The Development of a Reliable Change Index and Cutoff for the Revised Dyadic Adjustment Scale

The Revised Dyadic Adjustment Scale (RDAS; Busby, Crane, Larson, & Christensen, 1995) is a measure of couple relationship adjustment that is often used to differentiate between distressed and non‐distressed couples. While the measure currently allows for a determination of whether group mean scores change significantly across administrations, it lacks the ability to determine whether an individual's change in dyadic adjustment is clinically significant. This study addresses this limitation by establishing a cutoff of 47.31 and reliable change index of 11.58 for the RDAS by pooling data across multiple community and clinical samples. An individual whose score on the RDAS moves across the cutoff changes by 12 or more points can be classified as experiencing clinically significant change.     

Effectiveness of the Coral Tree Family Service family inpatient unit: a longitudinal study exploring change in family functioning

Child mental health disorders represent a major burden to public health in Australia due to high prevalence rates, the widespread impact across domains, and the potential for difficulties to persist into adolescence and adulthood. Extensive evidence exists for the use of parent management training and cognitive behavioural therapy to treat difficulties experienced by children; however, a proportion of children do not benefit as expected from these treatments. The use of complementary therapeutic approaches and variations to the mode and intensity of existing intervention is warranted; family inpatient units represent a unique example of this. The aim of this study is to evaluate the effectiveness of a well-established Australian inpatient unit that admits the whole family, for children aged 12 years and younger referred with mental health, behavioural, or emotional difficulties. This study's longitudinal within-subject study design utilised routinely collected outcome data from the systemic clinical outcome and routine evaluation, 15 item (SCORE-15)—a valid and reliable measure of family functioning—from a sample of 980 participants attending the Family Residential Program. This study reported significant improvement in family functioning across all outcome variables between baseline and post-intervention, with no variables returning to pre-intervention levels at follow-up. Clinically significant changes in overall family functioning showed that 37% of participant scores moved from the clinical range at baseline to the nonclinical range post-intervention. This study represents the first empirical evaluation of the Family Residential Program, and the reported results provide compelling evidence for the program to effect improvement in family functioning for families with long-standing and severe difficulties. Poor rates of questionnaire completion following intervention frequent the literature base of family inpatient units, with low post-intervention (56%) and follow-up (12%) rates evident in this study. This study uniquely contributes to the growing evidence base of family inpatient units using rigorous evaluation methods.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Effects of Affective and Anxiety Disorders on Outcome in Problem Gamblers Attending Routine Cognitive–Behavioural Treatment in South Australia

This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive–behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) ‘harm to self’ sub-scale with validated cut score 21+ (score range 0–60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56 %) were males. At baseline, 353 (92.9 %) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46 %) had a very high probability of a 12-month affective or anxiety disorder, 103 (27 %) in the high range and 102 (27 %) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitive–behavioural therapy in the mid-term.     

Randomized controlled trial of the Resilience and Coping Intervention (RCI) with undergraduate university students

Objective: The purpose of this pilot study was to evaluate the Resilience and Coping Intervention (RCI) with college students. Participants: College students (aged 18–23) from a large Midwest US university who volunteered for a randomized controlled trial during the 2015 spring semester. Methods: College students were randomly assigned to an intervention (n = 64) or a control (n = 65) group. Intervention participants received three 45-minute RCI sessions over subsequent weeks. All participants completed pre- and post-intervention assessments at the beginning of Week 1 and end of Week 3. Student resilience, coping, hope, stress, depression, and anxiety were assessed. Results. RCI participants reported significantly more hope and less stress and depression from Week 1 to Week 3 compared with control participants. Results for resilience also approached statistical significance. Effect sizes were small to moderate. Conclusions: This study found preliminary evidence that RCI is an effective resilience intervention for use with college students.     

