Psychotherapy and the recovery of memories of childhood sexual abuse: U.S. and British practitioners' opinions, practices, and experiences.

Psychotherapists were surveyed regarding clients' memories of childhood sexual abuse (CSA). The 3 samples were highly similar on the vast majority of measures. Respondents listed a wide variety of behavioral symptoms as potential indicators of CSA, and 71% indicated that they had used various techniques (e.g., hypnosis, interpretation of dreams) to help clients recover suspected memories of CSA . Across samples, 25% of the respondents reported a constellation of beliefs and practices suggestive of a focus on memory recovery, and these psychologists reported relatively high rates of memory recovery in their clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remembering childhood sexual abuse: A national survey of psychologists' clinical practices, beliefs, and personal experiences.

A national survey of 1,000 psychologists, to which 223 responded, assessed professionals' clinical practices and beliefs about the treatment of adult survivors of childhood sexual abuse (CSA), personal CSA history, and the phenomenon of clients remembering CSA in therapy. Results indicated that over 25% of therapists reported using guided imagery, dream interpretation, bibliotherapy regarding sexual abuse, referral to sexual abuse survivors' group, and free association of childhood memories as memory retrieval techniques with clients who had no specific memory of CSA. However, the majority of therapists reported that they had not seen any cases of adult clients entering therapy with no memory of CSA and subsequently recalling abuse in the course of therapy. A personal history of CSA was not associated with most clinical practices related to treating sexual abuse survivors. The implications for training and establishing scientific standards of psychological practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Routine inquiry into sexual victimization: A survey of therapists' practices.

Surveyed therapists regarding their practices in assessing clients' sexual abuse history. Of the 105 respondents, 51% reported that they routinely ask all clients or most clients about sexual abuse at some time during the course of therapy; 19% reported that they had asked only a few clients or that they never ask clients directly about sexual abuse. Therapists who were younger, who had been in practice for a shorter period of time, and whose current caseload included a high percentage of sexually abused women were most likely to have asked all or most of their clients about having been sexually abused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' self-reported training and success rates in treating clients with childhood sexual abuse

In this two-part study, three groups of therapists (16 psychologists, 11 counselors, and 14 social workers) were compared with regard to their success rates with clients presenting with childhood sexual abuse, and 43 graduate programs were asked whether they offered courses covering counseling techniques with such clients. Therapists' self-reported success rates were not significantly related to therapists' training, but type of therapy was. Given a response rate of 18.6%, self-reports should be treated cautiously. Over two-thirds of the training programs (45% response rate) offered courses covering issues in childhood sexual abuse and 67% offered courses covering counseling techniques with such clients. However, in 85% of these courses, treatment of childhood sexual abuse was a topic covered under more general course headings.     

To Google or not to Google: Graduate students' use of the Internet to access personal information about clients.

The emergence of Internet search and social media sites now permits therapists to obtain a plethora of personal information about their clients online. These behaviors raise a number of ethical issues related to client privacy, self-determination, and informed consent. The purpose of this study is to examine student therapists' opinions and behaviors in regard to the use these websites to search for information about their clients. A national sample of 854 psychology doctoral students was surveyed in regard to their online activities, attitudes, and frequency of searching for client information online. Results showed that Internet usage is pervasive in this group, with the majority reporting daily use of search engine or social networking sites. Most participants reported that searching for information about clients online using search engines (66.9%) or social networking websites (76.8%) was “always” or “usually” unacceptable. Nevertheless, 97.8% of participants reported searching for at least one client's information using search engines in the past year; 94.4% reported searching for client information on social networking websites. Overall, student therapists reported searching for 16.5% of clients seen in the past year, using either search engine or social networking sites. The ethical and training implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapists' attitudes toward clients reporting mystical experiences.

