Subscribe: Psychotherapy: Theory, Research, Practice, Training - Vol 46, Iss 4
Preview: Psychotherapy: Theory, Research, Practice, Training - Vol 46, Iss 4

Psychotherapy - Vol 53, Iss 4

Psychotherapy Theory, Research, Practice, Training publishes a wide variety of articles relevant to the field of psychotherapy. We strive to foster interactions among training, practice, theory, and research because all are essential to psychotherapy.

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Copyright: Copyright 2017 American Psychological Association

The effectiveness of couple therapy: Clinical outcomes in a naturalistic United Kingdom setting.


Couple therapy outcomes tend to be judged by randomized controlled trial evidence, which comes primarily from the United States. United Kingdom and European outcome studies have tended to be naturalistic and there is a debate as to whether “laboratory” (RCT) studies are useful benchmarks for the outcomes of “clinic” (naturalistic) studies, not least because the therapies tested in the RCTs are hardly used in these settings. The current paper surveys the naturalistic studies in the literature and presents results from a U.K. setting of 877 individually and relationally distressed participants who completed at least 2 sessions of psychodynamic couple therapy and completed self-report measures assessing psychological well-being (CORE-OM) and relationship quality (Golombok Rust Inventory of Marital State, GRIMS). A clinical vignette is given that demonstrates the psychodynamic approach used. Analysis of the measure data conducted using hierarchical linear modeling showed an overall significant decrease in individual psychological distress for both male and female clients at the end of therapy, with a large effect size of d = −1.04. There was also a significant improvement in relationship satisfaction for both male and female clients, with a medium effect size of d = −0.58. These findings suggest that psychodynamic couple therapy is an effective treatment for couples experiencing individual and relational distress, with effect sizes similar in strength to those reported in RCTs. It argues that naturalistic effectiveness studies should be given a stronger role in assessments of which therapies work. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Mentalization-based therapy for parents in entrenched conflict: A random allocation feasibility study.


To explore the effectiveness of a mentalization-based therapeutic intervention specifically developed for parents in entrenched conflict over their children. To the best of our knowledge, this is the first randomized controlled intervention study in the United Kingdom to work with both parents postseparation, and the first to focus on mentalization in this situation. Using a mixed-methods study design, 30 parents were randomly allocated to either mentalization-based therapy for parental conflict—Parenting Together, or the Parents’ Group, a psycho-educational intervention for separated parents based on elements of the Separated Parents Information Program—part of the U.K. Family Justice System and approximating to treatment as usual. Given the challenges of recruiting parents in these difficult circumstances, the sample size was small and permitted only the detection of large differences between conditions. The data, involving repeated measures of related individuals, was explored statistically, using hierarchical linear modeling, and qualitatively. Significant findings were reported on the main predicted outcomes, with clinically important trends on other measures. Qualitative findings further contributed to the understanding of parents’ subjective experience, pre- and posttreatment. Findings indicate that a larger scale randomized controlled trial would be worthwhile. These encouraging findings shed light on the dynamics maintaining these high-conflict situations known to be damaging to children. We established that both forms of intervention were acceptable to most parents, and we were able to operate a random allocation design with extensive quantitative and qualitative assessments of the kind that would make a larger-scale trial feasible and productive. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Inpatient schema therapy for nonresponsive patients with personality pathology: Changes in symptomatic distress, schemas, schema modes, coping styles, experienced parenting styles, and mental well-being.


This study provides an evaluation of group schema therapy (ST) for inpatient treatment of patients with personality pathology who did not respond to previous psychotherapeutic interventions. Forty-two patients were assessed pre- and posttreatment, and 35 patients were evaluated at follow-up 6 months later. The results showed a dropout rate of 35%. Those who dropped out did not differ from those who completed treatment with regard to demographic and clinical variables; the only exception was that those who dropped out showed a lower prevalence of mood disorders. Furthermore, intention-to-treat analyses showed a significant improvement in maladaptive schemas, schema modes, maladaptive coping styles, mental well-being, and psychological distress after treatment, and these improvements were maintained at follow-up. On the other hand, there was no significant change in experienced parenting style as self-reported by patients. Changes in schemas and schema modes measured from pre- to posttreatment were predictive of general psychological distress at follow-up. Overall, these preliminary findings suggest that positive treatment results can be obtained with group ST-based inpatient treatment for patients who did not respond to previous psychotherapeutic interventions. Moreover, these findings are comparable with treatment results for patients without such a nonresponsive treatment history. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Between-client and within-client engagement and outcome in a residential wilderness treatment group: An actor partner interdependence analysis.


We examine aspects of engagement (MacKenzie, 1983) as predictors of longitudinal change in Outcome Questionnaire-45.2 scores (Lambert, Kahler, Harmon, Burlingame, & Shimokawa, 2011) for 68, 18–24-year-old male residents in a 10-bed, open enrollment 90-day residential, substance use treatment program. Engagement was partitioned into within-member, between-member, within-other members, and between-other members’ effects. Within-member engagement represented how a group member’s score for a week deviated from that member’s average engagement score (across all weeks), whereas between-member engagement was the member’s average engagement score. Similarly, within-other member engagement represented how the other group members’ scores for a week deviated from the other group members’ average engagement score (across all weeks), whereas between-other member engagement was the other group members’ average engagement score. A 2-level hierarchical linear model showed the interaction of between-member engagement and between-other member engagement was related to decreasing OQ-45 scores. When other group members generally saw the group as more engaged, higher group member average engagement ratings were related to improvement. There was a significant interaction between within-member engagement and between-member engagement in predicting OQ-45 scores. When clients generally saw the group as more engaged, weeks with relatively more member engagement, compared with other weeks, were associated with improvement in OQ-45 scores. However, when clients generally saw the group as less engaged, weeks with relatively more group member engagement, compared with other weeks, were associated with greater deterioration in OQ scores. We recommend tracking week-to-week changes in member and other member engagement to identify group members who are not getting optimal program benefits. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Quasi-experimental evaluation of the impact of a cognitive behavioral pretreatment intervention for veterans seeking psychotherapy.


