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PubMed2005

Ethnic matching between therapist and patient in psychotherapy: an overview of findings, together with methodological and conceptual issues.

This article reviews the empirical support for ethnic matching between therapist and patient in psychotherapy. The research has 3 sources: analog studies, archival studies of number of attended sessions and dropout rates, and process-outcome studies of psychotherapy. Clinical trials studying ethnic matching are absent. Empirical support for ethnic matching suffers from low validity and is inconclusive, with few studies of actual psychotherapy. The research is hampered by poor conceptualization of key concepts, difficulties in forming ethnically homogeneous groups for comparisons, and an abundance of uncontrolled within-group variables. Therapist variables, for example cultural sensitivity, are rarely investigated. There is a need for large-scale psychotherapy studies with well-defined key concepts in which the impacts of within-group and therapist variables are investigated.

Acculturation↗
PubMedDate not supplied

[Research on results and psychoanalytic therapy. Experiences in the planning and carrying out of a follow up project].

The present project, now entering the initial stages after a 3-year preparation period, covers all patients admitted to the Psychosomatische Universitätsklinik Heidelberg a the beginning of 1978 or later. The project is a prospective one; therapeutic goals are formulated from a psychoanalytic perspective at the commencement of treatment, establishing criteria by which later treatment results can be evaluated as successful or unsuccessful. Furthermore, various criteria have been elaborated to observe changes in the patients during the waiting-period, in treatment and two years after treatment termination. Determining which patients and patients-groups have been successfully treated and which less so provides a basis for the study of the influence of individual factors in the therapeutic process: the various psychoanalytic techniques used, the patient variables and the therapist variables. The project is designed to affect treatment in progress as little as possible, while at the same time using empirical methods to elucidate treatment results and the factors significantly involved in producing such results. The planning aspect and the difficulties encountered in operationalising such a project centred around "Work in progress" are also dealt with.

Follow-Up Studies↗
PubMed1997

Toward a stepped care approach to treating problem drinkers: the predictive utility of within-treatment variables and therapist prognostic ratings.

AIMS: Cost containment, a central issue in current health planning, encourages the use of brief interventions. Although brief interventions for problem drinkers have proved successful, a portion of such individuals do not change their alcohol use during treatment. DESIGN: Repeated measures design (pre-treatment, within-treatment and 6 months post-treatment). SETTING AND PARTICIPANTS: To identify individuals at risk for continued problem drinking, predictors of post-treatment drinking were examined for 212 problem drinkers who presented for treatment in an outpatient treatment clinic. INTERVENTION: All participants completed a brief cognitive behavioral motivational intervention. MEASUREMENTS: At the pre-treatment assessment demographic, drinking pattern, severity of dependence and other cognitive variables (e.g. self-efficacy, goal choice) were collected. Within-treatment, drinking pattern and cognitive variables such as self-efficacy and goal choice were again measured. FINDINGS: Regression analyses showed that therapist prognosis ratings contributed significantly to the prediction of outcome even when pre-treatment variables were controlled. However, when within-treatment variables were included in the prediction, variables such as within treatment drinking eliminated the predictive utility of therapist prognosis ratings. This pattern held for both percentage of days abstinent and drinks per drinking day at a 6-month follow-up. CONCLUSIONS: It is suggested that a stepped care approach based on prediction models that include clients' within-treatment response can be applied to the treatment of problem drinkers who show little initial response to treatment.

Adult↗
PubMed2004

Protocol- and therapist-related variables affecting outcomes of behavioral interventions for urinary and fecal incontinence.

Biofeedback techniques used to treat urinary and fecal incontinence lack standardization. Most early protocols used a pressure device placed within the vagina or anal canal, or electromyographic (EMG) sensors in the same locations, to measure the external anal sphincter (EAS) or pelvic floor muscle (PFM) contractile function, and most early studies provided feedback from a single physiological transducer. The goal was to improve bowel and bladder control by improving EAS or PFM contractile function. Protocols that have resulted in the most consistent reductions in urinary incontinent episodes used 2 or more channels of physiological information to reinforce stable abdominal and bladder pressures concurrently with PFM contraction. For fecal incontinence, more significant treatment results were derived when protocols measured (1) patient perception of sensory cues associated with rectal distention and potential loss of stool, (2) short-latency EAS contraction when perceiving rectal distention, (3) inhibition of (extraneous muscle) activity that would increase intra-abdominal pressure during EAS contraction, and (4) reinforcement of sustained (up to 30 seconds) contractions rather than only brief 1- to 2-second contractions. Limited data support the use of surface abdominal EMG measures as indices of extraneous muscle activity associated with increased intra-abdominal pressure and anal or vaginal EMG probes to obtain measures of PFM function. Better results may also be obtained when there are at least 4 training sessions, when daily home exercises are prescribed, and when the therapist is well trained and experienced. These inferences are based for the most part on indirect evidence, and more studies are needed that compare different treatment protocols.

