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PubMed2000

Perceptions of confidentiality violations among psychologists.

This study explored psychologists' perceptions of confidentiality violations. One hundred ninety-five psychologists answered questionnaires about a vignette regarding a male therapist accused of violating the confidentiality of a female client. The vignette varied on the following variables: (a) Confidential information was conveyed to either an insurance company or another client, (b) the therapist's account of the violation included either an excuse or a justification, and (c) scapegoating was included or not included in the account. The insurance condition and excuse condition produced more lenient judgements of the violations. However, excuses elicited more negative judgments of the therapist. Scapegoating generally elicited more negative judgments. Differences in the recipient of confidential information and the accounts given for violations have an impact on psychologists' perceptions of confidentiality violations.

Attitude of Health Personnel↗
PubMed1992

Drugs and human interactions.

Some reflections and hypotheses on drugs and human interactions are presented from a psychiatric-psychotherapeutic point of view. Considering the drug both as an agent and a relational mediator, an attempt is made to systematize the interactive whole of the intraindividual and interindividual effects activated by drugs. The hypothesis is presented that pharmacological effects on mind are prevalently due to an energic action and that this action is status-specific, in other words relative to a mental-relational good order of the individual in that particular moment of his history. Concerning the extra-pharmacological effects in therapeutic relations, the values assumed from the drug during the course of the interaction are different and variable, depending in the same individual (patient or therapist) on superimposition of several experiential and semantic orders. Finally some elements of drug relational psychology are introduced.

Behavior↗
PubMed1998

The changing aims of psychoanalytic psychotherapy. An integrative perspective.

The purpose of this paper is to relate traditional psychoanalytic ideas on aims and outcomes to the changing world of contemporary psychoanalytic psychotherapy, with its financial constraints and theoretical and technical innovations. An emphasis on splitting rather than repression, on the nature of the attachment between therapist and patient, and on realistic goals and modest change all characterise contemporary perspectives. Recent developments in the cognitive behavioural psychotherapy literature indicate possible areas of overlap with psychoanalytic psychotherapy. Attachment theory proposes that patient-therapist attunement is likely to be a key variable in outcome. Since attunement is intrinsically responsive rather than directive, the paradox of psychoanalytic 'aimlessness' is inherent in the nature of psychoanalytic psychotherapy.

Awareness↗
PubMed1978

Covert outpatient drug abuse. Incidence and therapist recognition.

One hundred ninety-five consecutive psychiatric outpatients were surveyed for covert drug abuse by a standardized technique for determining opiates, cocaine, barbiturates, and amphetamines in urine samples. On the basis of demographic variables, diagnostic information, and treatment course, patterns of abuse were defined for the 13.3 per cent with positive test results. Covert abusers demonstrated a higher incidence of adverse drug reactions and a less favorable therapy course than controls. Covert abuse was meaningfuly related to misdiagnosis, management problems, and therapist's response. Demographic variables and patient reports of previous abuse were not found to be reliable predicators of covert drug abuse. Urine screening for drug use is recommended as an aid to proper diagnosis of psychiatric outpatients that present diagnostic questions.

Adolescent↗
PubMed1996

Longitudinal profile of early motor recovery following severe traumatic brain injury.

A prospective longitudinal design was employed to describe early (first 6 weeks post-injury) motor function recovery in 16 individuals with severe traumatic brain injury (TBI). Reliable, standardized testing and scoring protocols were used by a physical therapist to evaluate subjects on several different aspects of motor function, including primitive reflexes, equilibrium/protective reactions, and a wide range of motor skills. The findings revealed that subjects demonstrated significant changes (chi 2, p < or = 0.05) between 1 and 6 weeks for the following variables: equilibrium reactions in sitting, rolling prone to side-lying, sitting (supported and unsupported), kneeling, standing (assisted and independently), walking (assisted and independently), stair climbing with the use of the handrail and walking 25 m on even ground. A significant change in ability to sit supported between 1 and 3 weeks post-injury was also observed. In addition, recovery was found to be a heterogeneous process, in that different patterns of recovery were evident for the 26 variables and among individual subjects. The clinical implications for physical therapists involved in the rehabilitation of adults with a severe TBI are discussed.

