Effect Of Therapists Research Articles

The Role of Therapists' Attachment and Introject in Their Treatment Process and Outcome: A Systematic Review.

Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.

The effect of therapists’ enactment interventions in promoting vulnerability sharing in emotion focused couple therapy

Objective The primary purported change process in emotion-focused therapy for couples (EFT-C) involves partners accessing and revealing their underlying vulnerable emotions and responding empathically when their partners disclose their vulnerable emotions. One main intervention to facilitate vulnerability sharing is enactment – guiding partners to interact directly with each other. The objective of the current study was to identify interventions therapists can use to help partners share vulnerability in the context of enactment. The primary hypothesis of this study was that promoting these interventions would lead to more vulnerability expressions during enactments. Method One hundred and five vulnerability enactment events were identified from videod therapy sessions of 33 couples dealing with a significant emotional injury who received 12 sessions of EFT-C. Four therapists’ interventions were coded: setting a meaningful systemic context, promoting the revealing partner’s emotional engagement, preparing the revealing partner for enactment, and promoting the listening partner’s emotional engagement in the enactment. In addition, vulnerability expression was coded. Results Multilevel regression models showed that two interventions were significantly associated with greater levels of expressed vulnerability: setting a meaningful systemic context, and preparing the revealing partner for enactment. Conclusion These findings suggest that therapists can facilitated vulnerability sharing using specific preparatory interventions.

Addressing interpersonal patterns in patients with personality disorders partially explains psychotherapy outcome via changes in interaction patterns: A mediation analysis

ABSTRACT Objective Many patients with personality disorders (PDs) present with problematic interaction patterns. These may also manifest in the therapeutic relationship. For successful treatment, therapists must therefore find effective ways to address such problematic interaction patterns. Methods: A total of 382 patients with PDs were recruited within a naturalistic setting and received integrative cognitive–behavioral therapy (CBT). Two subscales of the observer-rated Process-Content-Relationship Scale were applied to sessions 15, 20, and 25 of treatment: one on patient interaction patterns and the other on therapist addressing these. Symptom severity was assessed at intake and discharge. Mediation analysis was applied. Results: We found significant main effects of (1) therapists’ addressing problematic interaction patterns in session 15 on patients’ changes in such patterns from session 15 to 25 and (2) patients’ changes in problematic interaction patterns on symptom severity at treatment termination. Further, the effect of therapists’ addressing problematic interaction patterns on outcome was mediated by changes in patients’ interaction patterns. Conclusion: The results indicate that therapists’ addressing of PD patients’ problematic interaction patterns may be particularly important to improve such patterns and thereby treatment outcome. Future research should identify in which patients the mechanism of addressing interaction patterns works best.

The effects of therapists’ attractiveness and attributes on clients’ inclination toward self-disclosure – to wear makeup or not to wear makeup?

ABSTRACT Previous research suggests that more attractive therapists can encourage clients to disclose themselves more. On account of the halo effect, it can be conjectured that this relationship is mediated by other perceived attributes of therapists, such as their counselling competence and empathic understanding. Nonetheless, no study has been undertaken to examine this mediation effect. This study was therefore geared towards testing the indirect effect of therapists’ physical attractiveness on clients’ inclination towards self-disclosure via therapists’ core attributes. In addition, the application of cosmetic makeup, therapist age, and client sex were considered. A total of 129 young adults were recruited to complete the Therapist Attribute Inventory and Jourard Self-Disclosure Questionnaire based on one of the four photographs of female therapists with or without wearing makeup. The data was analysed using 7 PROCESS Macro models. The results indicate that positive ratings on perceived therapist attractiveness can be transferred to other therapist attributes, which in turn promote clients’ inclination towards self-disclosure. The application of cosmetics has an impact on this mediation effect, albeit being in an unexpected fashion. This has implications for whether therapists should wear makeup in a Hong Kong Chinese counselling setting and how it would affect clients’ self-disclosure.

Psychotherapists' Challenges With Online Therapy During COVID-19: Concerns About Connectedness Predict Therapists' Negative View of Online Therapy and Its Perceived Efficacy Over Time.

