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The present paper gives a review of diary methods in clinical psychology and psychotherapy. After a brief discussion of the history and the development of the diary method a description of the methodology and technology of diaries in their scientific and practical uses is given. The main part of the paper presents an overview of instruments used in research and practice in clinical psychology concerning mood and affectivity, anxiety disorders, pain, psycho-physiological states, eating disorders and alcoholism. Additionally, methodological advantages and problems of these tools are discussed. Finally strategies for the assurance and enhancement of the methodological quality of diary data are discussed. The paper comes to several conclusions: (1) although many instruments have been developed during recent years for research and practical aims, they are concerned with only a few of the many clinical phenomena; (2) although some diaries achieve favourable psychometric results, the reliability and validity of most of the instruments has not yet been explored in a satisfactory manner; (3) although most diaries would also be useful for practical reasons, many deal with research aims. Therefore, future work should focus on practical use as well as on psychometric testing. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Therapeutic boundaries are limits to appropriate behaviours within a therapist–client relationship (e.g. related to accepting gifts, self‐disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions. Method: Six databases were searched. Following full‐text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis. Results: Three major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re‐Conceptualisation of Therapy as 'Clinical Political' and Re‐Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries—Not becoming 'Hardened' or 'Haunted'. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist–client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re‐conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn‐out. Conclusions: Boundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well‐being and training needs for therapists supporting this population. [ABSTRACT FROM AUTHOR]

Purpose: To synthesise qualitative research on individuals diagnosed with (or reportedly showing traits of) borderline pattern personality disorder who underwent dialectical behaviour therapy, aiming to comprehend their perceptions of change processes and the therapy's effects. Method: A comprehensive literature search was conducted across multiple online databases and grey literature sources. Papers were quality appraised using an adapted version of the Critical Appraisal Skills Programme tool. A metaethnographic approach was employed during the synthesis. Results: Eleven studies met criteria for inclusion in the review. The main themes identified through the synthesis process were the impact of DBT, the supportive structure and the 1:1 therapy component. Conclusions: The synthesis uncovered the importance of various processes within DBT that patients perceived as active ingredients for their change. Many of these processes aligned with proposed theoretical processes of change and quantitative research on DBT's effectiveness. [ABSTRACT FROM AUTHOR]

Satisfying daily life functioning is essential in mental healthcare. Standard assessments focus on symptoms and are designed to detect underlying vulnerabilities. However, they offer insufficient insight into patterns of contextual variability and resilience. Consequently, interventions are planned using incomplete information. The experience‐sampling method (ESM) is a structured moment‐to‐moment diary assessing the individual's affect, thoughts, perception and behaviour in the daily life context. ESM helps to understand variation in mental states (e.g., anxiety or sleeping problems) as adaptational processes in relation to contextual challenges (functional analysis). Although ESM has been extensively studied across psychological disorders, the adoption by mental health professionals and their patients remains limited because the 'how to' is unclear. This paper presents a practical guide for ESM application in routine clinical care. It integrates empirical knowledge with expert experiences and provides real‐world examples and recommendations for successful implementation. The guide comprises how to engage and motivate patients and how to customize assessments to the patient's needs. It also includes instructions to interpret results and create an atmosphere of shared decision‐making. Experience‐sampling technology has merits for patients with various mental health complaints and across healthcare settings, although the exact use and implementation may vary depending on the individual case. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic, which has affected a significant number of individuals worldwide, is generating serious mental health issues. Recovered COVID‐19 patients have experienced traumatic events related to their symptoms, isolation, possible hospitalization, bereavement, fear of infecting loved ones and the physical consequences of COVID‐19. One effective psychological treatment for these patients is Eye Movement Desensitization and Reprocessing (EMDR). The aim of this paper is to describe the therapeutic intervention and effects of EMDR in a pool of COVID‐19 survivors referred to an integrated psychological/psychiatric outpatient service. Twelve patients, comprising of nine males and three females, underwent EMDR psychotherapy from October 2020 to February 2022. Each patient received 8–16 weekly treatment sessions. The standard EMDR protocol of eight stages was administered to enable desensitization and reprocessing of four main targets: first positive swab, hospitalization, isolation and fear for relatives' health. Efficacy of EMDR was demonstrated by the significant improvement at clinical scale for subjective distress caused by traumatic events. For the therapists, carrying out these treatments was an intense and challenging experience. In fact, the perceived distance between therapist and patient was less defined than in other hospital settings because the pandemic affects everyone equally. However, with the widespread availability of vaccines and although the pandemic is still ongoing with the emergence of new variants, a window of improvement in the mental health landscape is starting to open up. [ABSTRACT FROM AUTHOR]

Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood. Childhood trauma is a robust risk factor for positive symptoms in psychosis, but the association with negative symptoms is less well established. Our aim was to examine the association between childhood interpersonal trauma and negative symptoms and the psychological mediators of this relationship. Two hundred and forty participants experiencing psychosis completed validated self‐report measures of childhood trauma, attachment, dissociation, compartmentalization, and symptoms. Mediation analyses showed that disorganized attachment and dissociative experiences mediated the association between childhood trauma and negative symptoms, when analysed individually and in a combined model. Models adjusted for age and positive and depressive symptoms. Avoidant attachment and compartmentalization were independently associated with negative symptoms but not childhood trauma and thus were not significant mediators. Childhood trauma was not independently associated with negative symptoms. This paper is the first to present empirical data to support a model implicating attachment and dissociation as important psychological processes in the link between childhood trauma and negative symptoms. These exploratory findings suggest that it may be beneficial to consider these relationships in trauma‐informed formulations and interventions. Further longitudinal research is required to establish causality and test theoretical models of mechanisms in the pathway to negative symptoms. [ABSTRACT FROM AUTHOR]

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance‐assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed‐methods investigations, treatment manuals, study protocols, quasi‐experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic–experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy‐related factors is needed. [ABSTRACT FROM AUTHOR]

Introduction: Innovative moments (IMs) pinpoint new and more adaptative meanings that emerge in clients' discourse during psychotherapy. Studies with adult clients have found a greater proportion of IMs in recovered compared to unchanged cases, but similar studies have yet to be conducted with adolescents. Aims: The paper aims (1) to study retrospectively the emergence of IMs in therapy, using a post‐therapy interview, in adolescents that underwent psychotherapy for depression, and (2) to characterize the themes present in IMs identified retrospectively in the interviews. Method: Semi‐structured post‐treatment interviews conducted with 24 adolescents on the experience of taking part in a clinical trial of youth depression, were coded using the Innovative Moments Coding System. After identifying IMs, a thematic analysis identified the prominent themes within them. Results: Higher presence of IMs were found in recovered compared to unchanged cases. Two main themes emerged in the IMs, changes that occurred with therapy and attributions of changes. Recovered cases presented more IMs centred on the self, whereas unchanged cases identified more non‐specific changes. Conclusion: This study suggests that it is possible to code IMs, identified retrospectively, based on post‐therapy interviews with adolescents. Meaningful differences were found between recovered compared to unchanged cases. Therapeutic recovery was associated with a higher focus on the self and more specificity in clients' representations of the change process. [ABSTRACT FROM AUTHOR]

Background: Treatment of schizotypal personality disorder is complex. Currently, there are no clear evidence‐based recommendations for use of psychotherapy for individuals suffering from this mental illness, and studies are sparse. Our aim in this review is to map and describe the existing research and to answer the research question: What do we know about the use of psychotherapy for people with schizotypal personality disorder? Methods: We conducted a scoping review using systematic searches in the Embase, MEDLINE and PsycINFO databases. Two reviewers screened possible studies and extracted data on subject samples, type of psychotherapy, outcomes and suggested mechanisms of change. The review is based on the PRISMA checklist for scoping reviews. Results: Twenty‐three papers were included, and we found a wide variety of study types, psychotherapeutic orientations and outcomes. Few studies emerged that focused solely on schizotypal personality disorder. Conclusion: Psychotherapy as a treatment for schizotypal personality disorder is understudied compared with diagnoses such as schizophrenia and borderline personality disorder. Our results included two randomized controlled studies, as well as mainly smaller studies with different approaches to diagnostic criteria, psychotherapeutic orientation and outcome measures. The findings are too sparse and too diverse to make any evidence‐based recommendations. We found some indications that psychotherapy may support and assist individuals with schizotypal personality disorder. [ABSTRACT FROM AUTHOR]

