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Objectives: Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation. Methods: A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to 'psychological formulation' and 'experience'. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised. Results: Three analytical themes were identified: toleration of the formulation process—'a necessary evil', which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship—'it's like a two way thing, isn't it?', which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors—'walking a tightrope', which highlights the constraints of resources and team dynamics in therapists' ability to engage in collaborative formulation. Conclusion: Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, 'doing with' activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training. [ABSTRACT FROM AUTHOR]

Since the publication of DSM‐III in 1980, the scientist‐practitioner gap in clinical psychology has expanded, as almost all outcome research in clinical psychology has been on diagnosed mental disorders within a medical model using drug trial methodologies, whereas most practising clinicians undertake functional analyses and case formulations of clinical psychological problems (CPPs) and then apply tailored interventions within an ongoing hypothesis‐testing methodology. But comparatively reliable assessment and generalizable conclusions in psychotherapy outcome research require a comprehensive theory‐derived conception or operational definition of 'CPPs', standardized functional analyses, and a taxonomy of CPPs comparable to DSM's listings of mental disorders. An alternative conception and taxonomy of CPPs have recently been proposed, offering improvements in the reliability and generalizability of case formulation‐based psychotherapy outcome research. It conceives of CPPs as instances of the formation and operation of self‐sustaining problem‐maintaining circles (PMCs) of psychological‐level causal elements—that is, at the level of cognitions, behaviours, emotions, and events or situations (stimuli). The paper describes this new conception of CPPs, a subsequent nascent taxonomy of evidence‐based PMCs which standardizes the underlying mechanisms that maintain CPPs, and ensuing benefits to research (as well as to practice) in clinical psychology. These benefits include being able to encompass all treatment‐worthy CPPs, not just diagnosable mental disorders; to assess theory‐derived intervention strategies, not just arbitrary therapy bundles; and to directly feed back into psychological theories, not just expand an atheoretical list of patented "evidence supported therapies." [ABSTRACT FROM AUTHOR]

As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning‐making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual‐concrete, abstract‐rational, projective‐impulsive, argumentative, contemplative‐mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed. [ABSTRACT FROM AUTHOR]

The need for novel approaches to understanding and treating anorexia nervosa (AN) is well recognized. The aim of this paper is to describe an integrative bio-psycho-social theory of maintaining factors in AN. We took a triangulation approach to develop a clinically relevant theory with face validity and internal consistency. We developed theoretical ideas from our clinical practice and reviewed theoretical ideas within the eating disorders and wider bio-psycho-social literature. The synthesis of these ideas and concepts into a clinically meaningful framework is described here. We suggest eight key factors central to understanding the maintenance and treatment resistance of anorexia nervosa: genetic or experiential predisposing factors; dysfunctional feelings processing and regulation systems; excessive vulnerable feelings; 'feared self' beliefs; starvation as a maladaptive physiological feelings regulation mechanism; maladaptive psychological coping modes; maladaptive social behaviour; and unmet physical and psychological core needs. Each of these factors serves to maintain the disorder. The concept of universal physical and psychological core needs can provide an underpinning integrative framework for working with this distinctly physical and psychological disorder. This framework could be used within any treatment model. We suggest that treatments which help address the profound lack of trust, emotional security and self-acceptance in this patient group will in turn address unmet needs and improve well-being. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message The concept of unmet physical and psychological needs can be used as an underlying integrative framework for understanding and working with this patient group, alongside any treatment model., A functional understanding of the neuro-biological, physiological and psychological mechanisms involved in anorexia nervosa can help patients reduce self-criticism and shame., Fears about being or becoming fat, greedy, needy, selfish and unacceptable ('Feared Self') drive over-compensatory self-depriving behaviour ('Anorexic Self')., Psychological treatment for anorexia nervosa should emphasize a focus on feelings and fostering experiences of acceptance and trust., Treatment for patients with anorexia nervosa needs to be longer than current clinical practice. [ABSTRACT FROM AUTHOR]

