Therapists' patient preferences and their relationship to two patient variables.
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Health Personnel↗
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The relationship of cognitive variables to therapeutic ability and training of client centered therapists.
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Cognition↗
Methadone maintenance. Does dose determine differences in outcome?
We conducted a naturalistic study to determine if higher methadone doses were more effective than lower doses in the outcome variables of illicit drug use, treatment retention, missed medication days, and ratings of patient progress by assigned counselor among 265 patients in a Department of Veterans Affairs Methadone Maintenance Treatment Program. Results indicated no significant differences on any outcome variable by methadone dose. However, we found a significant effect by assigned therapist. Some therapists achieved better outcome results on these same variables compared to other assigned therapists independent of dose level. We conclude that, while methadone maintenance dose is an important variable, researchers need to pay more attention to the interpersonal aspects of methadone maintenance treatment.
Adult↗
Do therapists vary much in their success? Findings from four outcome studies.
Success rates of psychotherapists were compared across each of four treatment outcome studies, with results indicating: considerable difference between therapists in their average success rates; considerable variability in outcome within the caseload of individual therapists; little support for the widely held view that certain therapists are best for certain kinds of patients; and variations in success rate typically have more to do with the therapist than with the type of treatment.
Follow-Up Studies↗
Multiple family group therapy with a tri-therapist team.
In summary, we attempt to minimize personal and professional factors that may hinder the group or be deleterious to the tri-therapists' working relationship. With such contract variables in mind, it is hoped that other co-therapists would find similar approaches that will make co-therapy a satisfying experience.
Child↗
Occupational therapists: personality and job performance.
This study was conducted to determine the personality structure of a group of occupational therapists and to examine the relationship between specific personality variables and job performance of practicing occupational therapists. The results indicated that occupational therapists as a group are not distinguishable from people in general, in terms of personality; however, a number of personality variables were significantly related to job performance. Implications for both the field of occupational therapy and for the selection of students are discussed.
Employee Performance Appraisal↗
Efficacy of psychotherapy. Asking the right questions.
Economic pressures and "value" judgments both compel and contaminate the current debate on the efficacy of psychotherapy. Too often, complex clinical trial outcome studies ignore the clinical or treatment process, as well as personality or contextual variables. Thus, they fail to build the foundations of a clinical science that makes possible the development of individually tailored treatment approaches and outcome predictions for specific patients with unique personalities, symptoms, and life circumstances. The real challenge, therefore, is for each psychotherapeutic approach to delineate its "process steps" and relate these steps to different outcomes. The "process" is the "final common pathway" for a number of patient, therapist, technique, and contextual variables. The capacity to predict the relationship between process and outcome at each stage in a therapeutic procedure is the relevant clinical test of "efficacy."
Behavior Therapy↗
Is Music Therapy an Effective Intervention for Dementia?A Meta-Analytic Review of Literature.
A recent qualitative review of literature in the area of music/ music therapy and dementias published since 1985 suggested that music/music therapy is an effective intervention for maintaining and improving active involvement, social, emotional and cognitive skills, and for decreasing behavioral problems of individuals with dementias (Brotons, Koger, & Pickett-Cooper, 1997). The present analysis sought to update and quantify this relationship, and investigate the extent to which methodological variables influenced treatment effectiveness. Twenty-one empirical studies, with a total of 336 subjects suffering from symptoms of dementia, were included in the meta-analysis. Overall, the effect of music/music therapy was found to be highly significant. A homogeneity analysis determined that the effect sizes were not consistent across studies; thus, a series of moderating variable analyses were conducted. We were unable to determine the source of variability between studies by analyzing type of therapeutic intervention (active or passive), music (live or taped), therapist's training (trained music therapist vs. other professional), dependent variable (behavioral, cognitive, or social), or length of treatment. Although the published literature demonstrates that music/music therapy is an effective method overall for treating symptoms of dementia, systematic variation of treatment protocols is necessary to identify the underlying mechanisms and delineate the most effective techniques.
Journal Article↗
Gait outcome following outpatient physiotherapy based on the Bobath concept in people post stroke.
