Predicting response to intensive multimodal inpatient treatment: a comparison of single- and multiple-class growth modeling approaches.

In a modest body of research, personality functioning assessed via performance-based instruments has been found to validly predict treatment outcome and, to some extent, differential response to treatment. However, state-of-the-science longitudinal and mixture modeling techniques, which are common in many areas of clinical psychology, have rarely been used. In this article, we compare multilevel growth curve modeling (MLM) and latent class growth modeling (LCGM) approaches with the same data set to illustrate the different research questions that can be addressed by each method. Global Assessment of Functioning (GAF) scores collected at 6 points during the course of a long-term multimodal inpatient treatment of 58 severely and persistently mentally ill adults were used to model the trajectory of treatment outcome. Pretreatment Rorschach-based markers of personality functioning and other markers of psychiatric severity were examined as covariates in each modeling approach. The results of both modeling approaches generally indicated that more psychologically impaired clients responded less favorably to treatment. The LCGM approach revealed 2 unique trajectories of improvement (a persistently low group and a higher starting, improving group). Personality functioning and baseline psychiatric variables significantly predicted group membership and the rate of change within the groups. A side-by-side examination of these 2 methods was found to be useful in predicting differential treatment response with personality functioning variables.

Video-tape role induction for psychotherapy: moving forward.

Role induction (RI) has been shown to decrease premature termination and to enhance the therapeutic alliance and symptom relief. We examine the effects of a video-tape RI on premature termination rates, outcome, and the process variable of therapeutic alliance. Sixty-eight clients and their therapists (N = 26) participated in the study. Each client completed baseline measures of symptom status before beginning the therapy. Clients were then randomly assigned to either a video-tape RI condition or a no videotape treatment-as-usual condition. After the first session of therapy, clients and therapists separately completed outcome and alliance measures. Providing a video-tape RI to clients as they entered therapy did not lead to better results in attendance, outcome, or process variables. Considering possibilities that lie beyond the design of this study, so as to understand these results, is encouraged in an effort to advance the field's thinking about RI and how it can best be harnessed for continued positive effects moving forward.

Examining the potential impact of a family session in therapeutic assessment: a single-case experiment.

Most clinicians concede the benefits of conceptualizing children in systemic terms. Yet, many child assessments involve parents only on a limited basis. The Therapeutic Assessment model for children and families (TA-C) emphasizes parental involvement and family-driven collaboration throughout the intervention. Child TA has shown promise as an effective brief intervention (e.g., Smith, Handler, & Nash, 2010; Tharinger et al., 2009). Family intervention sessions (Finn, 2007; Tharinger, Finn, Austin, et al., 2008) are an integral component of the child TA model in facilitating familial changes. However, TA-C research has yet to empirically examine the potential impact of a family session on treatment trajectory. This case study includes an extended presentation of the development and execution of a family session. The authors use a daily measures time-series experiment to empirically examine the clinical effectiveness of the TA-C and the hypothesis that the family session was a tipping point in the trajectory of improvement.

Therapeutic assessment for preadolescent boys with oppositional defiant disorder: a replicated single-case time-series design.

The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to track the process of change as it unfolds. All 3 families benefitted from participation in TA across multiple domains of functioning, but the way in which change unfolded was unique for each family. These findings are substantiated by the Behavior Assessment System for Children (Reynolds & Kamphaus, 2004). The TA model is shown to be an effective treatment for preadolescent boys with oppositional defiant disorder and their families. Further, the time-series design of this study illustrated how this empirically grounded case-based methodology reveals when and how change unfolds during treatment in a way that is usually not possible with other research designs.

Therapeutic assessment of families in healthcare settings: a case presentation of the model's application.

In this article, we present a case study of a Therapeutic Assessment (TA) with an 11-year-old boy who had two unexplained behavioral episodes suggesting neurological impairment, which led to two emergency department visits at a children's hospital. TA is a semistructured approach that blends the extensive conceptualizing benefits of psychological assessment with the principles and techniques of evidence-based child and family interventions. We use this case to illustrate how TA is an adaptive and flexible approach to child-centered family assessment that can meet the goals of psychologists working in pediatric and general medical hospitals, primary care clinics, family medicine practices, and other health care settings. With the current case, the clinician was able to use the procedures of TA to clarify for the family their son's unexplained behaviors, while also providing them with a therapeutic experience. In addition to addressing the family's concerns, the clinician also addressed a number of specific questions provided by the referring neurologist that informed ongoing care of the child. This case illustrates the potential utility and effectiveness of the TA model with children and families referred to a typical psychology service in a health care setting. This case is one of the first applications of the TA model with this population and its success suggests further research in this area is warranted.

Testing the effectiveness of family therapeutic assessment: a case study using a time-series design.

We describe a family Therapeutic Assessment (TA) case study employing 2 assessors, 2 assessment rooms, and a video link. In the study, we employed a daily measures time-series design with a pretreatment baseline and follow-up period to examine the family TA treatment model. In addition to being an illustrative addition to a number of clinical reports suggesting the efficacy of family TA, this study is the first to apply a case-based time-series design to test whether family TA leads to clinical improvement and also illustrates when that improvement occurs. Results support the trajectory of change proposed by Finn (2007), the TA model's creator, who posits that benefits continue beyond the formal treatment itself.

"Why do I get in trouble so much?": a family therapeutic assessment case study.

