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PubMed2006

[Predictors for patients' starting psychotherapy].

BACKGROUND: The aim of this study was to discover prognostic criteria for outpatients' making use of psychotherapy. Data from patients and therapists were collected. SUBJECTS AND METHODS: After initial psychoanalytic interviews, 92 patients at a university psychotherapy outpatient department were asked to complete narrative forms and standardized questionnaires (FMP) regarding their motivation to seek psychotherapy. In addition, the therapists contributed a Global Assessment of Functioning (GAF) and estimate of the initial therapeutic working alliance (iTAB) for each patient. In the follow-up, we investigated patients' actual use of psychotherapy. RESULTS: Sociodemographic variables, personality variables, and diagnoses had only minor prognostic relevance, whereas therapists' assessments of patient resources for therapeutic relationship and work proved to be of high predictive value. CONCLUSION: Positive assessment of a patient's ability for therapeutic working alliance in the initial diagnostic interview is shown to be an important prognostic factor of a patient's entering psychotherapy.

Adult↗
PubMed1996

Determining suitability for home versus community-based ambulatory therapy services for adults with arthritis.

OBJECTIVE: A survey of clients seen by a community-based arthritis therapy service was conducted to investigate how characteristics of clients might provide information to assist in the development of guidelines for services delivered in the home versus in a community-based ambulatory setting. METHODS: Clients completed a self-administered questionnaire, which included the Health Assessment Questionnaire, and a mobility handicap measure. Two indicator variables selected as criteria for suitability for ambulatory therapy were the therapists' rating of client suitability and the clients' report of going out more than once weekly. RESULTS: Based on these indicator variables, 60-76% of clients currently receiving home therapy by this service could potentially receive services in a community-based ambulatory setting. CONCLUSION: The results demonstrate the usefulness of considering client characteristics when deciding whether clients need to be seen at home. This study emphasizes the need to determine the most efficient and effective methods of providing services to people in the community with chronic conditions.

Activities of Daily Living↗
PubMed1998

The role of personal therapy for therapists: a review.

This paper reviews the research literature on personal therapy and makes some recommendations for how future work in this area may be improved. Despite the general acceptance of the importance of personal therapy amongst therapists, there has been relatively little research to evaluate its effectiveness. The vast majority of studies have consisted of surveys of therapists' opinions and experiences of therapy or naturalistic comparisons across therapists who have or have not had therapy. The interpretation of most findings is compromised because of small sample sizes and confounding variables, nevertheless some conclusions can be made. Whilst the majority of therapists feel that they have benefited professionally from personal therapy there is very little empirical evidence that it has any measurable effect on client outcome. However, there is some evidence that personal therapy has a positive effect on those therapist qualities often cited as constructive to client change (e.g. empathy, warmth, genuineness). What is evident is that there is a need for more methodologically sound research as well as a more theoretical understanding of how personal therapy affects clinical practice, before any firm conclusions can be drawn about its usefulness. It is suggested that it may be more useful for future research in this area to focus on therapy process rather than client outcome.

Humans↗
PubMed1975

A-B therapist characteristics vs. psychotherapy outcome: current status and prospects.

For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the "A-B" variable. Various A-B scales have been used to predict differential process and outcome of A and B therapist with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapists-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors "make the difference" seems rather premature. A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled "schizophrenic" or "neurotic" in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-Bresearch, but it clearly demands greater specificity in hypotheses and in research design. The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become "extinct." To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significatly skewed in either the A or B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.

Female↗
PubMed1991

Acceptability ratings and intelligibility scores of alaryngeal speakers by three listener groups.

Acceptability and intelligibility of three groups of alaryngeal speakers were examined: four oesophageal speakers, four tracheo-oesophageal puncture speakers using a tracheostoma valve and four tracheo-oesophageal puncture speakers using digital occlusion. Speakers were video-taped producing samples from the Assessment of Intelligibility of Dysarthric Speech, in addition to a section of spontaneous speech. Three groups of listeners were used: nine speech and language therapists, five ENT surgeons and ten naïve listeners. Specific variables including fluency, rate, quality, intensity, extraneous noise, effort required, pitch and general acceptability were rated on a 7-point scale. Overall no significant difference was found between the speaker groups but listener groups did obtain significantly different intelligibility scores with speech and language therapists scoring highest and ENT surgeons lowest. Analysis suggests that speech and language therapist listeners cope equally well with all speaker groups but ENT surgeons and naïve listeners cope best with tracheo-oesophageal puncture speakers using the tracheostoma valve; only the data from ENT surgeons showed a significant difference between scores for the different speaker groups.