Pretreatment interventions have documented efficacy for reducing initial therapy refusal and early therapy departure. However, these interventions have not been well-studied in diagnostically diverse patient populations or within Veterans Affairs (VA) health care settings. We designed a manualized 4-session group cognitive–behavioral therapy-based pretreatment intervention (PTI) for a diagnostically diverse population of Veterans referred for psychotherapy in a general mental health clinic (MHC) in a large VA hospital. Retrospective record review was used to collect patient data over a period of 6 months after their completion of the PTI. A sample of 50 Veterans who were referred for care at the MHC prior to the implementation of the PTI was used for comparison (NoPTI). Two hundred sixty-six Veterans participated in the PTI. Veterans who participated in the PTI were equally as likely to attend at least one psychotherapy session as NoPTI Veterans, but had more individual and group therapy sessions during the 6-month therapy tracking period. PTI participants were also less likely to have a psychiatric hospitalization during the 6-month therapy tracking period. Study findings suggest that PTIs are a good fit to a VA general mental health setting and effective in bolstering therapy attendance. Limitations and future directions are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Comparative study of group treatments for posttraumatic stress disorder.


Presented herein is a comparative study of group treatments for posttraumatic stress disorder (PTSD). In this study, an emerging intervention, memory specificity training (MeST), was compared with cognitive processing therapy (CPT) using standardized outcome measures of target symptoms (i.e., anxiety and depression from client perspective; memory specificity from independent rater perspective) and global functioning (independent rater perspective), as well as a process measure of expectancy (client perspective). Clients were assessed on 3 separate occasions: at baseline, posttreatment, and 3 months posttreatment. Adherence and treatment fidelity (independent rater perspective) were monitored throughout the course of both treatment conditions. Improvement in PTSD symptoms, depressive symptoms, and global functioning were similar between MeST and CPT; an increase in ability to specify memories upon retrieval was also similar between MeST and CPT. Positive reliable change was observed in both groups on all outcome measures. With respect to the primary target of PTSD symptoms, 88% of participants in both treatment groups moved into the functional distribution by posttreatment and maintained these gains at follow-up. Notably, compared with CPT, MeST required only half the dosage (i.e., number of sessions) to accomplish these gains. Illustrative vignettes from client–therapist exchanges are provided, and results are discussed in terms of the potential mechanisms of action. Implications for both clinical practice and clinical research are also included. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective.


There are mixed findings regarding the differential efficacy of the group and individual format. One explanation of these mixed findings is that nearly all-recent meta-analyses use between-study effect sizes to test format equivalence introducing uncontrolled differences in patients, treatments, and outcome measures. Only 3 meta-analyses were located from the past 20 years that directly tested format differences in the same study using within-study effect sizes; mixed findings were reported with a primary limitation being the small number of studies. However, we located 67 studies that compared both formats in the same study. Format equivalence (g = −0.01) with low effect size heterogeneity (variability) was found in 46 studies that compared identical treatments, patients, and doses on primary outcome measures. Format equivalence (g = −0.06) with moderate effect size heterogeneity was found for 21 studies that compared nonidentical treatments; however, allegiance to a specific format moderated differences in effect sizes. There were no differences between formats for rates of treatment acceptance, dropout, remission, and improvement. Additionally, there were no differences in outcome between formats by patient diagnosis; however, differences in pre-to-post improvement were explained by diagnosis with depression, anxiety, and substance disorder posting the highest outcomes and medical and childhood disorders the lowest. Findings are discussed with reference to the practical challenges of implementing groups in clinical practice from an agency, clinician, and reimbursement perspective. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Uncontrolled pilot study of an Acceptance and Commitment Therapy and Health at Every Size intervention for obese, depressed women: Accept Yourself!


Depression and obesity frequently co-occur, but providing adequate treatment to depressed obese women is challenging because existing treatments for each problem in isolation are suboptimal, and treatments to address one problem may exacerbate the other. This study used an uncontrolled, pretreatment-to-posttreatment design, with 3-month follow-up, to evaluate the feasibility and outcome of a novel, self-acceptance-based treatment for obese women with depression, “Accept Yourself!” Accept Yourself! is an 11-week manualized, group-based intervention that integrates Health At Every Size (an evidence-based paradigm to enhance physical health) and Acceptance and Commitment Therapy (an evidence-based psychotherapy often used to treat depression and eating-related concerns) to improve the physical and mental health of obese, depressed women without encouraging weight loss. Twenty-one obese women with Major Depressive Disorder received the intervention; 18 completed at least seven sessions, a minimal dose of the intervention. Depressive symptoms, depression diagnosis, physical health outcomes (including physical activity and blood pressure), and obesity-related quality of life were assessed at baseline, posttreatment, and 3-month follow-up. Weight was also monitored. Depression, blood pressure, and obesity-related quality of life significantly improved from pretreatment to posttreatment, and improvements were sustained over a 3-month follow-up. Participants did not gain significant weight during the intervention or at follow-up. These data, although preliminary and nonexperimental, suggest that Accept Yourself! could be a promising treatment for obese, depressed women, and support the value of larger randomized controlled trials. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)