Therapists’ forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists’ views and challenges with online therapy. This study aimed to investigate the main challenges experienced by therapists during the transition from in-person to online therapy at the beginning of the pandemic and 3 months later, and the association between these challenges and therapists’ perception of the quality of the relationship with their online patients, and therapists’ attitudes and views about online therapy and its efficacy at these two timepoints. As part of a large-scale international longitudinal survey, we collected data from 1,257 therapists at two timepoints: at the start of COVID-19, when many therapists switched from providing in-person therapy to online therapy, as well as 3 months later, when they had had the opportunity to adjust to the online therapy format. At both timepoints, therapists reported on perceived challenges, quality of working alliance and real relationship, attitudes toward online therapy, and their views on online therapy’s efficacy compared to in-person therapy. Factor analysis of individual survey items at both timepoints identified four different types of challenges among this therapist sample: Emotional connection (feeling connected with patients, reading emotions, express or feel empathy), Distraction during sessions (therapist or patient), Patients’ privacy (private space, confidentiality), and Therapists’ boundaries (professional space, boundary setting). Older and more experienced therapists perceived fewer challenges in their online sessions. At baseline, all four types of challenges were associated with lower perceived quality of the therapeutic relationship (working alliance and real relationship), and more negative attitudes toward online therapy and its efficacy. After 3 months, perceived challenges with three domains – Emotional connection, Patients’ privacy, and Therapists’ boundaries significantly decreased – whereas challenges in the fourth domain – Distraction – increased. In our study, therapists’ concerns about being able to connect with patients online appeared to be the most impactful, in that it predicted negative attitudes toward online therapy and its perceived efficacy 3 months later, above and beyond the effect of therapists’ age and clinical experience. Clinical and training implications are discussed.

Congruence about working alliance in Chinese context: The moderating effect of therapists' self-efficacy and the relationship between congruence and psychotherapy outcome.

The present study was conducted to (a) identify the clients and therapists' perceptual directional discrepancy and temporal congruence in different aspects of working alliance (i.e., goals/tasks and bond), (b) examine the moderating effect of therapists' client-specific self-efficacy on the directional discrepancy and congruence, (c) clarify the relationship between specific working alliance aspects congruence and the next-session symptom, and (d) test the relationship between the congruence of goals/tasks or bond and the psychotherapy outcome under different levels of therapists' self-efficacy. Clients (n = 87, 80.9% female, average age = 21.78 [1.90]) and therapists (n = 43, 65% female) in a Chinese university mental health center evaluated the working alliance session by session. Clients self-reported session-level symptom severity were assessed at the beginning of every session and therapists' self-efficacy for a specific client were assessed at the end of the first session. The truth-and-bias approach was used to analyze the perceptual directional discrepancy and temporal congruence in goals/tasks and bond, and examine the moderating effect of therapists' self-efficacy. Multilevel polynomial regression and response surface analysis were used to clear the relationship between congruence/incongruence and client symptom level in the next session. (a) Clients and therapists temporally agreed on both the goals/tasks and bond dimensions of the working alliance. Averagely, therapists tended to rate goals/tasks agreement lower than clients but did not rate more or less intense bond than clients. (b) Therapists with low or medium self-efficacy for specific client underrated goals/tasks and bond more than therapists with high client-specific efficacy, and among the therapist-client dyads, the higher therapists' client-specific self-efficacy, the higher temporal congruence in bond rather than goals/tasks. (c) For both goals/tasks and bond, when clients and therapists were in agreement, client symptoms decreased as the congruent combinations of therapists' and clients' goals/tasks increased. Clients' symptom level increased more sharply as the degree of discrepancy increases for goals/tasks, not affected by the direction. (d) However, for therapists with high client-specific self-efficacy, their underestimations were more associated with the less severe next-session symptoms of their clients than their overestimations. This association was not found among clients whose therapists' self-efficacies for them were low. The findings provide a deeper insight into the congruence of the working alliance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Supplemental Material for Congruence About Working Alliance in Chinese Context: The Moderating Effect of Therapists’ Self-Efficacy and the Relationship Between Congruence and Psychotherapy Outcome

Supplemental Material for Congruence About Working Alliance in Chinese Context: The Moderating Effect of Therapists’ Self-Efficacy and the Relationship Between Congruence and Psychotherapy Outcome

A Systematic Review of the Effect of Therapists' Internalized Models of Relationships on the Quality of the Therapeutic Relationship.

Previous reviews have found equivocal evidence of an association between therapists' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists' manner and feelings toward their clients, was stronger. Evidence clearly shows that therapists' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice.

The effect of therapists' adherence and competence in delivering the adolescent community reinforcement approach on client outcomes.