Specific phobia of vomiting (also known as emetophobia) is a relatively understudied phobia with respect to its aetiology, clinical features and treatment. In this stage, research is mostly based on people with self-reported fear of vomiting. This paper presents a survey on the clinical features of fear of vomiting of individuals. Self-reported vomit-fearful subjects from the Dutch community and from an Internet support group are included. Both vomit-fearful groups were characterized by high reports of fear, the presence of panic symptoms, and by extensive avoidance and safety behaviours. They also reported other psychiatric complaints, which were measured with a structured screening instrument. Vomiting complaints started mostly in late puberty. A significant proportion of the vomit-fearful participants had a treatment history. The prevalence rate of fear of vomiting in the community sample was established at 8.8% (female : male ratio = 4:1). Overall, results show that fear of vomiting is a common phenomenon, which can seriously impair daily functioning. Finally, clinical questions to be addressed in future research are formulated. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Specific phobia of vomiting (also known as emetophobia) is among the least studied phobias., Most clinical data come from research with self-described fear of vomiting., This paper presents data on the clinical features, prevalence and additional psychiatric complaints of fear of vomiting in two vomit-fearful samples and one control sample with no fear of vomiting., Estimates of prevalence of fear of vomiting in a Dutch community sample were established at 1.8% for men and 7% for women., Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning. [ABSTRACT FROM AUTHOR]

Schemas are one of the key concepts of modern psychotherapy. However, there remains much confusion regarding the nature of this concept. For example, it is sometimes confused with related concepts (e.g. core beliefs) and often used incorrectly to describe specific forms of cognition (e.g. self-referent beliefs). The present paper suggests that core beliefs and self-referent beliefs are sub-components of schemas, and thus should not be used synonymously with the parent concept. For many clinicians, these distinctions may appear rather pedantic or academic, but we would argue that correct differentiation is essential if one intends to deliver good therapy. It is suggested that a more appropriate understanding of the concept of schemas would draw clinicians' attention to many of the information processing mechanisms and biases that both hinder and facilitate therapeutic change. This paper also makes suggestions about how one could clarify the nature of schemas in terms of specific dimensions, which may provide better precision with respect to their use and function within clinical settings. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Working with older people requires therapists to examine issues regarding information processing often not dealt with by therapists working with younger patients. It is suggested that these processing issues may be especially salient to therapists working with older people, owing to their greater reliance on their theoretical knowledge of memory (declarative, procedural, working etc.) and neuropsychology. The present paper draws on this more holistic background, and presents a theory designed to facilitate therapy in general: particularly schema focused therapy for both the young and old. Employing knowledge and models routinely used in an older people's setting, this paper redefines schemata in terms of networks of information and memories rather than viewing them solely as self-referent beliefs (e.g. I am worthless; I am inadequate). This change in perspective allows us to see schemata more validly as elaborate structures, composed of many elements, including behavioural, emotional and visceral features. A rationale in support of this holistic perspective is outlined, together with a review of its implications in terms of schema assessment and change techniques. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper aims to outline some of the implications of attachment theory for understanding the way in which older adults deal with the salient developmental tasks of later life. The paper aims to illustrate this theme by exploring the way in which negative childhood attachment-related experiences brought about by the Second World War may have adversely affected the way in which some of the current generation of older adults function in old age. The paper begins with a brief introduction to attachment theory and research and then moves on to consider some of the ways in which the Second World War may have affected the attachment-related experiences of the United Kingdom population. Finally, some of the clinical implications of attachment theory are briefly discussed, and the implications for assessing and treating older adults are considered. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper introduces the special section on psychological therapy with older adults. It is widely accepted that the provision of health services, including psychological services, to older people is subject to ageism. There is no justification for arbitrary age cut-offs in making decisions about the appropriateness of psychological treatment, and good practice with younger adults is just as applicable in later life. The specialist aspects of working with older adults, which are highlighted in this paper, include working with people with cognitive impairment, the recognition of the importance and impact of past events and the importance of the social context in which older people find themselves. These aspects are not unique to work with older adults, and indeed should also be considered in work with younger adults. However, they form a constant backdrop to psychological therapy with older adults, which has an increasingly strong evidence-base to underpin it. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Bowlby's attachment theory has had considerable impact on research in developmental psychology. Despite this, its relation to other literature and application to clinical practice have been poorly exploited. This paper seeks to outline the current conceptualization of adult attachment styles, and explore the evidence for a link between attachment style and psychopathology in adulthood. The paper also provides a review of the cognitive research on the beliefs people hold in relation to their attachment style. Furthermore, the importance of building on this theoretical and empirical base to examine the connections between adult attachment style and schemas is highlighted. The last part of the review explores how attending to both the concepts of attachment style and schema may contribute to developing clinical practice. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Cognitive therapy was originally formulated as a way of helping clients by applying rational thinking to the appraisal of their realities. The expectation was that this would undo ways of thinking that cause distress and maladaptive behaviours. However this model has been called into question by recent experimental data. This paper argues from a philosophical perspective that empirical rationality has significant shortcomings as a method of promoting self-understanding in the therapeutic situation. However, rational thinking forms the basis of one of the major schools of moral theory, formulated by the philosopher Immanuel Kant. The present paper argues that his ideas have important applications to cognitive therapy. It suggests that therapy might use rationality not only to appraise reality more accurately but also to generate precepts for personal behaviour. This idea is illustrated using an example of a client receiving cognitive therapy. The paper concludes with a discussion of the applicability of moral theory to clinical practice and a suggestion that cognitive therapy might be viewed as a form of applied ethics. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper outlines a theoretical analysis of current psychological conceptualizations of psychosis that draws on Teasdale and Barnard's (1993) Interacting Cognitive Subsystems (ICS) model of depression. The ICS model differs from Beck et al .'s (1979) model of emotional disorders in that it specifies two qualitatively different levels of meaning. These different levels of meaning play a different role in the production, maintenance and modification of emotion, and indeed, also recognize the distinction between ‘intellectual' belief and ‘emotional' belief. Intellectual beliefs are at the level of specific propositional meaning: they have a truth value which can be assessed and they are not directly influenced by sensory information such as voice tone, arousal and body state, or visual stimuli. Given this, propositional meaning does not have a direct link to the production of emotion. Rather the link to emotion is an indirect one, through the activation of more generic and holistic affect-related schematic models. These latter schematic models are hypothesized to have implicational meaning, and correspond to schematic models derived from emotive experiences. In consequence they do not have a specific truth-value and they reflect contributions from a wide variety of sources, including multiple patterns of specific meanings, and patterns of direct sensory input. This ICS perspective proposes that integration of these two levels of meaning can facilitate the psychological conceptualization of the initiation, acceleration, and maintenance of positive psychotic symptomatology during relapse. This theoretical analysis is illustrated by the use of a case study, which describes the process and application of ICS to facilitating recovery from acute psychosis. This paper also provides a detailed discussion of the implications of this analysis for future research and psychological therapy. In particular, ICS has relevance for tracing the evolution of schematic beliefs during the early episodes of psychosis, which are hypothesized to have a bearing on the future course of psychosis. This has implications for the further development and expansion of psychological treatments for relapse and recovery from psychosis. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This introductory paper for the Special Series on Post-traumatic Stress Disorder (PTSD) provides an overview of the psychological literature on chronic PTSD. We describe the symptoms of PTSD, the common associated features of the disorder, and common themes in the clinical presentation of traumatized individuals. Epidemiological studies are reviewed that reveal the widespread occurrence of potentially traumatizing events and the prevalence of PTSD among traumatized populations. We next provide an overview of psychological assessment procedures. This is followed by a description of three psychological theories of PTSD that have received a good deal of attention along with their implications for treatment. Two of the most widely applied treatments of PTSD are next reviewed in some detail: direct therapeutic exposure therapy and stress management approaches. Finally, we introduce the six papers that follow in the series in the context of a brief discussion of directions for future research in the field of chronic PTSD. [ABSTRACT FROM AUTHOR]

