Search

Idiographic patient‐reported outcome measures (I‐PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem‐based, and seven goal‐based, I‐PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I‐PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient‐centered approach. However, there are several challenges for I‐PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I‐PROM score. Based on the current state of the literature, we recommend that I‐PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I‐PROM data. [ABSTRACT FROM AUTHOR]

Background and Objectives: The utilization of Between‐Session Homework (BSH) holds a longstanding tradition in the field of psychotherapy. Significantly, it serves as a pivotal catalyst for change within behavioral and cognitive‐behavioral therapies, and has also garnered endorsement within psychodynamic and humanistic‐experiential therapies. While our current conceptualization of BSH is characterized by assimilation and integration, diversity prevails in how BSH is incorporated into the treatment plan, spanning various therapy stages, thus necessitating a customized therapist‐client interpersonal dynamic. Far from being a panacea, the employment of BSH emerges as a highly sophisticated and intricate clinical methodology, demanding a high degree of therapist proficiency and competence to facilitate client engagement. Methods: In this introductory paper, we present an issue of the Journal of Clinical Psychology: In Session that exemplifies the diverse modalities through which BSH can be integrated into clinical practice across various client demographics and within distinct psychotherapeutic paradigms. We place specific emphasis on the pivotal role of BSH and its interplay with proposed mechanisms of change throughout the course of treatment. Results: Initially, we provide an overarching view of the subject and expound on empirical research substantiating the efficacy of BSH in psychotherapy. Subsequently, we delve into strategies for adeptly integrating and monitoring BSH within clinical practice. Conclusions: Our primary objectives encompass affording readers a more lucid comprehension of (1) the content and nature of homework; (2) the influence of BSH on treatment outcomes; and (3) the ways through which therapists can foster client engagement with BSH. Finally, we introduce the six papers comprising this issue. [ABSTRACT FROM AUTHOR]

Pathological narcissism is a personality constellation comprising distorted self‐image, maladaptive self‐esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control‐mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time‐limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism. [ABSTRACT FROM AUTHOR]

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed‐upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed. [ABSTRACT FROM AUTHOR]

Treatment of patients with pathological narcissism presents several challenges and there is paucity of published case reports that document meaningful and durable change in patients suffering from this condition. Using descriptive and atheoretical language, this paper presents a treatment of a young man in his transition from young adulthood to middle adulthood while he was negotiating complex residues of his experiences of growing up along with developmental challenges related to work and love. Against the backdrop of these transitions, the patient was working through various aspects of functioning related to pathological narcissism. Initially, given academic pressures and past romantic disappointments, he was confronting issues related to perfectionism, self‐criticism, and avoidance. While he was able to move past some of these dynamics and function academically, later challenges related to becoming an independent adult led to a retreat into an avoidant state of futility and pessimism. Working through painful family dynamics related to not being seen and controlled, along with a deepening attachment in therapy as well as confrontation with realities of his life, led him to take steps toward greater independence. Thereafter, his treatment focused on learning from life experiences such as a newly developed career and romantic life, accepting the complexity of self and others, and tolerating disillusionments. [ABSTRACT FROM AUTHOR]

Objectives: The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. Methods: The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST‐Q). Results: Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). Conclusion: We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children. [ABSTRACT FROM AUTHOR]

The idea that the therapeutic relationship is at the core of psychotherapy is shared by most therapeutic approaches. Also, an increasing variety of therapeutic approaches, consider experiential techniques as central tools to promote effective therapeutic change. Commonly, it is argued that the creation of a positive, empathic, safe, and solid therapeutic alliance should be a prerequisite for administering these techniques. However, recent evidence is beginning to challenge this cautious stance showing that the introduction of experiential work early in therapy can be safe and effective. So, the quality of the therapeutic relationship may either facilitate or hinder the use of experiential techniques, but the use of these techniques may also strengthen or cause ruptures in the therapeutic alliance. So how do we balance the attention to the therapeutic relationship and the use of active, emotionally arousing techniques? In this paper, we present an issue of the Journal of Clinical Psychology: In Session exploring the complex interplay between therapeutic relationship and experiential practices in light of different psychotherapeutic approaches. We do so by first providing an initial overview of the topic. Next, we introduce the five papers of the issue along with some thoughts on how authors from diverse psychotherapeutic orientations contributed to illustrate and reflect on this multifaceted "dance" between therapeutic relationship and techniques. [ABSTRACT FROM AUTHOR]

