How therapists manage potentially dangerous clients: Toward a standard of care for psychotherapists.

We assessed the techniques that psychotherapists use in the treatment and management of potentially dangerous clients. A nationwide sample of professional psychologists was surveyed in order to determine what they perceived to be important therapeutic interventions for use with dangerous outpatients. From these responses, a 46-item rating scale was developed. Another sample (n?=?101) of practicing psychologists completed the scale by indicating the likelihood that they would use each of the 46 interventions. Data were analyzed with respect to nine rationally derived subscales. Indicators of therapist expertise were related to several of the subscales, but theoretical orientation of therapists generally was not. We discuss three areas of future research that will be necessary in developing an empirically based standard of care for dangerous clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison.

[Correction Notice: An erratum for this article was reported in Vol 55(3) of Journal of Consulting and Clinical Psychology (see record 2008-10745-001). The data presented in Table 2 were incorrect because a row and a column were inadvertently omitted. The corrected Table 2 appears in the erratum.] This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondepressed adults? Is this adjustment maintained at follow-up? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI) were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Procedural variation in behavioral avoidance tests.

Varied level of demand for approach to a live snake in a behavioral avoidance test by presenting the test either as a measure of degree of avoidance (low demand) or as a measure of physiological components of anxiety which required that Ss handle the target object (high demand). Mode of presentation of instructions was also manipulated; 1/2 of the 50 female undergraduates in each condition heard "1-shot" tape-recorded instructions and were alone in the test room (impersonal mode), while the other 1/2 heard the instructions presented by a "live" E who accompanied the S to the test room and provided sequential instructions for each step in the behavioral avoidance test (personal mode). The main effect of context was significant on latency to touch and overt fear measures (with low-demand Ss displaying more fear), while the main effect of mode was significant for behavior approach score as well as overt fear (the personal mode was associated with less avoidance). Implications for psychotherapy outcome research employing behavioral avoidance tests are discussed. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Kaplan's view of DSM-III: The data revisited.

Comments on M. Kaplan's (see record 1984-06847-001) assertions of sexist biases in DSM-III, arguing that her reasoning is fallacious but persuasive because of its evocative appeal. It is further argued that Kaplan misinterpreted data reported by I. Broverman et al (see record 1970-06951-001), which she acknowledged as the only source of empirical support for her arguments. It is contended that Kaplan's claim that there is sexism because more women than men receive certain diagnoses (e.g., histrionic, dependent) indicates her confusion of the etiology of a possible sex-related disorder with the issue of sexism in the diagnostic criteria. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diversity among lower-class therapy clients: A comparison of Class IV and Class V psychotherapy recipients.

Studied demographic and treatment-relevant differences among 73 lower socioeconomic class psychotherapy clients at a predominantly rural comprehensive mental health center. Data were drawn from the records of all adult (46 females; 27 males) psychotherapy cases initiated and terminated in a recent 15-mo period. Results indicate several differences among Social Classes IV and V despite the literature's prevalent assumption of IV-V equivalency. In addition, sufficient heterogeneity exists among Class V clients to justify a partitioning of that class into 2 distinct subgroups. Class IV and Class V clients also differed on a global measure of final outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence that therapy works in clincally representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysts provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of instructionally mediated demand on the behavioral assessment of assertiveness.

Self-reported unassertive undergraduates participated in behavioral role-playing situations under low- and high-demand instructions. Analyses of Ss' responses for overall assertiveness, response latency, and response duration showed significant effects and/or interactions of demand characteristics on latency, time, and assertion scores. Results are relevant for the clinical determination of whether individuals' unassertiveness might be due to acquisition or performance deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of instrumental and affectional behaviors and self-esteem to marital satisfaction in distressed and nondistressed couples.

Examined the relationship of instrumental and affectional behavioral events to short- and long-term marital satisfaction. 11 distressed and 11 nondistressed couples made daily observations of their spouses' pleasurable and displeasurable behavior over a 14-day period. These behavioral ratings (on measures such as the Spouse Observation Checklist and the Enjoyment of Outside Experiences rating scale) were also related to several personality variables pertaining to sex role orientation and to reported activity during the 4 wks prior to the study. Results show a significant negative relationship between the frequency of displeasurable instrumental events and both overall and daily ratings of marital satisfaction. Affectional events were not significantly related to long-term satisfaction, contrary to expectation. Rates of displeasurable affectional events correlated negatively with daily ratings of satisfaction at a significant level. The most important finding was the degree to which wives' self-esteem correlated with couple-rated marital satisfaction. The need for further research that examines marriage as a source of mutual support and benefit for both partners is discussed. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of professional and paraprofessional helpers: A comment on Durlak.

J. A. Durlak's (see record 1979-31736-001) review of the comparative effectiveness of professional and paraprofessional helpers is reevaluated in terms of 3 problems that constrain the interpretability of the research: (a) inadequate internal validity, (b) inconsistent and inappropriate definitions of professional and paraprofessional status, and (c) the uncertain meaning of unrejected null hypotheses in studies with low power and insensitive designs. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)