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PubMed1983

A scale for rating suitability for insight-oriented psychotherapy.

An instrumental for rating patients as suitable (I) or not suitable (NI) for insight-oriented psychotherapy, is described. It is based on factors suggested by Dewald, and consists of 24 scales, each with 5 steps. Inter-rater reliability was greater than 0.60 in 11 of the scales in a study of 25 cases, and four subscales were significantly correlated to suitability for insight-oriented psychotherapy according to the total scale: "influence of environmental factors on the symptoms", "variability of the symptoms during the last year", "self-confidence", and "possibility to psychodynamic formulation with circumscribed focus". Construct validity was estimated by comparing 29 pairs of I and NI patients. I patients belonged to a higher social class, scored higher on the personality trait dominance and low on neuroticism, had a more positive experience of the therapist, had lower symptom intensities, and were given a lower global rating of the disorder. I patients were more improved than NI patients when given unspecific treatments. The differences were, however, small. Predictive validity in 38 patients was low which may be due to the fact that the rater had to consider the research points of view, the global nature of several variables and the course criteria for correct allocation.

Awareness↗

PubMed1978

The empirical evaluation of the effects of different group treatment strategies against a controlled treatment strategy on behavior exhibited by antisocial children, behaviors of the therapist, and two self-rating scales that measure antisocial behavior.

Evaluated two group treatment strategies against a control treatment strategy on the behaviors exhibited by antisocial children, behaviors of their therapists, and two self-rating scales. The first year 139 antisocial children were stratified according to age and then randomly placed into 14 groups. For the second year, 100 children were placed into 11 groups composed of antisocial children. Behavioral measurements of the children's and therapists' behaviors were secured at each weekly 2-hour meeting. Children were pre- and posttested on the various inventories postulated to measure antisocial behavior. In addition, significant adults, such as group therapists, filled out pre- and posttest inventories to measure antisocial behavior. For both years very few significant differences occurred between the treatment groups and the control groups on the dependent variables studies. The findings are discussed in terms of their relevance for behavior therapy.

Adolescent↗

PubMed2003

Technical skills in paediatrics: a qualitative study of acquisition, attitudes and assumptions in the neonatal intensive care unit.

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate observational findings. Using a constant comparative process, field notes, interview and focus group transcripts were analysed by 2 researchers for emergent themes in the grounded theory tradition. RESULTS: Data sourced from over 90 hours of observation and 21 observed technical procedures, and both individual and group interviews are presented thematically. Dominant themes include: the nature, timing and purpose of feedback about technical procedures; opportunities to learn technical skills; multiple demands that intersect with technical procedure attempts; competing priorities, and teachers' and learners' differing perceptions. These themes interact to affect the learning environment. CONCLUSION: The NICU learning environment represents a complex interplay between competing priorities, learning opportunities and attributions about learners. This interplay must be understood if improvements to technical skills training in this domain are to be developed.

Attitude of Health Personnel↗

PubMedDate not supplied

An outcome in need of clarity: building a predictive model of subjective quality of life for persons with severe mental illness living in the community.

PURPOSE: The study purpose was to construct a predictive model of subjective quality of life for persons with severe mental illness living in the community with particular attention to participation in occupations. METHOD: Persons with severe mental illness (N=154) rated their subjective quality of life. Several measures for each of the following categories of variables were completed: demographics, clinical, social participation, and self-measured well-being. Regression analysis was used to determine the significant predictors for each category and then to build the predictive model from these significant variables. RESULTS: Symptom distress accounted for the most variance (33%) in subjective quality of life, followed by psychological integration (3%) and physical integration (2%). CONCLUSIONS: The study suggests that occupational therapists should attend to subjective experience of symptoms to influence quality of life. Therapists are also in a good position to address their clients' sense of belonging to their communities and to enable community participation.

Adolescent↗

PubMed2004

Caregiver role strain of older workers.