Despite widespread interest in the development of process‐based psychotherapies, little is still known about the underlying processes that underpin our most effective therapies. Statistical mediation analysis is a commonly used analytical method to evaluate how, or by which processes, a therapy causes change in an outcome. Causal mediation analysis (CMA) represents a new advancement in mediation analysis that employs causally defined direct and indirect effects based on potential outcomes. These novel ideas and analytical techniques have been characterized as revolutionary in epidemiology and biostatistics, although they are not (yet) widely known among researchers in clinical psychology. In this paper, I outline the fundamental concepts underlying CMA, clarify the differences between the CMA approach and the traditional approach to mediation, and identify two important data analytical aspects that have been emphasized as a result of these recent advancements. To illustrate the key ideas, assumptions, and mathematical definitions intuitively, an applied clinical example from a previously published randomized controlled trial is used. CMA's main contributions are discussed, as well as some of the key challenges. Finally, it is argued that the most significant contribution of CMA is the formalization of mediation in a unified causal framework with clear assumptions. [ABSTRACT FROM AUTHOR]

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive–compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive–compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization‐based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities. [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]

Objectives: Waiting times for secondary care psychological therapy remain a 'blind spot' in serious mental illness (SMI) provision, and their reduction is a priority within the National Health Service (NHS) Five Year Forward View. The paper describes the eradication of waiting times within a community‐based NHS service and the effectiveness of strategies whilst examining help‐seeking behaviour, compliance and therapeutic need. Methods: Analyses are reported for treatment compliance and therapeutic outcomes for 208 waiting‐list cohort individuals seen by the SMI psychology service over an 18‐month period between October 2014 and March 2016. Results: No significant clinical or demographic differentiation between individuals who successfully completed therapy compared to those who disengaged was observed. Despite an average 2.20‐year waiting time, this alone did not significantly impact engagement with psychological treatment and all psychological therapies provided led to a significant clinical improvement and no individuals who completed therapy required re‐referral at 12‐month follow‐up. Conclusions: If imposed appropriately over a suitable time frame evidence‐based practice coupled with effective operationalization can result in efficient needs‐led psychological provision within SMI and secondary care. Potentially debilitating waiting times for service users and other referring professionals can be avoided, whilst psychology provision retains a flexible, formulation‐based and person‐centred approach. [ABSTRACT FROM AUTHOR]

Prolonged exposure (PE) has been proved as an efficacious psychological treatment for post‐traumatic stress disorder (PTSD). There are mainly two changed formats of PE: the modified PE (mPE) and the PE combined with drug (PE/d). Symptom reduction following these two PE training formats has been reported in the patients with PTSD. However, very little is focusing on the direct comparison of mPE + PE/d and PE. Therefore, this paper aims to compare the mPE + PE/d with PE on the PTSD treatment effect and the dropout rate directly through the meta‐analysis. Eighteen studies with total sample size of 1,397 met the final inclusion criteria. The results showed that mPE + PE/d had significantly lower posttreatment PTSD severity than control group (relaxation, wait list, etc.). There was no significant difference between mPE + PE/d and PE on the posttreatment, the follow‐up PTSD score, and the posttreatment dropout rate. Compared with PE, lower PTSD symptoms and marginally lower dropout rate following the treatment were observed in the PE/d group. PE/d yielded a significantly larger effect size than mPE when compared with PE on the posttreatment PTSD symptom severity. The significance of the above results would not be changed even if studies causing high heterogeneity were removed. Although PE/d enhanced treatment effect and lowered dropout rate when compared with PE, it was still insufficient to draw the conclusion that formats of adjustments would specifically improve the implementation of PE. Further studies are warranted to develop an easily accomplished and efficacy‐guaranteeing PE programme for PTSD patients. [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]