Objective: Group‐analytic psychotherapy is probably the most commonly used psychodynamic group therapy in Europe. This paper describes focused group analytic psychotherapy (FGAP), a new time–limited version of this therapy, based on clinical experience and research. The therapy/suitability of patients: It is relatively structured and individually oriented, and designed for patients with a certain ability to tolerate internal and external stress, without decompensating or developing serious behavioral disturbances (they should have a limited degree of personality pathology). Patients entering FGAP should establish a circumscribed therapy focus ahead of therapy, based on some dysfunctional patterns of interpersonal problems, conflicts, and/or symptoms related to a psychodynamic hypothesis/case formulation. Selection/preparation: The paper describes patient selection and preparation, the evolvement of the group process, and how therapist and other group members interact/intervene. Clinical material/vignettes: Central elements in the evaluation and aspects of the therapy are described and illustrated with an extensive case description and clinical material and vignettes from the group process. [ABSTRACT FROM AUTHOR]

The paper aims to show the multilevel and complex cooperation and the inclusion of the psychotherapist leading the psychotherapy in the medical team at the radiotherapy and clinical oncology clinic. We illustrate these interventions with the case of Stan. This 43‐year‐old firefighter was diagnosed with advanced head and neck cancer and pre‐existing mental health problems meeting the criteria of ICD‐10: obsessive‐compulsive disorder, post‐traumatic stress disorder and psychoactive substance abuse. During the treatment, suicidal thoughts and impulses emerged, triggered at the hospital by electronic noises and the feeling of entrapment without a way out. This situation put the patient at high risk and the whole healthcare team needed an urgent effective response. The patient agreed to stay in the secured room, where he was cared for by doctors, nurses, a dietitian, and a psychotherapist. He actively attended daily sessions with noticeable engagement. Psychotherapy sessions focused on alleviating posttraumatic stress disorder and OCD. Mindfulness and breathwork‐based exercises were implemented to increase non‐judgemental self‐awareness and regulate the over‐aroused nervous system. As a result, the patient's mental health has improved and the completion of the cancer treatment was possible. Psychotherapy, good therapeutic alliance, and attentive teamwork effectively managed his mental health and treatment‐related symptoms. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents a randomized controlled trial on assimilative integration, which is aimed at integrating elements from other orientations within one approach to enrich its conceptual and practical repertoire. Elements from Emotion‐Focused Therapy (EFT) were integrated into a form of cognitive behavior therapy: Psychological Therapy (PT). In one treatment condition, EFT was added to PT (+EFT) with the intent to enhance therapists' working with emotions. In the other condition, concepts and interventions based on the socialpsychological self‐regulation approach were added to PT (+SR). Our assumption was that the +EFT would lead to greater and deeper change, particularly in the follow‐up assessments. Method: Patients (n = 104) with anxiety, depression, or adjustment disorders were randomized to the two conditions and treated by 38 therapists who self‐selected between the conditions. Primary outcome was symptom severity at 12‐month follow‐up; secondary outcomes included several measures such as interpersonal problems and quality of life. Variables were assessed at baseline, after 8 and 16 sessions, at posttreatment, and at 6‐ and 12‐month follow‐up. Results: Contrary to our hypothesis, no significant between‐group effects were found. Conclusion: The findings first suggest the difficulty of topping an already very effective approach to psychotherapy. Alternative interpretations were that the EFT training, while corresponding to regular practice in AI, was not sufficient to make a difference in outcome, or that while profiting from the enhancement of abilities for working with emotions, this was outbalanced by negative effects of difficulties related to the implementation of the new elements. [ABSTRACT FROM AUTHOR]