UNLABELLED: The purpose of this study was to measure role strain in older adult workers who were also caregivers of frail elders according to Komarovsky's role strain theory, and to determine whether different patterns of role strain exist for male worker-caregivers than females. METHOD: Researchers developed the Job-Caregiver Role Strain Scale Survey, which was adapted from a survey that measured role strain in working parents and spouses. Surveys were distributed to 11 male and 34 female older workers who were also caregivers. RESULTS: A factor analysis was completed, which isolated four factors of role strain. Researchers named the factors time management and arrangements, health and competing role demands, low rewards, and reactions to perceptions. Role strain in older adult worker-caregivers is complex and involves multiple variables. A discriminant function analysis predicted differences in the way older male and female worker-caregivers perceived role strain. Use of role strain theory can assist employers and occupational therapists in developing and maintaining work environments that support not only the older employee's work performance, but participation in the role of elder caregiver as well.

Aged↗

PubMed2004

Quality of object relations as a moderator of the relationship between pattern of alliance and outcome in short-term individual psychotherapy.

In this study, we investigated the personality variable quality of object relations (QOR) as a moderator of the relationship between the pattern of the therapeutic alliance and treatment outcome in two forms (interpretive, supportive) of short-term individual psychotherapy. In a sample of 72 psychiatric outpatients who completed interpretive therapy, QOR emerged as a moderator for the outcome factor general symptomatology and dysfunction. For high-QOR patients, an increasing level of alliance was directly related to benefit, whereas for low-QOR patients, a decreasing level of alliance was directly related to benefit. An explanation for these findings emphasized the importance of patients repeating their typical pattern of maladaptive interpersonal behavior in the therapy sessions in the context of the therapist working with the transference. In a sample of 72 psychiatric outpatients who completed supportive therapy, QOR did not emerge as a moderator. These findings in combination with evidence from previous studies suggest that QOR should be investigated as a moderator variable in future studies of short-term psychotherapy.

Adolescent↗

PubMed2001

Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial.

BACKGROUND: Cognitive behaviour therapy (CBT) seems a promising treatment for chronic fatigue syndrome (CFS), but the applicability of this treatment outside specialised settings has been questioned. We compared CBT with guided support groups and the natural course in a randomised trial at three centres. METHODS: Of 476 patients diagnosed with CFS, 278 were eligible and willing to take part. 93 were randomly assigned CBT (administered by 13 therapists recently trained in this technique for CFS), 94 were assigned the support-group approach, and 91 the control natural course. Multidimensional assessments were done at baseline, 8 months, and 14 months. The primary outcome variables were fatigue severity (on the checklist individual strength) and functional impairment (on the sickness impact profile) at 8 and 14 months. Data were analysed by intention to treat. FINDINGS: 241 patients had complete data (83 CBT, 80 support groups, 78 natural course) at 8 months. At 14 months CBT was significantly more effective than both control conditions for fatigue severity (CBT vs support groups 5.8 [2.2-9.4]; CBT vs natural course 5.6 [2.1-9.0]) and for functional impairment (CBT vs support groups 263 [38-488]; CBT vs natural course 222 [3-441]). Support groups were not more effective for CFS patients than the natural course. Among the CBT group, clinically significant improvement was seen in fatigue severity for 20 of 58 (35%), in Karnofsky performance status for 28 of 57 (49%), and self-rated improvement for 29 of 58 (50%). Prognostic factors for outcome after CBT were a higher sense of control predicting more improvement, and a passive activity pattern and focusing on bodily symptoms predicting less improvement. INTERPRETATION: CBT was more effective than guided support groups and the natural course in a multicentre trial with many therapists. Our study showed a lower proportion of patients with improvement than CBT trials with a few highly skilled therapists.

Adult↗

PubMed1975

Correlates of initial client disturbance: expectations for therapy, dropout, resistance, and demographic description.