Adolescent↗
PubMed1987

Attrition in respiratory care: the role of stress versus the role of intrinsic and extrinsic rewards.

UNLABELLED: In this study, I sought to determine the contribution of potential stressors and intrinsic and extrinsic job rewards to the job satisfaction and attrition of respiratory therapists. METHOD: The Stress Index, the Job Dimension Survey, and a demographic questionnaire were completed by 71 therapists in three large metropolitan hospitals. RESULTS: I determined by discriminant analysis that the predictor variables contributing to the decision to leave the work force are dissatisfaction with supervision and people on the job, and role, goal, and financial stress, whereas predictor variables for remaining in the field are performance comfort, self-appreciation, proactivity, and regional aspects. CONCLUSION: Although therapists credit the desire for more job satisfaction and better salary with being responsible for their decision to leave the field, this study shows that dissatisfaction with supervision and co-workers and role, and financial stress are more important.

Hospital Bed Capacity, 500 and over↗
PubMed2004

Suitability for psychoanalytic psychotherapy: a review.

OBJECTIVE: To review empirical studies on outpatients' pretherapy suitability for psychoanalytic psychotherapy. METHOD: A literature search for studies in English was made in the databases MEDLINE, PsychInfo and EM-base. Forty-one studies spanning 20 years were selected for a thorough evaluation. RESULTS: Seventy-five per cent of the studies concerned brief dynamic psychotherapy. In general, application of single measures of suitability had a modest predictive value with correlations in the range of 0.17-0.73. There was no consistent difference between various formats of therapies. Most promising variables with the highest correlations with good outcome were: 'good quality of object relations', 'psychological mindedness' and 'motivation for change'. Some clinical guidelines can be drawn from quantitative research to provide the therapist with best method and format. CONCLUSION: The importance of psychological variables known from the development of the brief dynamic therapies and earlier research was confirmed. Most correlations were modest and single factors could not be identified. Multivariate designs that combine different methods and formats with patient characteristics seem most promising in future predictor-outcome research.

Clinical Trials as Topic↗
PubMed1986

Live and taped relaxation instructions: effects of procedural variables.

Two experiments were designed to assess the effects of relaxation training, therapist presence or absence, live versus taped voice, and response-contingent versus noncontingent instructional progress on measures of subjective relaxation and frontal EMG. In the first experiment, it was found that subjects receiving taped instructions showed greater within-session subjective relaxation and lowering of within-session frontal EMG than subjects in a control condition. No differential training effects of therapist presence or absence was noted. In a second experiment, no significant differences in relaxation measures were found between subjects receiving live, response-contingent instructions and subjects receiving live, noncontingent instructions. Moreover, no meaningful differences in relaxation measures were found between subjects receiving live and taped instructions.

Adolescent↗
PubMed1999

Unpacking the black box of therapy -- a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke.

OBJECTIVE: To describe the components used in the practice of occupational therapy and physiotherapy for people with stroke and to examine variability between services. DESIGN: A time-sampling strategy in which therapists recorded their face-to-face interventions with stroke patients during 12 weeks over a total of 17 months. SETTINGS AND SUBJECTS: Six occupational therapists and seven physiotherapists from four services (three day hospitals and one domiciliary stroke rehabilitation service) recorded interventions with 89 stroke patients recruited to a larger randomized controlled trial. MAIN OUTCOME MEASURES: Frequencies of use of interventions, together with other details about delivery of therapy, were recorded using a data collection booklet and coding system designed by the participating therapists. RESULTS: The median treatment time for a session was 45 minutes. The most frequently recorded components of physiotherapy intervention were 'walking', 'standing balance' and 'upper limb movement pattern', and of occupational therapy 'physical function', 'social and leisure activities' and 'other'. There was variability between the services in terms of median treatment time, use of intervention codes, frequency of treatment sessions, amount of time spent working with assistance and amount of group work. CONCLUSIONS: The findings support the view that occupational therapy and physiotherapy with people with stroke are not homogeneous activities, and vary between therapists and services. Recommendations include further development of the tool, and use of other methodologies to explore the process and nature of stroke rehabilitation.