Introduction: Early intervention studies for adolescents and early adults are required to explore the acceptability and effectiveness of psychological therapies across the full range of personality disorders (PDs) beyond just borderline PD. The main aim of the current paper was to describe a Metacognitive Interpersonal Therapy group adaptation for adolescents (MIT‐GA) presenting with PDs featuring overcontrol and social inhibition, and in particular Avoidant PD characteristics. Methods: We report findings from a single case of a female adolescent diagnosed with Avoidant PD providing preliminary data on feasibility and the possible effectiveness of MIT‐GA. Results: Evidence of acceptability and meaningful clinical gains are described. Conclusions: Results suggest that MIT‐GA could be a powerful treatment option in patients with generalized social avoidance who do not currently receive gold‐standard psychotherapeutic treatments. This intervention also appears to be effective and cost‐effective in initiating significant clinical changes in profiles of young patients with non‐borderline PD symptoms. [ABSTRACT FROM AUTHOR]

In the case of psychological treatments, these outcome monitoring tools consist of psychological self-report scales (patient-reported outcome measures, PROMs), which are filled out by the patient usually before each session to capture ongoing therapeutic change. Routine outcome monitoring (ROM) is the regular assessment of patient outcomes to evaluate clinical progress during the course of therapy. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. [Extracted from the article]

This issue of Journal of Clinical Psychology: In Session focuses on the nature and consequences of psychotherapy clients' disclosures, secrets, and dishonesty, with a particular emphasis on the ways in which therapists can best facilitate greater and more honest disclosure. This introduction to this issue reviews the growing theoretical and empirical literature on the frequency, types, motives, and consequences of client and therapist dishonesty (broadly defined); it also reviews the contributions within this issue, noting the welcome focus of the majority of these papers on the nature of client dishonesty in specific disorders (e.g., eating disorders; substance abuse) and/or specific clinical settings (e.g., prisons). Taken together, these papers speak to the ways that therapists may tailor their clinical interventions to match the specific ways that dishonesty manifests in different clinical populations. [ABSTRACT FROM AUTHOR]

This document is an expression of concern regarding an article titled "Interaction of psychosocial and physical risk factors in the causation of mammary cancer, and its prevention through psychological methods of treatment" published in the Journal of Clinical Psychology in 2000. The journal became aware of concerns raised by King's College about 26 papers co-authored by Hans Eysenck and R. Grossarth-Maticek, including this article. King's College found issues with the data and the plausibility of the results. The journal attempted to contact King's College for more information but received no response. Therefore, the journal has decided to issue this expression of concern to inform readers. [Extracted from the article]

This paper provides data on the experiences of 267 patients, all with self‐reported symptoms of depression or anxiety, engaged in an interactive text‐based delivery system for psychotherapy. The paper also offers a case study that illustrates the use of this treatment, indicating ways in which such systems can be useful for patients who may not access or benefit from more traditional therapeutic models. [ABSTRACT FROM AUTHOR]

Perfectionism includes a tendency for high standards for self and others with a clear goal of successful performance in a variety of areas. A perfectionist often reacts with critical evaluations whenever performance falls below these standards. Moreover, perfectionists emphasize personal goals to gauge their worth, neglecting intimate bonds or openness to new experience. At the core of perfectionism lies a view of self as weak, flawed, and easily rejected. Perfectionism can result in chronic tendencies for emotional distress and interpersonal conflict. Treatment aims to explore personal views of self and others, viewing perfectionism as a form of maladaptive coping. When clients understand the role of perfectionism, they can discontinue striving to meet their extreme goals and unrealistic standards. The authors of the papers in the issue present their views on how to treat these maladaptive tendencies according to their preferred therapeutic orientation. [ABSTRACT FROM AUTHOR]