The goal of this paper is to show (i) how the moment-to-moment tracking and processing of emotion to completion —in an emotionally engaged patient–therapist dyad where the individual feels safe and known—constitutes a powerful mechanism of therapeutic transformation, and (ii) how positive emotions are sensitive affective markers of that transformational process. Evidence from transformational studies is used to elaborate the vital role of positive emotions in the process of change in general, and, more specifically, in the course of therapeutic work with painful and overwhelming emotional experience. It is proposed that these emergent positive emotions are affective markers which signal the operation of healing transformational processes in psychotherapy. Several types of positive emotion that arise spontaneously during moment-to-moment experiential therapeutic work will be described and their role as markers of different transformational processes will be elucidated. The paper begins with examples of clinical work with emotion in AEDP (Accelerated Experiential–Dynamic Psychotherapy), an emotion-focused and attachment-based model of therapy that places the dyadic regulation of affect at the centre of both theory and practice. 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 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]

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]

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]

This paper shows the convergence of voices in psychotherapy in the context of the assimilation model. Convergence is the link between patients' voices within the community of voices. The main aim of the paper was to explore (a) how convergence (and divergence) is shown during sessions and the usefulness of convergence for the process of assimilation; (b) if a well-structured patient is able to track the sociohistorical antecedents of his/her main voices; and (c) if, at the end of the therapy, the self becomes richer and with more resources. For this aim to be realized, a case study of a patient, María, treated with linguistic therapy of evaluation for 14 sessions, was analysed by using the Assimilation of Problematic Experiences Scale (APES). Three main problematic experiences or non-dominant voices were identified with the APES: inability to do things, dizziness and tiredness. María's main dominant voices were to cure, solve and overcome problems, to be always doing things and to cope. Results showed a convergence but no divergence of voices as early as session 3. Results also showed how continuity-benevolence assumptions were broken and that, at the end of therapy, the patient's self became richer due to assimilation through the dialogue between non-dominant and dominant voices. Discussion emphasized these results, which are especially representative of a well-integrated patient who showed a healthy multiplicity. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Compassionate mind training (CMT) was developed for people with high shame and self-criticism, whose problems tend to be chronic, and who find self-warmth and self-acceptance difficult and/or frightening. This paper offers a short overview of the role of shame and self-criticism in psychological difficulties, the importance of considering different types of affect system (activating versus soothing) and the theory and therapy process of CMT. The paper explores patient acceptability, understanding, abilities to utilize and practice compassion focused processes and the effectiveness of CMT from an uncontrolled trial. Six patients attending a cognitive–behavioural-based day centre for chronic difficulties completed 12 two-hour sessions in compassionate mind training. They were advised that this was part of a research programme to look at the process and effectiveness of CMT and to become active collaborators, advising the researchers on what was helpful and what was not. Results showed significant reductions in depression, anxiety, self-criticism, shame, inferiority and submissive behaviour. There was also a significant increase in the participants' ability to be self-soothing and focus on feelings of warmth and reassurance for the self. Compassionate mind training may be a useful addition for some patients with chronic difficulties, especially those from traumatic backgrounds, who may lack a sense of inner warmth or abilities to be self-soothing. Copyright © 2006 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]

Objectives New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion. Methods The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a 'clinical map,' by which therapist may orient themselves in-session and plan treatment interventions. Results Emotional processing offers as a trans-theoretical framework for therapists who wish to conduct emotion-based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method. Conclusions The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a 'process map' of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where 'multimorbidities', and/or 'overdiagnosis' and/or 'diagnosis overlap' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the 'here and now'. Methods I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt's 'here and now' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder. Results After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the 'here and now' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message People with substance use disorder (where 'multimorbidities', 'overdiagnosis' or 'diagnosis overlap' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the 'here and now'., Gestalt therapy should not be regarded as a practitioner's toolbox but as a therapeutic process allowing awareness and I-boundaries development in the 'here and now' through authentic and genuine relationships., The therapist's awareness and contact with themselves and their environment are reflected in the therapist's relaxed but awake and aware state of mind as well as their wise, spontaneous and mindful approach. [ABSTRACT FROM AUTHOR]