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10 800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking., The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment., Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study investigating clinical psychology programme selectors' perceptions of psychological 'woundedness' in the autobiographical narratives of applicants for clinical psychology training. Woundedness was here defined in terms of the ongoing or residual psychological impact of adverse experiences and psychic conflicts. Ten selectors were presented with a sample of applicants' written autobiographical narratives, differentiated by the conspicuous presence or absence of psychological woundedness. The selectors, who were not informed of the specific aims of the study, ranked applicant protocols and were interviewed individually about their impressions of the protocols and the criteria that they used to rank them. Most selectors were positively biased toward 'wounded' narratives and suspicious of those in which woundedness was manifestly absent. Although generally disposed to favour wounded applicants, how woundedness was presented, rather than the mere presence of it, was a discriminating feature in selectors' appraisal of wounded narratives. Selectors were concerned that unresolved woundedness may compromise applicants' professional boundaries, impair self-reflective capacity and lead to damaging countertransference enactments. The relative extent to which applicant woundedness appeared to be resolved was significant in selectors' assessment of applicants' clinical training potential. A distinction is thus proposed between obstructive and facilitative woundedness in clinical psychology applicants. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message A sample of clinical psychology programme selectors identified psychological woundedness as a significant feature in applicant autobiographies., Selectors favoured applicant autobiographies showing evidence of woundedness., The distinction between obstructive and facilitative woundedness is important in how the selector sample evaluated woundedness. [ABSTRACT FROM AUTHOR]

