Social Work News Headlines
Updated on: Tue, 09 Mar 2010 01:35:12 EST
Is integrative use of techniques in psychotherapy the exception or the rule? Results of a national survey of doctoral-level practitioners.
This study sought to investigate the extent to which therapists endorse techniques outside of their self-identified orientation and which techniques are endorsed across orientations. A survey consisting of 127 techniques from 8 major theories of psychotherapy was administered via U.S. mail to a national random sample of doctoral-level psychotherapy practitioners. The 201 participants endorsed substantial numbers of techniques from outside their respective orientations. Many of these techniques were quite different from those of the core theories of the respective orientations. Further examining when and why experienced practitioners switch to techniques outside their primary orientation may help reveal where certain techniques fall short and where others excel, indicating a need for further research that taps the collective experience of practitioners. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Does a continuous feedback system improve psychotherapy outcome?
Using outcome data on a continual basis to monitor treatment progress has been identified as a way to enhance psychotherapy outcome. The purpose of this study was to investigate the use of a continuous feedback assessment system, the Partners for Change Outcome Management System (PCOMS; Miller & Duncan, 2004). Findings from 2 client samples that attended individual therapy at a university counseling center (N = 74) or a graduate training clinic (N = 74) indicated that clients who used PCOMS with their therapists (feedback condition) demonstrated statistically significant treatment gains when compared to clients receiving treatment as usual (no-feedback condition). Clients using PCOMS were also more likely to experience reliable change and in fewer sessions. A survival analysis demonstrated that approximately 50% of the clients in the feedback condition demonstrated reliable change after the 7th (graduate training clinic) or 9th session (university counseling center). Further findings, limitations of the study and ideas for future research are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Clients' assimilation of experiences of their therapists.
In this study, we examined how clients internalize their therapists, understanding this phenomenon through the lens of the assimilation model, a theory of psychological change. The assimilation model describes people as comprised of multiple voices, each voice being a representation of interrelated experiences organized around significant people or events. In this study, we interviewed five former psychotherapy clients and asked them to describe how they experienced, and continue to experience, their therapists internally. On the basis of these interviews, we extended the assimilation model by constructing an account of how clients’ experiences of their therapists are internalized. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Empirical search for psychotherapists' gender competence in psychotherapy.
Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients’ gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists’ gender competence truly exists. We propose that psychotherapists’ gender competence should be defined as the psychotherapist’s ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients’ gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients’ gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists’ gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Informed consent with suicidal patients: Rethinking risks in (and out of) treatment.
Informed consent is uniformly accepted as essential to the treatment process. However, the relevant literature has not discussed issues of risk specific to suicidal patients, nor has such information routinely been included in the informed consent process. The implications of including suicide-specific risk information in the informed consent process is discussed and examples provided. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Thorough informed consent: A developing clinical intervention with suicidal clients.
In this article, I provide commentary on the Rudd et al. (2009) article advocating thorough informed consent with suicidal clients. I examine the Rudd et al. recommendations in light of their previous empirical-research and clinical-practice articles on suicidality, and from the perspective of clinical practice with suicidal clients in university counseling center settings. I conclude that thorough informed consent is a clinical intervention that is still in preliminary stages of development, necessitating empirical research and clinical training before actual implementation as an ethical clinical intervention. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Time for full disclosure with suicidal patients.
Rudd et al. (2009) provide robust data to support their recommendation that mental health providers should include data about frequency of suicide attempts as part of the informed consent process with suicidal clients/patients. Adding information about suicide risks into the informed consent process is an important extension of the patient rights movement begun in the 1970s. Data from research in psychological assessment suggest that feedback about hard-to-hear issues can facilitate therapeutic change when conducted in the context of a collaborative relationship. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
The realities of risk, the nature of hope, and the role of science: A response to Cook and VandeCreek.
A response is offered to the critiques of both Cook and VandeCreek. Among the points emphasized are the simple realities of risk with suicidal patients, existing empirical research with informed consent in both clinical psychology and other health care areas, as well as the persistence of common myths in clinical practice with suicidal patients. Although empirical science provides a firm foundation to much of what is proposed, it is critical for practitioners to recognize and respond to the ethical demands for openness and transparency with high-risk clients in an effort to achieve shared responsibility in care. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Improving peer supervisor ratings of therapist performance in dialectical behavior therapy: An Internet-based training system.