Wilderness adventure therapy effects on the mental health of youth participants

Adventure therapy offers a prevention, early intervention, and treatment modality for people with behavioural, psychological, and psychosocial issues. It can appeal to youth-at-risk who are often less responsive to traditional psychotherapeutic interventions. This study evaluated Wilderness Adventure Therapy (WAT) outcomes based on participants’ pre-program, post-program, and follow-up responses to self-report questionnaires. The sample consisted of 36 adolescent out-patients with mixed mental health issues who completed a 10-week, manualised WAT intervention. The overall short-term standardised mean effect size was small, positive, and statistically significant (0.26), with moderate, statistically significant improvements in psychological resilience and social self-esteem. Total short-term effects were within age-based adventure therapy meta-analytic benchmark 90% confidence intervals, except for the change in suicidality which was lower than the comparable benchmark. The short-term changes were retained at the three-month follow-up, except for family functioning (significant reduction) and suicidality (significant improvement). For participants in clinical ranges pre-program, there was a large, statistically significant reduction in depressive symptomology, and large to very large, statistically significant improvements in behavioural and emotional functioning. These changes were retained at the three-month follow-up. These findings indicate that WAT is as effective as traditional psychotherapy techniques for clinically symptomatic people. Future research utilising a comparison or wait-list control group, multiple sources of data, and a larger sample, could help to qualify and extend these findings.     

Family therapy with selectively mute children: a case study

Due to its rarity (<1% of all clinical cases), few Marriage and Family Therapists have significant expertise in dealing with children who have become selectively mute, and little research has been conducted to determine the effectiveness of family therapy in treating this disorder. Much of what has been researched does not serve to provide a cohesive or uniform road map to follow in determining the course of treatment. The purposes of this article are (a) to present a case study outlining specific treatment interventions in a specific case used over the course of 2 years in a school-based setting, (b) to demonstrate the efficacy of utilizing school-based family-centered treatment, and (c) to stimulate further research and development on the efficacy of family therapy in alleviating anxiety and stress in children who have developed this disorder.     

Recovery Among Youths Referred to Outpatient Psychotherapy: Reliable Change,Clinical Significance,and Predictors of Outcome

Although psychotherapy for children and adolescents is efficacious when administered in university-based research settings, relatively little data support its effectiveness in the community. This study examined the outcomes of 35,429 youths (5–17 years of age) referred to public outpatient psychotherapy programs in Ohio. All youths showed statistical elevations in symptom severity and were assigned at least one DSM-IV diagnosis at intake. Parents, therapists, and adolescents completed the same norm-referenced symptom severity measure at intake and at 3 month intervals until termination. One year after intake, approximately 55% of youths showed statistically reliable symptom reduction whereas 8% showed reliable symptom exacerbation. Approximately one-third of the sample showed both reliable and clinically significant improvement. Outcomes varied significantly by informant, client age, and client gender. Results indicate that many youths improve during the course of therapy but most remain symptomatic 1 year after intake.     

The Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale Nonclinical Sample

The conceptualization of hypersexuality has begun to converge as a result of proposed diagnostic criteria. However, its measurement is still diverse. The Hypersexual Behavior Inventory (HBI) is one of the most appropriate scales used to assess hypersexuality, but further examination is needed to test its psychometric properties among different clinical and nonclinical groups, including samples outside of the United States. The aim of the present study was to investigate the reliability and the generalizability of HBI and to determine a cutoff score on a large, diverse, online, nonclinical sample (N = 18,034 participants; females = 6132; 34.0%; M_age = 33.6 years, SD_age = 11.1). Confirmatory factor analysis (CFA) and reliability indices provided support for the structure of the HBI and demonstrated excellent reliability. Employing latent profile analysis (LPA), seven classes emerged, but they could not be reliably distinguished by objective sexuality-related characteristics. Moreover, it was not possible to determine an adequate cutoff score, most likely due to the low prevalence rate of hypersexuality in the population. HBI can be reliably used to measure the extent of hypersexual urges, fantasies, and behavior; however, objective indicators and a clinical interview are essential to claim that a given individual may exhibit features of problematic sexual behavior.     