In this paper, a triphasic metacognitive formulation of problem drinking and its implications for treatment are presented together with a summary of the evidence consistent with this approach. In the triphasic formulation during the pre-alcohol use phase, alcohol-related triggers, in the form of cravings, images, memories or thoughts, activate positive metacognitive beliefs about extended thinking, which lead to desire thinking, rumination and worry or their combination. The activation of the latter brings to an escalation of cravings and negative affect, strengthening negative metacognitive beliefs about the need to control thoughts and enhancing the likelihood of alcohol use. In the alcohol use phase, positive metacognitive beliefs about alcohol use and a reduction in metacognitive monitoring contribute to dysregulation in alcohol use. Over the course of time and as the drinking problem escalates in severity, negative metacognitive beliefs about the uncontrollability of alcohol use and alcohol-related thoughts emerge, contributing to the perseveration of dysregulated alcohol use. In the post-alcohol use phase following the activation of positive metacognitive beliefs about post-event rumination, the affective, cognitive and physiological consequences of dysregulated alcohol use become the subject of rumination. This, in turn, leads to a paradoxical increase in negative affect and alcohol-related thoughts, together with the strengthening of negative metacognitive beliefs about such thoughts. Intermittent attempts to suppress alcohol-related thoughts increase the likelihood of returning to use alcohol as a means of achieving self-regulation. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message A metacognitive formulation of problem drinking that may aid assessment, conceptualization and treatment across the problem drinking spectrum. [ABSTRACT FROM AUTHOR]

Objectives This paper aims to study dysfunctional self-schematic processes, abnormal coping styles, over-responsiveness to reward stimuli (indicative of an over-sensitive behavioural activation system) and stability of self-esteem in relation to subclinical hypomania. Design Three cross-sectional studies were conducted on selected students on the basis of their scores on the Hypomanic Personality Scale (HPS) (study 1) and on elevated HPS and Dysfunctional Attitude Scale scores (studies 2 and 3). Methods In studies 1 and 2, participants completed questionnaires and kept a self-esteem diary for 6 days. In study 3, the experience sampling method was used to assess momentary self-esteem, emotion and use of different coping styles over a 6-day period. Results Study 1 demonstrated that hypomanic traits are associated with high fluctuations in self-esteem. In study 2, high scores on both the HPS and the Dysfunctional Attitude Scale, but not the HPS alone, were associated with bipolar spectrum symptoms. These participants showed more evidence of alcohol and substance abuse, greater self-esteem fluctuation and dysfunctional coping styles (rumination and risk-taking) compared with controls. Changes in self-esteem were related to the use of these strategies. Conclusions Vulnerability to bipolar disorder is associated with a combination of depression-related and reward-related processes. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There is increasing recognition of emotions other than fear in post-traumatic stress disorder (PTSD), and recent research has looked at the role of shame. Cognitive theory suggests that PTSD is caused by traumatic experiences being processed in a way that causes ongoing current threat. In this paper we suggest that shame might contribute to the creation/maintenance of ongoing current threat as it attacks an individual's psychological integrity. A correlational design was used to investigate some of the factors that might contribute to a shame response within a PTSD sample. It was hypothesized that individuals with PTSD who report higher levels of shame would be more prone to engage in self-critical thinking and less prone to engage in self-reassuring thinking than individuals with PTSD who report lower levels of shame. Data were gathered using self-report questionnaires, and results supported the hypotheses. It is suggested therapy for shame-based PTSD needs to incorporate strategies to help individuals develop inner caring, compassion and self-reassurance. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Some individuals with PTSD report high levels of shame. • High levels of shame are associated with high levels of self-critical thinking and low levels of self-reassuring thinking. • Therapy for shame-based PTSD needs to incorporate strategies that help individuals develop inner caring, compassion and self-reassurance. [ABSTRACT FROM AUTHOR]

