Showing papers in "Clinical Psychology-science and Practice in 1996"
TL;DR: The psychopathy checklist (PCL/PCL-R) continues to receive recognition among clinicians and researchers for its ability to predict violent and nonviolent recidivism as mentioned in this paper.
Abstract: The Psychopathy Checklist (PCL/PCL-R) continues to receive recognition among clinicians and researchers for its ability to predict violent and nonviolent recidivism. This article reviews the psychometric properties and the clinical utility of the PCL-R and reports a meta-analysis of 18 studies that Investigate the relationship between the PCL/PCL-R and violent and nonviolent recidivism. We found that the PCL and the PCL-R had moderate to strong effect sizes and appear to be good predictors of violence and general recidivism. As a component of dangerousness assessments, psychologists may want to consider utilizing the PCL-R when making probability statements regarding placement decisions in institutions, parole and conditional release decisions, and community placement decisions for psychiatric patients. The generalizabilfty of the PCL beyond these groups, which have primarily consisted of Anglo-American samples, is still in question and requires further research.
729 citations
TL;DR: Findings from the Oregon Adolescent Depression Project are summarized as they pertain to the suicidal behavior of older (14–18-year-old) adolescents, including issues relevant to assessment and screening.
Abstract: In this article we summarize findings from our program of research (the Oregon Adolescent Depression Project) as they pertain to the suicidal behavior of older (14–18-year-old) adolescents Specifically, we (a) present information regarding the epidemiology of suicidal ideation and suicide attempts (eg, prevalence, incidence, onset age, methods, severity); (b) describe the psychosocial characteristics associated with past and future suicide attempts, in comparison to depression; (c) discuss issues relevant to assessment and screening, including our development of a new assessment instrument, the Life Attitudes Schedule; (d) share recommendations gained from our experience in providing treatment for depressed adolescents, approximately 40% of whom had made a suicide attempt; and (e) identify gaps in current knowledge for which more research is needed
641 citations
TL;DR: This article is a response to the report of the Task Force on Promotion and Dissemination of Psychological Procedures of the Division of Clinical Psychology of the American Psychological Association (1995).
Abstract: This article is a response to the report of the Task Force on Promotion and Dissemination of Psychological Procedures of the Division of Clinical Psychology of the American Psychological Association (1995). The conclusions and recommendations of the task force concerning the “validated” therapies for both training and practice appear premature. In particular, they overlook possible limitations in existing research, the importance of client and therapist variability, the role of common factors in psychotherapy, and the need to adapt therapeutic procedures for the problems of the individual client or patient.
224 citations
TL;DR: A reconciliation of past taxonomies is proposed to define school refusal behavior and its essential features as well as specific categories, dimensions, and strategies to organize, assess, and treat this heterogeneous population as discussed by the authors.
Abstract: We address issues pertaining to problematic school absenteeism, a pressing social dilemma that is a substantial correlate of behavior disorders in youth and linked to later problems in adulthood. Adequate taxonomic strategies for school refusal behavior have been elusive and controversial, however, contributing to a lack of consensus regarding definition, subtypes, and assessment and treatment strategies for this population. The evolution of classification systems for this population is discussed, with a critique of the literature based on provisions of explicit, reliable, and applicable criteria, discriminant validity, and interface with clinically useful assessment procedures linked to prescriptive treatments. A reconciliation of past taxonomies is proposed to define school refusal behavior and its essential features as well as specific categories, dimensions, and strategies to organize, assess, and treat this heterogeneous population.
139 citations
TL;DR: In this paper, issues concerning the use of manuals in psychotherapy training and practice and the value of specific treatments for specific problems are discussed, as well as the importance of specific treatment for particular problems.
Abstract: Misconceptions apparent in Garfield's comments on the report of the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures are corrected. Issues concerning the use of manuals in psychotherapy training and practice and the value of specific treatments for specific problems are discussed.