Integrating Family Therapy Training in a Clinical Psychology Course

Teaching family therapy to clinical psychology trainees is not common practice in Australian clinical psychology training programs. There is sparse discussion in the literature. Family therapy is an evidence based intervention that complements a diversity of established theories and psychotherapies and would complement the intervention skills of trainee clinical psychologists. The aim of this paper is to illustrate how family therapy training may be integrated into a postgraduate clinical psychology course. The literature on core family therapy knowledge, skills and training methods will form the backdrop to a review of specific family therapy training courses for clinical psychology trainees. This will then be mapped against a consideration of accreditation requirements of clinical psychology courses in Australia and suggestions made for integrating family therapy into their training curriculum. Anecdotal feedback from students provides an initial step toward evaluation.     

Child Advocacy Center Based Group Treatment for Child Sexual Abuse

The present study examines initial symptom presentation among participants, outcomes, and social validity for a group treatment for child sexual abuse delivered at a child advocacy center. Participants were 97 children and their nonoffending caregivers who were referred to Project SAFE (Sexual Abuse Family Education), a standardized, 12-week cognitive-behavioral group treatment for families who have experienced child sexual abuse. Sixty-four percent of children presented with clinically significant symptoms on at least one measure with established clinical cutoffs. Caregivers of children who presented with clinically significant symptoms reported more distress about their competence as caregivers. Children who presented as subclinical were more likely to have experienced intrafamilial sexual abuse. Posttreatment results indicated significant improvements in functioning for all children who participated in treatment, with greater improvements reported for children who initially presented with clinically significant symptoms. Overall, the program was rated favorably on the posttreatment evaluation of social validity.     

Attachment Change in the Beginning Stages of Therapy: Examining Change Trajectories for Avoidance and Anxiety

The purpose of this study was to investigate the nature of self‐reported attachment change (avoidance and anxiety) in the context of six sessions of couple therapy designed to emphasize both therapist‐centered and couple‐centered (i.e., enactment‐based) clinical process during the beginning stages of therapy. A total of 48 couples with at least one partner who reported clinically significant relationship dissatisfaction participated in this study. Findings confirmed that some couples experience positive attachment‐related change (anxiety or avoidance), while also identifying a subset of individuals who may not experience optimal levels of attachment‐related change. In addition, findings point toward both differences and similarities between change trajectories for avoidance and anxiety. Finally, there was evidence that socio‐demographic factors may be associated with attachment change.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Family Therapy in a Psychiatric Hospital: A Case-Controlled Evaluation

Thirty-five patients (20 women) treated by a Family Therapy Unit based in a psychiatric hospital were compared with 35 matched control inpatients who were not treated by the Unit. Family Therapy averaged 4.5 one hour sessions and was cybernetic rather than behavioural or psychoeducational. The main outcome measure was days spent in the hospital in the year after family therapy. Women, but not men, showed a significant improvement after family therapy, reducing their days in hospital from a mean of 50 in the year before family therapy to 18 in the year after. The best response was shown by women with affective disorder. Control men and women showed a slight increase in days spent in hospital. Improvement after family therapy was associated with a markedly positive change in key relatives' attitudes to the patient, and a strongly positive attitude towards family therapy.     

SEXISM IN FAMILY THERAPY: DOES TRAINING IN GENDER MAKE A DIFFERENCE?

The purpose of this study was to investigate the clinical decision making of marriage and family therapists who had no training in gender compared to those who had such training, either through a separate course or by having gender issues integrated throughout the curriculum. Specifically, levels of feminism and sexism in the clinical assumptions and interventions of therapists were evaluated using clinical vignettes. Participants for this study included 150 beginning or entry-level therapists from marriage and family therapy training programs in academic settings. Of the 102 participants with some training in gender isues, 64% reported having received gender training from a faeminist perspective. contrary to expectations, a multivariate analyssis of variance revealed that training in gender issues alone did not significantly influence levels of feminism and sexism in clinical decision making. However, the levels of sexism in clinical interventions were significantly lower if therapists had received gender coursework from a feminist perspective, whether in a separate course or integrated throughout the curriculuim. These findings raise a question as to the wtility of teaching gender issues if what is taught and how it is taught are not also considered.     

Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS)

The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (Q_MAX), while the second group of patients exhibited significant improvement in both PVR and Q_MAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.     

Heterogeneity of Individuals with a History of Child Sexual Abuse: An Examination of Children Presenting to Treatment

The current study examined children and families who presented for treatment through Project SAFE (Sexual Abuse Family Education) following childhood sexual abuse. Pretreatment assessment data were used to develop clusters of participants with significantly differing presentation of symptom outcome following abuse. Four clusters were discovered: (a) a Highly Distressed group, whose members had clinically elevated scores on all self- and parent-report measures; (b) a Problem Behaviors group, whose members had scores within the normal range for self-report measures and elevated scores on all parent-report measures; (c) a Subclinical group, whose participants had scores below the mean and below cutoff scores for all self- and parent-report measures; and (d) a Self-reported Distress group, whose members had elevated scores on self-report measures and scores below clinical cutoffs for all parent-report measures.     

Using the Therapist's Inner Conversation in Teamwork with Novice Therapists

Peter Rober's work (2005a) on the therapist’s inner conversation (TIC) has been a significant contribution to understanding the therapist's 'here and now' experience that focuses on the emergence of different voices responding to what is said in the therapy session. Frediani and Rober (2016) conducted an investigation into the experience and TIC of novice therapists concerning emotions aroused and how they deal with them during family therapy. Their research prompted us to ask how this methodology could work with recent graduates and those in the last year of their undergraduate training. This was addressed in the adolescent psychotherapy team that is part of the Equipo de Trabajo y Asesoría Sistémica (Systemic Counselling and Teamwork) (eQtasis) of the Psychology Department of the University of Chile. An important characteristic has been developing an ethics for clinical practice and generating a collaborative reflexive approach as a central aspect of the clinical training. The paper aims to promote the legitimacy of the experience of novice therapists who despite limited professional experience have many stories that connect with what is said in therapy.     

Heterogeneity of individuals with a history of child sexual abuse: an examination of children presenting to treatment

The current study examined children and families who presented for treatment through Project SAFE (Sexual Abuse Family Education) following childhood sexual abuse. Pretreatment assessment data were used to develop clusters of participants with significantly differing presentation of symptom outcome following abuse. Four clusters were discovered: (a) a Highly Distressed group, whose members had clinically elevated scores on all self- and parent-report measures; (b) a Problem Behaviors group, whose members had scores within the normal range for self-report measures and elevated scores on all parent-report measures; (c) a Subclinical group, whose participants had scores below the mean and below cutoff scores for all self- and parent-report measures; and (d) a Self-reported Distress group, whose members had elevated scores on self-report measures and scores below clinical cutoffs for all parent-report measures.     

A mixed methods inquiry of caregivers of U.S. veterans with sustained “invisible” injuries from Iraq/Afghanistan

ABSTRACT

An exploratory study of caregiver burden associated with family caregivers enrolled in the VA Caregiver Support Program who assist veterans with serious invisible injuries sustained post September 11, 2001. A mixed methods analysis was completed with a retroactive chart review of already collected data (172 participants) in addition to a phenomenological query of 16 participants. Results: T-tests resulted in a significantly higher caregiver burden score with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = ?2.36, p = .02. An ANOVA across caregiver role (parent, spouse, significant other and other) and the Zarit Burden Inventory (ZBI) resulted in a significant difference (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M = 6.83; SD = 3.10) than parental caregivers (M = 4.46; SD = 2.70). The phenomenological research resulted in 22 major themes (family adjustment, subjective demands, coping techniques, social support, VA/DOD, self-care, intimacy, role strain, financial resources, life course, obligation, rewards, isolation/loss of self, reciprocity, stigma, community resources, spiritual support, tools, hope, uncertainty, guilt, leash syndrome) which supported quantitative findings. Conclusions: Caregivers and their families had a difficult time adjusting post injury. Caregivers relied heavily on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers and caregivers with children in the home had more difficulty adjusting when compared with parental caregivers.