Abstract: The election and postelection policies of Donald Trump have seeped into the psychotherapy sessions of many clients, in ways that are somewhat unique but also somewhat reminiscent of the ways that other dramatic social–political events, including 9/11 and the social divisions that were characteristic of the 1960s, were brought into the treatment room. The nine articles within this issue—seven papers from practicing psychotherapists, one from an executive coach, and one empirical paper—suggest strongly that the political events surrounding the election of 2016 have become a significant part of psychotherapeutic discourse for many clients, that many therapists have been willing participants in such discussions, and that a focus on political issues (broadly speaking) can have important clinical benefits, facilitating the therapeutic alliance and leading to greater understanding of long‐standing client problems and interpersonal functioning. Taken together, these papers lead to the conclusion that, at a minimum, clinicians need to be sensitive to the very real possibility that their clients are acutely aware of and affected by the political events surrounding the 2016 presidential election and may welcome open discussion of these events and their consequences. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on a focus‐group discussion of four expert psychotherapy researchers facilitated at an international conference from the Society of Psychotherapy Research. A discussion was facilitated to explore their perspectives on psychotherapy practices of personal growth (intentionally working towards a strengthened sense of autonomy, mastery, and self‐acceptance) in different countries (United States, Canada, Argentina, and Chile) and different modalities (psychoanalysis, humanistic therapy, and cognitive behavioral therapy). Methods: Following the conference, the audio recording of this discussion was transcribed and analyzed using consensual qualitative research methods. Results. Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma. Results: Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma. Conclusion: Future research examining the cost‐effectiveness and benefits of psychotherapy for personal growth is warranted. Building on the six domains, specific future research projects on the evidence‐based practice of psychotherapy for personal growth are suggested. [ABSTRACT FROM AUTHOR]

As in the Vietnam era, the wars in Iraq and Afghanistan are not the focus of the nightly news. Nevertheless, there are countless numbers of individuals enlisting, serving, deploying, redeploying, and leaving military branches every day. These individuals are underserved in many ways, especially after they end their formal relationship with their service. The purpose of this introduction is to describe the ongoing concerns and psychological problems of our military personnel and the efforts, described by the authors of papers in this issue, to address these concerns and problems. [ABSTRACT FROM AUTHOR]

Incarcerated individuals experience mental health symptoms resulting from the stress of incarceration, as well as from prior histories of trauma. In addition, the growth of the prison population and the increase in sentence lengths have eroded conditions in correctional facilities, leading to increased stress, trauma, and other mental health issues. Psychologists can help incarcerated individuals address existing mental health issues, cope with the trauma of incarceration, and prepare for successful re‐entry into society. However, the effectiveness of psychotherapy may be hampered by a number of factors that inhibit client disclosure in correctional settings. Based on interviews with forensic psychologists and an incarcerated patient, this paper explores the circumstances that prevent disclosure in correctional settings and proposes recommendations for psychologists to facilitate disclosure to improve therapeutic effectiveness. [ABSTRACT FROM AUTHOR]

This paper summarizes a course of psychotherapy in which the therapist integrated concepts and strategies from psychoanalytic and cognitive‐behavioral orientations in treating a gay man with HIV‐associated neurocognitive disorder and a history of sexual abuse. The article highlights the psychologically protective function that deception served in the treatment of this patient, and how the therapist navigated the fragility of these inner fictions. Further, it illustrates the way in which the therapist–patient dynamic was colored by a psychoanalytic process known as projective identification. [ABSTRACT FROM AUTHOR]