121 citations
TL;DR: The history of the integration movement is described in this article, along with several approaches to integration that have been developed, including the assimilative approach, based on a psychodynamic model but incorporating technlques from various active approaches to treatment.
Abstract: Psychotherapy integration is an approach to treatment that goes beyond any single theory or set of techniques. The history of the psychotherapy integration movement is described, along with several approaches to integration that have been developed. We #en desclibe our assimilative approach, based on a psychodynamic model but incorporating technlques from various active approaches to treatment. A case history is provided illustrating the model that we describe. Key wods: psychotherapy integration, assimilative inte(p.tion. Lain Psycho/ Sci Prrc 3:47-58, 19961 Psychotherapists always have been interested in, and have attempted to use, new developments in the natural and social sciences, philosophy, theology, the arts, and literature. However, for the most part, we have rehsed to learn psychotherapy from each other if our ideologies and allegiances are different. This isolationism has been contradicted by a small, but growing, group of scholars and clinicians who have been able to cross sectarian lines. These integrationists have aimed at establishing a useful dialogue among members of the various sectarian schools of psychotherapy. Their goal has been the development of the most effective forms of psychotherapy possible. The integration of therapies involves the synthesis of the “best and brightest” concepts and methods into new theories and practical systems of treatment. Given the rise of publications, journals, and professional societies concerned with psychotherapy integration, it seems that, as
112 citations
TL;DR: Feminist approaches have been offered as eti-ological explanations for the development and maintenance of anorexia nervosa and bulimia nervosa as mentioned in this paper, along with a discussion of empirical support and research issues.
Abstract: Feminist approaches have recently been offered as eti-ological explanations for the development and maintenance of anorexia nervosa and bulimia nervosa. Specific hypotheses and postulates have varied across different theorists. An overview of the rationale for each of four identified theoretical explanations is provided, along with a discussion of empirical support and research issues. We conclude that feminist approaches offer the possibility of substantially adding to our knowledge of etiological factors for the development of eating disorders. We suggest that the area would benefit from the development of pertinent measurement indices and the utilization of longitudinal designs incorporating variables deemed important by feminist writers, but also including factors supported by other etiological frameworks, such as family systems, developmental, and cognitive-behavioral approaches.
64 citations
TL;DR: It is argued that the relationship between the clinical psychologist and the clinical researcher is an unworkable model because these are independent fields, each with its own problems and its own styles of thinking.
Abstract: The relationship between the clinical psychologist and the clinical researcher is often presented as an integrated model in which the researcher conceives and the clinician executes. We argue that this is an unworkable model because these are independent fields, each with its own problems and its own styles of thinking. The plea is made to deintegrate the two fields, to have them interact on the basis of mutual respect but not to merge with each other.
63 citations
TL;DR: If psychotherapy may well be at a substantial disadvantage as clinical practice guidelines are prepared by government and private agencies, and possible limitations regarding the generality and clinical utility of the authors' interventions are currently hypotheses that need systematic evaluation, particularly since some existing evidence suggests that these limitations may be minor.
Abstract: Sol Carfield agrees that we have psychological interventions with proven efficacy for a number of problems and disorders, but points out that among other problems, we know relatively little about the generality of effectiveness of these interventions across clients and therapists, and that we have a poor understanding of the mechanisms of action of many of these procedures. Thus, he concludes that dissemination of these procedures is premature. These knowledge gaps clearly exist, but from the point of view of policy, similar gaps in knowledge have not precluded the widespread dissemination of pharmacological treatments. It is suggested that if we do not communicate what we know about efficacy at this time (with appropriate caveats), psychotherapy may well be at a substantial disadvantage as clinical practice guidelines are prepared by government and private agencies. In addition, possible limitations regarding the generality and clinical utility of our interventions are currently hypotheses that need systematic evaluation, particularly since some existing evidence suggests that these limitations may be minor.