Behavior Therapy↗
PubMedDate not supplied

Predictors of restful sleep in a rehabilitation hospital.

The effect of hypnotic use on self-rated quality of sleep and therapist-rated level of alertness was examined in an inpatient rehabilitation setting. We examined what other factors were predictive of a restful sleep in this population. Seventy-five inpatients at the Jewish Rehabilitation Hospital in Montreal were included. Patients were asked to rate the quality of their own sleep on a given night. Night nurses recorded whether sleeping pills had been used and rated patients' sleep and number of awakenings during the same night. Patients were evaluated by their physiotherapists and occupational therapists the next day regarding how well rested they seemed according to three parameters: alertness, fatigue, and level of participation in therapy. Thirty-three percent of the patients received sleeping pills on the study night. Sleeping pill use did not predict patient perception of getting a good night of sleep or the somewhat more objective sleep rating by the night nurse. Whether a sleeping pill was taken was also found not to be predictive of restful sleep as estimated by the physical and occupational therapists. Variables significantly associated with therapists' ratings of apparently restful sleep included number of comorbidities, the nurses' rating of how well the patient had slept, the patients' self-assessment of sleep, and whether the patient felt well rested the morning after sleep. However, the patients' own assessment of sleep quality was negatively related to their performance in rehabilitation therapy. This suggests that patient self-report of sleeping difficulty may not be the best or only guideline to follow when considering intervention such as prescribing sleeping pills, particularly because sleeping pill use seems not to influence either patient perception of sleep or how well rested they seem in therapy.

Adult↗
PubMed1982

The therapeutic value of psychotherapists' values and therapy orientations.

This study investigated novice psychotherapists' personal values and therapy orientations as a therapist variable affecting their therapeutic rapport with psychotic patients. Both types of therapist characteristics were found significantly related to their initial success in terms of rapport with patients, while psychological differentiation and A-B types (Whitehorn and Betz 1954) were not so related. "Equilitarianism" among the values, expressive-experiential qualities among self-declared fortes, and directiveness among therapy orientations were the specific areas found associated with therapists' initial rapport. Conversely, emphasis on "identification" and "suggestive powers" as modes of change produced inverse correlations with success. The results underscore the importance of these variables as therapist attributes but do not necessarily argue for the absolute or intrinsic advantage of these values and doctrines. The composite picture which emerged of the effective therapists suggested equalitarianism combined with some degree of individualism and eclecticism underlying their personal and professional orientations. This may reflect the prevailing actual pragmatism in the professional community, even though it may contrast with their declared ideological loyalties.

Adult↗
PubMed1993

Effects of training in time-limited dynamic psychotherapy: mediators of therapists' responses to training.

Sixteen therapists were enrolled in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy (TLDP). The training program successfully changed therapists' interventions in line with prescriptions of the TLDP manual, but some unanticipated changes ran counter to the intent of the training, including increased negative interpersonal transactions as indicated by process measures such as the Structural Analysis of Social Behavior (SASB). We examined therapist variables, patient variables, and training variables that appeared to mediate therapist responses to the training program. Results indicate that patient difficulty may mediate certain aspects of therapists' responses to training. Therapists with self-reported hostile and controlling introjects showed the greatest technical adherence, which was intriguing because prior research has linked hostile therapist introject to greater frequency of counter-therapeutic interpersonal process. Of special interest were differences in effects of training associated with individual training faculty. This finding, if generalizable, has important implications for manualized therapy research, especially multisite trials.

Adult↗
PubMed2000

Mental health service utilization by victims of crime.

Records of 318 adult and 608 child victims of crime, eligible for Crime Victims Compensation (CVC) in Washington State, were examined. Demographic, crime, and mental health information was collected. A majority of child victims had experienced sexual assault (88%); adults were victims of both sexual (38%) and physical assault (40%). The median number of mental health sessions used by children was 23 sessions, at an average cost of $975 per case to the CVC program. Adults used a median of 15 mental health sessions at a cost of $905. Patterns of treatment utilization were associated with some demographic, crime, and psychological variables. Sexual assault and PTSD diagnosis were associated with greater use for both children and adults. Therapist variables were unrelated to use. Findings are discussed in light of concerns about coverage of mental health services.

Adolescent↗
PubMed1976

Residential treatment of disturbed children and adequacy of their subsequent adjustment: a follow-up study.

