The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.

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Using the framework method for the analysis of qualitative data in multi-disciplinary health research

Cost Effectiveness in Health and Medicine.

QUITE apart from the academic consideration that vital and medical statistics now form an obligatory part of the education of students seeking the University of London's diploma in public health, the demand for information about the methods of vital and medical statistics is increasing. The most casual reader of the newspapers is now aware that population problems are of serious practical importance and that the publications of the General Register Office cannot be ignored. It is scarcely an exaggeration to say that the recently issued preliminary report on the census of 1931 is one of the most sensational documents which has appeared for years, and that he who reads it intelligently will understand what is meant by saying that civilisation is in the melting pot. An Introduction to Medical Statistics. By Hilda M. Woods William T. Russell. Pp. x + 125. (London: P. S. King and Son, Ltd., 1931.) 7s. 6d.

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An Introduction to Medical Statistics

The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapies studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.

The Great Psychotherapy Debate

Purpose: The purpose of this review was to present an in-depth analysis of literature identifying the extent of dropout from Internet-based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes. ----- ----- Methods: A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non-compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet-based treatment programmes involving minimal therapist contact were identified and included in the review. ----- ----- Results: Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet-based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet-based treatment is currently limited. ----- ----- Conclusions: This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet-based treatment for psychological disorders.

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Dropout from Internet‐based treatment for psychological disorders

Background - In the past two decades, a number of studies investigating the role of the therapeutic alliance in drug treatment have been published and it is timely that their findings are brought together in a comprehensive review.

Aims - This paper has two principal aims: (1) to assess the degree to which the relationship between drug user and counsellor predicts treatment outcome and (2) to examine critically the evidence on determinants of the quality of the alliance.

Methods - Peer-reviewed research located through the literature databases Medline, PsycInfo and Ovid Full Text Mental Health Journals using predefined search-terms and published in the past 20 years is considered. Further papers were identified from the bibliographies of relevant publications.

Findings - A key finding is that the early therapeutic alliance appears to be a consistent predictor of engagement and retention in drug treatment. With regard to other treatment outcomes, the early alliance appears to influence early improvements during treatment, but it is an inconsistent predictor of post-treatment outcomes. There is relatively little research on the determinants of the alliance. In studies that are available, clients' demographic or diagnostic pre-treatment characteristics did not appear to predict the therapeutic alliance, whereas modest but consistent relationships were reported for motivation, treatment readiness and positive previous treatment experiences.

Conclusions - The therapeutic alliance plays an important role in predicting drug treatment process outcomes, but too little is known about what determines the quality of the relationship between drug users and counsellors.

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The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature.

The role of the early therapeutic alliance in predicting drug treatment dropout.

Aims - To predict the early therapeutic alliance from a range of potentially relevant factors, including clients' social relationships, motivation and psychological resources, and counsellors' professional experience and ex-user status.

Design - The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and client and counsellor ratings of the alliance were obtained during weeks 1, 2 and 3.

Measurements - The intake assessment battery included scales on psychological wellbeing, treatment motivation, coping strategies and attachment style. Client and counsellor versions of the Working Alliance Inventory (WAI-S) were used for weekly alliance measurement. Hierarchical linear models were used to examine the relationship between alliance and predictor variables.

Findings - Clients who had better motivation, coping strategies, social support and a secure attachment style were more likely to develop good alliances. Findings with regard to counsellor characteristics were not clear cut: clients rated their relationships with ex-user counsellors, experienced counsellors and male counsellors as better, but more experienced counsellors rated their alliances as worse.

Conclusions - The findings offer important leads as to what interventions might improve the therapeutic alliance. Further work will need to establish whether the therapeutic alliance and ultimately treatment outcomes can be enhanced by working on improving clients' motivation and psychosocial resources.

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Predicting the early therapeutic alliance in the treatment of drug misuse

i Summary Most improvements occur within the first few months of entering treatment. The changes in behaviour observed at first follow-up (three to five months after initial interview) are mainly only sustained at second follow-up (11 to13 months), although there are some additional improvements during this later stage of treatment. This may suggest that there are opportunities to further capitalise on the early gains that are achieved. Further work is needed to establish whether these gains are sustained once treatment has stopped. Levels of drug use declined rapidly within the first three months of starting treatment, and then continued at the same rate, for up to six months. These findings support the validity of the national performance indicator of retention in treatment for at least three months, but suggest potential value in longer measures of retention than currently employed as well as the need for treatment facilities to focus on a continuing process of change.

http://www.ama.lu/docs/DTORS_Final_Main.pdf

The Drug Treatment Outcomes Research Study (DTORS): Final outcomes report

Over the last decades inside and outside of Europe, treatment-based data have been used in epidemiological research on drugs and drug abuse. They offer information on hidden populations and allow to follow socially stigmatised behaviour. As this type of research can be done on rather low budgets, there are long-term projects run in many countries. Experts from the national systems in several EU member states have been working together to develop a common standard on the basis of the Pompidou Group (PG) Definitive Protocol. The items and basic definitions of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)/PG Treatment Demand Indicator Protocol are described, which plays an important role in the process of harmonisation of data collection for the EMCDDA. Implementation strategies are described, and future steps are discussed.

Michael Donmall

Papers

The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature.

The role of the early therapeutic alliance in predicting drug treatment dropout.

Predicting the early therapeutic alliance in the treatment of drug misuse

The Drug Treatment Outcomes Research Study (DTORS): Final outcomes report

The EMCDDA/Pompidou Group Treatment Demand Indicator Protocol: A European Core Item Set for Treatment Monitoring and Reporting