[Correction Notice: An Erratum for this article was reported in Vol 31(1) of Psychology of Addictive Behaviors (see record 2016-59284-001). In the article, the disclosed interest for Mark D. Godley in the author note is misrepresented. The accurate representation is that the organization employing Mark D. Godley, Chestnut Health Systems, receives fees for A-CRA training. In addition, the disclosed interest statement for Jane Ellen Smith and Robert J. Meyers should read Jane Ellen Smith and Robert J. Meyers each have private consulting businesses that conduct workshops on CRA or A-CRA; they also receive royalties on the CRA book. All versions of this article have been corrected.] Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists' skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach (A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients' days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes. (PsycINFO Database Record

"The effect of therapists' adherence and competence in delivering the adolescent community reinforcement approach on client outcomes": Correction to Campos-Melady et al. (2016).

Reports an error in "The Effect of Therapists' Adherence and Competence in Delivering the Adolescent Community Reinforcement Approach on Client Outcomes" by Marita Campos-Melady, Jane Ellen Smith, Robert J. Meyers, Susan H. Godley and Mark D. Godley (Psychology of Addictive Behaviors, Advanced Online Publication, Oct 13, 2016, np). In the article, the disclosed interest for Mark D. Godley in the author note is misrepresented. The accurate representation is that the organization employing Mark D. Godley, Chestnut Health Systems, receives fees for A-CRA training. In addition, the disclosed interest statement for Jane Ellen Smith and Robert J. Meyers should read Jane Ellen Smith and Robert J. Meyers each have private consulting businesses that conduct workshops on CRA or A-CRA; they also receive royalties on the CRA book. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-49310-001.) Central to the debate over the implementation of empirically supported treatments is whether therapist skill has a measurable, positive relationship with client outcome. The fidelity and skill with which therapists deliver treatments have been studied under the constructs of adherence and competence. Evidence for a relationship between adherence and competence and client outcomes has been mixed, possibly due to small sample sizes, potentially inadequate measures for rating therapists' skill, and limited statistical methods. The current study used a data set in which 91 therapists provided services to 384 clients from the Assertive Adolescent and Family Treatment project. Therapists trained to deliver the Adolescent Community Reinforcement Approach (A-CRA) submitted audiorecorded sessions to independent raters during their training process. Measures of adherence and competence derived from session ratings were examined in a multilevel model for associations with client substance use outcomes at 3-, 6-, and 12-month follow-ups. Therapist competence was significantly predictive of decreases in clients' days of substance use. Therapist adherence was not predictive of client substance use outcomes in the full sample; however, when only those clients who completed the 12-month follow-up were included, between-therapists adherence was found to be predictive of a decrease in client substance use. This study adds to the evidence that competence in the delivery of treatment is associated with better client treatment outcomes. Adherence may be associated with better treatment outcomes as it was in follow-up completers. Future research should investigate the nature of the relationship between protocol-specific adherence and competence and client outcomes. (PsycINFO Database Record

Spirituality and Religion as Mitigating Factors in Compassion Fatigue among Trauma Therapists in Romania

Emerging research suggests that, among trauma therapists, religiousness and spirituality may (a) buffer against compassion fatigue, secondary traumatic stress, and burnout and (b) bolster spiritual growth and compassion satisfaction (Newmeyer et al., 2014). Despite findings that indicate spirituality and religion are sources of hope for people coping with painful circumstances (Pargament, 2013), research investigating the role of religion and spirituality as a protective factor (Weaver, Flannelly, Garbarino, Figley, & Flannelly, 2003) or as potentially promoting wellness for trauma therapists is limited. This study (N = 46) replicated a previous finding in which trauma therapists who endorsed a strong spiritual orientation reported increased compassion satisfaction when engaged in short-term (1–2 weeks), cross-cultural trauma work. Additionally, these short-term trauma therapists were compared to equally trained professionals working in the same context for 2 to 5 months and 6 months to 1 year (intermediate and long-term trauma therapists, respectively). The self-report instruments evidenced statistically significant increases in secondary trauma in both the intermediate and long-term trauma therapists when compared with short-term therapists. An unanticipated effect of the short-term trauma therapists’ presence was revealed: On pre- and post-measures the long-term trauma therapists reported statistically significant increases in resilience. This implies that the presence of the short-term therapists was beneficial to the long-term therapists. Thus, “respite care” for trauma therapists in long-term trauma settings might increase their capacity to thrive professionally.