Cultural competence refers to our ability to understand, engage, and treat patients from diverse backgrounds or belief systems different from our own. Although addressing culture and cultural difference as part of diversity is important, it is also critical to consider how systemic and economic forces influence the patient's presenting problem and clinical interactions. Summarizing research on cultural competence, attachment, and inequality, this paper reconsiders diversity considerations by discussing how structural inequities disrupt one's ability to trust others interpersonally and across cultural difference. Psychotherapy from this point of view is a relationship that attempts to address the effects of inequality at an individual level by repairing trust and using that trust to work toward change. To illustrate this perspective, the author presents a case of a Puerto Rican migrant whose developmental and family history was impacted by colonial, racial, cultural, and socioeconomic inequality. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the ways empirically supported treatments (ESTs) help patients, therapists, and institutional administrators contain anxiety regarding complex human problems. Method: The authors synthesized relevant literature with their experience as clinicians and psychotherapy researchers. Results: ESTs may manage patient anxieties by framing their symptoms in clearly stated mechanisms and relying on a therapist who is an "expert" capable of healing them quickly. ESTs allow therapists to streamline treatment decisions and minimize intersubjective aspects of treatment which reduces the complexity of therapy. ESTs assist institutional administrators in the top–down dissemination of treatments and limit concerns about malpractice and insurance reimbursement by providing assurance that interventions have been vetted. Conclusions: While recognizing the benefits of ESTs, relying on ESTs to manage anxieties may diminish the importance of patient factors and clinical judgment, the other critical aspects of evidence‐based practice, and thus limit the potential of clinical practice to reduce human distress. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. Method: In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. Conclusion: The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies. [ABSTRACT FROM AUTHOR]

Abstract: When there are politically polarizing events taking place in the world, can it be useful for a therapist to disclose his or her political views within the context of a psychotherapeutic dyad? This paper examines this question through the example of a Marxist therapist working with a politically conservative patient in the polarized political atmosphere following Donald Trump's election to the Presidency of the United States. Also explored are the patient's dynamics that might have made it particularly salient for the therapist to eschew a more neutral stance. The theoretical and technical bases for this disclosure are examined via the Affect Theory of Silvan S. Tomkins as well as the Person‐Centered Therapy of Carl Rogers. The family history of the patient is examined to further understand the context in which the political/therapeutic interactions take place. [ABSTRACT FROM AUTHOR]

Abstract: This paper offers an integration of social issues, psychoanalytic theory, and analytic experience in the treatment of a patient whose political values and identifications differed significantly from my own. Our political leanings facilitated a dynamic tension of difference, power, and aggression that mirrored how each of us felt in relation to the current social‐political milieu. In particular, the sadomasochistic dynamics on display in the treatment offered me a unique way of understanding my relationship with my patient and opened new ways of understanding the political present. In the end, I learned to stop worrying about getting rid of anger, aggression, and splitting, and instead to embrace what these feelings and behaviors can tell me as a therapist, and what they can inform for my patients about the nature of relationality, identity, and difference. [ABSTRACT FROM AUTHOR]

Abstract: This paper addresses how musical metaphors can be useful in understanding the substructure of psychotherapy by considering how our patients resonate inside us, what that resonance does to and for us, and how these acoustic properties seem to be foundational in the construction of the therapist as an instrument of healing. From this perspective, psychotherapy involves “living music” with another person, as the process of psychotherapy always involves the passing of sound back and forth across an interpersonal divide. This requires both psychotherapist and patient to step into the roles of performer and audience member. Additionally, psychotherapists can be meaningfully thought of not only as an “instrument” of healing, but also an “instrumentalist” who produces unique “therapeutic music.” Moreover, the patient and therapist cocreate the concert space in which treatment is performed. This concert space has unique “architectural,” and thus acoustic, properties within which we hear and remember one another. [ABSTRACT FROM AUTHOR]

Abstract: The physical spaces in which we conduct psychotherapy are an important yet underacknowledged aspect of psychotherapeutic work. Although a few contemporary publications have provided suggestions for the creation of welcoming, comfortable, and efficient practice spaces, considerations of what it means to transform a room into a therapeutic space have remained largely absent from recent literature. This paper reviews the existing literature on this subject and describes the ways in which the therapist's office is intimately tied to several processes of the therapy itself, by way of creating an adaptive environment that is able to meet the needs of both therapist and client over the course of their work together. [ABSTRACT FROM AUTHOR]

