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PubMed1993

Dropping out of marriage and family therapy: a critical review of research.

The lack of attention given to research on the premature termination by clients in marriage and family therapy is evident in research reviews of the dropout phenomenon in psychotherapy. This article is an attempt to fill that void. The research literature on dropping out of family therapy is reviewed and organized. Studies in this area tend to focus on four kinds of variables: client characteristics, therapist characteristics, therapy process variables, and interventions. Stable findings in each of these areas are pointed out. Both limitations and recommendations for future research are discussed.

Family Therapy↗
PubMed2005

Secondary traumatic stress among disaster mental health workers responding to the September 11 attacks.

Relationships between secondary traumatic stress (STS) symptoms and therapist characteristics and assignment variables were examined for 81 disaster mental health (DMH) workers who responded to the terrorist attacks of September 11, 2001. Higher STS was associated with therapist variables of heavier prior trauma caseload, less professional experience, youth, and therapist's discussion of his or her own trauma or trauma work in his or her own therapy. Therapist gender and personal trauma history were not significantly related to STS. Assignment variables associated with higher STS included longer length of assignment and more time spent with child clients, firefighters (who suffered great losses in the tragedy), or clients who discussed morbid material. Recommendations for practice include informing DMH recruits of therapist risk factors and assigning at-risk DMH workers to lower-risk assignments.

Adult↗
PubMed1990

Verbal affective expression during group and individual psychotherapy. Towards a description of therapist- and setting-related variables.

The paper deals with a comparison between verbal affective interventions by the same psychoanalyst in different therapeutic settings, individual and group therapy. Since the same therapist is involved, an exploration of interactional aspects of his therapeutic style becomes possible, taking into consideration his theoretical allegiance and his hypotheses about the structure and development of the psychotherapeutic milieu. The conformation of therapist-group and therapist-individual dyads shows a high thematic concordance across both settings, particularly with regard to separation anxiety, but also to a significant degree in relation to other verbally expressed affects. However similar the correlations do appear, there remain certain differences in the affective interactions between group or individual patients and the therapist that are due to developmental aspects of the therapeutic relationship in either setting.

Adult↗
PubMed1994

Stuttering therapy with British-Asian children. II: Speech and language therapists' perceptions of their effectiveness.

This paper tested hypotheses arising from the literature on the treatment of stuttering in British-Asian children and adolescents, using data obtained from a postal questionnaire completed by 87 therapists. The results showed therapists treating lower numbers of Asian clients than expected, but perceiving their therapy to be less effective with their Asian clients than with their British ones. The variables affecting therapists' perceived success were not those expected. Greater experience with Asian clients did not increase perceived success, nor did Asian therapist and client sharing broadly the same cultural background guarantee success. A satisfactory interpreter service did not lead to a higher perceived success rate, nor did postgraduate training or making special changes to usual working practices. On the contrary, therapists in the last two categories were less likely to perceive success with their Asian clients. Therapists identified a very wide range of cultural factors needing special consideration in therapy, but consensus centred around parental attitudes to stuttering and to therapy.

Adolescent↗
PubMed2005

Pain management procedures used by dental and maxillofacial surgeons: an investigation with special regard to odontalgia.

BACKGROUND: Little is known about the procedures used by German dental and maxillofacial surgeons treating patients suffering from chronic orofacial pain (COP). This study aimed to evaluate the ambulatory management of COP. METHODS: Using a standardized questionnaire we collected data of dental and maxillofacial surgeons treating patients with COP. Therapists described variables as patients' demographics, chronic pain disorders and their aetiologies, own diagnostic and treatment principles during a period of 3 months. RESULTS: Although only 13.5% of the 520 addressed therapists returned completely evaluable questionnaires, 985 patients with COP could be identified. An orofacial pain syndrome named atypical odontalgia (17.0 %) was frequent. Although those patients revealed signs of chronification, pain therapists were rarely involved (12.5%). For assessing pain the use of Analogue Scales (7%) or interventional diagnostics (4.6%) was uncommon. Despite the fact that surgical procedures are cofactors of COP therapists preferred further surgery (41.9%) and neglected the prescription of analgesics (15.7%). However, most therapists self-evaluated the efficacy of their pain management as good (69.7 %). CONCLUSION: Often ambulatory dental and maxillofacial surgeons do not follow guidelines for COP management despite a high prevalence of severe orofacial pain syndromes.

Adult↗
PubMed2005

Predicting therapist adherence to a transported family-based treatment for youth.