Relationships were investigated between initial levels of client disturbance in each of 10 problem areas and client drop-out, lateness to, and absence from therapy, expectations with regard to therapy, and various demographic variables. Data were obtained from 154 outpatients at a university psychological clinic. Correlations computed between initial disturbance scores and all other variables revealed many significant relationships. Most noteworthy were the significant relationships betwee initial disturbance levels in the areas of future goals and self-satisfaction and expectations in a psychodynamically oriented therapist. Results were discussed in terms of client's awareness of the need to deal with the psychological factors that underlie their problems and their desire for the therapist to focus on such material.

Adolescent↗

PubMed1986

Predictors of academic achievement in physical therapy.

We undertook this retrospective study to determine the best predictors of academic achievement in a baccalaureate physical therapy program. The files of 83 matriculated students were reviewed, and data on the following admission requirements were compiled: 1) preprofessional grade point averages (GPAs), 2) scores on the Allied Health Professions Admission Test, 3) scores on the written composition (ESSAY), 4) preprofessional faculty recommendation scores, 5) ratings by a physical therapist after a 70-hour clinical observation before the professional training, and 6) personal interview ratings. Data were analyzed with multiple and stepwise regression models using the admission data as independent variables to predict academic achievement (QPAPT) at the end of the two-year professional program. When all independent variables were included in the multiple regression equation, 53% of the variance in the QPAPT was explained (p less than .0001). The stepwise regression revealed that the best predictors of the QPAPT were the GPA (accounted for 40% of variance) and the ESSAY (accounted for 11% of variance).

Achievement↗

PubMed1998

A community-based clinic survey of antidepressant use in persons with schizophrenia.

OBJECTIVE: To determine the rates of antidepressant and antipsychotic use in the treatment of schizophrenia. METHOD: The primary therapists at 8 community mental health centres in a metropolitan Canadian city completed a survey questionnaire for all of their active clients. Information was collected about diagnoses, medication treatments, and clinical variables. RESULTS: There were 3555 clients, 1552 (43.7%) of which had a diagnosis of schizophrenia. Of clients with schizophrenia, 94% were prescribed antipsychotic medications, and 11.6% of these were also prescribed antidepressant medications. There were differences between the combination-treatment group and the antipsychotic-alone group in gender ratio, rates of concurrent diagnoses of mood disorder, level of current functioning, and total number of hospitalizations. CONCLUSION: In this community-based sample of clients with schizophrenia, antidepressants and antipsychotics are commonly prescribed in combination, even though the rate of concurrent mood disorders diagnoses is low. Further studies should clarify the efficacy and indications for antidepressant use in this population.

Antidepressive Agents↗

PubMed2004

Decreased home health use: does it decrease satisfaction?

This study investigates differences in satisfaction and quality of life for Medicare beneficiaries using home health care services before and after implementation of the Interim Payment System (IPS) as part of the Balanced Budget Act (BBA) of 1997. Data are from surveys conducted pre- and post-BBA. Multivariate analyses estimate the effect of being in the post-BBA period controlling for beneficiary, agency, and community characteristics. Sixteen dependent variables measure satisfaction with the agency, and two measure life quality. Despite dramatic utilization decreases, differences were not found for overall agency satisfaction, satisfaction with discharge, or with the nursing and therapist care received. Decreases in satisfaction were found for some interpersonal aspects of staff interaction and, for the group of respondents who received services in the agencies that participated in both the pre- and postperiods, with the decreased provision of personal care services. A large increase was found in staff encouraging independence.

Aged↗

PubMed2002

Clinical Application of Dynamic Theory Concepts According to Tscharnuter Akademie for Movement Organization (TAMO) Therapy.