59 citations
TL;DR: The impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored.
Abstract: Models of mental health service delivery in managed care have evolved without considering the needs of ethnic minorities in any systematic manner. Consequently, these new systems may pose additional barriers to access and treatment. In this article, the impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored. A quality-of-care framework is used for addressing the notion of cultural competence as a critical dimension of quality of care for ethnic minority populations. Research in minority mental health and quality of care is integrated in order to explore how various structures, processes, and outcomes in managed care systems (e.g., cost containment structures for controlling the supply and demand of mental health services, utilization management and gatekeeping processes) may impact mental health service delivery to ethnic minorities. Cultural competence is conceptualized as a critical component of quality care for ethnic minority populations.
50 citations
TL;DR: The limitations of present data on so-called “validated treatments” preclude conclusions about what forms of treatment to reimburse or include/exclude in graduate training programs.
Abstract: Outcome research is important to improving psycho-therapeutic procedures. Empirical evaluation of “manu-alized” clinical procedures, both broad and narrow, is a valuable current research trend. However, the conditions of such research are far removed from the conditions that exist in everyday clinical practice. The limitations of present data on so-called “validated treatments” preclude conclusions about what forms of treatment to reimburse or include/exclude in graduate training programs. Future research should emphasize commonly used forms of treatment and more typical patient populations.
TL;DR: This review indicates five characteristics related to HIV risk in psychiatric populations: psychopathology severity and symptomatology, substance abuse proximal to sexual behavior, misinformation about HIV transmission, perceptions of invulnerability, and sttuational, lifestyle factors.
Abstract: Seriously mentally ill adults are at high risk for human immunodeficiency virus (HIV) infection. We review the empirical literature that documents this elevated risk in psychiatric patients and identify factors that have been associated with enhanced risk. Our review indicates five characteristics related to HIV risk in psychiatric populations: psychopathology severity and symptomatology, substance abuse proximal to sexual behavior, misinformation about HIV transmission, perceptions of invulnerability, and sttuational, lifestyle factors. Understanding these characteristics can lead to improved HIV preventive intervention models. However, we also note that studies have been limited by unreliable psychiatric diagnoses and sampling constraints. We conclude with suggestions for research, practice, and prevention based on findings in the empirical literature and theories of HIV risk reduction.
TL;DR: In this paper, the authors evaluate the multiple influences leading to the use of combined treatments, different ways in which treatments are combined, and challenges that combined treatments raise for research and practice.
Abstract: Combinations of treatment are used increasingly in child and adolescent therapy research, following a pattern long evident in clinical practice. The present article evaluates the multiple influences leading to the use of combined treatments, different ways in which treatments are combined, and challenges that combined treatments raise for research and practice. The central thesis is that combined treatments are unlikely to contribute to treatment outcome unless there are significant changes in the way research is conceptualized and conducted. Limitations in methods of combining treatment, the absence of explicit and empirically defensible decision rules for individually tailored treatments, perpetuation of current limitations in the ways treatments are tested and delivered, and methodological obstacles for evaluating combined treatments are used to bolster the thesis. Recommendations are made for Improving research on combined treatments, such as investigating the decision-making process guiding the combinations of treatment, the constituent techniques that are used to form combinations, novel models of delivering services to bolster outcome, and processes and mechanisms of therapeutic change.
TL;DR: A review of computer-identified outcome evaluation reports from community service settings, during the past 5 years, suggests that much more has been said than has been done as discussed by the authors, which suggests that the need for pertinent outcome information must take priority over scientific rigor.
Abstract: There is an urgent need for pertinent outcome information. Relevance for decision makers must take priority over scientific rigor. However, a review of computer-identified outcome evaluation reports from community service settings, during the past 5 years, suggests that much more has been said than has been done. Although relatively heterogeneous in scope, these studies focused on the effects of community support services for adults with persistent and severe mental illness; traditional outpatient services have been neglected. Studies are characterized by multidimensional, standardized outcome assessment, and nonequivalent comparison group and single cohort designs. Randomized designs, with usual services as the control condition, were feasible in some situations. Inadequate sample size and attrition continue to be method problems.