Adult↗
PubMed1997

Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population.

OBJECTIVE: To present initial findings on the validity of a recently developed maltreatment inventory, the Childhood Trauma Questionnaire (CTQ), in a sample of adolescent psychiatric patients. METHOD: Three hundred ninety-eight male and female adolescents (aged 12 to 17 years) admitted to the inpatient service of a private psychiatric hospital were given the CTQ as part of a larger test battery. Structured interviews were also conducted with the primary therapists of 190 of the patients to obtain ratings of abuse and neglect based on all available data, including clinical interviews with patients and their relatives and information from referring clinicians and agencies. RESULTS: Principal-components analysis of the CTQ items yielded five rotated factors-emotional abuse, emotional neglect, sexual abuse, physical abuse, and physical neglect-closely replicating the factor structure in an earlier study of adult patients. The internal consistency of the CTQ factors was extremely high both in the entire sample and in every subgroup examined. When CTQ factor scores were compared with therapists' ratings in a series of logistic regression analyses, relationships between the two sets of variables were highly specific, supporting the convergent and discriminant validity of the CTQ. Finally, when therapists' ratings were used as the validity criterion, the CTQ exhibited good sensitivity for all forms of maltreatment, and satisfactory or better levels of specificity. CONCLUSIONS: These initial findings suggest that the CTQ is a sensitive and valid screening questionnaire for childhood trauma in an adolescent psychiatric inpatient setting.

Adolescent↗
PubMed1988

[Assessment of motivation for achievement in connection with rehabilitation measures].

Reported are the results obtained in assessing young brain-injured patients of a rehabilitation hospital (N = 39, male subjects). "Vocational therapists" had evaluated the patients relative to achievement and achievement motivation variables, and results of routine performance testing had also been available. The KEMB (Konstanzer Erfolgs-Misserfolgs-Batterie--Constancy success-failure battery) was administered in addition. Vocational therapists' ratings and KEMB findings permit the conclusion that the less severely disabled patients tend to hold unrealistically high objectives. Whereas results were found to be consistent in this patient group even across the different methods used for evaluating achievement motivation variables, this did not apply to the more severely disabled subjects. For this latter group, the KEMB achievement motivation findings show hardly any relation with the achievement motivation ratings given, but, rather, with specific performance tests used in organic brain damage and with duration of the condition. It seems that achievement motivation can in the less severely disabled subjects be understood in its usual sense; those with more severe disability on the other hand seem to strongly orientate their motivation on the specific deficits associated with the organic brain damage, thus arriving at possibly more reality-adjusted objectives. KEMB and progress in general performance within the rehabilitation programme--especially in the more severely disabled patients--are found to correlate much closer then is the case for the various performance tests administered routinely for outcome prediction.

Achievement↗
PubMed1992

Stochastic progression of new states in psychotherapy.

This paper presents a study of the stochastic behaviour of the entry of a 5-dimensional, 2400 state, system into new states. Each state consists of five measurements on variables that are sensitive measures of the degree of activated unconscious communication. The data come from six psychotherapy consultation sessions. The study sought to investigate the manner in which patient and therapist progress into new configurations (new states) of the five variables, and the way tension accumulates to the point of overcoming the inertia in the patient/therapist system. We show that the time series that consists of the time intervals between successive new states is a generalized Poisson process. That is, the process is inherently governed by a Poisson parameter that is a continuous piecewise linear function of time. It increases rapidly in the opening moments of an interview and decreases slowly thereafter. This non-linear, non-stationary Markov model fits the data well according to the Kolmogorov-Smirnoff criterion. We discuss the model's implications for the nature of psychotherapy and its participants.

Communication↗
PubMedDate not supplied

[Differential indications in the clinical field. Empirical study of management of indications for analytic individual and group psychotherapy respectively in a psychotherayp clinic ].

This study aims at a systematic description of factors which influence the practice of differential indication between psycho-analytic individual and group-therapy in apsychotherapeutic clinic. The self-description of inclinic patients for who individual therapy was indicated, was compared to the self-description of those who were expected to join a therapeutic group. Two personality-tests (Giessentest "GT" and Freiburger Persönlichkeitsinventar "FPI") and a symptom-questionnaire (Beschwerdenliste"BSB") were applicated. If the self-description fo patients is an important factor influencing differential indication, then a difference should be found in comparison of the self-description of both samples. The result is , that important differences are not to be found, and that, moreover the little differences are variable by the time. In conclusion, patient-centered explorations give no sufficient explanation, why group therapy was indicated in some cases and individual therapy in others. Basing on these results, differential indication in clinical psychotherapy is defined as an interactional process which is influenced by specific cognitive factors of the therapist and his clinical socialisation on the background of variable institution-bound experience.