Compulsive buying (CB) has only relatively recently become a topic of interest for researchers and clinicians alike. This hiatus means that (unlike other impulse control disorders) there is currently little theoretical guidance for clinicians attempting to intervene with CB clients and no established model for researchers to evaluate, distil and refine. The current paper summarizes and organizes the main extant identified factors in the CB literature into four distinct phases: (1) antecedents; (2) internal/external triggers; (3) the act of buying; and finally, (4) post-purchase. The relationships and interactions between the identified phases are then hypothesized, within the proposed cognitive–behavioural model. The model distinguishes the key cognitive, affective and behavioural factors within each phase and identifies how CB can become self-reinforcing over time. The over-arching treatment implication is that CB can be re-conceptualized as chronic and repetitive failure in self-regulation efforts, and that psychological interventions can accommodate this in attempting to facilitate change. A successful case example is provided of a ‘co-dependent compulsive buyer’ using the model, with psychometric evaluation of key aspects of CB and mental health at assessment, termination and 6-month follow-up. The research and clinical implications of the proposed model are discussed, alongside identified short-comings and the need for psychological services to respond appropriately to CB clients seeking help. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper is an exploratory study in two parts into the adaptation of the NEO-PI-R for use with individuals with intellectual disabilities (IDs). Study 1 was concerned with the simplification and reliability of questions to retain the meaning of the original. Eight participants completed both the original and the adapted versions, showing a very high consistency between versions. In Study 2, the adapted questionnaire was administered to an outpatient group of 40 people with ID. A rater version of each was also completed. Significant differences occurred between self and rater in the domains of Extraversion, Agreeableness and Conscientiousness. Consistent and inconsistent responding between S and R forms were highlighted, emphasizing the value of the rater form in the NEO-PI-R. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Emotion regulation is an emerging field in psychology concerned with the processes involved in recognizing, monitoring, evaluating and modifying emotional reactions. Few measures have been developed specifically to assess individual differences in the use of emotion regulation strategies. This paper reports on a new self-report instrument designed to assess the frequency with which adolescents use both functional and dysfunctional emotion regulation strategies, which draw on both internal (intrapersonal) and external (interpersonal) resources to regulate emotions. The new measure was used in a cross-sectional survey of 225 adolescents. Factor analyses supported the structure of the measure, which has four scales: ‘internal-functional’, ‘internal-dysfunctional’, ‘external-functional’ and ‘external-dysfunctional’ emotion regulation. The new measure demonstrated good psychometric properties. Frequent use of dysfunctional emotion regulation was significantly positively correlated with parent reports of level of emotional and behavioural problems, and also with self-reported level of psychosomatic health problems. Frequent use of functional emotion regulation was significantly positively correlated with self-reported quality of life across a number of different dimensions. These results provide evidence for the validity of the measure. The results also highlight that assessment of both functional and dysfunctional emotion regulation is important. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Clinical psychology research productivity is an issue of great professional concern. The current paper explores the rate and nature of trainee publication of research projects in peer-reviewed journals, together with reasons likely to be relevant to its success and failure. Twenty-one out of 28 courses responded to a survey composed of closed and open-ended questions. Data were analysed using inferential statistics and content analysis. Twenty-four percent of trainees in any one cohort during the period 1999–2004 successfully wrote up their research for publication. Most publications were in psychology journals with modest but respectable impact factors. The most important theme thought to be related to success was supervisor factors, followed by trainee factors, general course factors, study characteristics and the demands of a new job following qualification. Recommendations to enhance publication success are made within the context of a broader discussion of the importance of facilitating the development of the new generation of clinical psychology researchers. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The original publication of the Inventory of Interpersonal Problems (IIP) heralded an interpersonal measure that had wide acceptability across theoretical orientations. Since then, 10 derivative versions have been developed. A benefit of this situation is that there is now a ‘family’ of related measures from which researchers and clinicians can select the most appropriate version for their particular use. However, a weakness is that these versions could be seen as fragmentary and lacking in cohesion. This paper sets out to (a) provide a scoping review of the versions of the IIP, (b) summarize the psychometric properties of the versions and (c) map out the extent of commonality between the derivative versions. The situation is evaluated in the context of the need for a robust outcome measure of interpersonal issues and it is debated as to whether the multiple derivative versions have benefited or hindered the adoption of the IIP within a core outcome battery to complement other candidate measures (e.g. CORE-OM). Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Evidence-based clinical practice guidelines have proliferated over the past two decades. Few are limited to psychological therapies or are targeted at clinical psychologists and psychotherapists – the UK guideline Treatment Choice in Psychotherapy and Counselling is a major exception. However, psychological therapies will increasingly be considered alongside medical treatments in diagnosis-specific guidelines. There has been interest and debate about the place of guidelines in the psychological therapies, with views ranging from scepticism to enthusiasm. This paper defines clinical practice guidelines, describes major guideline programmes internationally, examines guidelines of specific interest to psychologists and psychotherapists, explores issues in their implementation, reviews evidence for their effectiveness in changing practice and improving therapy outcomes and draws out implications for practice. Guidelines are only one aspect of informing psychologists and psychotherapists about best practice. They need to be supplemented by other clinical support methods and with methods of monitoring what is actually done in practice. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes a systematic approach to generating practice-based evidence in a United Kingdom adult psychological therapies service. Routine clinical outcomes using standardized measures at referral, assessment, the beginning of therapy, discharge and 6-month follow-up are reported. The system is integrated into the clinical service in many ways including contributing to risk assessment and feeding back clinical outcome data to the therapists. A number of issues related to such an approach are discussed in the light of the clinical governance and clinical effectiveness agendas in the UK NHS. These include practical constraints, the costs, getting staff on board, attrition from such services and service user involvement. Such an approach provides a framework for routine, systematic and integrated service evaluation that can be fed back to therapists. It contributes to the evidence for the effectiveness of psychological therapies in routine clinical settings and also provides opportunities to link evidence with practice in more creative ways to enhance therapists' reflection on their practice. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper proposes a new strategy for bridging the gap between psychotherapy process research and practice. Constructs covering the full spectrum of potential change mechanisms are derived from a general theory of human functioning (Grawe's Consistency Theory) and operationalized by Therapy Spectrum Analysis (TSA), a measure of the realization of therapeutic change mechanisms within individual therapy sessions. Using the data generated by TSA, we conducted an exploratory search for meaningful patterns of process and session-outcome variables using Answer Tree as a context-sensitive method of data analysis. Results show that process-activated resources of the patients, in particular their responsiveness to interventions and motivation are especially predictive of the session productivity experienced. Further analyses were conducted to uncover how the patients' participation can be promoted and results translate into guidelines for the session-to-session decisions by clinicians. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Recent multifactorial models of psychotic symptoms such as delusions emphasize a role for reasoning biases in the maintenance of delusional beliefs. Specifically, people with delusions are seen to jump to conclusions. This well-replicated experimental finding has received little in the way of theoretical explanation. In this paper we review this and other research findings examining reasoning of people with delusions and account for these findings by drawing on a model of reasoning. This theoretical integration helps understand the tendency of people with delusions to exhibit this reasoning style. Specifically, we propose that people without delusions demonstrate a normal tendency to confirm danger-related conditional statements and that people with delusions perceive danger and threat where others do not. Hence, this normal reasoning style is extended to non-threatening situations. The theoretical and clinical implications are discussed. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper contrasts the loss of mind from the loss of brain cells in Alzheimer's Disease and other neurodegenerative conditions with the threats to one's mind from the mindlessness of others from a cognitive-analytic perspective. Case studies are presented that show how the therapeutic framework of Cognitive-Analytic Therapy (CAT: Ryle 1990, 1995, 1997) can bring containment for both client and therapist for clients facing this dilemma, particularly when past trauma is potentially overwhelming. This is set in a dialogue with the pioneering work of Tom Kitwood (1990, 1995, 1997) in dementia care, in which Kitwood's thesis of the ‘malignant social psychology’ surrounding people with dementia is re-stated in terms of ‘reciprocal roles’ developed in Cognitive-Analytic Therapy. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The traditional treatment of substance abuse based on the medical disease model has neglected psychological approaches to substance abuse, partly influenced by misconceptions regarding therapy. Other forms of treatment such as Cognitive-Behavioural, Motivation Enhancement, and Transtheoretical Models have also been recently utilized. While these approaches have been effective for many individuals, they are not typically guided by a psychodynamic understanding of the individual nor do they address the interpersonal factors that influence psychotherapy. Psychoanalytic therapies do address these issues, although they have been an underutilized form of psychological treatment. The scope of this paper addresses how psychoanalytic models, that are not necessarily incompatible with other approaches may be utilized. Wurmser's Conflict Model and Khantzian's Self and Ego Deficit Model are discussed, and clinical case examples are provided to elucidate the application of psychoanalytic psychotherapy in practice. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes two studies in which 18 participants with OCD (Study 1) and 73 students (Study 2) rated the subjective probability and severity of future negative events, as well as their anticipated coping ability. The negative events were idiographic in that participants wrote and rated events that were particularly salient to them personally. In both samples, results indicated that, as OC symptoms increased, severity estimation increased and coping ability decreased. However, probability estimation increased with OC symptoms in the student sample, but not in the OCD sample. Results also suggested that OC symptoms may relate to the product of probability and severity, divided by coping ability. Regression results indicated that higher probability estimation for students, and worse predicted coping ability for OCD patients, was the most predictive of OC symptoms. Findings are discussed in the context of cognitive theory of OCD. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The fundamentals of attachment theory and family systems theory are outlined in this paper. Theoretical strengths and weaknesses of both approaches are discussed. First, the similarities of both approaches are analysed (focus on family relationships; focus on normal as well as disturbed development; status as metatheoretical perspectives). Then, the differences are outlined (empirical consolidation versus speculative theory development; integration versus abandonment of the concept of ‘personality’; normativity versus non-normativity; deficit orientation versus resource orientation; dyadic versus triadic view; focus on past and present time versus focus on present and future). Finally, an integrative proposal of a systemic attachment theory is presented. It includes the following main positions: (1) Attachment needs are inborn and of vital importance for humans of all ages. (2) Relationship experiences are internalized and shape the personality. (3) Inner working models of attachment tend to remain stable, but it is possible to change them through new relationship experiences. (4) Attachment can be conceptualized as having an intrapsychic as well as an interpersonal dimension. (5) Internal models and interpersonal relationships influence each other. (6) Focus on normativity and resource orientation. (7) Focus on the present and future, with limited consideration of the past. (8) Sensitivity for losses and ‘inherited trauma’. (9) Triadic view. Research implications (focus on triadic interactions, on inner working models of attachment, and on interrelationships between both) and clinical-psychotherapeutic implications are derived from this proposal. Bowlby's (1979) recommendations for individual therapy are extended to couples/family therapy and supplemented by a competence-based basic attitude, flexibility of therapy setting, sensitivity for ‘inherited trauma’ and sensitivity for complex triadic relationships. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes preliminary findings of a pilot project designed to evaluate a teleconferencing clinical psychology service between Aberdeen and Shetland. Over a 12-month period, 10 clients were assessed face-to-face in Shetland, then attended an average of 12 therapy sessions each via a teleconferencing link with a clinical psychologist based in Aberdeen. The majority of clients reported that they were satisfied with the tele-therapy, and some expressed a preference for this mode of communication because they felt it reduced confrontational aspects of contact and increased their perception of control. One client was not able to continue after two initial sessions due his discomfort at discussing his difficulties ‘in cyberspace’. The clinical psychologist was satisfied with using teleconferencing as a mode of providing treatment, and felt that therapeutic rapport was not compromised by the technology. A number of recommendations are made for consideration by those planning to deliver telepsychology services in future. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Cognitive-behavioural therapy (CBT) is one of the most widely-researched therapies for children and adolescents. In this paper, the general tenets of CBT are described, followed by a review of the treatment outcome literature. Overall, there is strong empirical support for CBT with internalizing disorders such as anxiety and depressive disorders whereas more moderate empirical support exists for CBT with externalizing disorders such as attention-deficit hyperactivity disorder and conduct disorder. The relative efficacy of individual, family, and group forms of CBT is also examined. Finally, future directions for research on CBT are discussed, including (a) determining the focal person(s) of treatment; (b) the importance of field effectiveness trials; and (c) the integration of CBT with other approaches (e.g. function analytic techniques, acceptance-based approaches). Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The present paper reviews what is currently known about sexual abuse and the treatment of the offenders. Sexual offending is primarily committed by males and as many as 50% of females and 33% of males are sexually victimized in some way during their life. While some of these acts involve minimally intrusive behaviours (e.g. exhibitionists), many involve forced vaginal or anal intercourse and varying degrees of associated physical violence and deliberate humiliation of the victim. The effects on the victim can be severe and long-lasting. Current theories of the aetiology of these behaviours incorporate biological and developmental factors occurring within a socio-cultural context that fails to discourage sexual abuse. Experience is said to create a vulnerability that in some men finds expression in sexually abusive behaviour. Appropriate assessment targets the issues that are addressed in treatment, including: cognitive distortions, sexual behaviours and attitudes, social functioning and substance abuse. In addition, treatment also attempts to generate a set of relapse prevention plans for each offender. While some reports have not found benefits for treatment, the majority of acceptable studies have demonstrated clear reductions in re-offending among treated sexual offenders. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper addresses certain fundamental issues that frequently emerge in clinical work with ex-patriates—individuals who have chosen to live in a country other than their own, temporarily or permanently. In particular, internal factors integrally involved in the decision to live abroad are examined using clinical examples. These include efforts to re-negotiate issues of separation-individuation, identity formation, narcissistic difficulties, conflicts regarding achievement and/or success and difficulties in proceeding with basic tasks of adulthood. The implications of these motivational factors for psychodynamic psychotherapy are discussed. More specifically, the ways in which these issues appear in treatment and the patient's capacity for insight regarding them1 are considered with respect to the use of optimal treatment technique. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide an overview of developments in the area of relapse prevention for selected psychological disorders: problem drinking; smoking; obesity; and depression. Relapse prevention methods, including booster sessions, have been associated with mixed outcomes, although there are some encouraging findings, particularly in the treatment of obesity and alcohol problems. A number of recommendations are made for research and/or clinical practice. In the treatment of alcohol problems it is recommended that more attention be paid to reducing co-existent marital problems and mood disorders. In obesity, there is a need for evaluations of intensive, long-term therapist contact with the severely obese, particularly those with serious medial problems. Studies of the complete relapse prevention approach advocated by Marlatt and Gordon (1985) are needed in the evaluation of smoking cessation programmes. It is concluded that maintenance of gains in smoking, obesity and problem drinking comes at a considerable cost in time and therapist contact. To date, there has been little application of relapse prevention methods to depression, and further empirical work is needed to identify the determinants of relapse and the efficacy of specific maintenance-enhancement strategies. Consistent themes in the prediction of relapse are identified, including low social support, ongoing interpersonal difficulties, and low self-efficacy. [ABSTRACT FROM AUTHOR]

