Long‐term continuous clients and their needs: a New Zealand analysis

National New Zealand data (2002) indicate that 27% of gambling clients remain in treatment for longer than 12 months. This research retrospectively analysed data from long‐term continuous, re‐admitted and brief therapy clients. The data were obtained from a national database and were analysed quantitatively and qualitatively. Results indicated that relevant differences between long‐term continuous and other clients occurred in ethnicity and clinic location. The latter was confounded by the number of clinics versus clients. The average age of long‐term continuous clients was 43 years; 5–6 years older than other clients; however, this marginally failed to reach a level of statistical significance. The results led to the proposal of two alternative models of therapy for clients with gambling problems: (a) a six‐session capsule model and (b) an inductive, open‐ended model (with regular review component). Further research is required to test the efficacy of these models.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

Examining the Incidence and Clients’ Experiences of Single Session Therapy in Italy: A Feasibility Study

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.     

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.     

‘Somebody Watching You’: Impact of Reflecting Teams on Hope in Couple Relationships

Reflecting teams (RTs) represent both an epistemological stance and a therapeutic technique. Most commonly associated with narrative and systemic approaches to therapy, RTs offer an outsider perspective that can bring hope and alternative narratives and perspectives for therapists and clients to explore. Relational hope is a little researched concept in the field of couple therapy research. This study explores the experience of RTs in couple relationships and the aspects of the experience that couples describe as connected to a sense of hope for their relationship. The study also considers whether difference in attachment style shows any relationship with hope in couple relationships before and after the clients’ session with a reflecting team. Couples completed questionnaires about their attachment style, demographics, and relational hope and were given the option to complete an interview about their experience with the reflecting team within 1 month of their therapy session. Our findings suggest that RTs contribute positively to hope in couple relationships particularly for clients who present with an anxious attachment style. This direction for research is important because there is very little research about hope in couple relationships despite its importance (Merolla, 2014; Snyder, 2002) and there is no research about what aspects of a reflecting team contribute to hope in couple relationships. Analysis of interviews indicates a number of features of the reflecting team feedback that were valued by clients.     

Managed care. The effect of case management on state psychiatric clients.

This study examined whether case management services, mandated under the managed care contract for adult clients in a medium-sized state psychiatric hospital in Tennessee between July 1996 and June 1997, were offered as specified, and the impact these services had on recidivism for individuals who were identified as having a severe or persistent mental illness. Although all of the clients were offered case management, 47% refused the service. Of the 14 who had one or more readmissions, six (43%) had case management. These findings demonstrate that health care providers must offer sufficient information to their clients so that they can use the managed care system more effectively.     

Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Clients' Perceptions of Single Session Consultations as an Option to Waiting for Family Therapy

A single-session program was mailed at Bouverie Family Therapy Centre (BFTC), Melbourne, and results indicated a high level of client satisfaction with the service. Within the review period 53% of clients chose to attend for a one off consultation only, with the option of an ‘open door’ to return far therapy if they felt the need. The BFTC outcome supported findings of Moshe Talmon (an international advocate of the effectiveness of single session therapy), and also of two other Australian agencies whose research was reviewed and compared with the BFTC results.     

A Study of Clinical Change in Individual Career Counseling

This study examined the clinical significance of career counseling effects. Participants were 111 university students (83% women) who participated in individual career counseling sessions at their university. All participants completed the French version of the Outcome Questionnaire–30.2 (OQ‐30.2; Lambert, Finch, Okiishi, & Burlingame, 2005) immediately before the 1st session (pretest) and at the beginning of the last session (posttest). The OQ‐30.2 assesses 3 client life domains: subjective discomfort, problems in interpersonal relationships, and problems in social role satisfaction. Using Jacobson and Truax’s (1991) statistical approach to assessing clinical change, the authors compared clients’ pretest OQ‐30.2 scores with their posttest scores. Among clients with a “dysfunctional” score (n = 59) at the study’s inception, 34% recovered and 14% improved, whereas 41% of clients with functional scores (n = 52) at the study’s inception improved. The results suggest that individual career counseling can make a difference in the lives of many clients; they also highlight the importance of further outcome research that accounts for possible variability in clients’ responses to career counseling.     