Humans↗
PubMed2005

Canadian physical therapists' interest in web-based and computer-assisted continuing education.

BACKGROUND AND PURPOSE: Distance education via computer-assisted learning (CAL), including Web-based and CD-ROM learning, confers a number of advantages compared with traditional learning methods. The purposes of this study were (1) to determine the interest of Canadian physical therapists in participating in continuing education using CAL methods and (2) to determine whether interest in CAL was related to type of employment, area of practice, education, computer skill and access, and other demographic variables. SUBJECTS AND METHODS: A random sample of Canadian physical therapists and all members of cardiopulmonary interest groups were surveyed. RESULTS: Of 1,426 survey questionnaires mailed, 69 were returned (58 were unopened and 11 were duplicates). From the remaining 1,357 potential survey responses, 757 responses were received, for an overall response rate of 56%. Seventy-eight percent of the respondents indicated their interest in participating in CAL. Factors associated with interest in CAL included 2 or more hours of Internet access per week, Internet access at both home and work, computer skill, education level, practice area, and belonging to a cardiopulmonary interest group. DISCUSSION AND CONCLUSION: The findings indicate a large positive interest in CAL. Increasing CAL continuing education opportunities could increase options for physical therapists to meet professional expectations for continuing competency.

Attitude of Health Personnel↗
PubMed1995

Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles.

OBJECTIVES: The present study compared the return rate, length of treatment, and treatment outcome of ethnic minority adults who received services from ethnicity-specific or mainstream programs. METHODS: The sample consisted of 1516 African Americans, 1888 Asian Americans, and 1306 Mexican Americans who used 1 of 36 predominantly White (mainstream) or 18 ethnicity-specific mental health centers in Los Angeles County over a 6-year period. Predictor variables included type of program (ethnicity specific vs mainstream), disorder, ethnic match (whether or not clients had a therapist of the same ethnicity), gender, age, and Medi-Cal eligibility. The criterion variables were return after one session, total number of sessions, and treatment outcome. RESULTS: The study indicated that ethnic clients who attended ethnicity-specific programs had a higher return rate and stayed in the treatment longer than those using mainstream services. The data analyses were less clear cut when treatment outcome was examined. CONCLUSIONS: The findings support the notion that ethnicity-specific programs seem to increase the continued use of mental health services among ethnic minority groups.

Adult↗
PubMedDate not supplied

The resource utilization groups system of nursing home reimbursement policies: influences on occupational therapy practice.

OBJECTIVE: This study explored the effects of federal and state reimbursement mechanisms on occupational therapy practice in the nursing home setting, specifically, the selection and scheduling of patients for treatment programs, the content of the therapy provided, and the documentation requirements. METHOD: A questionnaire developed for the study was mailed to the chief occupational therapist in each of the 171 nursing homes located in New York city. Descriptive data on the research variables were collected from 83 respondents. RESULTS: Government regulation and reimbursement mechanisms specifically affected therapists' treatment decisions and patient programming and scheduling in the nursing home setting. Survey results described the clinical impact of the resource utilization groups (RUGs) data collection periods. Negative effects were seen in a substantial incidence of withholding therapies from patients and the decline in the use of some traditional occupational therapy treatments. Positive effects included an increase in staff and equipment and therapists' improved documentation skills. CONCLUSION: Occupational therapy practitioners in the nursing home setting need to find ways to live with the realities of government reimbursement without compromising professionalism or clinical judgment. Documentation is the key to assuring that patients receive the therapy they need. Therapists should be aware of the regulations, document accordingly, and review those cases that were denied reimbursement to learn of documentation errors.

Health Policy↗
PubMed1999

Stoma complications: the Cook County Hospital experience.

PURPOSE: A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications. METHODS: From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. RESULTS: There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (<1 month postoperative), and 105 (6 percent) occurred late (>1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications. CONCLUSIONS: Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.

Adolescent↗
PubMed1994

Male occupational therapists in Ontario: a survey of work-related issues.

