Patient crying during psychotherapy intake sessions: Relationship to patient characteristics and early treatment process.

The aim of the present study is to further the understanding of who cries at the beginning of psychotherapy and patients' experience of crying in that process. Intake sessions for 53 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics were also collected at intake. Results indicate that crying during intake sessions was related to lower global functioning and higher severity of childhood sexual abuse. Furthermore, patients who cried at intake were over four times more likely to also cry at feedback, and those who cried at feedback were almost 12 times more likely to have cried at intake. Finally, crying in the intake session did not appear to be related to patient- or therapist-rated working alliance. Overall, the present study provides valuable information about characteristics of patients who cry at the outset of the therapy process and patients' experience of crying over time in therapy. Findings suggest the need for further research on patient characteristics and aspects of the therapy process that may predict patient crying over the course of treatment, as well as how these early crying experiences may be related to eventual patient outcomes.

Changing developmental trajectory in high-risk families: the effectiveness of an attachment-informed Therapeutic Nursery Program (TNP) for preschool children with complex emotional and behavioral problems.

The article describes a "Therapeutic Nursery Program" (TNP) and presents a study that examined its effectiveness. This attachment-informed program serves preschoolers with severe emotional and behavioral problems. Efficacy was assessed based on: 1) children's success in transitioning from the TNP to typical schools; (2) improvement in children's outcomes as a function of specific intervention factors; (3) gains in social informational processing during the school year. The sample included 60 children from mostly low-income African American families (>60%). Nearly 80 percent of graduates attended typical educational settings after graduation. More classroom attendance and more individual child therapy sessions were associated with better social, academic, and cognitive child outcomes. Finally, TNP children with better attendanceclosed the gap with a comparison group in their social information processing. Our findings point to the TNP as a promising prevention approach with specific implications for the practice of attachment in the "real world."

Children and Caregivers' Exposure to Adverse Childhood Experiences (ACES): Association with Children's and Caregivers' Psychological Outcomes in a Therapeutic Preschool Program.

Exposure to adverse childhood experiences (ACE) has been found to have a profound negative impact on multiple child outcomes, including academic achievement, social cognition patterns, and behavioral adjustment. However, these links have yet to be examined in preschool children that are already experiencing behavior or social-emotional problems. Thus, the present study examined the links between the caregiver's and the child's exposure to ACE and multiple child and caregiver's outcomes in a sample of 30 preschool children enrolled in a Therapeutic Nursery Program (TNP). Children are typically referred to this TNP due to significant delays in their social emotional development that often result in difficulty functioning in typical childcare, home, and community settings. Analyses revealed some contradictory patterns that may be specific to this clinical sample. Children with higher exposure to ACE showed more biased social information processing patterns and their caregivers reported lower child social skills than caregivers of children with less exposure, however their inhibitory control levels were higher (better control) and staff reported that these children exhibited better social skills as well as better approaches to learning than children with less exposure. No such contradictions were found in relation to the caregiver's exposure to ACE, as it was positively associated with a number of negative child and caregiver outcomes.