In the present paper, it is argued that suggestive forms of influence are ubiquitous in human interaction, and represent a neglected phenomenon in clinical psychology and psychotherapy. This phenomenon, which is referred to as ‘normal suggestion’, is analysed as an interpersonal priming process, whereby one person (the ‘suggestor’) influences another (the ‘suggestant’) to respond, feel, or think in a way that is congruent with the suggestor's feelings, intentions, beliefs, or desires. Suggestion may be intentional or unintentional on the part of the suggestor, but it always relies on automatic information processes in the suggestant. The paper discusses the psychological processes which take place in the suggestant, and in the suggestor. A theoretical framework is sketched where each social situation (including each psychotherapeutic treatment) is assumed to be characterized by a certain ‘suggestive climate’, as a function of the frequency with which various ideas, intentions, feelings, etc, are primed. It is also assumed that each person has a certain ‘suggestibility profile’ as a function of his or her cognitive-affective meaning structures. Finally, it is argued that it is impossible to engage in suggestion-free psychotherapy, and that the recognition of this basic fact may improve psychotherapeutic practice and minimize the potentially damaging influence of suggestion in psychotherapy. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper discusses problems in case conceptualization in Cognitive Therapy, particularly in relation to the concept of a ‘core belief’. It is argued that this concept is ill-defined and that its ambiguity can create problems for the clinician. Changes in core beliefs should be associated with the most therapeutic leverage, thus it becomes vital to have reliable ways of identifying them. An illustrative case example is presented of the treatment of a young woman for depression. In our formulation, she held a number of self-referent beliefs which appeared to be differentially responsive to challenge. For example, her doubts about competence at work were much more easily modified than her belief that she was unattractive. This suggested that the latter belief was more central or ‘core’ to our client's view of herself. This approach, together with the charting of how modification of beliefs was related to the alleviation of depression, was taken in the current paper in order to highlight the need for clinical tools to aid conceptualization in distinguishing between core and peripheral processes. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper explores the problem of fragmentation in clinical psychology. It is suggested that this is due to the nature of clinical psychology with its multitude of different concerns, ranging from the cultural to the physiological. To help us become more integrative we could more formally adopt the biopsychosocial approach which explicitly asks the clinician and theorist to focus on the interactions between various levels. This paper also argues that the biopsychosocial approach could be informed by evolutionary theory because this theory provides possible explanations of why certain developmental and social contexts can so powerfully impact on physiology. An evolutionary psychology relevant to clinical psychology can focus on the archetypal nature of human experience, be helpful in exploring therapeutic issues, and avoid some of the reductionist aspects of sociobiology. [ABSTRACT FROM AUTHOR]

Randomized controlled trials (RCTs) are currently the dominant methodology for evaluating psychological treatments. They are widely regarded as the gold standard, and in the current climate, it is unlikely that any particular psychotherapy would be considered evidence-based unless it had been subjected to at least one, and usually more, RCTs. Despite the esteem within which they are held, RCTs have serious shortcomings. They are the methodology of choice for answering some questions but are not well suited for answering others. In particular, they seem poorly suited for answering questions related to why therapies work in some situations and not in others and how therapies work in general. Ironically, the questions that RCTs cannot answer are the questions that are of most interest to clinicians and of most benefit to patients. In this paper, we review some of the shortcomings of RCTs and suggest a number of other approaches. With a more nuanced understanding of the strengths and weaknesses of RCTs and a greater awareness of other research strategies, we might begin to develop a more realistic and precise understanding of which treatment options would be most effective for particular clients with different problems and in different circumstances. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Practitioners can think more critically about evidence provided by RCTs and can contribute to progress in psychotherapy by conducting research using different methodologies. [ABSTRACT FROM AUTHOR]

This article presents a novel clinical application of questionnaire feedback, which focuses on change at the individual question level rather than the totalmean or clinical score level. We termthe approach 'TrackingResponses to Items inMeasures' (TRIM) and promote the key aims to be (1) providing both client and practitioner with feedback on areas of positive change that may be masked by numerical feedback, (2) reinforcingclient strengthsandself-efficacy, (3) exploringpotential extra-therapeutic factors thatmay contribute to the lack of change or deterioration onindividualquestions and(4) establishinga collaborativedialogue relating clients' problems to their goals and the consequent aims of treatment. This paper profiles the clinical origins and technical development of TRIMas a clear, user-friendly display of item change across sessions using colour codes and illustrates the clinical utility through two clinical vignettes. Although the profile of the TRIM method herein uses the Clinical Outcomes in Routine Evaluation OutcomeMeasure, we believe themethod could easily be used with other measures. These could include Generalized Anxiety Disorder 7 and Patient HealthQuestionnaire 9 used in English NationalHealth Service primary care Improving Access to Psychological Therapies services, or disorder specificmeasures for particular problems commonly used in National Health Service specialist services. We suggest TRIMis a practical complement to existing feedback systems, especially in work with clients who may be less likely to show empirically meaningful change on mean itemor clinical score levels. [ABSTRACT FROM AUTHOR]