Clients with Obsessive Compulsive Personality Disorder (OCPD) take normally positive characteristics such as conscientiousness and attention to detail to such an extreme that these characteristics become seriously dysfunctional. This disorder has received only limited attention from cognitive-behavioural investigators and the one empirical investigation of the treatment of individuals with OCPD found that simply inducing these individuals to engage in treatment was difficult. This paper presents a cognitive-behavioural conceptualization of OCPD and uses a detailed case example to illustrate an approach to intervention which shows promise for providing an effective approach to intervention. [ABSTRACT FROM AUTHOR]

Cognitive therapists are presently striving to establish a theoretical foundation for their therapeutical practice. Having shown the efficacy of cognitive therapies in the treatment of certain psychiatric disorders and having refined their intervention techniques, these therapists are seeking a theory-based understanding of the psychological mechanisms subtending the changes occurring during therapy. The absence of a directly relevant cognitive theory led us to consider how certain concepts of Piaget's constructivism-essentially a theory of knowledge change-might contribute to the issue. Our paper is thus not an instance of applying Piagetian theory to cognitive psychotherapy but of its use as an epistemic instrument. Egocentrism and decentration, the growth of awareness and action, and the relations between cognition and emotion are elements of Piagetian theory as well as nodal points in the area of cognitive therapy. Some clinical examples illustrate our approach. [ABSTRACT FROM AUTHOR]