Job satisfaction greatly influences an individual's decision to remain in his or her work situation. In many studies, one of the primary reasons for men leaving the profession of occupational therapy was due to job dissatisfaction. The purpose of this study was to further investigate the issue of job satisfaction in male occupational therapists. In March 1992, a survey was mailed to all (n = 82) male occupational therapists practicing in Ontario. A 67% (n = 55) response rate was obtained. This study addressed several factors pertaining to job satisfaction and other work-related issues. When using the median years of OT work experience (ie. seven) to divide the sample, two items were found to be significantly different when using one-way analyses of variance (ANOVA's): "satisfaction with the standing of the profession" and cumulative "satisfaction variable" items. In this study, less experienced male occupational therapists reported themselves to be less satisfied, more inclined to leave the profession or pursue another profession, but did not feel more isolated than their more experienced counterparts. The means of all items revealed a feeling of dissatisfaction on the Likert-scale used in this survey. Although no statistical significance could be achieved, a clear trend existed toward a lower level of satisfaction among the less experienced group.

Adult↗
PubMed2006

Parent-therapist communication and satisfaction with the services of a child development center: a comparison between Israeli parents-Jews and Bedouins.

This study evaluates the level of general satisfaction with the services of a child development center in 2 groups of Israeli parents, Jews and Bedouins. It also assesses which 3 dimensions of therapist-parent communication significantly explain general satisfaction with the center's services. A total of 193 parents of children ranging from 6 months to 6 years of age participated in the study (84% response rate). Parents' attitudes regarding their communication with the center's therapists were evaluated by 15 items that were clustered into 3 dimensions of communication: caring, collaboration, and interest. General satisfaction with the center's services was high in both groups. Relatively high average scores were also given to the studied dimensions of communication. Jews were more satisfied with the center's services than were Bedouins and ranked caring and collaboration significantly higher than did Bedouins. Caring and collaboration best explained the variability in general satisfaction in a multivariate analysis. Being a Jew or a Bedouin parent was not found to be a significant explanatory variable of general satisfaction with the center's services. Therapists' expressions of care and collaboration with parents seem to be key factors in explaining parents' general satisfaction with rehabilitation services in the 2 different cultural groups. These factors should therefore be nurtured in order to ensure parents' satisfaction and participation in the ongoing and demanding process of child rehabilitation. The question of whether this finding is applicable to other populations has to be further studied.

Arabs↗
PubMedDate not supplied

Key ingredients to effective addictions treatment.

Based on previous reviews and recent empirical findings a number of assertions can be made as to what constitutes the active ingredients for the effective treatment of addictive disorders. These key ingredients include the following: easy accessibility of care, treatment flexibility, the involvement of collaterals, good therapists, motivated clients, matching treatment to salient client variables, client accountability for their sobriety, focused treatment approaches, and the follow-up of drop-outs and program graduates. A program developed based on these key ingredients showed a 64% abstinence rate among clients in the Action stage of recovery and a 56% abstinence rate for clients in the Contemplation stage. It is proposed that these key ingredients are generic to all effective substance abuse treatment programs and apply at both a programmatic level and an individual practitioner level.

Health Services Accessibility↗
PubMed2004

[Understand placebo effect to better treat pain].

PURPOSE: The clinical efficiency of every therapeutic, medicinal or other, contains a part of not specific effect, or placebo effect, of which the frequency of appearance and the importance, in the treatment of pain, can be particularly raised. The practitioners use often, deliberately either not, this effect to modulate their therapeutic efficiency, or in a diagnostic purpose to investigate the mechanism of a pain; our objective is to analyze, in the light of a review of the recent medical literature, what the understanding of the placebo effect brings to the treatment of pain. CURRENT KNOWLEDGE AND KEY POINTS: Neurobiologic mechanisms which sub-aim placebo effect begin to be understood by several studies showing the role of endogen opioid mechanisms. Other studies allow better to understand the psychological determiners of the effect placebo: conditioning mechanisms, and/or cognitive variables, as expectations of the patient or the therapist. FUTURE PROSPECTS AND PROJECTS: At term of this review, we will conclude that the use of a placebo has no value of diagnostic test as for the mechanism of the pain; it is neither necessary nor desirable to implement placebo effect in the daily practice because any therapeutics acts by associating specific and not specific effects. The quality of the relation doctor-patient will allow to mobilize not specific factors susceptible to modulate favorably any therapeutic action. For controlled clinical trials, certain methodologies can be envisaged to by-pass the administration of placebo, reducing so ethical constraints bound to their use.

Humans↗
PubMed1976

Survey of psychiatric treatment effectiveness in a medical student clinic.

Eighty patients, from four university-based psychiatric outpatient departments, were seen for four to six weeks by medical students. Eighty-two percent of the patients reported "some" to "marked" improvement. The four groups were studied to determine significant variables. A mutually positive attitude between patient and therapist appeared to be the only significant factor.

Adolescent↗