The effect of music therapists’ burn-out and self-resilience on occupational identity

Background: This study aimed to investigate the influence of music therapists’ burn-out and self-reliance on their occupational identity, so that it can suggest ways to maintain the professional identity for music therapists. The research hypotheses were: (1) music therapists’ burn-out would have a negative influence on their occupational identity; (2) music therapist’ self-resilience would have a positive influence on their occupational identity.Method: The study collected the survey data from randomly sampled 102 music therapists in South Korea and tested its hypotheses using the regression analysis.Results: The testing results were: (1) the more the burn-out, the lower the occupational identity; the influence of burn-out on occupational identity was estimated as 17%; (2) the higher the self-resilience, the higher the occupational identity; the influence of self-resilience on occupational identity was at about 7%.Discussion: Music therapists’ burn-out had a negative influence while self-resilience had a...

The Effect of Music Therapists’ Burn-out and Self-resilience on Occupational Identity

The Effect of Music Therapists’ Burn-out and Self-resilience on Occupational Identity

Rehabilitation aimed at improving outdoor mobility for people after stroke: a multicentre randomised controlled study (the Getting out of the House Study).

One-third of stroke patients are dependent on others to get outside their homes. This can cause people to become housebound, leading to increased immobility, poor health, isolation and misery. There is some evidence that outdoor mobility rehabilitation can reduce these limitations. To test the clinical effectiveness and cost-effectiveness of an outdoor mobility rehabilitation intervention for stroke patients. Multicentre, parallel-group randomised controlled trial, with two groups allocated at a 1 : 1 ratio plus qualitative participant interviews. Fifteen UK NHS stroke services throughout England, Scotland and Wales. A total of 568 stroke patients who wished to get out of the house more often, mean age of 71 years: 508 reached the 6-month follow-up and 10 were interviewed. Control was delivered prior to randomisation to all participants, and consisted of verbal advice and transport and outdoor mobility leaflets. Intervention was a targeted outdoor mobility rehabilitation programme delivered by 29 NHS therapists to 287 randomly chosen participants for up to 12 sessions over 4 months. Primary outcome was participant health-related quality of life, measured by the Short Form questionnaire-36 items, version 2 (Social Function domain), 6 months after baseline. Secondary outcomes were functional ability, mobility, number of journeys (from monthly travel diaries), satisfaction with outdoor mobility (SWOM), psychological well-being and resource use [health care and Personal Social Services (PSS)] 6 months after baseline. Carer well-being was recorded. All outcome measures were collected by post and repeated 12 months after baseline. Outcomes for the groups were compared using statistical significance testing and adjusted for multiple membership to account for the effect of multiple therapists at different sites. Interviews were analysed using interpretive phenomenology to explore confidence. A median of seven intervention sessions [interquartile range (IQR) 3-7 sessions], median duration of 369 minutes (IQR 170-691.5 minutes) per participant was delivered. There was no significant difference between the groups on health-related quality of life (social function). There were no significant differences between groups in functional ability, psychological well-being or SWOM at 6- or 12-month follow-ups. There was a significant difference observed for travel journeys with the intervention group being 42% more likely to make a journey compared with the control group [rate ratio 1.42, 95% confidence interval (95% CI) 1.14 to 1.67] at 6 months and 76% more likely (rate ratio 1.76, 95% CI 1.36 to 1.95) at 12 months. The number of journeys was affected by the therapist effect. The mean incremental cost (total NHS and PSS cost) of the intervention was £3413.75 (95% CI -£448.43 to £7121.00), with an incremental quality-adjusted life-year gain of -0.027 (95% CI -0.060 to 0.007) according to the European Quality of Life-5 Dimensions and -0.003 (95% CI -0.016 to 0.006) according to the Short Form questionnaire-6 Dimensions. At baseline, 259 out of 281 (92.2%) participants in the control group were dissatisfied with outdoor mobility but at the 6-month assessment this had reduced to 77.7% (181/233), a 15% reduction. The corresponding reduction in the intervention group was slightly greater (21%) than 268 out of 287 (93.4%) participants dissatisfied with outdoor mobility at baseline to 189 out of 261 (72.4%) at 6 months. Participants described losing confidence after stroke as being detrimental to outdoor mobility. Recruitment and retention rates were high. The intervention was deliverable by the NHS but had a neutral effect in all areas apart from potentially increasing the number of journeys. This was dependent on the therapist effect, meaning that some therapists were more successful than others. The control appeared to affect change. The outdoor mobility intervention provided in this study to these stroke patients was not clinically effective or cost-effective. However, the provision of personalised information and monthly diaries should be considered for all people who wish to get out more. Current Controlled Trials ISRCTN58683841. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 29. See the NIHR Journals Library website for further project information.