TL;DR: The Task Force report as discussed by the authors represents an important step toward identifying effective treatments for major clinical disorders, and the commitment to empirical research that this report embodies is part of what could be an overdue move toward greater accountability in clinical training and practice.
Abstract: Although not free from methodological problems, the Task Force report represents an important step toward identifying effective treatments for major clinical disorders. The commitment to empirical research that this report embodies is part of what could be an overdue move toward greater accountability in clinical training and practice. The time-honored reliance on therapists' clinical judgments in formulating individual treatment plans needs to be critically examined in the light of their well-documented limitations and the informed use of empirically supported, manual-based treatments. The reality of common factors across different treatments does not conflict with the effectiveness of specific treatments for particular disorders.
TL;DR: The present article presents a model for routine evaluation that combines concurrent monitoring of treatment integrity and the documentation of professional services rendered to hold a competitive edge over those that do not.
Abstract: Given the growing pressure for therapist accountability and validation of effectiveness of individual therapists, groups of therapists, and treatment packages, individual practitioners or groups that develop database management systems to measure their effectiveness are likely to hold a competitive edge over those that do not. The concurrent monitoring of treatment integrity and the documentation of professional services rendered has potential for improving quality of care. Diagnosis, treatment plan preparation, treatment setting, agent of change, goals, Interventions, duration of treatment, criteria for termination, compliance with the treatment plan, outcome of treatment, quality of records, satisfaction of patients, satisfaction of referring professionals, absence of ethical complaints or litigation, and time consumed in administrating a private practice are important targets of evaluation. The present article presents a model for routine evaluation.
TL;DR: In this paper, the main points discussed and elaborated on in this article are as follows: (a) There appear to be no data to support the notion that a combination of different theories can result in a more robust therapeutic technique, (b) It is techniques, not theories, that are actually used on people, (c) the effectiveness of specific techniques may have no bearing on the theories that begot them, (d) Different treatment combinations should be tried only when well-documented methods do not exist for a particular disorder or when proven techniques are not achieving the desired results,
Abstract: Some of the main points discussed and elaborated on in this article are as follows: (a) There appear to be no data to support the notion that a combination of different theories can result in a more robust therapeutic technique, (b) It is techniques, not theories, that are actually used on people, (c) The effectiveness of specific techniques may have no bearing on the theories that begot them, (d) Different treatment combinations should be tried only when well-documented methods do not exist for a particular disorder or when proven techniques are not achieving the desired results, (e) When using behavioral or psychoanalytic techniques one is not necessarily practicing behavior therapy or psychoanalytic therapy. The emphasis throughout is on avoiding confusing and specious conclusions.
TL;DR: Sample data are presented illustrating the value of using cutoff scores and social validation methodology to improve the quality of psycho-therapeutic services and increase the understanding of the impacts of treatment.
Abstract: Clement has proposed several categories of data to be included in data-based management of clinical practice for the purpose of improving quality of patient care. His model for routine evaluation includes a proposed system for evaluating treatment outcome. An alternative system for evaluating outcome is suggested by the authors. Its presumed value Is greater efficiency in clinician (and patient) time involvement, more likelihood of contributing to the empirical understanding of therapeutic effects, and greater ease of comparison with the data produced from controlled research and from other private practitioners. Sample data are presented illustrating the value of using cutoff scores and social validation methodology to improve the quality of psycho-therapeutic services and increase our understanding of the impacts of treatment.
TL;DR: The list of empirically validated treatments by the American Psychological Association Division 12 Task Force was not an effort at minimizing the importance of such client, therapist, and common factors but rather an attempt to help disseminate what has been learned regarding treatments as mentioned in this paper.