Studied the proportion of therapy clients who report mystical experiences, the diagnostic attitudes of their therapists, and the influence of personal and professional factors on attitudes toward these clients by analyzing the survey responses of 285 32–82 yr old psychotherapists (primarily males). Of the 20,670 clients seen during a 12-mo period, 4.5% reported a mystical experience; 67% of Ss had seen at least one such client during that period. Psychodynamic and behavioral therapists attributed significantly more pathology to such clients than did humanistic/existential therapists. Responses suggested that some therapists were biased in their diagnostic attitudes toward clients reporting mystical experiences. 50% of Ss said they had personally had a mystical experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose-effect relations and responsive regulation of treatment duration: The good enough level.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N = 1,868; 73.1% female; 92.4% White; average age = 40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n = 1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r =-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dependent opioid users assessed for methadone treatment in Otago: patterns of drug use

AIMS: To provide detailed information about the types of drugs used and the patterns of drug use for injecting drug users presenting for methadone treatment. METHODS: A retrospective case note review was carried out for 126 consecutive clients who were assessed for methadone treatment in the Otago province over a 2 year period. Patterns of drug use in the three months prior to presentation were recorded. RESULTS: Over 60% of those presenting were using three or more opioid drugs, with the most common being homebake (63%), sustained release morphine sulphate tablets (62%), buprenorphine (52%), opium poppies (50%) and methadone (41%). Use of diacetylmorphine (heroin) was reported primarily by those returning from recent overseas travel. Most clients reported the regular use of multiple other of clients using benzodiazepines daily. Almost 80% of the group were regular tobacco smokers and 11% showed evidence of alcohol disorders (abuse or dependence). Low levels of use were reported for cocaine, amphetamines, and hallucinogens. CONCLUSION: These patterns of drug use have important implications for the planning of methadone treatment programmes.     

Beneath the surface of long-term therapy: Therapist and client report of their own and each other's covert processes.

Therapists and clients reported on their own and their perceptions of each other's covert processes in long-term therapy. Therapists had a match rate of .45 for client reactions, with therapists rating match on therapeutic work reactions as helpful. Although 65% of clients left somethimg unsaid (primarily because of avoidance), only 27% of therapists were able to match what clients left unsaid. Of the clients, 46% had secrets (often sexual), primarily because of shame or insecurity. Clients had a match rate of .50 for therapist intentions, with therapists rating match on exploratory and restructuring intentions as helpful and both clients and therapists rating match on assessment intentions as not helpful. Thus, awareness of the other's covert processes had an effect on therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating condom use with clients during commercial sex in Nevada's legal brothels

OBJECTIVES: This study examined condom use in legal Nevada brothels. METHODS: Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. RESULTS: Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%,3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lowers) than with clients. CONCLUSIONS: Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients.     

Clients’ secret keeping and the working alliance in adult outpatient therapy.

This research investigated the relations among clients’ keeping relevant secrets in therapy, the working alliance, and symptom change. Clients (N = 83) in outpatient therapy and their therapists (N = 22) at a mental health hospital completed confidential surveys after a session of ongoing therapy. The clients who reported keeping a relevant secret (27.7%) scored significantly lower on the Working Alliance Inventory (WAI) than did clients who said that they were not, even when the analyses controlled for clients’ social desirability scores and for therapist effects. Therapists of these clients also reported a weaker working alliance, even though the therapists typically did not know that the clients were keeping a relevant secret. However, keeping a relevant secret was not related to symptom change. The findings support the long-standing belief that secret keeping in therapy either hurts the therapeutic relationship or happens when the relationship is relatively weak. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Value of sedative premedication in female sterilization via minilaparotomy: a prospective study of two local anaesthesia regimen

A prospective study of two local anaesthesia regimen for female sterilization is presented. A total of 1,077 female clients were sterilized via minilaparotomy under local anaesthesia (ML/LA) as outpatients. The clients underwent pre-operative screening and received pre-operative and continuing counselling. The first 257 of these clients were sedated with an intramuscular injection of pethidine after atropine premedication (pre-sedated group). The other clients (non-sedated group) were premedicated with atropine alone, without sedation. For the pre-sedated group, the mean volume of one percent lignocaine used was 18.3 (S.D. 2.2) ml, the mean length of surgical incision was 2.8 (S.D. 0.5) cm, and the mean duration of surgical was 15.8 (S.D. 5.3) minutes; 8.2% of these clients reported that they felt much pain. In comparison, 7.7% of the non-sedated group clients reported much pain following a mean of 17.7 ml of one percent lignocaine (S.D. 2.7) through an incision of mean length 2.5 (S.D. 0.5) cm for surgery lasting a mean of 14.5 (S.D. 4.5) minutes. Clients who were pre-medicated with pethidine were more likely to have multiple post-operative complaints, especially dizziness, faintness, headache, nausea and vomiting. This study found no significant difference in the clinical performance of female sterilization by minilaparotomy, duration of operation, length of incision, amount of local anaesthesia required or perception of pain between clients who were premedicated with intramuscular pethidine and those who were not.     