To study residential treatment outcome, a follow-up questionnaire sent to families of former child patients was used to assign them to categories of "good", "fair," or "poor" overall adjustment. The three groups were compared on variables such as presenting symptoms, duration of psychotherapy, amount of drug therapy, and prognosis on discharge; several therapist variables were also studied. Findings, some unexpected, are discussed.

Adolescent↗
PubMed2006

Palpation identification of spinous processes in the lumbar spine.

The purpose of this study was to determine the accuracy of manipulative physiotherapists in palpating radiologically identified lumbar spinous processes (SPs). Five experienced manipulative physiotherapists were each allocated a cohort of 15 consecutive low back pain (LBP) patients presenting for X-rays and were asked to use surface palpation to identify the L1, L3 and L5 SPs. Spherical radio-opaque markers were taped to the skin over these palpated points and standard lateral radiographs taken. Measurements were made to determine the proximity of these nominated markers to identified SPs. Seventy-two percent of markers were either placed accurately over the nominated SP or consistently within one SP of the nominated level. Forty-seven percent were accurately placed over the nominated SPs. A greater SP height at L3 and L5, and decreased soft tissue thickness over L5, were associated with an increase in palpation accuracy levels, yet the patient variables of age, sex and body mass index (BMI) had no effect. The strongest effect on accuracy was between-therapist variability. The manipulative physiotherapists used in this study appear to be moderately successful in either palpating a nominated SP or being no more than one spinal level in error. Further research will focus on the choice of palpation procedure and a larger sample.

Adult↗
PubMed2000

The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. A review of empirical studies.

Empirical studies are reviewed, the aim being to investigate characteristics of the therapeutic relationship in cognitive-behavior therapy (CBT) and to identify therapist or patient interpersonal behavior that affects treatment outcome. CBT is characterized by a more active and directive stance on the part of the therapists and higher levels of emotional support than are found in insight-oriented psychotherapies. Therapists express high levels of empathy and unconditional positive regard, similar to those expressed by insight-oriented psychotherapists. Two clusters of interpersonal behavior have been identified that are clearly associated with CBT outcome: (a) the Rogerian therapist variables--empathy, nonpossessive warmth, positive regard, and genuineness; and (b) therapeutic alliance. There is some evidence for the impact on outcome of three additional clusters of patient behavior: (a) the patients' perception of the therapist as being self-confident, skillful, and active; (b) the patients' openness to discuss their problems; and (c) the patients' pretreatment predisposition to change and to accept psychological treatment as a means of achieving this. It is further concluded that relationship factors in general have a consistent but moderate impact on CBT outcome.

Behavior Therapy↗
PubMed2001

Emotional experiencing: to facilitate or regulate?

In the preceding several decades, both empirical research and advances in the theoretical literatures of diverse schools of thought suggest that greater client in-session emotional experiencing is related to therapeutic change. What has yet to be explored and explicated are the variables that indicate when, and with whom, facilitating emotional experiencing may be most and least helpful. This article offers an exploration of the clinical and empirical literatures that bear on this issue. It also suggests preliminary client and therapist variables that point either toward or away from the therapeutic facilitation of client emotional experiencing.

Adaptation, Psychological↗
PubMed1999

Difficulties in treating patients with eating disorders: a review of patient and clinician variables.

OBJECTIVE: Patients with eating disorders (EDs) are often difficult to treat. Despite recent advances in treatment, a significant percentage of patients remain treatment refractory. This paper reviews variables that contribute to these difficulties and recent strategies that focus on increasing patient motivation for treatment. METHOD: The authors relate their clinical experience and synthesize the literature examining aspects of patients with EDs that may contribute to their treatment resistance and therapist variables that may contribute to negative nontherapeutic reactions. RESULTS: Patient variables include the nature of the symptoms that patients experience, issues of trust, the not uncommon failure of ambulatory treatments, and issues related to comorbidity. Aspects of clinicians include lack of understanding of the biopsychosocial pathophysiology of these conditions and lack of experience and appreciation for the countertransferential reactions that these patients evoke in caregivers. CONCLUSIONS: Improving understanding of the reasons for treatment refractoriness in patients with EDs is critical to improving their care. New interventions aimed at enhancing motivation may facilitate this process.

Attitude of Health Personnel↗
PubMed1982

Discharge against medical advice (AMA) from an acute care private psychiatric hospital.