Abstract: I concur with Dr. Garfield that therapist, client, and common treatment factors are important and are often likely to explain significant outcome variance. I disagree with him in terms of whether the existence of such other outcome predictors should lead to a decision not to disseminate efficacious treatments. The list of examples of empirically validated treatments by the American Psychological Association Division 12 Task Force was not an effort at minimizing the importance of such client, therapist, and common factors but rather an attempt to help disseminate what has been learned regarding treatments. The list of empirically validated treatments is fully compatible with an eclectic approach. I conclude with the recommendation that dissemination of empirically validated treatments is probably most successfully done through training programs.
TL;DR: It is suggested that the understanding of the mechanisms by which EE is associated with relapse will be enhanced by integrating EE with existing theories of the etiologies and courses of the varieties of affective disorders.
Abstract: The concept of expressed emotion, or EE, plays an important role in understanding psychosocial factors in the course of schizophrenia. More recently, the concept of EE has been applied to affectively ill samples, and our review of this research indicates that, overall, depressed patients with a high-EE relative are 13 times more likely to relapse than those with a low-EE relative. Next, we consider whether high EE is an indicator of the depressed patient-relative relationship, characteristics of the depressed person, or (in some cases) an indicator of parental psychopathology. Finally, we recommend that our understanding of the mechanisms by which EE is associated with relapse will be enhanced by integrating EE with existing theories of the etiologies and courses of the varieties of affective disorders.
TL;DR: In this paper, Carfield's critique of the report of the Task Force on Promotion and Dissemination of Psychological Procedures is amplified, before discussing three strategic questions: (a) Why do we focus on treatment methods? (b) What Is to be done about unvalidated methods? and (c) How can evidence-based psychological treatment services be developed.
Abstract: In commenting on Carfield's critique of the report of the Task Force on Promotion and Dissemination of Psychological Procedures, some of his observations are amplified, before discussing three strategic questions: (a) Why do we focus on treatment methods? (b) What Is to be done about “unvalidated” methods? (c) How can evidence-based psychological treatment services be developed? It is concluded that a listing of “validated” treatments cannot serve as a rational and dependable basis for evidence-based psychological treatment services.
TL;DR: In this paper, the authors provide evidence for several unexpected deleterious or moderating effects of utilizing standardized treatment manuals and conclude that naturalistic research using flexible treatments is necessary for making the development of treatment manuals, and their modification, a truly scientific process.
Abstract: In contemporary psychosocial treatment research, the test of the efficacy of standardized treatment manuals predominates in respectability relative to naturalistic research on the process components of flexible treatments, though the latter strategy is necessary for the empirical identification of effective process components. Standardizing a treatment constrains the variance of process variables and, thereby, attenuates the manifestation of potential correlations. Research is reviewed, providing evidence for several unexpected deleterious or moderating effects of utilizing standardized treatment manuals. We conclude that naturalistic research using flexible treatments is necessary for making the development of treatment manuals, and their modification, a truly scientific process.
TL;DR: It is argued here that nomothetic outcome measures should be supplemented by outcome measures that are Idiographic to particular diagnostic categories and/or to particular clients.
Abstract: One possible effect of managed health care may be the increased use of nomothetic outcome measures, that is, outcome measures that are utilized across clients, regardless of diagnosis or identified treatment goals. It is argued here that such measures should be supplemented by outcome measures that are Idiographic to particular diagnostic categories and/or to particular clients.
TL;DR: A review of the empirical literature on sex differences in dependent personality disorder (DPD) prevalence rates indicates that women receive DPD diagnoses at significantly higher rates than do men as mentioned in this paper.