Aged↗
PubMed2002

Burnout in radiation therapists: the predictive value of selected stressors.

PURPOSE: As cancer caregivers, radiation therapists experience a variety of stresses that may develop into burnout, which has been demonstrated to impact patient care, employee health, and organizational effectiveness. The purpose of the study was to assess the levels of radiation therapists' burnout at three stages. Additionally, the ability of selected workplace variables to predict each of the three stages of burnout was examined. METHODS AND MATERIALS: We used descriptive and inferential statistical analyses on reliable and valid instruments, which measured stress, burnout, and social support. RESULTS: Radiation therapists have high levels of the first two stages of burnout: emotional exhaustion and depersonalization. Although personal stress, organizational stress, guidance, reassurance of worth, and work load predicted 50% or more of the variance in emotional exhaustion and depersonalization, their predictive ability for personal accomplishment was low. CONCLUSION: Efforts to alleviate burnout among radiation therapists within an organization should have positive effects, including increased quality of patient care, improved quality of work life, higher levels of job satisfaction, and commitment and lower staff turnover.

Burnout, Professional↗
PubMed1983

Aftercare of schizophrenic patients: pharmacotherapy and consistency of therapists.

Fifty-seven chronic schizophrenic patients were followed an average of six years after index mental hospital admission and compared on the variables of depot fluphenazine (N = 26) versus oral antipsychotic medications (N = 31), and of consistent aftercare with one therapist (N = 17) versus aftercare with multiple therapists or caregivers (N = 40). The patients who had been maintained on depot fluphenazine scored significantly better on measures of mental status than did those on oral medications, but had a significantly lower score on work performance. The group with consistent aftercare scored better on self-ratings and time without serious psychotic symptoms, but showed no difference on objective mental status when compared with the multiple-therapist aftercare group. The authors conclude that consistent aftercare and provision of medications that do not require a major commitment by the patient to remain well may make a small but significant contribution to the welfare of the chronic schizophrenic patient.

Administration, Oral↗
PubMed1990

The problems of the employment of child and adolescent psychotherapeutical care.

We attempted to clarify the questions as to which variables were important for the acceptance or nonacceptance of a psychotherapy offer to the patients of our department. 1. We attempted to interpret some of the interpersonal variables hermeneutically: pressure of suffering and ability to suffer. We reflected these concepts as regards their ontogenesis and their significance for the initial contact with the therapist and the later compliance with the doctor-patient-relationship. 2. Other variables could be dealt with empirically. A group of patients whose psychotherapy was offered within one year of their initial contact with the clinic was examined. Here it was a question of 106 children and adolescents, 62 of these boys and 40 girls. No statistically significant influence upon the acceptance or refusal of an offer of therapy appeared in the variables--age and sex of the patients; distance between place of residence and clinic; the mother's occupation; psychiatric illnesses in relatives. On the other hand, a statistically significant influence is exercised by the variables--time interval between offer of therapy and its acceptance; therapy with psychopharmaceuticals at the same time; necessity of a depth psychologically-oriented individual therapy.

Adolescent↗
PubMed2003

Transportability of multisystemic therapy: evidence for multilevel influences.

This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.

Adolescent↗
PubMed1993

Effects of training in time-limited dynamic psychotherapy: changes in therapist behavior.

Sixteen therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant-observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways.

Adult↗
PubMed1991

[Empirical study of inpatients viewed from the individual psychotherapy].

