Study Of Psychotherapy Research Articles

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy.

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.

Psychosocial interventions for premature ejaculation

Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up. To assess the efficacy of psychosocial interventions for PE.To investigate any differences in efficacy between different types of psychosocial treatments for PE.To compare psychosocial interventions with pharmacological treatment and pharmacological treatment in association with psychosocial treatment for PE. Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers. Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE. Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires. In one study (De Carufel 2006) behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples' sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples' sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list.One study (Li 2006) showed that the combination of chlorpromazine and BT was superior than chlorpromazine alone for IELT (MD 1.11, 95% CI 0.82 to 1.40), SAS (Self-rating Anxiety Scale) (MD -8.72, 95% CI -11.09 to -6.35) and for some CIPE (Chinese Index Premature Ejaculation) questions ('anxiety in sexual activity', 'partner sexual satisfaction', 'patient sexual satisfaction', 'control ejaculatory reflex' and 'ejaculatory latency') ('Analysis 1.2').One study (Yuan 2008) showed that citalopram significantly improved IELT (RR (risk ratio) 0.52, 95% CI 0.34 to 0.78) and the number of couples satisfied with their sex life after treatment (RR 0.60, 95% CI 0.39 to 0.93), versus BT.In the last study (Abdel-Hamid 2001), 31 patients received 1 of 4 drugs administered on an as-needed basis 35 hours before anticipated coitus (clomipramine, sertraline, paroxetine, sildenafil), or were instructed to use the pause-squeeze technique. The study consisted of five four-week periods of treatment, separated by two-week washout periods. Anxiety score and ejaculation latency time were measured before treatment, after each treatment and during washout periods. Sexual satisfaction scores were measured after each treatment. However the available data from the article were not sufficient to be included, and the related database was not available anymore, according to the main author. Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.

A Literature Review of Cost-Benefit Analyses for the Treatment of Alcohol Dependence

The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and two pharmacotherapy studies from Europe. In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.

Utilization of personal therapy by psychotherapists: a practice‐friendly review and a new study

This article offers both a practice-friendly review of research on therapists' personal therapy and a new study of personal psychotherapy among 3,995 psychologists, counselors, social workers, psychiatrists, and nurses in 6 English-speaking countries. The prevalence of personal therapy as it relates to professional discipline, theoretical orientation, gender, and career level are studied. Findings showed that 87% of the overall sample embarked on personal therapy at least once: 94% of analytic/psychodynamic therapists, 91% of humanistic therapists, 73% of cognitive-behavioral therapists, 82% of the novice therapists to 89% of senior therapists. Both the existing research and this new study demonstrate the extraordinary commonality of personal therapy among psychotherapists, and encourage further use for professional training, clinical practice, and therapist self-care.

Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8–12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child’s age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children’s mental health may improve service utilization patterns in this population.

Addressing the Decline in Counseling and Supervision Process and Outcome Research in the Journal of Counseling Psychology

Scheel et al. have argued convincingly that there has been a decline in counseling-related research in the Journal of Counseling Psychology ( JCP) and The Counseling Psychologist ( TCP). This response focuses on the relatively steady 35-year decline in this type of research published in JCP. The author conducted a new analysis based on the frequency of PsycINFO thesaurus terms used to index 2,330 articles published in JCP over successive 5-year periods from 1975 to 2009. Results confirmed the basic conclusions of Scheel et al. that studies of the counseling and supervision process and outcome have declined over this period. Results also indicate the other types of research that have grown in frequency. These include studies of attachment behavior, multicultural issues, sexual minorities, coping, well-being, social support, and psychotherapy. The author argues that these new research areas are “counseling related” as well and that they have not crowded out the traditional studies Scheel et al. highlight.

