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.     

Collective Trauma,Implicit Memories,the Body,and Active Imagination in Jungian Analysis1

This presentation attempts to show the healing potential underlying the inclusion of the patient's body in the analytic process, while honouring and revisiting the understanding of the psyche-body connection described by Jung in his early work. In addition, the author offers reflections on the impact of collective trauma whose aftermath, among others, has been the disappearance of thousands of people, consequently breaking the family genealogy, leaving hundreds of children stripped of their roots and true identity. Referencing clinical material, the author describes how the process of translation and integration—from the sensory-perceptual to the conceptual-symbolic—can be halted on account of collective trauma occurring at an early stage in development. Moreover, it is shown how the potential of the archetype or image schema, linked to the somatic-affective early experiences encoded as implicit memories, can be recovered, when Embodied Active Imagination is included in the analytic work. The patient's bodily gestures and somatic experience may bridge the gap between the preverbal-implicit knowledge and the emergence of emotions and images that allow for the creation of a new symbolic narrative.     

Themes in Therapist Development During the First Three Months of Clinical Experience

The results of a qualitative research study designed to better understand the developmental processes active in beginning therapists during the first three months of clinical contact is reported. Thirteen beginning therapists were asked to complete a monthly log describing experiences impacting their clinical work and themselves as therapists during their first three months of client contact. Data analysis revealed that the primary developmental theme active during this period of time is the development of therapist confidence. Two additional themes, the development of an internal gauge on which to evaluate current experiences and the development of boundaries around the self as a professional, were also found to be active during this time. These additional themes support the development of therapist confidence. Implications for training and research are identified.     

Neurobehavioral deficits,adolescent traumatic brain injury,and transition to college

Outcome following traumatic brain injury (TBI) has been frequently evaluated for adults, although there has been minimal research on adolescents with TBI. It has been argued that TBI sequelae may be more difficult for adolescents to adjust to given developmental changes in physical (puberty), interpersonal (self-concept), and environmental domains (transition to college). In addition, it is commonly acknowledged that moderator variables such as psychiatric history, family functioning, substance use, and sexuality impact functional outcome following TBI, although it is often difficult to objectively evaluate these variables. The current study examined relationships among TBI-related deficits, moderator variables, and academic outcomes for six adolescents transitioning to college. The findings suggest that it may not be appropriate to predict functional outcome based solely on objective neuropsychological results. However, moderator variables appear to have a more direct relationship with outcome, depending on the moderator variable and the individual.     

Clinical neuropsychology and brain injury rehabilitation in Israel: A twenty-year perspective

The development of the field of neuropsychology in Israel is primarily the result of the development of rehabilitation services for traumatic brain-injured patients. The responsibility to care for and help disabled veterans has always been an important motivation for the establishment of rehabilitation services. Israel is probably one of the first countries in the world to develop community-based services specifically designed to address the needs of young patients with severe traumatic brain injury. The fairly extensive therapeutic and community services available today for both military and civilian brain-injured persons in Israel are the result of initiatives and funding by the Israel Ministry of Defense's Department of Rehabilitation. There are two principles that characterize most of the programs in Israel: (1) multidimensional remedial intervention and (2) life-time commitment to provide support. The accessibility of patients in a small country enables professionals to conduct follow-up studies in order to evaluate the long-term effects of brain injury. Current developments in neuropsychology are in three directions. First, formal training programs in neuropsychology are being set up. Second, the involvement of neuropsychologists is being extended beyond the treatment of young patients suffering from traumatic brain injury to include the treatment of different brain pathologies in children and the elderly. Third, sophisticated neuroimaging techniques are being applied to studies in cognitive neuropsychology.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Drug effects on repeated acquisition: comparison of cumulative and non-cumulative dosing

Pigeons acquired a different four-response chain each session by responding sequentially on three keys in the presence of a sequence of four colors. The response chain was maintained by food presentation under a fixed-ratio schedule. Errors produced a brief timeout but did not reset the chain. Each day there were four 15-minute sessions, with a 10-minute inter-session interval. Cumulative dose-effect curves for phencyclidine, pentobarbital, and d-amphetamine were obtained by giving an injection before each of the four sessions; successive injections increased the cumulative dose in equally spaced logarithmic steps. For comparison, non-cumulative doses of each drug (i.e., doses not preceded by other doses on the same day) were also tested. As the cumulative dose of each drug increased, the overall response rate decreased, the percent errors increased, and there was less within-session error reduction (acquisition). With phencyclidine and pentobarbital, the rate-decreasing and error-increasing effects tended to be greater with a non-cumulative dose than with the corresponding cumulative dose. In contrast, with d-amphetamine, the effects were considerably greater with the cumulative doses. The results indicate that although the cumulative-dosing procedure saved a substantial amount of time in determining dose-effect curves, there were quantitative differences in effects between cumulative and non-cumulative doses.     

The microanalysis of fixed-interval responding

The fixed-interval schedule of reinforcement is one of the more widely studied schedules in the experimental analysis of behavior and is also a common baseline for behavior pharmacology. Despite many intensive studies, the controlling variables and the pattern of behavior engendered are not well understood. The present study examined the microstructure and superstructure of the behavior engendered by a fixed-interval 5- and a fixed-interval 15-minute schedule of food reinforcement in the pigeon. Analysis of performance typical of fixed-interval responding indicated that the scalloped pattern does not result from smooth acceleration in responding, but, rather, from renewed pausing early in the interval. Individual interresponse-time (IRT) analyses provided no evidence of acceleration. There was a strong indication of alternation in shorter-longer IRTs, but these shorter-longer IRTs did not occur at random, reflecting instead a sequential dependency in successive IRTs. Furthermore, early in the interval there was a high relative frequency of short IRTs. Such a pattern of early pauses and short IRTs does not suggest behavior typical of reinforced responding as exemplified by the pattern found near the end of the interval. Thus, behavior from clearly scalloped performance can be classified into three states: postreinforcement pause, interim behavior, and terminal behavior.     

Adverse caregiving in early life: The trauma and deprivation distinction in young children

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.     

The Lived Experiences of Addiction Counselors After Marijuana Legalization

This qualitative study examines the perceptions of counselors who work with populations with addictions in states where marijuana has been legalized. Findings include themes related to client experiences, counselor experiences, specific interventions, and lack of understanding.