There are very few empirical studies which address the effect of psychotherapy in inpatient settings. The author extracted 45 inpatient cases which could withstand detailed statistical analysis among patients who had been admitted to the psychiatric ward of the Tokai University Hospital between 1975 and 1981. Therapists of the cases were interviewed individually and the cases were evaluated retrospectively based on the criteria proposed by the study of Menninger Foundation. Significant statistical improvements were found on every items of evaluation. Furthermore, patients who had shown good interpersonal relationships and motivation at the time of admission showed positive conditions at the time of discharge. Factor analysis of therapeutic variables yielded five factors which delineated the following characteristics of the therapists: 1) having a psychoanalytic orientation, 2) viewing the improvement of symptoms as the goal of therapy, 3) utilizing one's experiences and skills, 4) utilizing a supportive approach, and 5) giving careful attention to the structuring of the psychotherapy sessions. As for the situational variables of the patients, factor analysis yielded only one factor, and multiple regression analysis revealed no significant therapeutic effects. Two types of multiple regression analysis were conducted to determine therapeutic effects and therapeutic variables, but no significant factors were found. Thus, the cases were classified into five groups according to interpersonal relationships factors and were analyzed according to "quantification method II" (Hayashi, C.). The following results were obtained: 1) the structuring of inpatient therapy should correspond with the patient's level of responsibility, 2) as for the structure of psychotherapy, the quality of improvement depended on the closeness to the psychoanalytic structure, i.e., the closer to the psychoanalytic structure, the higher the improvement, 3) the quality of improvement was poor when transference issues (in the sessions) were not brought up during the psychotherapy sessions, 4) the quality of improvement rose according to the degree that dreams and fantasies were dealt with, 5) hospital admission periods of 101 to 120 days showed the highest of improvement, 6) the frequency of sessions did not determine the quality of improvement, 7) the personality of therapist had strong effects when it worked in a negative way, and 8) the quality of improvement corresponded to the degree of the permissive atmosphere in the therapeutic relationship.

Adolescent↗
PubMed1998

Assessment of swallowing and referral to speech and language therapists in acute stroke.

The best clinical assessment of swallowing following acute stroke, in order to decide whether to refer a patient to a speech and language therapist (SLT), is uncertain. Independently of the managing clinical team, we prospectively investigated 115 patients (51 male) with acute stroke, mean age 75 years (range 24-94) within 72 h of admission, using a questionnaire, structured examination and timed water swallowing test. Outcome variables included referral to and intervention by a speech and language therapist (SLT), dietary modification, respiratory complications and death. Of those patients in whom an SLT recommended intervention, 97% were detected by an abnormal quantitative water swallowing test; specificity was 69%. An SLT was very unlikely to recommend any intervention if the test was normal. Inability to perform a water test and/or abnormality of the test was associated with significantly increased relative risks of death, chest infection and dietary modification. A timed water swallowing test can be a useful test of swallowing and may be used to screen patients for referral to a speech and language therapist after acute stroke.

Acute Disease↗
PubMed2000

Race, age, and back pain as factors in completion of residential substance abuse treatment by veterans.

OBJECTIVE: Variables associated with successful completion of residential substance abuse treatment were identified. METHODS: The records of 340 veterans admitted to a 120-day substance abuse treatment program were retrospectively analyzed. The likelihood of successful treatment completion was calculated as a function of race, age, gender, psychiatric diagnosis, past suicide attempts, homelessness, legal history, childhood physical or sexual abuse, parental history of addiction, multiple substance dependence, medical problems, and the race of the therapist. Univariate analysis and logistic regression analysis were used to identify variables that were significant predictors of treatment completion. RESULTS: Overall, 66 percent of veterans completed the program. Eighty-two percent of the veterans admitted to the program were black, and 16 percent were white. The completion rate of black veterans (71 percent) was significantly higher than that of white veterans (49 percent). Veterans completing treatment were significantly more likely to be older, by an average of two years, than those who did not complete treatment. The association between younger age and failure to complete the program was largely accounted for by younger black veterans. Veterans with back pain were significantly less likely to complete treatment than those without back pain. Completion rates did not vary by the other variables examined. In the regression analysis that included age, race, and back pain, each variable, when adjusted by the other variables, was a significant predictor of completion. CONCLUSIONS: White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

Adult↗
PubMed2000

Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review.

To identify underlying patterns in the alliance literature, an empirical review of the many existing studies that relate alliance to outcome was conducted. After an exhaustive literature review, the data from 79 studies (58 published, 21 unpublished) were aggregated using meta-analytic procedures. The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship. For patient, therapist, and observer ratings, the various alliance scales have adequate reliability. Across most alliance scales, there seems to be no difference in the ability of raters to predict outcome. Moreover, the relation of alliance and outcome does not appear to be influenced by other moderator variables, such as the type of outcome measure used in the study, the type of outcome rater, the time of alliance assessment, the type of alliance rater, the type of treatment provided, or the publication status of the study.

Humans↗