A comparison of dose-response curves in cognitive-behavioral and psychodynamic psychotherapies.

Changes in patient- and therapist-rated process items, and patient-rated symptom severity assessed over a maximum of 30 sessions of psychodynamic or cognitive-behavioral psychotherapy were compared in an outpatient mental-health clinic. Patients' ratings in psychodynamic psychotherapy on two of the process items were superior to ratings by patients in cognitive-behavioral therapy, and interactions with time were discovered for an interpersonal item. Comparisons between patients who reported their initial symptom severities as most severe and those with less severe symptoms also were made, with results indicating differential effects of treatment according to perceptions of symptom severity. Interactions between length of stay in treatment and number of sessions also were investigated. Findings indicated that patients benefit from psychotherapy over time and support the usefulness of a contextual model for psychotherapy funding.

Severity of symptoms of depression and anxiety as predictors of duration of psychotherapy.

The present study explored predictors of the duration of therapy exclusive of outcome utilizing data on 77 patients at St. John's University Center for Psychological Services. Measures of time in therapy were the total number of sessions attended and the number of sessions attended within the first six months of therapy. A bivariate Pearson product-moment correlation matrix was constructed, comprised of measures for time in therapy, severity of symptom measures, treatment modality (psychodynamic or cognitive-behavioral), age, and sex. There was a significant correlation between scores on state anxiety and the total number of sessions as well as between scores on state anxiety and number of sessions attended within six months, but no other correlations between measures of severity of symptoms and time in therapy were significant (p > .05). The results indicate that severity of symptoms does not significantly predict the duration of therapy.

Methodological problems encountered in research with psychiatric inpatients: a case example.

In this article, problems associated with several methods commonly employed in research with psychiatric inpatients are discussed and the implications that these problems have for the validity of research with this population are explored, using an investigation of the relationship between moral reasoning and aggression among psychiatric inpatients as a case example. Specific issues examined include the adequacy of hospital records for diagnosing patients, the difficulty of determining when it is appropriate to approach recently admitted patients for research, and problems in the measurement of behavioral and psychological variables such as aggression and moral reasoning. Suggestions and recommendations for addressing these issues in future research are offered.

Interpersonal perceptions of depressed and borderline inpatients.

Distortions in interpersonal perceptions among patients with borderline personality disorder (BPD) were explored to investigate the validity of object relations theories. Depressed patients with BPD were compared to patients with major depressive disorder (MD) without BPD. Subjects were 77 male and female inpatients (BPD = 55, MD = 22). The mean ages were 30.5 for BPD subjects and 36.3 for MD subjects. Perceptions of patients, relatives, and interviewers were compared on the following measures: Structural Analysis of Social Behavior, Perceived Criticism Scale, and Camberwell Family Interview. Findings are consistent with object relations theory. BPD patients saw themselves as hostile, labile, and unstable. MD patients avoid acknowledging and responding to relatives criticallity.

Ethnic diversification in clinical psychology graduate training.

Thirty-eight directors and 334 advanced graduate students from clinical psychology programs completed a survey on ethnic minority training offered in clinical doctoral programs. Comparisons were made between directors' and students' ratings on the following variables: students' level of interest in ethnic minority training, the importance of this training, and the effectiveness of the clinical programs' minority-related education. Minority and nonminority students' responses were also compared on these variables. Supplementary data were collected on ethnic minority education in coursework, research, and clinical practica. Findings indicate that students, relative to clinical directors, assign more importance to ethnic minority training and lower efficacy ratings to their programs' ethnic minority education. The results also suggest that minority students feel more strongly about the value of ethnic minority training than do their nonminority peers and the directors. The implications of these results are discussed, and recommendations are made to address identified problems.

Revisiting fee policies.

Charging for missed sessions is presented as part of an ethical flexible fee policy that is being challenged and will require continued appraisal.

The complexity of sexuality.

Recent genetic and environmental theories of the etiology of homosexuality are evaluated. Interactive theory is proposed as a better alternative for understanding the development of sexual identity and sexual preference.

The dynamics of managed mental health care.

Presented here is an exploration of the motivations involved in the development and application of managed mental health care to the private practice of outpatient psychotherapy. The interaction of management policy and psychotherapy is conceptualized in a dynamic model designed to provide insights into effective care policies. The model is described first, then the development of managed care, which appears defensive and is becoming symptomatic to the point of needing significant change. It is suggested that management policies providing choices of therapists and therapies will be the most effective in addressing ethical, fiscal, and psychological concerns of funders, consumers, and providers.