PURPOSE: The purpose of this study was to characterize the gait cycle of patients with hemiplegia before and after a period of outpatient physiotherapy based on the Bobath concept. METHODS: Nine patients, at least 6 weeks post stroke and recently discharged from a stroke unit, were measured before and after a period of outpatient physiotherapy (mean duration = 17.4 weeks). Therapy was documented using a treatment checklist for each patient. The primary outcome measures were a number of gait variables related to the therapists' treatment hypothesis, recorded during the gait cycle using the CODA motion analysis system. Other secondary outcome measures were the Motor Assessment Scale, Modified Ashworth Scale, subtests of the Sodring Motor Evaluation Scale, the Step test, a 10-m walk test, the Barthel Index and the London Handicap Score. RESULTS: Recovery of more normal gait patterns in the gait cycle (using motion analysis) did not occur. Significant changes in temporal parameters (loading response, single support time) for both legs, in one kinematic (dorsiflexion during stance) and one kinetic variable on the unaffected side (hip flexor moment), and most of the clinical measures of impairment, activity and participation (with the exception of the Modified Ashworth Scale and the 10-m walk) were noted. CONCLUSIONS: Study findings did not support the hypothesis that the Bobath approach restored more normal movement patterns to the gait cycle. Further research is required to investigate the treatment techniques that are effective at improving walking ability in people after stroke.
Aged↗
Use of alternative therapists among people in care for HIV in the United States.
OBJECTIVES: This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV. METHODS: Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted. RESULTS: Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/lesbian, had incomes above 40,000 dollars, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count. CONCLUSIONS: Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed.
Adolescent↗
Why do eating disorder patients drop out?
BACKGROUND: Dropout from psychotherapy is an important problem that has received little systematic attention. Although previous research suggests that the number of patients who drop out is considerable, it is not clear why they drop out or what might be done to limit the problem. The present study attempted to examine the role of the patient-therapist relationship as well as other variables for dropout among eating disorder patients. METHODS: Eating disorder patients and their therapists were assessed on a measure of treatment expectations previously developed by the author: the former were also assessed on measures of psychiatric symptoms (Crown-Crisp Experiential Index) and eating disorder psychopathology (Eating Disorder Inventory), as well as relevant background and treatment variables. Patients were divided into those who had completed their course of treatment, and those who dropped out during assessment or treatment. RESULTS: Lack of congruence between patients' and therapists' expectations of potential treatment interventions was associated with increased risk of dropout, whereas other patient-, therapist- and treatment-specific factors were not. In particular, dropouts had significantly greater expectations of being helped by insight-related interventions than their therapists. CONCLUSIONS: Dropout among eating disorder patients appears to be related to the patient-therapist relationship. It may be important for therapists to openly discuss patient expectations of treatment from the outset, and focus on particular areas of discrepancy to limit potential dropout.
Adult↗
Inpatient PTSD treatment: a study of pretreatment measures, treatment dropout, and therapist ratings of response to treatment.
Pretreatment measures including demographic variables, adjustment index variables and psychological testing variables were studied in relationship to treatment dropout and therapist ratings of overall response to treatment among PTSD veterans in an inpatient PTSD program. Analysis comparing a group of fourteen veterans who dropped out of treatment early and a random sample of fourteen who successfully completed treatment showed no significant differences. Analysis comparing a group of 35 veterans who received the highest therapist ratings on response to treatment with a group of 35 veterans receiving the lowest ratings on response to treatment also showed no significant differences. Analysis of subgroups of patients who had completed the Millon Clinical Multiaxial Inventory (MCMI) and received high versus low therapist ratings showed one significant difference on the hypomania scale. Overall findings on the MMPI and MCMI appeared similar to other investigations of PTSD.
Adult↗
Ethnicity and psychiatric diagnosis.
Examined diagnostic differences between black, white, and Hispanic-American patients (N = 1968) seen in psychiatric outpatient clinics of a large hospital in the South Bronx. Distribution of diagnoses also was compared statistically in relation to the diagnostician's ethnicity. Results indicated statistical differences between the patient's ethnicity and psychiatric diagnosis, as well as interactions between the therapists' ethnicity and these variables. Implications of the findings were discussed, and suggestions were offered for future research.
Adult↗
Assessing auditory comprehension in the context of severe physical disability: the PACST.
