Use Of Therapy Techniques Research Articles

Therapist- and Client-Level Predictors of Use of Therapy Techniques During Implementation in a Large Public Mental Health System.

Many youths receiving community mental health treatment do not receive evidence-based interventions. Research suggests that community mental health therapists use a broad range of therapeutic techniques at low intensities. This study examined the relationship between therapist- and client-level predictors of community-based therapists' report of cognitive, behavioral, psychodynamic, and family techniques within the context of implementation efforts. A total of 130 therapists participated from 23 organizations in an urban, publicly funded behavioral health system implementing evidence-based practices. Therapist-level predictors included age, gender, clinical experience, licensure status, and participation in evidence-based practice initiatives. Child-level predictors included therapist-reported child primary disorder (externalizing, internalizing, or other) and child age. Therapists completed the Therapist Procedures Checklist-Family Revised, a self-report measure of therapeutic techniques used. Unlicensed therapists were more likely than licensed therapists to report using psychodynamic and behavioral techniques. Therapists who did not participate in an evidence-based practice initiative were less likely to report use of cognitive techniques. Those with clients with externalizing disorders were more likely to report use of behavioral and family techniques. Therapists with the youngest clients (ages three to seven years) were most likely to report use of behavioral techniques and less likely to report use of cognitive and psychodynamic techniques. Results suggest that both therapist and client factors predict self-reported use of therapy techniques. Participating in an evidence-based practice initiative was associated with increased reports of using cognitive techniques. Therapists reported using behavioral and family techniques more than other techniques when working with youths with externalizing disorders and using fewer cognitive and psychodynamic techniques with young clients.

Predictors of community therapists' use of therapy techniques in a large public mental health system.

Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.

Windows and Bridges of Sand: Cross-cultural Counseling Using Sand Tray Methods

In this time of increasing globalization, it is not uncommon to practice counseling in a context with native speakers of multiple languages seeking therapy with a practitioner in a shared language that is not their own. Providing therapeutic counseling across cultures can be a complicated endeavor. Sand tray is an expressive therapy, which allows significant non-verbal and pre-verbal material to be shared. This can be especially valuable when working in a cross-cultural, or language learner context. The sand tray allows the therapist to become a “visitor” to the inner world of the client, and literally see their interpretation of events and relationships without the limiting constraints of vocabulary and culture based assumptions. It provides a cultural window for insight in assessment and diagnosis and a bridge for the use of therapy techniques within the cultural context. In this paper, the sand tray method is discussed with regards to multicultural communication. The discussion includes a brief history of sand tray therapy development, and the sand tray method used. Case study examples of cross-cultural work done in Kosovo illustrate the effective use of sand tray as a medium for therapeutic intervention. The possibility of future research in the exploration of sand tray therapy as a cross-cultural means of counseling assessment and intervention are discussed.