Exploring the effect of therapists' treatment practices on client attendance in community-based care for children.

Sustained treatment attendance has been reported to be poor in publicly funded community-based clinic settings serving children and families. Several child and family characteristics have been shown to predict attendance in community-based care, but virtually no research has been conducted to examine how experiences in care, including psychotherapists' within-session practices, influence client attendance. The goal of this exploratory study was to examine how observed practice within sessions, in particular the extent to which therapists delivered elements consistent with evidence-based practices, impacts total number of sessions attended, while accounting for an array of other potential predictors. Participants include 181 children ages 4-13 and their parents entering a new episode of care for disruptive behavior problems in publicly funded clinics. Data sources include administrative billing records on treatment attendance; coded videotaped treatment sessions; and self-reports from children, parents, and therapists. Results indicate that parent education, service funding source, parent alliance with therapist, and therapist experience predicted number of sessions attended; intensity of evidence-based treatment techniques delivered to children was marginally associated with attendance (p = .059). Implications for improving engagement in community-based care are discussed.

Therapist effects in routine psychotherapy practice: An account from chronic fatigue syndrome

The effect of therapists in psychotherapy is a much debated topic, with a number of studies showing therapist variance being large while other studies show little or no variability in outcomes due to therapists. The aim of this study was to investigate therapist effects in a well-defined sample of patients and therapists from an outpatient service which specializes in providing cognitive behaviour therapy (CBT) for patients with chronic fatigue syndrome (CFS). Therapy was provided in a highly specialized clinical setting for CFS and was delivered by qualified CBT therapists with at least 2 years experience with this client group. Three hundred and seventy-four patients with CFS and 12 cognitive behavioural psychotherapists took part. Therapist effects on the primary outcomes of fatigue and disability were investigated with multilevel random effects models and variance component analysis. Different models were computed and compared. Results showed a reduction in fatigue and disability scores after therapy. Variance explained by therapists, when demographic covariates were accounted for, was 0% for fatigue and under 2% for disability. A number of important factors may have played a significant role in minimizing therapist effects in our study. These are: specialist setting, single centre, patients with the same primary diagnosis, therapists of the same orientation and training, shared environment and supervision. Future studies may stress the importance of these factors in the investigation of the therapist effect in psychotherapy.

Therapist predictors of early patient-rated working alliance: A multilevel approach

The present study investigated whether and how various therapists' (N=68) self-reported characteristics relating to their therapeutic work predicted patients' (N = 335) early ratings of the working alliance in a naturalistic psychotherapy study. Results from multilevel modeling demonstrated that certain self-reports accounted well for the therapist effect in the early alliance. The effect of therapists' experiences of difficulties in practice was particularly strong: a negative influence of difficulties termed negative personal reaction (NPR) and a surprising positive influence of another factor, professional self-doubt (PSD), were found. The latter was interpreted as reflecting an attitude of therapist humbleness and sensitivity, which seems to facilitate alliance development. A negative impact of self-reported skills in using one's own and the patients' emotional reactions in the therapeutic relationship (advanced relational skills) was found when controlling for a warm interpersonal style. The negative effect of advanced relational skills depended on the level of NPR difficulties. The findings suggest that therapists should be cautious in using this kind of relational skill unless they experience relating to patients in a warm manner and report low levels of NPR in their practice.

Treatment Completion in a Brief Motivational Intervention in the Emergency Department: The Effect of Multiple Interventions and Therapists' Behavior

The aim of this study was to identify therapist behaviors during a brief motivational intervention (BMI) given to injured emergency department patients that predicted participant return for a second BMI session and 12-month alcohol-related outcomes. This was a secondary data analysis of a randomized controlled trial (n = 539) previously demonstrating that random assignment to a BMI and booster session resulted in a significant reduction of 12-month post-intervention alcohol-related injuries and negative consequences relative to standard care. Participants who actually received 2 BMI sessions had significantly less alcohol-related negative consequences than those who received only 1 BMI session. Therapists who reported a higher focus on emotional support and low focus on participant drinking behaviors during the initial BMI session were more likely to have assigned participants return for the second BMI session. The results of these secondary analyses show that compliance with a 2-session therapeutic intervention (BIB) predicted fewer negative alcohol-related consequences, and that therapists' supportive emotional emphasis during the first BMI session was important in predicting participants returning for the second MI session.

Would discussion on patients?? needs add value to the rehabilitation process?