Interaction Between Alliance and Technique in Predicting Patient Outcome During Psychodynamic Psychotherapy

The current study examined whether alliance interacted with psychodynamic interventions to predict patients' psychotherapy outcomes. A prospective study of psychodynamic psychotherapy with 68 outpatients who were treated by 23 therapists was used. The patients rated the alliance with their therapist early in treatment. Therapist use of psychodynamic techniques was reliably rated by independent clinicians for the same sessions. The therapy outcomes were measured at the end of treatment based on the patients' global symptomatology as well as estimate of improvement across a broad range of functioning. In all models, we controlled for the patients' pretherapy psychiatric severity. Analyses were conducted using multilevel modeling to account for therapist effects. Results revealed that patient rated alliance was significantly related to improvement on a measure of broad band functioning. In addition, alliance and psychodynamic interventions interacted to predict this scale of multidimensional therapy outcome. Further, results showed that several individual psychodynamic techniques interacted with alliance that were meaningfully related to this measure of broad band outcome including (1) linking current feelings or perceptions to the past; (2) focusing attention on similarities among patient's relationships repeated over time, settings, or people; and (3) identifying recurrent patterns in patient's actions, feelings, and experiences. In this sample of outpatient psychodynamic treatments, the dynamic techniques were most effective when provided in the context of strong alliances.

Developing the Adjudicated Case Study Method

In this commentary we discuss Miller’s Panel of Psychological Inquiry (PPI) and Bohart’s Research Jury method approaches to the development of the adjudicated case study method, as represented by the papers assembled for this issue of Pragmatic Case Studies in Psychotherapy. In our view, the case studies presented here demonstrate the rapidly developing potential offered by this approach for psychotherapy research and reveal many parallels to recent research using the Hermeneutic Single Case Efficacy Design (HSCED) model. In our view, each of the three models has taken significant steps forward in adapting particular aspects of the legal process as viable psychotherapy research procedures. In this commentary we summarize the HSCED method, then take readers through the issues of the sources of the evidence used; ways in which that evidence is tested; claims, burden and standard of proof; and the handling of the adjudication process itself. We conclude with recommendations for further development of adjudicated case study methods..

CS05-04 - Cognitive behavioral analysis system of psychotherapy (CBASP)

Chronic depression accounts for roughly a third of all mood disorders. It is a particularly disabling disorder, which is associated with greater comorbidity and suicidality, more significant impairments in functioning, and increased health care utilization than acute major depressive episodes. In the past, chronic depression was often considered as treatment-resistant since traditional pharmacological and psychological treatment approaches show at most modest success. In addition, relatively few psychotherapy studies have focused on chronic (mostly dysthymia) forms of depression. However, in chronic Major Depression a specific form of psychotherapy, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), proved to be equally effective than medication; the combination of CBASP and medication revealed significant superiority over both monotherapies.CBASP-developed by James McCullough-is the only psychotherapeutic intervention specifically designed for chronic depression. The approach integrates behavioral, cognitive, psychodynamic, and interpersonal strategies. It focuses on problems resulting from an inhibition of maturation in early childhood often caused by early traumatization by using the therapeutic relationship in a disciplined personal way. In addition, other interpersonal strategies are applied to overcome preoperational thinking. By means of a specific behavioral technique, the Situation Analysis, patients learn to focus on the consequences of their behavior and to use efficient social problem-solving. The techniques of CBASP will be demonstrated.Results of two pilot studies will be presentedFirst, a randomized pilot outpatient study comparing CBASP with the interpersonal psychotherapy (IPT) in early onset chronically depressives was conducted showing significant superiority of CBASP against IPT. Second, a first open pilot study in the inpatient setting investigated a new modified multidisciplinary CBASP inpatient program. The data of the first patients suggest that the three-month CBASP inpatient program is a feasible and effective treatment for severely chronically depressed patients with severly to extreme traumatization.

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

The semiosis of family conflict: A case study of home-based psychotherapy

This is a case study of a blended family undergoing home-based psychotherapy. The study uses sociocultural theory (Vygotsky) and semiotic cultural psychology (Valsiner) in order to understand the appropriation and usage of signs as regulators of behavior. Furthermore, the article draws upon Foucault’s genealogical approach and Rose’s notion of Psydiscourse. It is argued that this approach is fruitful for understanding psychotherapy as a governing discourse that influences contemporary families. Technologies of the self, such as psychotherapy and signs like ‘time-out’ and ‘stop,’ are used by family members in attempts to break a cycle of conflict—violence but they also exacerbate negative emotions, which we see in the case of conflict. The article develops a critique of the practice of punishment and reward. By analyzing psychotherapy as signs and technologies of the self impacting family life, we start understanding the barriers to well-being in families and individual lives.