THERAPIST AND CLIENT BEHAVIORS IN THE FIRST INTERVIEW: EFFECGTS ON SESSION IMPACT AND TREATMENT DURATION

The first-session behaviors of therapists and clients in 38 cases were observationally codes and their relations to client ratings of session impact and treatment duration were examined. Results indicated that few first-session global types of behaviors of participants affect treatment durations. Clients may suspend judgement about continuing in therapy untill after they have attended more than one session, regardless of the first inverview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is individuals as opposed to couples and families.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

‘Bad Therapy’ as a Training Technique: An Empirical Analysis

The purpose of the present study was to gather empirical data to examine the usefulness of an intriguing training technique called “bad therapy”. The technique, developed by Lang (1980, 1982), is utilized in a role-play setting for experienced therapists who are having difficulty with specific clients showing little improvement. The therapist is instructed to disregard his or her usual style of treatment, and instead, within a role-play format with a colleague who plays the part of a client, to try an alternative style of treatment. This new treatment, termed “bad therapy”, instructs the therapist to try to make the client worse rather than better. Interestingly, reports from both the role-play therapist and client indicate that the “bad therapy” session was considered more beneficial than the therapist's usual mode of treatment. As well as empirically investigating Lang's assertion, the present study also attempted to look at different perspectives of bad therapy. Is “bad therapy” a directive to be harmful and destructive, or is it a suggestion to be more daring and to take more risks? Subjects were 56 therapists who formed twenty eight pairs of therapist-client dyads. First, each pair conducted a “session” where the therapist performed his or her typical therapy. Then, therapists in one group (N= 11) were given directives to try to make their clients worse rather than better (“destructive” set), while therapists in another group (N=11) were told to say and do things that they wished to, but never dared (“daring” set). Finally, six therapists were told to simply repeat their usual type of therapy (“control” set). Results indicated that clients perceived the destructive and daring groups differently with the daring group being perceived more favourably, yet more authoritarian. Similarly, therapists perceived the daring and control groups more positively than the destructive group. The results are discussed in terms of training techniques and current trends in psychotherapy.     

DO WE REALLY UNDERSTAND? AN EXPERIENTIAL EXERCISE FOR TRAINING FAMILY THERAPISTS

This paper presents an experiential exercise for training beginning marriage and family therapists, as well as several adaptations of the format. The basic exercise consists of role playing a therapy session in which the people playing the clients speak a language that is not understood by the therapist-in-training. Although the therapist cannot understand the clients, the clients can understand the therapist. This exercise assists students to become more cognizant of the need to be cautious and curious in the cocreation of meaning in therapy. In addition, this exercise builds confidence and clinical skills, such as learning about nonverbal communication while observing process.     

The Worker Role Interview: a powerful tool in Icelandic work rehabilitation

A pilot-study using the Worker Role Interview (WRI) was conducted to gather information from clients attending a work- rehabilitation program in an Icelandic psychiatric center. The work rehabilitation program traditionally used a performance-capacity-oriented assessment (PCA) to evaluate work readiness. Clients scoring 90% or higher on the PCA were considered able to re-enter the job market. However, scoring over 90% did not result in automatic return to work for the majority of clients. As a result, many questions were proposed about the effectiveness of the PCA to predict client ability to re-enter the work force. A pilot study using the Worker Role Interview was conducted with an aim to gain insight into what barriers prevented clients from entering the work force. Ten clients scoring 90% or over on the PCA were interviewed using the WRI. Qualitative methods were used to analyze the data. Results from the WRI indicated that clients failed to join the work force due to a number of psychosocial factors, such as lack of personal causation and self-efficacy combined with environmental factors. The WRI provided clients with an opportunity to express their attitudes and opinions towards work. Information gained through the WRI also gave new direction in goal setting for the work rehabilitation program and validated the need to expand occupational therapy services.     

Electronic case management with homeless youth

Case management, a widely practiced form of service brokerage, is associated with a variety of positive outcomes for homeless youth, but it may be difficult to implement, as youth face logistical barriers to attending in-person meetings. As part of a larger clinical trial, the current study investigates the feasibility of providing electronic case management (ECM) to homeless youth, using cell-phones, texts, email, and Facebook. Youth were given prepaid cell-phones and a case manager who provided four ECM sessions every 2–3 weeks over a 3-month period. Contact logs were used to record how many youth engaged in ECM, how many attempts were necessary to elicit engagement, and youths’ preferred technology methods for engaging. Although engagement in the number of ECM sessions varied, the majority of youth (87.5%) engaged in at least one ECM session. Youth (41%) most commonly needed one contact before they engaged in an ECM session, and the majority responded by the third attempt. While youth most commonly answered calls directly, their chosen method of returning calls was texting. The majority of youth (80%) described ECM positively, reporting themes of convenience, connection, and accountability. The use of ECM, particularly of texting, offers promising implications for providing services to homeless youth.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

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.