The present study involved the development of an Internet-based training system (ITS) to help train peer supervisors. The system, which was piloted with Dialectical Behavior Therapy (Linehan, 1993) using mock sessions, demonstrates how Internet-based technology can facilitate training protocols to support the ongoing training and supervision of therapists efficiently. Participant evaluation of the system was very positive, with over 90% of respondents reporting that they believed that the ITS was very useful or extremely useful for therapist training. Possible uses of the system include: (a) helping therapists to learn to discriminate more effective from less effective interventions to provide better feedback to supervisees and peers on their sessions, (b) helping therapists to improve their own ability to monitor and deliver a treatment effectively, and (c) helping to structure therapist training and supervision activities. The system could also be used to help with real-world supervision of therapists, assuming that legal and ethical issues associated with the use of the Internet for clinical supervision are addressed adequately. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy.
This study examined adherence to specific psychotherapeutic techniques as a predictor of outcome in dynamic deconstructive psychotherapy (DDP), a new psychodynamic therapy for treatment-resistant clients with borderline personality disorder (BPD). Ten clients dually diagnosed with BPD and alcohol use disorders underwent 12 months of DDP. Outcome indexes included measures of borderline symptoms, depression, dissociation, social support, alcohol misuse, parasuicide, and institutional care. Independent raters coded videorecorded sessions on adherence to DDP techniques, using a scale developed for this study, as well as therapeutic alliance and standard cognitive–behavioral and psychodynamic techniques. The adherence instrument demonstrated excellent interrater and test–retest reliability. Adherence to DDP techniques was positively related to improvement in BPD symptoms (? = .64) and most secondary outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Psychotherapy integration as practiced by experts.
Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive–behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive–behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive–behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Adaptation of imagery rehearsal therapy for nightmares in children: A brief report.
This study investigated the effectiveness of a psychotherapeutic treatment for nightmares that was adapted for 6- to 11-year-old children from imagery rehearsal therapy. Ten child–mother dyads took part in a 3-session, 8-week treatment protocol. Participation in the study (contact with clinician, keeping a prospective dream log) was associated with decreases unpleasant dreams frequency, nightmare distress, and manifest anxiety. Providing educational information about nightmares did contribute to this positive effect. Results also suggest that drawing modified versions of nightmares for 1 month was associated with further reductions in nightmare distress and anxiety, but with no changes in unpleasant dreams frequency. Follow-ups at 3 and 6 months posttreatment suggest that the intervention had maintained effects. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Review of Attachment, play, and authenticity: A Winnicott primer.
Reviews the book, Attachment, play, and authenticity: A Winnicott primer by Steven Tuber (see record 2008-04633-000). This book is a vibrant introduction and explication of one of the most important writers and thinkers in our field. The British pediatrician and psychoanalyst D.W. Winnicott gave us many concepts that have become part of our therapeutic lexicon, such as the “transitional object”, “good enough mothering”, “holding”, “the true and false self”, and “the capacity to be alone.” However, reading Winnicott’s work often proves to be a difficult task; his writing is often idiosyncratic and dense. This is where Steven Tuber has given us a real gift. This clear and clinically relevant book spells out with great clarity and richness the main ideas and structure of Winnicott’s contribution and how to apply them to one’s clinical thinking and work. The reviewer provides details on his personal experience while reading this book and concludes that this book is essential reading for every psychotherapist, regardless of one’s orientation or of the clinical population with which one works. (PsycINFO Database Record (c) 2009 APA, all rights reserved)
Review of Attachment, play, and authenticity: A Winnicott primer.
Reviews the book, Attachment, play, and authenticity: A Winnicott primer by Steven Tuber (see record 2008-04633-000). In this book, Tuber does not attempt to offer a comprehensive review of Winnicott’s work. Rather, he focuses on what he sees as Winnicott’s most central concepts, offering close examination of a few articles that he feels best represent each of these concepts, and frames each with the noting of a central dilemma or paradox. Tuber describes the book as an attempt to teach through “playing” with Winnicott (play being central to Winnicott’s ideas) and engaging the reader to join in the play. The book is based on a series of lectures from a course on Winnicott he has given to his clinical psychology doctoral students at the City University of New York. The reviewer noted that the author omitted some information that she considered to be important. However, she concludes that this book is a compelling read that captures what she sees as the essence of Winnicott’s work, and as Winnicott would have loved, presents it without jargon or pretense in the simple terms that best elucidate Winnicott’s view of the human experience. (PsycINFO Database Record (c) 2009 APA, all rights reserved)