Improving psychotherapy research: The example of mindfulness based interventions.

The increasing number and sophistication of available psychotherapies suggests that a critical appraisal of the methodological issues of psychotherapy studies is highly needed. Several key questions regarding the efficacy of a given intervention, the understanding of whether positive effects observed following the delivery of a psychotherapeutic intervention are specifically attributable to the intervention itself or to other "non specific" factors, such as benefit expectations, therapist attention and support, and the possibility of improving psychotherapy research need an answer. This, in turn, could provide clinicians with more rigorous information about psychotherapy outcomes and could properly address several shortcomings that are frequently observed in current psychotherapy studies. Accordingly, in this editorial I will highlight some of the most important critical issues that a well designed psychotherapy study should take into account, including the need for appropriate control groups, appropriate randomization and blinding procedures, and the importance of performing appropriately powered studies that include a sufficiently long follow-up period. Finally, I will build on my expertise in the field of mindfulness based interventions, in particular mindfulness based stress reduction and mindfulness based cognitive therapy, to show how such issues have been and can be successfully implemented in the design of future psychotherapy studies.

Is there room for criticism of studies of psychodynamic psychotherapy?

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler declared unequivocally that "empirical evidence supports the efficacy of psychodynamic therapy" (p. 98). He did not mention any specific criticisms that have been made of evidence on psychodynamic psychotherapies or address possible distinctions between evidence for short-term versus long-term psychodynamic psychotherapies. Instead, he attributed dissenting views to biases in evidence dissemination and review, which he suggested are rooted in a "lingering distaste in the mental health professions professions for past psychoanalytic arrogance and authority" related to a "hierarchical medical establishment that denied training to non-MDs and adopted a dismissive stance toward research" (Shedler, 2010, p. 98). Shedler (2010) justified his blanket dismissal of criticisms of evidence supporting psychodynamic psychotherapy on the basis of several published meta-analyses. The validity of conclusions from metaanalyses depends on the quality of the evidence synthesized, the nature of the studies included, and the rigor of the statistical analyses employed. Many meta-analyses, however, are not performed rigorously, which can result in treatment efficacy estimates that obscure important intertrial differences and that are unlikely to be replicated in clinical practice.

The dependability of alliance assessments: The alliance–outcome correlation is larger than you might think.

To examine the dependability of alliance scores at the patient and therapist level, to evaluate the potential causal direction of session-to-session changes in alliance and depressive symptoms, and to investigate the impact of aggregating the alliance over progressively more sessions on the size of the alliance-outcome relationship. We used data from a study (N = 45 patients; N = 9 therapists) of psychotherapy for major depressive disorder in which the alliance was measured at every treatment session to calculate generalizability coefficients and to predict change in depressive symptoms from alliance scores. Two replication samples were also used. At the therapist level, a large number of patients (about 60) per therapist is needed to provide a dependable therapist-level alliance score. At the patient level, generalizability coefficients revealed that a single assessment of the alliance is only marginally acceptable. Very good (>.90) dependability at the patient level is only achieved through aggregating 4 or more assessments of the alliance. Session-to-session change in the alliance predicted subsequent session-to-session changes in symptoms. Evidence for reverse causation was found in later-in-treatment sessions, suggesting that only aggregates of early treatment alliance scores should be used to predict outcome. Session 3 alliance scores explained 4.7% of outcome variance, but the average of Sessions 3-9 explained 14.7% of outcome variance. Adequate assessment of the alliance using multiple patients per therapist and at least 4 treatment sessions is crucial for fully understanding the size of the alliance-outcome relationship.

Collecting client feedback.

