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Kelley A Tompkins, Joshua K Swift, Tony G Rousmaniere, Jason L Whipple
The purpose of this study was to examine the relationship between clients' etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments-behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option...
September 19, 2016: Psychotherapy
Simon B Goldberg, Robbie Babins-Wagner, Tony Rousmaniere, Sandy Berzins, William T Hoyt, Jason L Whipple, Scott D Miller, Bruce E Wampold
Recent evidence suggests that psychotherapists may not increase in effectiveness over accrued experience in naturalistic settings, even settings that provide access to patients' outcomes. The current study examined changes in psychotherapists' effectiveness within an agency making a concerted effort to improve outcomes through the use of routine outcome monitoring coupled with ongoing consultation and the planful application of feedback including the use of deliberate practice. Data were available for 7 years of implementation from 5,128 patients seen by 153 psychotherapists...
September 2016: Psychotherapy
Elliot S Spengler, Deborah J Miller, Paul M Spengler
Sexual minority (SM) individuals live in a heterosexist society that denigrates their sexual orientation identity. The stigma and prejudice they regularly encounter is hypothesized to lead to their significantly increased risk for developing mental health disorders. Because of these factors, therapists should be diligent to create an affirming and supportive therapeutic environment but this is often not the case. SM clients frequently report experiencing sexual orientation microaggressions in therapy, such as heteronormative statements, a disregard for their sexual orientation identity, and an assumption that their presenting issues are rooted in their sexual orientation identity...
September 2016: Psychotherapy
Nathan T Walters, Paul M Spengler
Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment...
September 2016: Psychotherapy
Rayna D Markin
In this article, clinical errors in the treatment of perinatal grief after a miscarriage are discussed, including (a) minimizing or avoiding painful affects related to the miscarriage, (b) assuming grief is resolved upon a subsequent healthy pregnancy, and (c) neglecting early unresolved losses that are reawakened by the loss of the pregnancy. It is argued that these unintentional errors, frequently committed by significant others in the patient's life, are similarly made by well-intentioned clinicians due to a lack of knowledge about the psychological impact of miscarriage and, moreover, an unconscious avoidance of such a common yet distressing loss...
September 2016: Psychotherapy
Bruce S Liese, Daniel J Reis
Psychotherapists risk making 2 types of errors with clients who struggle with addictive behaviors: failure to addictive behaviors and failure to effectively addictive behaviors. Given the high prevalence of addictive behaviors in clinical populations, therapists are in a unique position to assist individuals with these problems. It is assumed that therapists possess general diagnostic and treatment skills and yet many do not diagnose or do not treat addictive behaviors. Reasons for making these errors include prohibitive beliefs and limited knowledge about addictive behaviors...
September 2016: Psychotherapy
Paul M Spengler, Deborah J Miller, Elliot S Spengler
In this paper, we discuss the need for medical rule outs in over 50% of diagnoses and the risk for mental health practitioners to engage in a clinical judgment error called psychological masquerade (Taylor, 2007). We use the specific example of thyroid dysfunction as a relevant rule out when a client presents with symptoms consistent with an affective disorder. A real clinical example is provided and discussed to illustrate how the first author invoked psychological masquerade resulting in clinical decision-making errors during the treatment of a mother participating in family therapy...
September 2016: Psychotherapy
Mavis Tsai, Tien Mandell, Daniel Maitland, Jonathan Kanter, Robert J Kohlenberg
Two common types of clinical errors, inadvertently reinforcing client problem behaviors or inadvertently punishing client improvements, are conceptualized from the viewpoint of Functional Analytic Psychotherapy (FAP), a treatment that harnesses the power of the therapeutic relationship. Understanding the functions of client behaviors such as incessant talking and over compliance can lead to more compassionate and effective intervention, and a functional analysis of seemingly problematic behaviors such as silence and lack of cooperation indicate how they may be client improvements...
September 2016: Psychotherapy
Giorgio A Tasca, Nancy Mcquaid, Louise Balfour
Clinical errors tend to be underreported even though examining them can provide important training and professional development opportunities. The group therapy context may be prone to clinician errors because of the added complexity within which therapists work and patients receive treatment. We discuss clinical errors that occurred within a group therapy in which a patient for whom group was not appropriate was admitted to the treatment and then was not removed by the clinicians. This was countertherapeutic for both patient and group...
September 2016: Psychotherapy
David Kealy, John S Ogrodniczuk, William E Piper, Carlos A Sierra-Hernandez
Group psychotherapy provides unique opportunities for clinical errors in the selection of patients and composition of therapy groups. This article introduces some of the difficulties and complexities that can be associated with group composition and patient selection errors. Clinical vignettes from psychodynamic/interpersonal psychotherapy groups are used to illustrate three variations of group composition and selection errors. The first vignette depicts an error in selecting a disruptive patient into a fledgling group...
September 2016: Psychotherapy
Shweta Sharma, J Christopher Fowler
The psychotherapeutic work is characterized by processes that are involved in the development of the alliance, as well as processes that lead to the ruptures in the alliance (error) and its repair. The purpose of this article is to highlight the clinical error that occurs when a clinician fails to adequately respond to a patient's emotional signals due to countertransference reactions that results in an overemphasis on predetermined tasks the clinician "naturally" deems as necessary. A clinical vignette is presented to illustrate the error and 3 alternative approaches to the error are discussed...