Emotion-focused therapy (EFT) has increasingly made use of case conceptualization. The current paper presents a development in the case conceptualization approach of EFT. It takes inspiration from recent research on emotion transformation in EFT. The case conceptualization presented here can guide the therapist in listening to the client's narrative and in observing the client's emotional presentation in sessions. Through observing regularities, the therapist can tentatively determine core emotion schemes' organizations, triggers that bring about the emotional pain, the client's self-treatment that contributes to the pain, the fear of emotional pain that drives avoidance and emotional interruption strategies. The framework recognizes global distress, into which the client falls, as a result of his or her inability to process the underlying pain, the underlying core pain and the unmet needs embedded in it. This conceptual framework then informs therapists as to which self-organizations (compassion and protective anger based) have to be facilitated to respond to the pain and unmet needs, so that they might transform it. The conceptual framework can guide the therapist's thinking/perceptions and actions in the session. [ABSTRACT FROM AUTHOR]

This paper presents a further step in the use and validation of a systematic, functional-analytic method of describing psychologists' verbal behaviour during therapy. We observed recordings from 92 clinical sessions of 19 adults (14women and 5men of Caucasian origin, with ages ranging from 19 to 51 years) treated by nine cognitive-behavioural therapists (eight women and one man, Caucasian as well, with ages ranging from 25 to 48 years). The therapists' verbal behaviourwas codified and then classified according to its possible functionality. A cluster analysis of the data, followed by a discriminant analysis, showed that the therapists' verbal behaviour tended to aggregate around four types of session differentiated by their clinical objective (assessment, explanation, treatment and consolidation). These results confirm the validity of our method and enable us to further describe clinical phenomena by distinguishing psychologists' classes of clinically relevant activities. Specific learningmechanismsmay be responsible for clinical change within each class. These issues should be analysed more closely when explaining therapeutic phenomena and when developing more effective forms of clinical intervention. [ABSTRACT FROM AUTHOR]

Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self-identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change. However, the 'therapeutic communities' that have developed since the Second World War have been under-researched. We suggest that the concept of community, as a change process, should be revisited within mainstream scientific research. This paper briefly reviews the historical development of therapeutic communities and critically evaluates their current theory, practice and outcomes in a systematic review. Attention is drawn to recent research on the nature of evolved emotion regulation systems, the way these are entrained by social relationships, the importance of affiliative emotions in the regulation of threat and the role of fear of affiliative emotions in psychopathology. We draw on concepts from compassion-focussed therapy, social learning theory and functional analytical psychotherapy to consider how members of a therapeutic community can be aware of each other's acts of courage and respond using compassion. Living in structured and affiliative-orientated communities that are guided by scientific models of affect and self-regulation offers potential therapeutic advantages over individual outpatient therapy for certain client groups. This conclusion should be investigated further. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Current therapeutic community practice is not sufficiently evidence based and may not be maximizing the potential therapeutic value of a community., Compassion-focussed therapy and social learning theory offer new approaches for a therapeutic environment, involving an understanding of the role, nature and complexities of compassionate and affiliative relationships from staff and members, behavioural change guided by learning theory, a clear formulation based on threat-derived safety strategies, goal setting and positive reinforcement. [ABSTRACT FROM AUTHOR]