While highly effective, psychotherapy outcome studies suggest 5-14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically collect feedback from psychotherapy clients are discussed and two systems for monitoring treatment response, feeding back this information, and assisting in problem-solving with such cases are described. Within these systems, obtaining client ratings of their relationship appear to be highly important. We summarize meta-analyses of the effects of these feedback systems (The combined weighted random effect size for the Partners for Change Outcome Management System was r = .23, 95% CI [.15, .31], p < .001, k = 3, n = 558; the effect size for the Feedback condition of the Outcome Questionnaire (OQ) system among not-on-track patients was r = .25, 95% CI [.15, .34], p < .001, k = 4, n = 454; the effect size for the Patient/Therapist Feedback condition of the OQ system among not-on-track patients was r = .25, 95% CI [.15, .34], p < .001, k = 3, n = 495; the effect size for the Clinical Support Tools feedback condition among not-on-track patients was r = .33, 95% CI [.25, .40], p < .001, k = 3, n = 535). The number of psychotherapy patients who deteriorate can be cut in half by use of these systems. We conclude with a series of practice implications, including that clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice.

Development through interruptions and reparations – A case study of a dual challenging psychotherapy

The aim of this study was to understand how relational difficulties in psychotherapy may be handled to represent possibilities for change. Temporary interruptions and subsequent reestablishment of contact were chosen as the strategic focus in one severely challenging case of long term psychodynamic psychotherapy where outcome was known to be good. Interruptions and reestablishments were conceptualised by how the informants gave meaning to them. The choice of focus represented a strategic selection of events in the course of therapy where the regulation of the alliance by the therapist as well as by the patient was at stake. A detailed case record was studied and interviews with patient and therapist were conducted. A hermeneutical-phenomenological approach was used to analyse the material. The narrative dimension was important in structuring and interpreting the data. It was shown how important relational difficulties, such as mutual incompatible expectations and demands was handled both on a structural and interpersonal level, and some important steps and hallmarks of the healing process was identified. Close inspection of the course of events in psychotherapies is seen as a promising method for bringing a better understanding of how change processes unfold.

A pilot study of affect-focused psychotherapy for antepartum depression.

A pilot study of affect-focused psychotherapy for antepartum depression.

Psychometric Properties of the Generalized Anxiety Disorder Questionnaire for DSM-IV Among Four Racial Groups

The Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV) is a self-report diagnostic measure of generalized anxiety disorder. Previous studies have established the psychometric properties of the GAD-Q-IV, revealing excellent diagnostic specificity and sensitivity as well as good test–retest reliability and convergent and discriminant validity (Newman et al., 2002). Recent analyses with other measures of anxiety symptoms have revealed differences across racial or national groups. Given that the GAD-Q-IV was tested primarily on Caucasians (78%), the purpose of this study was to demonstrate the psychometric properties of the GAD-Q-IV across four racial groups: African American, Caucasian, Hispanic/Latino, and Asian. A student sample of 585 undergraduate psychology students completed the GAD-Q-IV as well as other measures of anxiety symptoms. A clinical replication sample included 188 participants who completed the GAD-Q-IV as part of a larger psychotherapy study. Results indicated excellent and very similar factor structures in the student sample and similar psychometric properties in both samples across the racial groups. Implications for the use of the GAD-Q-IV across racial groups are discussed.

A pilot study of interpersonal psychotherapy for preventing excess weight gain in adolescent girls at‐risk for obesity

Interpersonal psychotherapy (IPT) is effective at reducing binge episodes and inducing weight stabilization in obese adults with binge eating disorder. We piloted the administration of IPT to girls at-risk for excess weight gain (BMI 75th-97th percentile; IPT-WG) with and without loss of control (LOC) eating. Thirty-eight girls (12-17 years) were randomized to IPT-WG or a standard-of-care health education group. All 38 girls completed the programs and all follow-up visits through 6 months. Thirty-five of 38 returned for a complete assessment visit at 1 year. Among girls with baseline LOC (n = 20), those in IPT-WG experienced greater reductions in such episodes than girls in health education (p = .036). Regardless of LOC status, over 1 year girls in IPT-WG were less likely to increase their BMI as expected for their age and BMI percentile (p = .028). IPT-WG is feasible and acceptable to adolescent girls at-risk for adult obesity and may prevent excess weight gain over 1 year.

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.