Treatment decisions: Their nature and their justification.

Investigated how clinicians make and justify treatment decisions by surveying 25 psychotherapists. A total of 75 outpatient cases were selected from Ss' completed cases and reviewed in a structured interview with Ss. In 96% of the cases, there was no evidence that Ss were using any systematic decision procedure (SDP) in choosing assessment techniques (ATs), 98% failed to use any SDP in choosing treatment goals (TGs), and 92% failed to use any SDP in choosing treatment methods (TMs). The interview was the most commonly used AT. In one-third of cases, Ss reported that clients had no involvement in determination of TGs. Ss' preference was the most important influence in determining TMs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system.

585 Division 42 (Psychologists in Private Practice) members responded to a 17-item questionnaire designed to gather initial information about the attraction therapists feel for their clients. 286 Ss were aged 45 yrs and under, while 299 Ss were aged 46 yrs and over. Results show that 508 Ss were attracted to clients; significantly more males than females reported such an attraction. Younger Ss were significantly more attracted to clients than were the older Ss. 104 Ss (primarily male) had considered sexual involvement, 91 more than once. Approximately 37 Ss had acted out sexually with clients. 488 Ss indicated feeling uncomfortable, guilty, or anxious about their attraction to clients. 55% of Ss indicated that they had received no education or training about sexual attraction to clients. (65 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Day hospital and residential addiction treatment: Randomized and nonrandomized managed care clients.

Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization and directed to residential treatment because of high environmental risk (n=82). American Society of Addiction Medicine criteria defined study and randomization eligibility. More than 50% of followed clients reported past-30-day abstinence at follow-ups (unadjusted rates, not significant between groups). Despite differing baseline severities, randomized, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models. Index treatment days and 12-step attendance were associated with abstinence (p     

Investigation of what clients and counselors do not say in brief therapy.

After each session in 24 cases of 6-session therapy, clients and counselors reported thoughts or feelings that they did not say, and counselors tried to guess what clients left unsaid. Results indicated that most things left unsaid were negative. Clients did not reveal behaviors/cognitions and emotions, whereas counselors did not reveal emotions and clinical conjectures. For clients, there was a positive correlation between (1) the proportion of things with emotional content left unsaid and (2) client-rated satisfaction with therapy and change, but there was a negative correlation between (1) the proportion of things left unsaid with behavioral/cognitive content and (2) client-rated satisfaction with change. Finally, counselors were aware of only 17% of the things clients left unsaid. When counselors accurately guessed what clients left unsaid, counselors rated the sessions as being rougher, and clients were less satisfied with treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A group counseling emphasis at a university counseling center.

Describes a service delivery system with a group personal counseling emphasis, based on the authors' 2 yrs of experience at a university counseling center. The local background and rationale for this system are discussed, and the practical logistics, the operational policies, and the group ground rules are presented. Utilization data are summarized: 36% of all clients and 88% of clients with 8 or more sessions were group members; groups typically grew to 9 clients and had 60% attendance. Results for a self-report outcome survey of 128 students are exemplified by the 95.1% who reported some level of improvement and the 92.2% who rated their psychologist "very" to "exceptionally effective." (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).

The Drug Abuse Treatment Outcome Study (DATOS) collected 1-year follow-up outcomes for 2,966 clients in outpatient methadone (OMT), long-term residential (LTR), outpatient drug-free (ODF), and short-term inpatient (STI) programs in 1991–1993. LTR, STI, and ODF clients reported 50% less weekly or daily cocaine use in the follow-up year than in the preadmission year. Reductions were greater (p?     

Length of psychotherapy for clients seen in private practice.

Length of treatment for all clients (N?=?100) seen for psychotherapy during 1975 by 7 therapists in a private practice psychological clinic was examined to determine the relative frequency of long-term (>25 sessions) vs short-term (≤25 sessions) psychotherapy. Clients were young, middle class, intelligent, and mildly to moderately disturbed. The median length of treatment was 8 sessions. Fully 80% of the clients had left treatment before receiving 25 sessions. This finding mirrors the trend for public treatment settings. Results reaffirm the necessity of further research and development of short-term treatment techniques designed to effectively utilize the brief time even private clients spend in psychotherapy. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)