Objective Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of theoretical concept on how to define, classify and assess psychotherapy side effects. This paper proposes a model for the definition, classification and assessment of psychotherapy side effects. Method Definitions are provided for 'unwanted events', 'treatment-emergent reactions', 'adverse treatment reactions', 'malpractice reactions', 'treatment non-response', 'deterioration of illness', 'therapeutic risks' and 'contraindications'. We describe processes analysing the causality of negative events and the correctness of treatment. Result A procedural model on how to find, classify and evaluate negative events is described, the unwanted event to adverse treatment reaction (UE-ATR) checklist. Conclusion Recognition of adverse treatment effects is a characteristic of good therapists and treatments. Psychotherapists should be sensitive for negative effects. This can help improve the quality of treatment. The UE-ATR checklist can be used in psychotherapy trials, quality assurance, clinical practice and training of psychotherapists.Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message If you do not find adverse treatment effects, then ask yourself why and do not assume that there are no side effects., The detection and management of adverse treatment effects is not a sign of bad but of good clinical practice. [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]

The present paper discusses theoretical and methodological issues involved in the processes of change in cognitive-behavioural treatment (CBT) of obsessive-compulsive disorder (OCD). Treatment outcome studies showed that CBT is effective in reducing obsessive-compulsive symptoms. However, why and how CBT works cannot be corroborated by comparing pre- and post-assessment. Recently, there has been a resurgence of interest in theory driven process studies. By showing patterns of change over time, process studies can contribute to our insight into the actual mechanisms of change during treatment. We review process research in the field of OCD and discuss methodological issues involved in process studies for this particular disorder. It is concluded that studying the processes of change harbours promising possibilities for bridging the gap between theory and clinical practice. [ABSTRACT FROM AUTHOR]

Cognitive–behavioural therapy can lead to significant improvements in relapse and inter-episode functioning for individuals with an established course of bipolar disorder. Both psychiatric and psychological models of bipolar disorder suggest that there may be additional benefits in offering this approach earlier in the illness course. This paper reports on the application of a modified cognitive–behavioural approach for individuals after first diagnosis of bipolar disorder using a single case approach across seven participants. Evidence is reported for improvements in mood symptoms and hopelessness following treatment, as well as increased self-control behaviours, more stable activity patterns and increased ability to detect and coping with early warning signs. Implications of these initial findings for future research are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The purpose of the studies reported in this paper was to evaluate the function of counterfactual thinking (CT) in depression. In Experiment 1, depressed and non-depressed participants were asked to imagine themselves as the protagonist of a hypothetical situation, and to think counterfactually about three different scenarios. The results showed that there was a similar CT style (in terms of direction, structure and focus of mutation) for the depressed and the non-depressed groups. It was also found that the perceived preparation for a future similar situation increased after CT and, contrary to our hypotheses, this effect was observed in both groups. In Experiment 2, a real-life situation was used (a course examination) in which participants experienced a negative outcome (a poor score on the test). Again, it was observed that depressed and non-depressed participants showed the same CT style, but non-depressed participants were more likely to use CT spontaneously. In addition, the second study showed further differences between the two groups: depressed participants not only showed a lack of cognitive benefits from thinking counterfactually (i.e., after CT they do not feel more prepared for future similar events, nor able to avoid a similar bad outcome, in contrast to the non-depressed participants), but also show a lack of behavioural changes (both intentions to change and actual changes over the subsequent week). In conclusion, these results provide evidence about the function of CT both in depressed and in non-depressed thinking, and highlight both the similarities and differences for these two groups. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. This paper examines the relationships between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive–behaviour therapy (CBT) for psychosis. Method. 29 patient and therapist dyads completed patient and therapist versions of the California Psychotherapeutic Alliance Scale (CALPAS) at session 3 and 21 at session 9. The level of patient homework compliance was rated by therapist and patient, using visual analogue scales, at therapy sessions 3 (29 dyads) and 9 (20 dyads). The Positive and Negative Symptoms of Schizophrenia (PANSS) scale was used to measure psychotic symptoms pre- and post-treatment. Patient suitability for the treatment was measured at session 3, using the Suitability for Short-Term Cognitive Therapy Scale. Results. Only two of the specific hypotheses were supported. There was no significant agreement between patients and therapists on the quality of the therapeutic alliance at session 3, but by session 9 two (patient commitment and working strategy consensus) of the four sub-scales were significantly associated, although there was little evidence that the quality improved over time. Lower patient suitability and insight at session three predicted a lower therapeutic alliance. Therapeutic alliance predicted level of homework compliance. The only significant predictor of outcome was the PANSS positive symptoms sub-scale pre-treatment score. Conclusions. These results suggest that patients who experience psychotic symptoms can be successfully engaged early in therapy as can those with affective disorders but that therapeutic alliance may not have a direct effect on outcome. Copyright © 2006 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]

