considering the extent to which the ideas shared herein are relevant for your work with clients. It is also our hope that you will consider evaluating and incorporating the utility of these ideas in your therapy.     

Critical Issues in Using Homework Assignments Within Cognitive-Behavioral Therapy for Schizophrenia

Presents an overview of the research findings to date and practical guidelines for the use of homework in cognitive-behavioral therapy for schizophrenia. In particular, the article outlines strategies to combat the common difficulties experienced when using homework with clients with schizophrenia and the types of homework assignments that may be most helpful. The empirical evidence suggests that cognitive-behavioral therapy incorporating homework assignments help clients to improve at least 60% more than those in treatment without homework. Despite that most therapy formulations incorporate homework as an integral component of treatment for schizophrenia, prior research has identified that practitioners consider homework to be less helpful for clients with delusions and hallucinations. Interventions to enhance homework compliance in the treatment of clients with schizophrenia are outlined.     

Equational Bases for Joins of Residuated-lattice Varieties

Given a positive universal formula in the language of residuated lattices, we construct a recursive basis of equations for a variety, such that a subdirectly irreducible residuated lattice is in the variety exactly when it satisfies the positive universal formula. We use this correspondence to prove, among other things, that the join of two finitely based varieties of commutative residuated lattices is also finitely based. This implies that the intersection of two finitely axiomatized substructural logics over FL ⁺ is also finitely axiomatized. Finally, we give examples of cases where the join of two varieties is their Cartesian product.     

Cognitive Behavior Therapy for Older Adults: Practical Guidelines for Adapting Therapy Structure

Cognitive behavioral therapy (CBT) has been shown to be an effective approach for a wide range of problems affecting older adults. While a variety of empirical and clinical papers have examined modifications to the content and delivery of CBT to enhance its efficacy with older adults, changes to the structure of therapy with this population have not been as widely discussed. Issues around optimizing the structure of CBT with older adults are presented, along with suggestions for realizing these changes within a clinical context.     

Working memory contributions to reading comprehension components in middle childhood children

This study examined working memory contributions to reading comprehension subskills in Greek children (mean age 9 years, 1 month). The phonological loop of the Baddeley and Hitch working memory model was assessed with 3 recall tasks (words, nonwords, and digits) and a word list matching task. The central executive (CE) was assessed with 3 tasks (listening, counting, and backward digit recall). Participants were also given a receptive vocabulary task, a reading fluency task, and written stories accompanied by comprehension questions. Canonical correlation analyses showed that the comprehension variables were related to the CE rather than the phonological loop measures. CE functions were more strongly associated with elaborative inference generation (involving significant offline processing) and comprehension control (involving metacognitive monitoring). Smaller yet significant associations were observed between the CE and the necessary inference and literal comprehension measures, whereas a moderate relationship was found in the case of the simile comprehension variable. Among the CE variables, listening recall demonstrated the highest loading on the canonical function, followed by moderate yet significant counting and backward digit recall loadings. Vocabulary was found to fully mediate several associations between working memory and comprehension measures; however, the relationship between listening recall and elaborative inferences was partly mediated. Reading fluency and, on several occasions, Greek vocabulary knowledge did not mediate the relationships between CE measures and comprehension skills assessed. This study demonstrates the usefulness of CE measures for identifying young children's possible difficulties in carrying out specific reading comprehension processes.     

Conceptualizing Patient Barriers to Nonadherence with Homework Assignments

Nonadherence with homework assignments and, by implication, “barriers” to homework assignments are a frequent occurrence in the practice of standard cognitive therapy (Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press). The clinical examples in this article illustrate some of the ways in which environmental, patient, task, and therapist factors can serve as barriers to homework completion. Although these classes of barriers may be discussed independently, they are actually overlapping processes and are more helpful when discussed in tandem. This article illustrates how the therapist’s ability to conceptualize can serve as the context for making sense of the patient’s perceived ability to undertake an activity, the patient’s beliefs about the specific task, and how our ability to use the conceptualization to anticipate barriers is part of evaluating our own therapeutic skills. Several clinical case examples are discussed.