Discharge from psychiatric hospitals against medical advice (AMA) is noncompliance with a physician's treatment regimen. Forty-one patients (26 male, 15 female) discharged AMA from a 32-bed proprietary acute care psychiatric hospital were matched by sex to 41 regularly discharged patients. Data that pertained to account status, marital status, race, month of admission, day of week of admission, time of admission, day of week of discharge, time of discharge, length of stay, religion, diagnosis, employment status, presence of prior psychiatric treatment, attending physician, hospital census, and adolescent census at time of admission were analyzed by Student's t-test, Chi-square, and Pearson correlation coefficients. Significant differences were found for length of stay (p less than .01), time of discharge (p less than .002), presence of prior psychiatric treatment (p less than .0005), and attending physician (p less than .02). Age and length of stay for the regularly discharged group were correlated (r = .47; p less than .001). The failure of this study to support much prior research may be related to differences in hospital setting, client population, and therapist variables.

Adult↗
PubMed2001

A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder.

The increasing demand for treatment for cannabis dependence in Australia and internationally has led to the identification of significant gaps in knowledge of effective interventions. A randomized controlled trial of brief cognitive-behavioral interventions (CBT) for cannabis dependence was undertaken to address this issue. A total of 229 participants were assessed and randomly assigned to either a six-session CBT program (6CBT), a single-session CBT intervention (1CBT), or a delayed-treatment control (DTC) group. Participants were assisted in acquiring skills to promote cannabis cessation and maintenance of abstinence. Participants were followed-up a median of 237 days after last attendance. Participants in the treatment groups reported better treatment outcomes than the DTC group. They were more likely to report abstinence, were significantly less concerned about their control over cannabis use, and reported significantly fewer cannabis-related problems than those in the DTC group. Those in the 6CBT group also reported more significantly reduced levels of cannabis consumption than the DTC group. While the therapist variable had no effect on any outcome, a secondary analysis of the 6CBT and 1CBT groups showed that treatment compliance was significantly associated with decreased dependence and cannabis-related problems. This study supports the attractiveness and effectiveness of individual CBT interventions for cannabis use disorders and the need for multisite replication trials.

Adult↗
PubMed1999

Testing complementary and alternative therapies within a research protocol.

In patients with cancer, the demand for complementary and alternative medicine (CAM) is considerable. Unfortunately, however, for many of these interventions there is a lack of evidence for efficacy, effectiveness and safety in patients with cancer. This review focuses on the prospective, randomised, controlled trial (RCT) as a tool for evaluating CAM. Although a number of difficulties and limitations are acknowledged, the RCT will continue to be the gold standard for evaluating the efficacy, effectiveness and safety of CAM. Developments in clinical trial methodology and in psychosocial oncology have made it more appropriate and feasible to evaluate CAM using RCT methodology. Two different kinds of RCTs are now accepted as valid, namely explanatory and pragmatic trials. The latter does not necessarily require that the patient or the therapist is 'blind' to the treatment being given. Furthermore, pragmatic trials can be designed to take patient preferences into account. A number of practical issues are discussed, including the choice of comparator or control interventions, ways of assessing the effects of individual differences, minimising therapist variability, the problem of finding acceptable inclusion-exclusion criteria and the assessment of treatment outcome. A number of randomised, controlled trials have demonstrated the efficacy, effectiveness and safety of various complementary and alternative interventions (the Cochrane Data Base has now established a CAM field). The publication of positive results from randomised trials of complementary interventions that have not yet been studied using this methodology would do a great deal to alleviate the scepticism of conventional practitioners towards these types of CAM and would facilitate further the integration of complementary and conventional interventions.

Complementary Therapies↗
PubMed2000

Effects of instructions on physical capacities outcome in a workers' compensation setting.

UNLABELLED: Physical Capacity Evaluations (PCE) are often used in Pain Management Programs (PMP) to help determine patients' return-to-work status, continued rehabilitation and compensation. STUDY DESIGN: Groups of patients participating in a 4-week PMP were given the PCE upon entry to the program and again near discharge. Change in performance between the first and second testing was examined. OBJECTIVES: The study was designed to examine the effects of instructions on patients' performance on the PCE. SUMMARY OF BACKGROUND DATA: An extensive literature suggests that, although commonly used, the PCE is of questionable validity in measuring actual physical capacity. METHODS: Patients were assigned to one of 2 physical therapists and given a PCE (in this setting, a dynamic vs static strength test) on admission and near the time of discharge. The assessment by the 2 therapists differed in the instructions they gave their patients for the PCE. Both therapists told their groups, "Do the best you can," but only one therapist added, "This test will be used to determine your job classification." In the second half of the study both therapists gave identical instructions, "Do the best you can," and did not add the explanation. RESULTS: Patients who were informed that the test would be used to determine their job classifications performed considerably worse than those not so informed. When both therapists gave the same instructions, groups performed comparably, suggesting that therapist variables did not explain the differences between the groups. CONCLUSIONS: Instructions on the PCE have an effect on performance.

Journal Article↗