This study examined relations between therapist, caregiver, and youth characteristics and therapist adherence to multisystemic therapy (MST). Participants were 405 therapists in 45 organizations and the 1,711 families they treated with MST. Therapist perceptions that the flexible hours required to implement MST are problematic predicted lower adherence. Therapist demographic variables, professional training and experience, endorsement of the MST model, perceived difficulty and rewards of doing MST, and perceived similarity to treatments previously used did not predict adherence. Therapist-caregiver similarity on ethnicity and gender predicted higher adherence. Low caregiver education and African American ethnicity predicted higher adherence. With the exception of youth psychosocial functioning, indicators of severity of youth problems did not predict adherence.

Adult↗
PubMed2000

When expertise and ethics diverge: lay and professional evaluation of psychotherapists in Israel.

Do psychotherapists' unethical practices influence how they are perceived? The 202 Israeli lay and professional psychology participants rated systematically varied descriptions of effective therapists and potential clients under conditions of no difficulties (standard), practice without a license, and a previous sexual boundary violation on indexes of evaluation and willingness to refer. Participants completed a measure of important variables in therapist selection. Effective standard therapists were rated most favorably, unlicensed therapists were rated favorably, and therapists who violated sexual boundaries in the past were rated least favorably. When results were analyzed by respondent characteristics, laypersons rated unlicensed professionals (p < .01) and sexual boundary violators (p < .0001) more positively than did clinical psychologists. Men rated the violators more favorably than did women (p < .05). Factor analysis of therapist selection measures identified professional and personal factors, but only the former were associated with ratings of "problem" therapists. The results underscore the gap between ethical standards and applied decisions made by professionals and laypersons. Further investigation is needed to ensure quality care in both professional and consumer approaches to psychotherapy.

Attitude of Health Personnel↗
PubMed1996

Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. Twenty-nine depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression. Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results.

Depressive Disorder↗
PubMed1999

[Psychodynamic personality markers of psychotherapists in relation to therapy outcome].

In the Berlin psychotherapy study data were collected not only from the patients but also from the therapists. Thus, the influence of personality variables of the therapists on the multidimensionally registered therapy success could be studied. To this end a nonlinear k-sets canonical analysis was applied resulting in a sample-specific optimal scaling. The relationship pattern of the two sets of variables found was satisfactory as regards the internal criteria of the programme as well as its clinical meaningfulness. The results can be used in similar studies for specifying therapist-related hypotheses.

Adult↗
PubMed1997

A three-paradigm treatment model using soft tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study.

It is not uncommon for physical therapists to report difficulty in treating certain subjects with chronic idiopathic low back pain. The purpose of this case study is to present a three-paradigm model of intervention that may be adapted to the treatment of such cases. The model consists of: 1) relaxation paradigm, consisting of pain modulation procedures; 2) corrective paradigm, involving manual techniques and exercise to correct specific faulty biomechanical alignment(s) eg., pelvic asymmetry); and 3) integrative paradigm, utilizing guided movement/mobilization techniques for improving the subject's overall pattern of posture and movement. The case study of a young adult with chronic low back pain correlated with unilateral innominate bone rotation is presented to illustrate the three-paradigm approach. Over six sessions, the subject received a corrective (sessions 1-3) and an integrative treatment protocol (sessions 4-6) consisting of Rolf's method of soft tissue mobilization and Alexander's system of guided movement-awareness techniques. Before and after each session and after a 4-week follow-up, the subject was assessed for sacroiliac joint pain using a compression technique, anterior rotation of the innominate bones, pelvic angle in the standing position, and vagal tone as determined from heart rate variability. The therapist's visual analysis of sit-to-stand movement and the subject's self-reports of pain were noted. A corrective paradigm protocol of soft tissue mobilization and exercise was unsuccessful in eliminating the subject's assessed anterior rotation of the innominate bone and associated low back pain for more than 1-2 days posttreatment. Only after the implementation of a third paradigm movement/mobilization protocol did the subject begin to exhibit sustained improvement through a 4-week follow-up. Interpretations of the results, appropriate selection of corrective and integrative protocols, and physiological mechanisms are discussed.

Adult↗
PubMed1982

Therapist expectancies: client gender, and therapist gender, profession, and level of training.