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

Affirmative therapy is a type of psychotherapy used to validate and advocate for the needs of sexual and gender minority clients. Therapists use verbal and nonverbal means to demonstrate an affirming stance toward lesbian, gay, bisexual, and transgender (LGBT) clients. Although this therapeutic approach can be used with LGBT individuals across the lifespan, the case presented in this paper highlights the benefit of using this approach with older LGBT individuals. Discussion of the unique challenges faced by older LGBT people will be followed with an illustrative case that shows ways that affirmative therapy can help individuals achieve greater self-actualization. The case formulation and conclusion will highlight specific ways that therapists can convey an affirmative stance and help clients feel welcome and accepted in the therapeutic setting. Recommendations for environmental cues, intake questions, and treatment skills will be offered at the conclusion. [ABSTRACT FROM AUTHOR]

In this introductory paper to the Global Mental Health volume, the inception and development of the filed in the last 15 years is reviewed, placing an emphasis on a series of pivotal turning points. A critical delivery strategy, task-shifting is briefly described, as well as the fundamental principles of Interpersonal Psychotherapy (IPT), an evidence-based psychotherapy being adapted and delivered in low-resource settings. Nine case studies by the trainees, supervisors, or local providers from India, the United States, Haiti, Israel, Colombia, and Kenya, presented in this volume, illustrate the prevention and treatment processes or in-depth assessment of 'psychological distress' as locally defined and expressed. [ABSTRACT FROM AUTHOR]

Objectives: Increasing evidence suggests that deficits in mindfulness (awareness, attentiveness, and acceptance of the present moment) play a role in a range of disorders involving behavioral dysregulation. This paper adds to that literature by describing a transdiagnostic psychotherapy (Mindfulness & Modification Therapy; MMT) developed to target behavioral dysregulation. Design: An open-treatment pilot-trial investigated the feasibility, acceptability, and pre-post effects of MMT targeting women ( N = 14) court-referred for alcohol abuse/dependence and aggression. Results: Pre-post comparisons revealed significant decreases in alcohol use, drug use, and aggression. In addition, the retention rate was 93%. Conclusion: Preliminary evidence suggests that MMT is a feasible and acceptable treatment that decreases dysregulated behaviors such as substance use and aggression, while also potentially increasing retention. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1-17, 2011. [ABSTRACT FROM AUTHOR]

This paper proposes a first step in deciding whether it is necessary to develop a cultural adaptation by comparing the cultural characteristics of an intervention with the same characteristics of a specific group. Larger cultural differences suggest a greater need to conduct a cultural adaptation. This recommendation stems from the cultural match theory (CMT) which, explains that therapeutic outcomes increase as interventions are more similar to the cultural characteristics of specific treatment groups. However, the CMT has rarely been tested, partly because strategies to effectively measure the cultural characteristics of an intervention are still lacking. This article addresses this gap by assessing two dimensions of the self-orientation relevant to cultural adaptations, namely, idiocentrism-the tendency to define oneself in isolation from others-and allocentrism-the tendency to define oneself in relationship to others-through a content analysis of guided imagery scripts. Two independent evaluators analyzed 123 guided imagery scripts (published during 1989-2008) using 6 theoretically derived categories to analyze idiocentrism versus allocentrism. Results indicated that idiocentric elements were 1.5 to 52.3 times more frequently used than were allocentric ones. The implications of these findings for the development of culturally adapted interventions are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 00:1-10, 2010. [ABSTRACT FROM AUTHOR]