Abstract: A review of the empirical literature on sex differences in dependent personality disorder (DPD) prevalence rates indicates that, contrary to the assertions of the DSM-IV, women receive DPD diagnoses at significantly higher rates than do men. Research in this area further suggests that sex differences In DPD prevalence rates are due in part to men's unwillingness to acknowledge dependent feelings, attitudes, and behaviors In interviews and on self-report tests. Variations in the magnitude of sex differences obtained with different types of dependency measures are reviewed, and the value of implementing a muftimodal approach to assessing dependency in research and clinical settings is discussed.
TL;DR: The profession will have to face its values crisis and decide if it is more important to protect the financially successful practice of people called “psychologists” or toprotect the consumers they supposedly serve.
Abstract: A wide variety of methods have been used to encourage competent, scientifically based practice. Exhortation, training, and licensing have all proved themselves useless. It may be more helpful to focus on validating procedures rather than people, and in the context of the changing health care system, such a change may even be practical. The profession will have to face its values crisis and decide if it is more important to protect the financially successful practice of people called “psychologists” or to protect the consumers they supposedly serve.
TL;DR: In this article, an alternative model for the integration of psychotherapy research with clinical procedures is described, in which the effective clinical service rests on research findings, professional consensus based on training and continuing education, evidence-based systematic practice, and monitoring of service delivery and outcomes.
Abstract: We address some of the objections, raised by Garfield and others, to the sarong application of outcome research to psychotherapy practice. We argue that while Garfield has offered strong arguments for each of these objections, they do not amount to a sufficient case against the radical application of outcome research. We describe an alternative model for the integration of psychotherapy research with clinical procedures, in which the effective clinical service rests on research findings, professional consensus based on training and continuing education, evidence-based systematic practice, and monitoring of service delivery and outcomes. This close collaboration between outcome researchers and clinicians would, we believe, enrich the work of both, and the field of psychotherapy as a whole.
TL;DR: The purpose of this article is to review and critique the existing empirical literature that has evaluated the psychometric integrity of self- report-based measures in psychiatric settings, and to outline a research agenda that promises to enhance the accuracy of alcohol assessment by persons receiving psychiatric treatment.
Abstract: Alcohol use disorders in persons with co-occurring psychiatric disorders are associated with high rates of psy-chosocial instability and poorer treatment outcomes. Thus, assessment of alcohol use and abuse should become an integral part of psychiatric care. Because setf-report-based measures are frequently used, issues of reliability and validity in this population should be critically examined. The purpose of this article is to review and critique the existing empirical literature that has evaluated the psychometric integrity of self- report-based measures in psychiatric settings, and to outline a research agenda that promises to enhance the accuracy of alcohol assessment by persons receiving psychiatric treatment.
TL;DR: In contrast to the Task Force approach, the proposed undertaking would draw efficacy distinctions among psychological and pharmacological treatments for a broader range of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders; moreover, it would utilize a dimensional rather than categorical system for judging the methodological adequacy of outcome studies as mentioned in this paper.
Abstract: The members of Division 12's Task Force on Promotion and Dissemination of Psychological Procedures have recently compiled a list of 22 “well-established treatments” and seven “probably efficacious treatments.” The lists were created after the Task Force had searched for and selected positive psychotherapy outcome studies that met a categorical set of criteria attesting to the methodological adequacy of the studies. Reacting to the Task Force report, Sol Carfield expresses the conviction that we are not yet at the point where we should attempt to draw valid efficacy distinctions among psychological treatments. This commentary describes and analyzes Carfield's concerns, then proposes an alternative effort, designed, like the Task Force endeavor, to move psychotherapy research toward a sustained practical outcome. In contrast to the Task Force approach, the proposed undertaking would draw efficacy distinctions among psychological and pharmacological treatments for a broader range of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) disorders; moreover, it would utilize a dimensional rather than categorical system for judging the methodological adequacy of outcome studies. By comparing the resultant contrasting lists of effective treatments, we should be able to evaluate the differential worth of dimensional and categorical views of methodological adequacy; in so doing, we might be find ourselves in a position to develop even more thoroughly grounded descriptions of effective psychological treatments.