Existing tests of auditory comprehension are frequently unsuitable for patients with physically disabling conditions as tests require skills such as physical manipulation of materials. A suitable test is required to assess the reliability and validity of responses in patients who can only indicate 'yes' and 'no'. This has implications for enabling patients to participate, for example, in decision making over their care. In the construction of the Putney Auditory Comprehension Screening Test (PACST) 200 normal participants were tested with 258 yes/no questions. From their results a test consisting of 60 unambiguous questions, varying in difficulty, type, syntactic complexity and length were selected. A clinical trial was completed with 112 patients from the Royal Hospital for Neuro-disability. The 60 item test was found to be reliable and valid. Results were also compared with independent ratings by ward managers and speech and language therapists. Effects of demographic variables were as expected. A 60 question test was developed which was shown by the clinical trial to be a useful tool. Questions vary in difficulty, but not enough to establish a difficulty gradient. On the basis of performance on the test, patients can be allocated to three groups: normal, impaired, and chance performance.
Adolescent↗
Perceptions of physical therapy competencies in rheumatology. Physical therapists versus rheumatologists.
The purpose of this article is to report the differences in perceptions among three groups of respondents who assessed the importance of 80 competencies for entry-level physical therapists who treat patients with arthritis. Nonparametric statistics were used to analyze the responses of physical therapists and rheumatologists who completed a questionnaire regarding the competencies. I used the Kruskal-Wallis one-way analysis of variance to make group comparisons and the Mann-Whitney U test to complete pair-wise comparisons. The results revealed significant differences of opinion among the groups (p = .007) for 20 of the 80 competencies. The significant differences in opinion were among physical therapy clinical educators (n = 100), physical therapy arthritis health professionals (n = 108), and rheumatologists (n = 80). Although the results suggested that some groups perceived certain physical therapy competencies in rheumatology to be useful but not essential for the entry-level physical therapist to perform, considerable variability existed within groups. Despite the variance in opinions, teaching of these competencies should be included in the entry-level physical therapy curriculum or in clinical settings.
Arthritis↗
Reminiscence groups with confused nursing center residents: an experimental study.
Reminiscence groups have been used successfully in several types of elder-care settings. This article is a study of the use of reminiscence groups with confused elderly residents of nursing centers in an attempt to improve the quality of subjects' social behaviors. Results partially supported the hypotheses. Social and demographic data were correlated with improvement or lack of it. The study suggests that the skills of the therapist are an important variable in reminiscence therapy as is true with other types of professional intervention.
Aged↗
[Psychoanalytically based psychotherapy in childhood and adolescents from the viewpoint of expert assessment].
Depth psychologically founded or analytically psychotherapy with children and adolescents is not only a question of the respective "Fachkunde", a variable referring to the therapist and his training. Aspects of differential indication and effective factors pertaining to psychoanalytic techniques must also be taken into consideration. There are different techniques which should be conceptulized as a continuum. The effective factors vary in their impact. It seems problematic to distinguish between single discrete techniques. Depth psychologically founded psychotherapy with children and adolescents is a technique characterized by a limited goal which can be formulated in a "focus". Special emphasis has to be laid on the environment and the present state of development. First findings from a workshop on focal psychotherapy with children and adolescents at the Psychoanalytischen Institut Bremen, are discussed by case illustration.
Adolescent↗
[Prognostic predictors in medium-term inpatient treatment in longitudinal assessment--is there a lower limit for inpatient length of stay?].
A predictor for the individual length of stay (ILOS) was stable for 3 consecutive cohorts of annual inpatient admissions (n = 1.230, excluding drop-outs, crisis interventions for 14 days and less, longterm treatment for 250 days and more), in spite of decreasing average length of stay (ALOS). The predictor consists of CASCAP psychopathology variables, motivational and social functioning variables assessed by the therapist. ICD-10-diagnoses had no influence on ILOS. Improvement on MAS axis VI needed longer average LOS than improvement in symptoms. Unchanged patients had shorter LOS than improved ones, the lower limit of effective LOS being more than about 55 days for improvement of symptoms. Due to our findings, DRGs are not an adequate instrument to determine reimbursement of inpatient treatment in child and adolescent psychiatry.
Adolescent↗