The objective of this study was to examine the effect of therapists' methods of addressing patients' problems (based on assessment results and discussions of patients' needs compared with assessment results only) on the level of agreement, between patients and therapists, over patients' daily living problems. A comparative design was adopted to examine the five most important daily living problems identified by patients and their occupational therapists. Twelve occupational therapists and five stroke patients of each therapist under in-patient rehabilitation were recruited. Thus, a total of 60 patients were recruited. Content analyses of the therapists' methods of analysing their patients' problems revealed that eight therapists had discussed their patients' needs with their patients (66.7%) and four relied on the assessment results (33.3%). The kappa statistics showed that a higher agreement of daily living problems was identified for the patients of those therapists who had held discussions (kappa=0.76; P<0.001). The results suggested that therapists should take their patients' needs into account in the planning of interventions. If therapists could help their patients to carry out their future life roles, it would lead the patients to better participate in the rehabilitation process.

Guidelines for the Systematic Treatment of the Depressed Patient

Back to table of contents Previous article Next article Book Forum: Treatment of DepressionFull AccessGuidelines for the Systematic Treatment of the Depressed PatientWILLIAM M. GREENBERG, M.D., WILLIAM M. GREENBERGSearch for more papers by this author, M.D., Ramsey, N.J.Published Online:1 Jul 2002https://doi.org/10.1176/appi.ajp.159.7.1256AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The authors of this monograph are three senior professors of psychology who are dissatisfied with available professional guidelines for the treatment of depression (e.g., those of APA and the Agency for Health Care and Policy Research). The authors offer a thoughtful critique and, in later chapters, mix in scholarly reviews of several related topics, although the one on basic research in psychobiology seems misplaced in this volume. Their focus, however, is an ambitious effort to develop their own treatment guidelines, comprising general treatment principles and not based on a particular model of psychotherapy.The authors analyzed published studies of individuals with symptoms of depression to elucidate which patient-centered factors appeared related to treatment outcome. They extracted provisional guidelines from these studies based on reviewers’ consensus, tested these principles on several retrospective and one new patient sample with a systematic approach, and produced this book to promote their resulting theses and computerized rating instrument. Their guidelines address the intensity and duration of treatment as well as the effect of therapists’ directiveness and actions on raising or lowering patients’ levels of distress, relating these variables to patients’ levels of functional impairment, experienced social support, and distress.This is an important and worthwhile effort, but its credibility nonetheless falters as it strains to achieve generalizations, frequently combining proverbial apples and oranges to offer fruit salad conclusions. For example, in reviewing old and disparate studies, the authors confound several issues into a notion of “complexity/chronicity” relating to the severity, chronicity, and multiple types of comorbidity someone with a depressive disorder might have. In addition, in addressing the important question of how valuable psychotropic medication may be for patients with mild depressive episodes, they principally draw conclusions from one study of 184 patients, 20 of whom received an antidepressant (desipramine); details of dose, duration, compliance, and comorbidity are not mentioned. There is a general bias against psychopharmacology, and only an idiosyncratic, selective review could result in assertions such as that depression fails to be a specific entity because it lacks a specific treatment, citing two studies allegedly demonstrating that “nonantidepressant medications and a variety of psychotherapies are all, on the average, similarly effective among patients diagnosed with Major Depression.” The fact that selective serotonin reuptake inhibitors may successfully treat individuals with depression, generalized anxiety disorder, posttraumatic stress disorder, obsessive-compulsive disorder, social phobia, panic disorder, and premature ejaculation does not mean that these disorders are not usefully separated, any more than the fact that propranolol is useful in treating hypertension, angina, essential tremor, and performance anxiety means that these disorders are not validly separable. There is poor understanding of the psychopharmacological literature, an atavistic belief in the validity of “endogenous depression,” and an opinion that psychotropic medication should not be a first-line treatment even for moderately severe depression.This volume could be somewhat more tightly and cleanly edited, and it is not pitched to the general mental health professional. Its flaws notwithstanding, it is scholarly and stimulating in its review of several areas and would be of interest to individuals writing guidelines for the treatment of depression or conducting such research, those who have an interest in factors relating to psychotherapy outcome, and forensic psychiatrists who need to be knowledgeable about guidelines and standards of care.By Larry E. Beutler, Ph.D., John F. Clarkin, Ph.D., and Bruce Bongar, Ph.D. New York, Oxford University Press, 2000, 455 pp., $55.00. FiguresReferencesCited byDetailsCited ByNone Volume 159Issue 7 July 2002Pages 1256-1256 Metrics History Published online 1 July 2002 Published in print 1 July 2002