Recent case studies have demonstrated the potential benefits of Finn's Therapeutic Assessment (TA) model with families (e.g., Handler, 2007; Tharinger, Finn, Wilkinson, & Schaber, 2007). This case study of a 6-year-old girl and her family follows the Therapeutic Assessment (TA) model, focusing on the specified goals of each session and how those goals were accomplished. In this article, we illustrate the flexibility afforded by the TA model to tailor an appropriate intervention for a specific family and also show that extensive experience with the TA model is not necessary for this approach to yield clinically significant results.

Empathic insights from the Rorschach: Paul Lerner's legacy.

In this article, I review the contributions of Paul Lerner concerning his "humanistic-clinical attitude" in using the Rorschach (Exner, 2003) with patients. To illustrate Paul's empathic attitude, I present a case in which the patient's percepts reflected his relationship problems and his experience of me and others as a threat to his emotional integrity. Asking the patient to give voice to his Rorschach percepts, thereby amplifying his experience of me and his world, helped me become empathically tuned to him, as described by Paul in his writings and in his approach to patients.

A Rorschach journey with Bruno Klopfer: clinical application and teaching.

This article is a draft of a speech given as the recipient of the 2008 Bruno Klopfer Memorial award. I review some important details of the life of Bruno Klopfer, his contributions to the scoring and interpretation of the Rorschach (Exner, 2003), and his emphasis on the use of phenomenology in the process. I then focused on Klopfer's flexible scoring method and his use of Testing of the Limits techniques on the Rorschach, emphasizing their application to therapeutic and collaborative assessment. I illustrate my own application of Testing of the Limits using case vignettes. Finally, I present selected parts of two 1959 radio interviews of Bruno Klopfer.

"Am I going crazy, doc?": a self psychology approach to therapeutic assessment.

In this case study, we explore the effectiveness of Therapeutic Assessment with a severely disturbed 25-year-old man, referred by his therapist, following Finn's (2007; Finn & Tonsager, 1992, 1997) model. This patient-therapist pair had been working together for approximately 2 months, but the therapy had ceased to progress. The therapist requested a clearer picture of his patient's affective functioning, interpersonal functioning, and self-functioning that might facilitate more effective treatment. Through a collaborative assessment process informed by the principles of Kohutian self psychology, the evaluator and patient slowly formed a working alliance that proved useful for the eventual communication to the patient of his psychologically tenuous reality. This case illustrates the utility of a collaborative, multimethod Therapeutic Assessment with a severely ill patient and the use of Therapeutic Assessment by a less experienced clinician.

Self-injurious behavior in human and non-human primates.

A review of the literature on human and non-human animal self-injury reveals that there has been little cross-fertilization of ideas between these two domains. Each body of research offers particular strengths, which, if combined, may more keenly inform clinicians and researchers alike about the nature of human self-injury. While research on self-injury among humans has necessarily relied upon correlational designs, researchers who study self-injury among non-human primates have more tightly controlled experimental methods at their disposal. Experimental research allows researchers and clinicians to address issues of causality in ways that are not possible with correlational designs. Despite the difficulties of drawing inferences from different species, a review of the experimental data on non-human primate self-injury may give researchers fresh insights into the elusive nature of human self-injury. This article highlights the research and theoretical material pertaining self-injury and identifies ways in which animal models of self-injury might inform research and clinical understanding of human self-injury.

A psychologist grows in Brooklyn: reflections from the past.

In this autobiography, I begin by describing how I made many important decisions in my life without much conscious or verbalized thought. I cover information about my parents, grandparents, early school experiences, and both college and graduate school. The autobiography also includes a detailed discussion of my 41 years of teaching at the University of Tennessee. I discuss important experiences that helped me to become a clinical psychologist and a teacher. I conclude the article with a personal experience concerning the death of my mother and an early memory.

Two assessments, by and for the assessor.

In this article, I describe 2 assessment experiences, 1 in graduate school and the other more recently, which taught me important personal lessons. Both of the experiences helped me grow as a psychologist and helped me in my own personal life as well. Both experiences dealt with highly personal central issues in my life; the first concerning the development of empathy and the second, important issues centering around aging and death.

A Rorschach study of oral dependence in alcoholics and depressives.

Despite the strong association between alcoholism and orality in psychoanalytic theory, use of the Rorschach Inkblot Test to provide empirical support for such a link has yielded decidedly mixed results. However, Masling's Rorschach Oral-Dependency (ROD) scale has shown twice that people with alcoholism give more oral-dependent responses on the Rorschach than matched comparison groups (Bertrand & Masling, 1969; Weiss & Masling, 1970), which is supportive of classical analytic theory. In this study, we investigated alcohol groups, depression groups, and "normal" undergraduates with the ROD scale and found that the 2 clinical groups produced higher ROD scores than the undergraduates. In addition, recent studies by Duberstein and Talbot (1993) and Fowler, Hilsenroth, and Handler (1996) provide evidence for an object relations model of dependency that suggests that a balance between anaclitic dependence and complete independence, in which dependency needs are acknowledged but are not overwhelming, is most adaptive. This model of dependency was evaluated; it was found that a simple difference in group means provided a better fit with the data, although some evidence of an object relations model also was found. Finally, Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) levels of general defensiveness and primary process manifestations in Rorschach content were investigated to assess whether participants were responding defensively to the testing and whether there were any differences in the nature of oral-dependent responses between the clinical groups.