PURPOSE: The purpose of this article is to describe the relationship between specific concepts of dynamic theories and specific Tscharnuter Akademie for Movement Organization (TAMO) therapy principles. KEY POINTS: Theories of dynamic perception, such as functional coupling between organism and environment, active pick-up of task-specific information, functional coupling between perception and action are emphasized. Principles of TAMO examination and treatment apply theoretical concepts of nonlinear, reciprocal interactions between organism and environment, information-based perception and action, internal and external forces acting on the body. To determine skill levels, TAMO focuses on self-produced actions, their adaptability to diverse situations, and the active and selective pick-up of task-specific information. Without moving the patient, the therapist provides task-specific information and changes the existing force distribution through a gentle, task-specific loading input; thus patients are challenged to actively reorganize to new situations. The variability associated with exploring available movement possibilities teaches patients which perceptual-motor aspects need to be monitored. Subsequently, these rules of coordination can be spontaneously generalized to a variety of similar situations.

Journal Article↗

PubMed1990

Psychotherapy and counseling for methadone-maintained opiate addicts: results of research studies.

Data have been presented about the potential role of psychotherapy for psychiatrically impaired methadone-maintained opiate addicts. Complete data from one study, and preliminary data from a second, indicate that professional psychotherapy can be helpful as a supplement to ongoing drug-counseling services for patients having clinically significant psychiatric symptoms. If psychotherapy is to be used, care must be taken to integrate it into the ongoing clinical services of the methadone-treatment program. Not all therapists are equally adept at engaging and working with addicts. In hiring therapists, attempts should be made to identify those who are not only technically competent but also interested and comfortable with this population. It should also be emphasized that there is considerable variability among methadone programs in such vital areas as leadership, staffing patterns, organization, dosing procedures, location, physical plant, and availability of ancillary services. These administrative differences may play a significant role in the feasibility and success of attempts to use psychotherapy in drug-treatment programs. Finally, it should be noted that there is no evidence that psychotherapy cures addiction or that it can be used successfully without integrating it into other important services, such as drug counseling, methadone treatment, and the overall program structure. There is reason to believe, however, that it can provide additional and clinically meaningful benefits to that subgroup of methadone patients who are psychiatrically impaired.

Antisocial Personality Disorder↗

PubMed2000

Reactions of nurses and therapists in mainstream health services to contact with people who have learning disabilities.

Government policy in the United Kingdom is to make the National Health Service accessible to all citizens, including those who hitherto may have relied on specialist services. It is recognized that the attitudes of health professionals can be a major influence in making this happen. To date there has been a paucity of research studies involving nurses and therapists, two of the largest groupings of health care workers. The present study contrasted the reactions of nurses and therapists to their contact with people who have learning disabilities, with those of staff working in specialist services for this client group, and with students who are not involved in health services. Over 1000 respondents - mainly university students on undergraduate or post-graduate courses - completed a written questionnaire. Although nurses and therapists had significantly less contact with people who had learning disabilities during their work than did staff in specialist services, there were no differences in terms of contact in personal life. In both instances their contacts were higher than those reported for non-healthcare students. However both nurses and therapists were significantly less confident in working with a patient who had learning disabilities as opposed to one with physical disabilities. By contrast, willingness for social contacts did not vary across the four groups although respondents with previous personal contact were significantly more willing for this than those with no prior contact. The results confirm that the form of contact is a more salient variable on staff attitudes than contact per se. Hence, changed reactions are more likely to come about from successful contacts in a work rather than social environment. The implications are discussed for initial and post-qualifying training courses, especially for suitable placement experiences. Suggestions are made for future research that focuses on increasing the expertise and confidence of nurses and therapists in working with patients who have learning disabilities.

Adolescent↗

PubMed2001

A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial.