Acceptance and mindfulness methods that emphasise the acceptance rather than control of symptoms are becoming more central to behavioural and cognitive therapies. Acceptance and Commitment Therapy (ACT) is the most developed of these methods; recent applications of ACT to psychosis suggest it to be a promising therapeutic approach. However, investigation of the mechanisms of therapy within this domain is difficult because there are no acceptance-based measures available specifically for psychotic symptoms. This paper describes the preliminary evaluation of a self-report instrument designed to assess acceptance-based attitudes and actions in relation to auditory and command hallucinations. Following initial scale development, a 56-item version of the Voices Acceptance and Action Scale (VAAS) was administered to 43 participants with command hallucinations as part of their baseline assessment in a larger trial. Measures of symptoms, quality of life, and depression were also administered. The scale was examined for reliability using corrected item total statistics. Based on this method, 31 items were retained. Internal consistency and test-retest reliability for the 31-item VAAS were acceptable. Subsequent examination of construct validity showed the VAAS to correlate significantly in the expected directions with depression, quality of life, and coping with command hallucinations. It also discriminated compliance from non-compliance with harmful command hallucinations. Although these results are preliminary and subject to a number of limitations, the VAAS shows promise as a useful aid in the assessment of the psychological impact of voices. © 2007 Wiley Periodicals, Inc. J Clin Psychol. [ABSTRACT FROM AUTHOR]

Using data from a large longitudinal naturalistic study on course and outcome of psychotherapy, the present paper investigates the amount of interpersonal problems in an outpatient sample (N = 714) and the extent to which a patient's interpersonal problems determine the quality of the helping alliance. The results show that at the beginning of psychotherapy, subjects reported significant interpersonal distress on 2.43 of the eight IIP scales. Interpersonal problems were most prevalent in the octants “introverted,” “submissive,” “exploitable,” and “overly nurturant.” Furthermore, interpersonal problems were related to the helping alliance in different ways: “Too hostile” patients reported relatively poor initial helping alliance whereas “too friendly” patients rated more favorably the relationship to the therapist. However, interpersonal problems at intake did not predict the therapeutic alliance one-and-a-half years later. The results indicate that a poor initial helping alliance might be reversed during the course of treatment. Implications for future research and psychotherapeutic practice are discussed. © 2004 Wiley Periodicals, Inc. J Clin Psychol. [ABSTRACT FROM AUTHOR]

Based on a narrative account, this paper highlights and reviews the experiences of the author, a psychologist, experiencing a chronic illness. Areas covered include coping with doctors and medical personnel, adjusting to illness, complying, actively coping, and even, at times, resisting unwarranted medical procedures. Experiences such as loss of trust, a sense of isolation, re-working relationships, and generative reaching-out are also covered. Some positive consequences of chronic illness for personal growth are suggested. Suggestions for conducting psychotherapy with clients who are dealing with serious chronic illness are made. [ABSTRACT FROM AUTHOR]

This article focuses on the difficulties facing the neophyte trainee in the filed of psychotherapy. Three areas of such difficulties are identified, and discussed: feelings of inadequacy and incompetence, anxieties concerning supervisors, and confusion concerning multiple theoretical views of clinical work. Two vignettes from the early training of the paper's junior authors illustrate and discuss these problems and their resolution in applied contexts. A conclusion is offered which emphasizes the value of supervisory recognition of these dimensions of trainees' experience, as well as their potential for modeling processes of growth that are likely to help supervisees' patients as well. [ABSTRACT FROM AUTHOR]

After nearly two decades of intensive investigation, adult borderline disorders have achieved wide currency, including a substantial psychological literature. The literature on the diagnostic psychological assessment of borderline children is, in contrast, quite sparse. This paper examines manifestations of childhood borderline conditions on the Rorschach, discusses them in light of current theoretical conceptualizations of adult borderline psychopathology, and explores the relationship between child and adult borderline disorders and the genesis of these conditions. [ABSTRACT FROM AUTHOR]

