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.     

组织政治环境如何影响领导者公正准则遵从？

论文基于自我控制的强度模型,研究了组织政治环境作为情境因素影响领导者公正准则遵从的作用机制和边界条件。对来自某国有商业银行73位网点主任连续10个工作日的570个经验取样法的数据分析结果发现：(1)在个体内层次,领导者组织政治感知提高了自我耗竭,领导者职位任期削弱了该正向关系。(2)个体内层次自我耗竭对公正准则遵从的作用取决于个体间层次领导身份认同的程度：当领导身份认同较高时,二者关系为正;当领导身份认同较低时,二者关系为负。(3)当领导者职位任期较短且领导身份认同较高时,组织政治感知通过自我耗竭促进公正准则遵从;当职位任期较短且领导身份认同较低时,组织政治感知通过自我耗竭阻碍公正准则遵从。上述研究结论将公正准则遵从的前因研究从行为者中心视角拓展到情境中心视角,率先研究了组织政治感知的个体内变化及其影响,同时增进了对自我耗竭作用机制和边界条件的认识。     

Predictors of Adherence to a Brief Behavioral Insomnia Intervention: Daily Process Analysis

Behavioral interventions for insomnia are effective in improving sleep, yet adherence is variable, and predictors of adherence have not been consistently replicated. The relationships between daily variations in state factors at the initiation of treatment and adherence have not been investigated. Using 2-week, self-report online logs, this study determined, among 53 college students with probable insomnia, the associations of pretreatment factors and daily factors during treatment on daily variations in adherence to one session of behavioral treatments for insomnia. These treatments included stimulus control therapy (SCT), sleep restriction therapy (SRT), and sleep hygiene (SH). Low self-efficacy was associated with poorer SCT and SH adherence. Participants with a “bed partner or pet” at least some of the time had better SCT adherence. Greater total sleep time and poorer sleep quality were associated with poor SCT and SRT adherence the following night. Greater sleep efficiency was related to greater next night SCT and SRT adherence. Alcohol consumption was related to poorer SRT and SH adherence the following night. Future studies should test the replicability of these findings. Adherence trials may want to test whether discouraging alcohol intake, enhancing treatment-related self-efficacy, and monitoring and providing feedback on sleep, early in treatment, affects adherence.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

A point contingency for homework submission in the graduate school classroom

We explored the effects of points versus no points on the submission of homework assignments and quiz performance in a graduate-level course. Students were more likely to submit homework assignments during points weeks, but quiz scores were relatively unaffected.     

Setting Generalization during Self-Reinforcement with Educationally Handicapped Children

Eight educationally handicapped boys ranging in age form 10 to 11 years old and described as the worst behavior problems in their class participated in a series of single-subject studies carried out in their self-contained classrooms. Three served as target subjects, using self-reinforcement procedures to increase their sustained on-task behavior in a treatment setting; five served as generalization subjects. Data were collected in three settings within the self-contained classroom; an early morning treatment setting, a late morning generalization setting, and an afternoon generalization setting. The three target subjects averaged a 51% increase over their baseline median levels of sustained on-task behavior in the treatment setting. They averaged 84% and 96% generalization to the late morning and afternoon generalization settings, respectively. These results demonstrate that self-reinforcement can produce setting generalization of treatment effects in the absence of prior externally determined reinforcement. Evidence for subject and subject-setting generalization was also obtained.     

Does Motivational Interviewing (MI) Work With Nonaddicted Clients? A Controlled Study Measuring the Effects of a Brief Training in MI on Client Outcomes

This study investigated the relationships between motivational interviewing (MI) and client symptoms, attendance, and satisfaction. Seventy‐nine clients attending a university‐based counseling center were purposefully assigned to treatment or control conditions. Statistical analyses revealed client symptoms in both groups improved. However, clients assigned to treatment conditions attended more sessions and missed fewer sessions than clients in the control group. Implications for using MI and suggestions for additional research are explored within the study.     

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This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.