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]

Psychological interventions, whether directed at cognitive functioning or emotional expression, are frequently offered on a group basis to people with dementia. This paper aims to review the range of therapies offered and to evaluate the evidence for their effectiveness. Four categories of group therapy are identified: early approaches to enhancing well-being (reality orientation, validation and reminiscence); methods aimed at improving memory and cognition (cognitive stimulation and memory training); psychotherapy; and support. Although the review demonstrates the wide range of group work offered, and the creativity of practitioners in this area, relatively little formal evaluation has been undertaken. It is therefore difficult to reach firm conclusions regarding evidence for efficacy. There is a need for more research, and future evaluations should pay increased attention to the selection of appropriate methodologies and outcome measures, the question of clinical relevance and the issue of individual differences in response to intervention. In addition, it will be important to enable people with dementia and their family members to play a role in determining what interventions are relevant and acceptable, and what outcomes are desirable. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Depression in the context of dementia is common, but treatment approaches are under-developed. This paper presents one of the first case series of cognitive therapy interventions with individuals with concurrent dementia and depression. Seven patients diagnosed as having mild/moderate dementia (MMSE range 20–30) each received eight individual cognitive therapy sessions. On average, there was a statistically significant 3.7 point improvement on the Geriatric Depression Scale (30 items). Two of the patients showed a significant Reliable Change Index. It is argued that with some modification a cognitive therapy approach can facilitate a reduction in the level of depression experienced by this particular group. In this sample, impaired cognitive abilities did not prove to be an insurmountable obstacle to the application of cognitive therapy. A number of common themes arose, including attributions about the cause of the cognitive impairment, catastrophic thinking regarding the implications of the diagnosis and the emergence of previous trauma. Whilst a full understanding of the interrelationship between dementia and depression has yet to be developed, a body of literature is developing that describes some of the skills necessary for this type of work. Controlled studies of psychological treatments for depression in dementia are now required. 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]

Several systems have been developed to monitor and feedback information about a patient's responses to psychotherapy as a method of enhancing patient outcome. Feedback is generated from decision rules based on a patient's expected level of progress. Those patients who do not make expected levels of progress or whose progress in therapy is less than adequate are referred to as signal–alarm cases. Research has shown that feedback based on rationally-derived identification procedures increased the duration of treatment and improved outcomes for patients identified as potential treatment failures (signal–alarms). This paper compared two identification methods: a rationally-derived method based on clinical judgments about poor progress, and an empirical method based on statistically-derived expected recovery curves. The concordance of these two methods was examined with regards to detecting signal–alarm cases. Results suggested that the empirically-derived method was more accurate in identifying patients who actually deteriorated. It was able to identify 100% of the cases that had deteriorated at termination, with 85% being identified by the time they had had three treatment sessions. However, the rationally-derived method was faster at identifying signal cases and more likely to identify the most seriously disturbed cases as potential treatment failures. Future directions for research in quality management were identified. 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]

Individual interpersonal psychotherapy, alone or in combination with pharmacological therapy, has proved effective in the treatment of late-life depression. In this paper we present an application of interpersonal psychotherapy in a group format (IPT-G) to treat depressed elderly patients and describe how this individual therapy was adapted to a group setting. The group format seems to lend itself to the interpersonal approach and provides some advantages over the individual setting. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes the treatment of depression in older adults using cognitive behaviour therapy (CBT) as first developed by Beck and colleagues. Evidence for the validity and effectiveness of this form of treatment is considered by reference to published outcome research and meta-analysis studies. Attempts to compare CBT approaches with other forms of psychotherapy have indicated minimal differences in outcome with all therapy modalities reporting beneficial effects in comparison to no treatment or placebo. It is clear that an empirical evaluation of cognitive-behaviour therapy for late life depression is still in its early stages as evidenced by the small number of published studies. The clinical issue of whether therapeutic adaptations are necessary in order for cognitive therapy to be effective with older adults is briefly discussed with reference to the literature from outcome research. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]