Examined the influence on therapists' expectancies of four variables: Client's gender, therapist's gender, therapist's professional affiliation, and therapist's level of training. A total of 893 counselors, clinical social workers, and clinical psychologists at three training levels (beginning master's student, ending master's student, post-master's professional) completed the Therapist Expectancy Inventory in reference to a male or female client description. Data were analyzed using MANOVA and discriminant function analysis procedures. Significant differences on diagnostic, prognostic, or process dimensions of expectancies were found for the main effects of therapist gender, professional affiliation, and level of training. The client gender effect was not significant. It is concluded that therapists' judgments about the client and their role in counseling are more a function of certain therapist characteristics than client gender.

Adult↗
PubMed2004

Walking to school: incidental physical activity in the daily occupations of Australian children.

Children's participation in physical activity is declining, and nowhere is this more apparent than in the incidental activity of walking to school. The aim of this pilot study was to examine the extent to which Australian children walked to and from primary school, and to survey parents to identify factors influencing this behaviour. Parents of 164 students in Grades 1 7 (mean age 9.1 +/- 2.02 years) from a primary school comprising 360 students responded to a questionnaire regarding psychosocial and environmental factors thought to influence the means by which their children went to and from school. Results indicated that parent perception of the importance of physical activity, parents' individual history of transport to school as well as distance from school were the most statistically significant factors determining children's involvement in walking to and from school. The results of this study highlight the attitudes and experiences of parents in determining the extent to which children are involved in non-motorized access to school. Also implicated are organizational policies about geographical school regions. While this study is limited to one school community, further study is recommended with others to better confirm findings by examining socioeconomic, geographic and policy variables. Occupational therapists are challenged to examine ways in which incidental physical activity can be increased in the lives of young children.

Activities of Daily Living↗
PubMed1977

Correlates of successful outcome in crisis intervention therapy.

The present study examines the correlates of successful outcome (subsequent inpatient or outpatient treatment) of 305 outpatient cases treated by crisis intervention therapy. Although the two measures of outcome were correlated with each, the respective relationships with the predictor variables were sometimes different. Demographic variables and therapist's characteristics were not correlated with either outcome measures. Past responses to stress (prior state hospitalization and suicidal behavior) were predictors of subsequent inpatient treatment, but not subsequent outpatient treatment. On the other hand, current precipitating events did not predict inpatient treatment, but did predict subsequent outpatient treatment. Several statistically nonsignificant relationships which either replicate or disagree with previous findings are also discussed.

Ambulatory Care↗
PubMed1995

Attitudes of therapists toward Holocaust survivors.

This study examined current feelings and attitudes toward Holocaust survivors in a sample of 205 Israeli mental health professionals. Subjects were asked to read two vignettes each describing an aged trauma victim who had recently applied for treatment. The first vignette presented a Holocaust survivor and the second a war veteran. The two "patients" were otherwise similar in background and clinical picture. After reading each vignette, subjects were asked to report their feelings toward the patient. Subjects also completed a detailed questionnaire that assessed attitudes on several issues related to the Holocaust. Feelings toward the Holocaust survivor were found to be more intense and more positive than feelings toward the combat veteran. Therapists' attitudes toward Holocaust survivors were also found to be highly and consistently positive. Compared to previous reports, they appear to reflect a change of heart in relation to the past. Therapist background variables were not found to play a major role in determining attitudes toward Holocaust survivors.

Adult↗
PubMed2000

[Not Available].

Although treatment selection in psychotherapy can be conceptualized as an interactive process, as yet there is few empirical research that aimed at addressing the significance of therapists' emotional reactions to their patients when selecting appropriate psychotherapeutic treatments. The present naturalistic-observational cross-sectional study investigates therapists' countertransference which was assessed after the completion of the intake interview. 13 psychotherapists rated their countertransference feelings regarding 237 patients who presented at a psychotherapy outpatient university department, using a 17-items feeling word checklist. By means of factor analysis, three dimensions of the countertransference ratings could be found: 1. sympathy; 2. helpfulness; 3. anger. Clusteranalytically, patients could be assigned to four groups that are characterized by specific countertransference patterns: 1. positive countertranference (n = 82); 2. weak countertransference (n=124); 3. ambivalent countertransference (n=16); and 4. negative countertransference (n=13). The frequencies of both diagnostic categories and selected treatments proved to differ between the clusters. In the positive countertransference cluster, patients with depressive disorders were more frequent and patients with somatoform disorders less frequent. In the positive countertransference cluster, the indication of cognitive-behavioral therapy was especially frequent. Regarding the combination of positive countertransference and selection of cognitive treatment, the result of a previous study could be replicated. This finding proved to reflect different countertransference attitudes and indication preferences of therapists with different therapeutic philosophy orientations (psychodynamic vs. cognitive-behavioral).

Countertransference↗