This study evaluated the equivalence of the original MMPI and the shortened MMPI-2 versions of the Barton (1953) Ego-strength scale, an important research scale. Three hundred fifty-five subjects took the MMPI-2 and the 16 MMPI-1 items dropped from the original scale. The omitted items appear to contribute little to the original scale. The revised version compares favorably with the old in terms of internal consistency, and the two versions are highly intercorrelated. Confirmatory Factor Analysis indicates that four of Stein and Chu's (1967) five groupings of the original items provide a reasonably good fit for the MMPI-2 as well. Compared to the original, the new version was slightly more correlated with other paper-and-pencil measures of psychological health and well-being. [ABSTRACT FROM AUTHOR]

The article focuses a study, which presents the normative data stratified by age and sex for 12 neurosychological tests. The present paper presents data collected from a large sample of neurologically intact, nonpsychiatric adults on 12 tests used in neuropsychological assessment. These tests were added to the H-R battery by the first author to permit finer differentiation of abilities and to facilitate localization and lateralization of brain function. Evidence for the augmented H-R battery's differential sensitivity to brain damage was obtained in an early study that employed factor analysis of the scores from a brain

This article focuses on the treatment of the adult blind patients. Over the past two decades a trend that has had dramatic implications for people with disabilities has been evident, that is, the integration of the disabled in general, and blind people in particular, into the wider society. The demand for psychological services by blind people has meant that an increasing number of clinical psychologists are faced with the need for clinically important information on blindness. The present paper is an attempt to develop a clinically useful conceptual framework for viewing the adult blind patient in psychotherapy. For the congenitally blind adult patient in psychotherapy, the treatment focus is the derivatives of the developmental deficits that have resulted from lack of vision in the earliest years of life. It is important to note that the impediments in human attachment, object permanence, and self-representation are potential hazards of congenital blindness.

This paper reports on the development and validation of an automated referral system. While a complete answer to the question posed earlier requires a demonstration that treatment gains are maximized, the current study only considers the efficacy of an automated procedure relative to clinical staff assignment. In short, the hypothesis examined is that treatment assignment of inpatient alcoholics can be accomplished via automation without a loss of effectiveness and with greater efficiency, when compared to assignment by a clinical treatment team. Establishing the efficacy of an automated referral system is an initial step toward the maximization of treatment benefits and, consequently, is the focus of the discussion.

This article presents information on the application of role playing, as a research technique, in a test of Sarbin's self role congruency theory. The present study attempts to provide further confirmation of Sarbin's congruency theory, in this case within a setting analogous to psychotherapy. It was believed that by using Ss who were playing the roles of therapist and clients it would be possible to obtain information relevant to the effects of self-role congruency and incongruency in the psychotherapeutic interaction. A secondary purpose of the study was to provide data on the validity of pencil and paper tests that purport to measure role-playing aptitude. Forty nine male Ss from various undergraduate classes volunteered to role play either a therapist or a client in a half-hour role-playing session designed to simulate psychotherapy.

This article studies the treatment of sexual dysfunction. The newness of the concept of sex therapy, together with the lack of adequate information about what specifically is being done with what success, may lead to confusion. There seems to be general agreement that sex therapy works, but why and when and bow are questions yet to be answered. Methodological problems are to be found in most studies to date. While researchers consider some of these issues in the following review, a detailed critique of each individual study is beyond the scope of the present paper.

This article constructs a Terminators-Remainers scale composed of those items of the Social History Questionnaire that best differentiated between Terminators and Remainers. A formidable problem encountered in clinical practice concerns the large number of clients who start psychotherapy but for various reasons terminate treatment prematurely. The initial sample of this study consisted of 95 clients accepted for psychotherapy during a 11-month period at a small mental health clinic. The measure used was the Social History Questionnaire, a 393-item, forced-choice, pencil-and-paper intake interview.

The preparation of psychotherapy supervisors to provide supervision services is examined briefly in this paper. The persistent paradox of psychotherapy supervision training-that the supervisor role is considered highly important in graduate and internship programs, but graduate and post-graduate training in how to be a supervisor is very limited-is discussed. The need to resolve this paradox in psychology training is considered. [ABSTRACT FROM AUTHOR]