Barriers and Facilitators to the Implementation of Intensive Treatments for PTSD: Early Lessons Learned From the Field

This article addresses the barriers and facilitators associated with the implementation of PTSD Intensive Outpatient Programs (IOP) across three VHA Medical Centers. Each site developed programs that delivered EBPs in a massed or condensed format and relied on implementation science and the i-PARIHS model to help direct the innovation. Face-to-face, virtual, and combined platforms were used, demonstrating flexibility in design. While each site experienced unique challenges associated with local contextual factors, multiple themes emerged across sites that may help guide future IOP and massed EBP implementations. Common facilitators of the implementation process included: the availability or presence of a credible lead (i.e., champion) to guide the innovation, opportunities to consult with national or outside experts, strong team engagement, processes in place that allowed for ongoing review, clinic operations that are aligned with principles of PTSD specialty care (e.g., time-limited, evidence-based, utilization of measurement based care, willingness to treat complex cases), and leadership support. Alternately, shared barriers included limitations on available resources, options for provider coverage, early staff buy-in, and organizational factors. Solutions to address these barriers and recommendations for future direction are shared.     

The nature space. A reflexive thematic analysis of therapists' experiences of 1:1 nature-based counselling and psychotherapy with children and young people: Exploring perspectives on the influence of nature within the therapeutic process

Nature-based therapy is an emerging and rapidly developing field within counselling and psychotherapy, yet there is little published empirical research, or integrated models relating to its practice with Children and Young People (CYP). The present study aimed to explore therapists’ experiences of one-to-one nature-based counselling and psychotherapy with CYP, eliciting perspectives on the interaction between nature and the therapeutic process. A reflexive thematic analysis provides preliminary insights into possible mechanisms of action with the potential to inform a longer-term exploration of whether nature-based therapy is effective, for whom and why. The study highlights the need to better explore and understand how nature-based therapy supports relational and intrapsychic change in interaction with developmental processes, to inform construction of coherent and consolidated theory and models for practice.     

BIOLOGY AND THE SOCIAL SCIENCES

Abstract. The sciences may be conceptualized as a hierarchy ranked by level of organization (e.g., many-body physics ranks above particle physics). Each science serves as an antidiscipline for the science above it; that is, between each pair, tense but creative interplay is inevitable. Biology has advanced through such tension between its subdisciplines and now can serve as an antidiscipline for the social sciences—for anthropology, for example, by examining the connection between cultural and biological evolution; for psychology, by addressing the nature of learning and the structure of the unconscious; for economics, by examining economically irrational behavior and by comparing economic activity in humans and other species. Sociology, concerned mainly with advanced literate societies, is relatively remote from the genetic basis of human social behavior. However, moving between biological and social levels of organization generates richness and points to new and unexpected principles.     

Art in existential psychotherapy with couples and families

The authors describe and outline how art can be used in existential psychotherapy to help a couple or family uncover, discover, and make use of the meanings and meaning potentials to be found in marital and family life. In existential psychotherapy with couples and families, art can be used to help the members of the relationship notice meaning potentials in the future, honor meaning potentials that have been actualized and deposited in the past, and discover new ways to actualize meaning potentials in the here and now.     

Three years follow-up of panic disorder patients: A naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.     

Aggression Observation Scale for Group Psychotherapy

An observational scale to record aggressive behaviors, defenses, and interventions that occur during a psychotherapy group has been developed. Content and process items were included. The content items focus on the spoken material and are on a continuum of increasing group members' awareness of and responsibility for their anger. The process items are directed to underlying psychodynamic issues on a continuum from avoiding anger, to indirect and then expression of anger. Leader interventions (responses) are also included. The development of the scale, the Aggression Observation Scale for Group Psychotherapy (AOSGP), is described including pilot testing and reliability and validity findings.     

Developing the matrix representation grid (MRG): A method for observing group processes. Findings from time-limited group psychotherapy for alcohol-dependent patients

The MRG was published 1988 in order to support developments in group psychotherapy methods as one of the all too few process observation research methods for studying group-as-a-whole. After 9 years of what pilot studies have labeled successful clinical trials, this study aims at validating the MRG against the established SAVI: Structural Analysis of Verbal Interaction (Agazarian & Simon 1989). Videotaped group sessions from short-term groups for alcohol dependent patients conducted along two therapy methods, one behaviorally oriented and the other group analytic, are used as material. The MRG is validated in the study, confirmed to be clinically valuable, and some interesting comparisons between the two treatment modalities are also made.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

A plea for more intervision

The author presents an argument for tolerance, mutual understanding and reconciliation in psychotherapy, instead of a continued emphasis of schools. Psychotherapists' work with clients is proposed as a likely area for mutual understanding, rather than continued emphasis on their particular theories and academic matters. Psychotherapeutic intervision groups in which a small number of therapists voluntarily discuss their cases with peers from various backgrounds have become increasingly common again in recent years.Slightly revised version of a presentation made at the Georgetown Family Center Symposium in November 1995.