Invited case transcript. The initial clinical hypothesis.

The interviewing skills of many behavior therapists are inadequate and several reasons are noted for this. The present manuscript focuses on construction and use of an initial clinical hypothesis. A strategy for generating the initial hypothesis is discussed and illustrated by means of transcripts from an initial interview with a complex clinical case. A method for teaching skills in initial clinical hypothesis generation is presented as well.

Prediction versus reflection in therapist demonstrations of understanding: a replication with clinical cases.

Previous analogue research with college students shows that therapists who make accurate predictions of their patient's behaviour are judged as more demonstrative of understanding their patient's problems than therapists who make reflections or request further information. The present study replicated this research and extended it by using psychotherapy out-patients as subjects. Similar findings were obtained. Further, therapists who employed accurate predictions were judged as more likely to mediate successful therapeutic outcomes.

An investigation of the aetiology of chronic headache. The role of headache models.

Headache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

Prediction versus reflection in therapist demonstrations of understanding: three analogue experiments.

Many forms of therapy deem it important for therapists to demonstrate to their clients that they understand the particular client's dilemma. The most common approach to therapists' demonstrations of understanding is the Rogerian method of reflection. Another approach to demonstrating understanding is to make accurate predictions of the client's behaviour. The purpose of the present experiments was to test the hypothesis that therapist predictions (predictive interactions) would be viewed by observers as more demonstrative of understanding the client than therapist reflections (reflective interactions) and therapist admissions of not understanding the client's problem (naive interactions). In each experiment, subjects were randomly assigned to conditions, read excerpts from an interview transcript, and then rated therapist understanding of the client's problems and therapist demonstrations of understanding. The results of all three experiments were consistent and indicated that: predictive interactions were judged as superior to reflective interactions and naive interactions on ratings of demonstrated understanding; reflective and naive interactions did not differ on any measure. These results question the utility of reflective interactions in clinical practice for communicating understanding to clients and support the notion that accurate therapist predictions of client behaviour may be more useful in demonstrating understanding. The results also indicate the need to study these phenomena more thoroughly in clinical settings.

Data-based versus symptomatic formulation of treatment: the case of a dependent personality.

A 48-year-old female presented anxiety and avoidances following diagnosis of her daughter as diabetic. A comprehensive formulation of the case seemed unobtainable. Symptomatic treatment was thus initiated which led to improvement then relapse. Subsequent clinical observation led to a new formulation, namely, anxiety about independent decision making. This hypothesis was assessed. The patient was found to be excessively reliant on others and deficient in autonomous behavior. Accordingly, treatment was aimed at modifying anxiety about independent decision making, and this proved successful. Improvements maintained at an 11-month follow-up. The implications of this case for clinical practice are discussed.

Test of reliability of perception of parental and childhood illness behavior.

This report details the reliability of perceived parental and childhood illness behavior. Three versions of the Illness Behavior Inventory were created to assess perceived illness behavior of one's mother, father, and oneself as a child. The measures were administered twice to 32 students of linguistics at a major university with a 2-wk. interval between administrations. Each measure across administrations correlated highly and significantly (.98 to .99). It was concluded that perceptions of parental and childhood illness behavior are reliable over time but their sensitivity to actual historical events remains an empirical question.

The use of EMG biofeedback with insulin-dependent diabetic patients.

A recent report on the use of EMG biofeedback with an insulin-dependent diabetic is discussed. An examination of the role of EMG biofeedback in the management of carbohydrate metabolism is presented. While still an empirical question, it is concluded that EMG biofeedback will prove most useful in cases where a demonstrable relationship between stress and carbohydrate metabolism is evidenced.

Covert positive reinforcement and pain modification: a test of efficacy and theory.

The effects of covert positive reinforcement, covert positive reinforcement plus positive expectancy, covert positive reinforcement plus negative expectancy, covert positive reinforcement of pain, attention placebo and no treatment on control of headache and finger pressure pain were examined. Self-report, behavioural and physiological measures were taken. Groups did not differ on any measures except for validity checks of the expectancy manipulation. The results provide little support for the efficacy of covert positive reinforcement in modifying pain. Additionally, the data failed to substantiate the theoretical basis of the procedure.