September 2016: Psychotherapy
Liat Leibovich, Sigal Zilcha-Mano
Although supportive-expressive (SE) psychotherapy is one of the most studied psychodynamic therapies today, little is known empirically about effective strategies in SE supervision, or in psychodynamic supervision in general (Diener & Mesrie, 2015; Watkins, 2011). One of the important questions in SE psychotherapy is how to decide when to use supportive and when to use expressive interventions. As a parallel process, this type of decision is relevant also to SE supervision. The present case study focuses on the decision-making process in an SE supervision session: when should supervisors use supportive as opposed to expressive strategies with their supervisees? Our aim is to develop decision rules that reliably support supervisors' decisions...
September 2016: Psychotherapy
John Snyder, Katie Aafjes-van Doorn
Clinical errors and ruptures are an inevitable part of clinical practice. Often times, therapists are unaware that a clinical error or rupture has occurred, leaving no space for repair, and potentially leading to patient dropout and/or less effective treatment. One way to overcome our blind spots is by frequently and systematically collecting measure-based feedback from the patient. Patient feedback measures that focus on the process of psychotherapy such as the Patient's Experience of Attunement and Responsiveness scale (PEAR) can be used in conjunction with treatment outcome measures such as the Outcome Questionnaire 45...
September 2016: Psychotherapy
Christoph Flückiger, Hansjörg Znoj, Andreea Vîslă
Since the programmatic Rosenhan study, there is a broad discussion of how to actively construct clinical realities on both "insane" and "sane" perspectives. To inform patients about the output of the psychometric questionnaires assessed at intake is a required task in many clinical routines. Information processing bias toward psychopathology may impact many clinical communications and thus lead to clinical errors. Based on an output of the commonly used Symptom Check List 90, case examples demonstrate various grades of balanced and unbalanced alternatives of how to consider the psychopathological as well as the unproblematic poles of Likert scales in discussing psychometric questionnaires at Session 1...
September 2016: Psychotherapy
Sharon Ziv-Beiman, Golan Shahar
Ascending to prominence in virtually all forms of psychotherapy, therapist self-disclosure (TSD) has recently been identified as a primarily integrative intervention (Ziv-Beiman, 2013). In the present article, we discuss various instances in which using TSD in integrative psychotherapy might constitute a clinical error. First, we briefly review extant theory and empirical research on TSD, followed by our preferred version of integrative psychotherapy (i.e., a version of Wachtel's Cyclical Psychodynamics [Wachtel, 1977, 1997, 2014]), which we title cognitive existential psychodynamics...
September 2016: Psychotherapy
William B Stiles, Isabel Caro Gabalda, Eugénia Ribeiro
The Assimilation of Problematic Experiences Scale (APES) summarizes a developmental continuum along which psychological problems progress in successful psychotherapy. The therapeutic zone of proximal development (TZPD) is the segment of the APES continuum within which the clients can proceed from their current APES level to the next with the therapist's assistance. It is the therapeutic working zone for a particular problem. As the client makes progress on a problem, its TZPD shifts up the APES. Theoretically, so long as the therapist's interventions remain within the TZPD, the client feels safe enough to work...
September 2016: Psychotherapy
Matteo Bugatti, James F Boswell
Although standardized treatments have the potential to decrease clinical errors, within-session responsiveness is complicated and complementary frameworks may be needed to foster enhanced responsiveness in the context of evidence-based treatments. Recent efforts have targeted the enhancement of flexibility and responsiveness in the delivery of manualized treatments, including the development of transdiagnostic treatments (i.e., protocols that are designed to be used across different diagnoses) intended to tailor intervention principles to the needs of individual patients...
September 2016: Psychotherapy
Stephanie L Budge
This special issue was created to address a very clear gap in the literature on clinical errors in psychotherapy. This special issue is comprised of 20 articles which follow the same format as the "Clinical Processes" special issue and "Supervision Processes" special section, previously published in. Specifically, authors were provided with instructions to describe the clinical error(s), along with recommendations to psychotherapists for preventing these errors, being prepared with alternative responses, or how to respond differently once an error has occurred...
September 2016: Psychotherapy
Jake Park, Jonathan Goode, Kelley A Tompkins, Joshua K Swift
Clinical errors occur in the psychotherapy decision-making process whenever a less-than-optimal treatment or approach is chosen when working with clients. A less-than-optimal approach may be one that a client is unwilling to try or fully invest in based on his/her expectations and preferences, or one that may have little chance of success based on contraindications and/or limited research support. The and the models are two decision-making models that are frequently used within psychology, but both are associated with an increased likelihood of errors in the treatment decision-making process...
September 2016: Psychotherapy
Cheri L Marmarosh
Often, group therapists collaborate with individual therapists in conjoint treatment. Many of these patients start in individual therapy and are referred to the group to help facilitate the treatment and address interpersonal and relational issues that either cannot or will not be addressed in the individual work. Although this has the potential to foster incredible growth for patients, it may also cause problems in treatment when collaboration between therapists falls apart. The current paper will examine mistakes made when multiple realities about a patient are ignored during the pregroup screening and preparation, and feedback from group treatment is not integrated into individual therapy...
September 2016: Psychotherapy
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