This paper describes a programme for inpatients with severe personality disorders as well as acute exacerbation of Axis II pathology. The goal of the programme was to quickly stabilize participants with respect to self-injurious behaviour and return them to the community. The programme consisted of frequent coordinated cognitive group therapy sessions with supporting written and audiovisual materials. The groups were open-ended and heterogenous, and employed educational and experiential-affective components. An extended group case example is presented in order to illustrate the operation of the programme. The range of typical participants is described, including their diagnoses, treatment plans, and homework assignments. Some comments on the personal and professional difficulties encountered by therapists working with this population ate described as well as some suggestions for alleviating those difficulties. [ABSTRACT FROM AUTHOR]

A common language is necessary for an integration of psychotherapy techniques. This means that each ‘brand name’ must surrender some historically used terminology. A modem cognitive language seems to be an acceptable ground. This paper suggests how a theory of states, schemas, and controls can use such a language while revitalizing dynamic conceptualizations in a way that promotes articulation to behavioural and family systems points of view. [ABSTRACT FROM AUTHOR]

This paper discusses short-term treatment for morbid jealousy. A brief account of the clinical presentation of morbid jealousy is given. Theoretical approaches to this phenomenon are summarized and commented on. Specific behavioural and cognitive techniques are described, and their rationale explained. Case examples are cited to illustrate the use of these techniques. Some general comments on the application of these techniques are also made. [ABSTRACT FROM AUTHOR]

The present paper is the first of two which seek to integrate the concepts of anxiety and attention within a cognitive framework and assess the empirical evidence which bears on this relationship. The current discussion concentrates on theoretical issues. An initial section examines the concept of attention at what Marr (1982) called the computational level of analysis. This is followed by a discussion of anxiety as a paradigm case within cognitive-appraisal models of emotion, particularly that of Oatley and Johnson-Laird (1987). An integrated framework is then proposed, in which four types of bias in attentional processing associated with anxiety are posited. This is supplemented by a discussion of the concept of self-focused attention. [ABSTRACT FROM AUTHOR]