A comparison of 16 systems to diagnose schizophrenia.

Sixteen diagnostic classification systems were compared to determine the degree of agreement on the diagnosis of schizophrenia. Data were collected by a structured interview method with 284 patients, 52 first admissions, and 196 readmissions. The kappa coefficient was used to calculate interrater reliability and concordance of the systems. Adequate reliability was found for 12 of the systems. However, concordance was generally low; 11 of 120 combinations reached kappa of .40 or higher for the total sample, 16 of 120 for first admissions, and only 6 of 120 for readmissions. These results indicate the restriction of generalization and raise questions as to the empirical validity of the construct of schizophrenia.

Homogeneity and heterogeneity in schizophrenia.

This study provides a description of replicated findings of limited heterogeneity in DSM-III schizophrenics. Based now on a sample of 145 schizophrenics, in 1984 and 182 in 1991 it is suggested that the diagnosis is primarily given to chronic patients with poor prognoses, in turn restricting the utility of a process-reactive conceptualization of schizophrenia.

Activity-withdrawal, diagnosis, and demographics as predictors of premorbid adjustment.

This study addressed the need for the establishment of clinically viable "easy access" data that could help predict outcome during the earliest stages of hospitalization. The study examined the contributions of an activity-withdrawal rating, a DSM-III diagnosis, and demographic variables to the prediction of prognosis. The subject population consisted of 152 patients drawn from the population of three psychiatric units. Prognosis was predicted successfully by activity-withdrawal, diagnosis, and demographic variables; the best estimate of prognosis resulted from the combination of all the predictor variables. Results are discussed in terms of the individual and joint contributions of the independent variables to prognostic prediction as well as the probable reasons for differential prognosis for each predictor category.

The supervisory relationship in psychotherapy over time.

This study investigated changes in the supervisors' and supervisees' perceptions of the supervisory relationship and the extent to which their perceptions were congruent. Salient dimensions of supervision were identified which predict the quality of the relationship. Twelve supervisory dyads involved in predominantly ongoing supervisory relationships completed an adapted Vanderbilt Psychotherapy Process Scale after each supervisory session for 10 consecutive weeks. The participants' perceptions of the supervisory relationships were relatively stable and positive. However, supervisees felt less dependent over time. With that exception, agreement among participants did not change significantly. Supervisors viewed supervisees' participation and increased assertiveness as significant positive elements in assessing the quality of the relationship. Supervisees' greater exploration and dependency was associated with negative ratings by supervisors. Since supervisors selected the supervisees for the study, the results primarily validate their judgments of the components of a positive continuing supervisory relationship.

Changes during the course of the psychotherapeutic relationship.

Changes in the therapeutic relationship over time were explored using the Therapy Session Report for 30 patients and six therapists at an out-patient clinic. 11 patients dropped out after the third session, while the continuing group consisted of 19 patients for whom sessions ranged from 5 to 33. Significant differences on both patient and therapist evaluations were found between the dropout and continuing groups, there being high agreement from inception to termination. Results emphasized the importance of early establishment of a collaborative relationship in short-term psychotherapy.

Psychotherapists' religious beliefs and their perception of the psychotherapy process.

In a comparison of religious and nonreligious psychotherapists' perceptions of a portion of a psychotherapeutic session no significant differences were found on the Vanderbilt Psychotherapy Process Scale for four groups of therapists designated according to their scores on three religious questionnaires. While the results suggest attitudes toward religion are not reflected in therapists' practice of psychotherapy, limitations of the study indicate the need for more rigorous testing of this possibility.

Homosexual and heterosexual sex-role orientation on six sex-role scales.

A comparison was made of the sex roles of homosexual and heterosexual men and women on the Bem Sex Role Inventory, Personality Attributes Questionnaire, Personality Research Form Androgyny Scale, Adjective Checklist Masculinity and Femininity Scales, Extended Personality Attributes Questionnaire and Undesirable Characteristics Scale. The results indicated that homosexuals and heterosexuals differ in their response to different aspects of sex roles. The most consistent difference was the greater femininity of male homosexuals in respect to male heterosexuals. Other differences were scale-specific and the low interscale comparability indicated such scales should not be used interchangeably. Differences between results of studies comparing sex roles of the homosexuals and heterosexuals appear attributable to sample heterogeneity and distinctions between sex-role scales.