Given the demand for interventions that may prevent the development of persistent musculoskeletal pain problems, we investigated the effects of a cognitive-behavioral program in a group of non-patients with neck or back pain symptoms. Two hundred and fifty-three people selected from a population study were invited to participate. These people had experienced four or more episodes of relatively intense spinal pain during the past year but had not been out of work more than 30 days. Participants were randomly assigned to either a cognitive-behavioral group intervention or a treatment as usual comparison group. The experimental group received a standardized six-session program, provided by a trained therapist according to a manual. A significant overall analysis at the 1-year follow-up showed that the cognitive-behavioral group produced better results on 26 of the 33 outcome variables. Group comparisons indicated that the cognitive-behavioral group, relative to the comparison group, had significantly better results with regard to fear-avoidance beliefs, number of pain-free days, as well as the key variable of sick leave. Participation in the cognitive behavioral group reduced the risk for long-term sick leave during the follow-up by threefold. Thus, despite the strong natural recovery rate for back pain, the cognitive-behavioral intervention produced a significant preventive effect with regard to disability.

Adult↗

PubMed2002

Tailoring cannabis dependence treatment for a diverse population.

Accumulating evidence suggests that psychosocial treatment for cannabis dependence is effective. Earlier investigations were well designed and sought to evaluate efficacy of manual-guided therapies with particular attention to protecting the independent variable. The Marijuana Treatment Project (MTP) represents an effort to build upon previous knowledge about cannabis dependence treatment through an evaluation of an integrative therapy, which was meant to allow for greater therapist latitude in its delivery, and to be more responsive to a potentially more diverse population of clients. The treatment intervention developed for delivery in the Marijuana Treatment Project (MTP) reflects an effort to find a true compromise between the needs of the scientific community to have clearly specified and measurable treatments, and the realities of the treatment community, which demand flexibility, appreciation of the multi-determined nature of most problems, and individualized approaches. This paper will describe the clinical interventions used with the MTP participants, the theoretical rationale guiding their design and practical aspects related to implementation and treatment response.

Decision Making↗

PubMed2005

A pilot randomized controlled trial of a daily muscle stretch regime to prevent contractures in the arm after stroke.

OBJECTIVE: To evaluate the feasibility and effects of daily stretch positioning for prevention of contractures in stroke patients without arm function. DESIGN: Randomized controlled pilot study. SETTING: Stroke rehabilitation ward, U.K. SUBJECTS: Twenty-five subjects drawn from an initial pool of 126 presenting with loss of arm function, all within four weeks of stroke. INTERVENTIONS: In addition to usual care, subjects in the experimental group (n=13) were prescribed two 30-min stretches for wrist and finger flexors and two 30-min stretches targeting shoulder adductors and internal rotators, per day for up to 12 weeks post stroke. Stretches were carried out by therapists and nursing staff. MAIN MEASURES: Passive range of wrist extension and shoulder external rotation to standard force or to pain at four, eight and twelve weeks after stroke. RESULTS: Compliance was variable. Frequency of positioning was fair from four to eight weeks post stroke but declined after that. Mean (SD) frequency of stretch positions completed between four and eight weeks was 36.5 (13.0) for the wrist, 31.2 (14.1) for the shoulder, out of 56 prescribed. There were no significant effects of treatment. By eight weeks post stroke the mean range of wrist extension and shoulder external rotation lost on the affected side in both groups was approximately 30 degrees. CONCLUSIONS: The stretch treatment was not well tolerated over many weeks. Statistical power was low due to the large degree of variability of range of motion and small sample size. The regime tested cannot be recommended as a workable treatment to prevent contractures.

Aged↗

PubMed1998

Linguistic psychotherapy research: new directions and promising findings.

Language configures experience and is our primary instrument of meaning making. Its central role in the construction of our subjective and interpersonal worlds provides the rationale for investigating its forms and functions in psychotherapy. Three clinically relevant dimensions of language (i.e., connectivity, modality, and complexity) are outlined and several examples of linguistic variables on each dimension are defined. Linguistic studies of psychotherapy are then presented in terms of focal points of assessment: pretherapy, intherapy, and posttherapy. At each focal point, innovative applications of linguistic variables are presented, often in contexts that permit direct contrast with more traditional methodologies. Promising preliminary results suggest that linguistic research can help to better differentiate and describe patient psychopathology at pretherapy, therapist and patient processes in therapy, and patient gains at posttherapy.

Child↗