<u>Introduction:</u> the area of process research has identified differences in the process of CB and PI therapy and has highlighted factors which contribute to outcome. The present research aimed to explore three factors, therapist focus, client experiencing and client cognitive change, in very brief 2+1 therapy, and explore their relation to immediate outcome as measured by the assimilation scale. <u>Method:</u> intensive quantitative analyses of eight cases receiving 2+1 therapy was carried out. Four cases received CB therapy, four received PI therapy. Two of each showed 'good' and 'poor' outcome. Ten excerpts, rated in a previous project as significant, were used as items of analysis. <u>Results:</u> PI therapists focused more than CB therapists on 'Constructing Meaning' (CM). Good outcome PI therapy showed a greater emphasis than poor outcome PI therapy on CM. PI therapy clients had higher levels of experiencing, which increased over therapy. Good outcome PI therapy was associated with higher EXP levels, good outcome CB therapy with lower levels of EXP. Good outcome CB clients had fewer negative selfstatements. Movement on the assimilation model was associated with increased EXP levels in PI and fewer negative self-statements in CB therapy. <u>Discussion:</u> results supported previous findings of differences in the process of CB and PI therapy. The mechanism of change in very brief CB and PI therapy are discussed, followed by implications for clinical practice and future research. Overall, findings suggest a picture of the process of therapy which may contribute to the clarification of the complex nature of change in psychotherapy and what is meant by therapeutic change.

This study examined the relationship between perceived parenting skills and youth externalizing symptoms throughout the course of routine treatment of youth receiving services in a community mental health setting. Specifically, this study investigated whether changes in parenting skills were associated with changes in three dimensions of youth externalizing behaviors (behavioral dysfunction, interpersonal relations, social problems). Participants were 401 youth (aged 4-17, mean aged 10.7, 48% female) and their parents/guardians. At regular intervals throughout treatment, parents completed the Treatment Support Measure (TSM) to assess perceived parenting skills along with the Youth Outcome Questionnaire (Y-OQ) to assess youth externalizing symptoms. Hierarchical linear modeling analyses revealed that changes in perceived parenting skills were not significantly related to changes youth behavioral dysfunction, interpersonal relations, or social problems. However, parenting skills and all facets of externalizing significantly changed throughout the course of therapy and higher parenting skills were associated with lower levels of youth externalizing throughout therapy. Parenting skill appears to require further study as a key factor involved in youth psychotherapy outcomes in real world settings, especially in relation to youth externalizing symptoms.

Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimowaka, Lambert & Smart, 2010). Only one randomized clinical trial has examined feedback-assisted treatment in an inpatient eating-disordered population. Results from this study suggested that those who received feedback-assisted (Fb) treatment were more likely to meet Jacobson and Truax's (1991) criteria for recovery than participants in the treatment-as-usual (TAU) condition; however, while these interventions appear to have worked well in the inpatient setting, the long-term effects of this treatment have not been investigated. This is especially pertinent in an eating disorder population, where outcomes tend to be poor and course of illness tends to be chronic. In this study, the effect of feedback interventions on long-term outcome was investigated. Fifty-three of the individuals from the aforementioned original study were contacted by mail, email, or telephone three to four years after leaving the inpatient facility to assess their current level of distress (as measured by the OQ-45) and overall psychological functioning. Comparisons were made between the outcomes of patients assigned to the experimental feedback condition and the TAU condition. Results suggested that both treatment conditions were nearly indistinguishable from one another and did not significantly differ at follow-up; however, the study was significantly underpowered. Our effect size suggested that the Fb group slightly deteriorated over time, while the TAU group slightly improved; however, effect sizes were minimal and did not meet criteria for "small" change according to Cohen's d. Patients’ Body Mass Index (BMI) largely remained the same since leaving the hospital, with a small portion deteriorating. The vast majority of women sought out multiple forms of treatment over the follow-up period, regardless of treatment condition. This is consistent with past research that suggests women with more severe pathology, and who thus require inpatient treatment, tend to experience a more chronic pattern of symptoms even after receiving intensive treatment. Overall, the superiority of feedback-assisted treatment that was found post-treatment appeared to diminish over time and was not detected at follow-up. Suggestions for further research are delineated.

It was hypothesized that effect size in therapy outcome research would correlate positively with congruence effects. Congruence was defined as the degree to which what had been practiced in treatment was scored as improvement when outcome was measured. Additionally, it was hypothesized that correcting effect sizes for estimated nongeneralizable change attributable to congruence (i.e., representativeness reduction) would significantly reduce the average magnitude of effect.

Recent research on psychotherapeutic outcome has highlighted cognitive behaviour therapy (CBT) as the preferred psychotherapeutic approach for most psychological problems. There is however considerable evidence supporting the comparative effectiveness of approaches alternative to CBT. Central to this alternative evidence base is the notion that ‘personal styles’ are influential in determining individual preferences for different psychotherapeutic approaches. This study examined the effect of the combination between the ‘personal style’ of the client and the type of psychotherapeutic approach they receive (more or less directive) on the client’s experience of therapy. A second aim of this study was to explore similarities and differences in the way clients with different 'personal styles' construe therapy through analysis of repertory grid data. Thirty participants with diagnoses of anxiety and/or depression were recruited from mental health charities and a local NHS community team. Participants completed a questionnaire measuring the direction of interest element of personal style, a self-report questionnaire rating their experience of psychotherapy and a repertory grid exploring their construing of psychotherapy. The study found that the fit between an individual’s ‘personal style’ and the type of therapeutic approach they received was predictive of therapy experience. Analysis of the repertory grids revealed few differences in the construing of participants with different ‘personal styles’. The use of a global measure of therapeutic experience was original in research looking at the helpful aspects of psychotherapy. The strengths and limitations of the study are discussed and ideas for future research are recommended.

En pharmaco-épidémiologie, les études visant à évaluer l’impact des médicaments sur la santé de la population en situation réelle d’utilisation à la demande des Autorités de Santé en France, sont conduites dans un contexte contraint, en l’absence de bases de données médicalisées populationnelle. Le choix des critères d’évaluation des études de terrain à mener est donc crucial. Les critères directs de mesure d’impact (mortalité, morbidité, qualité de vie) sont parfois complexes à obtenir à large échelle, aussi, l’utilisation de critères indirects est souvent nécessaire. La persistance des traitements est un critère combinant de nombreux avantages : reflet de la pratique médicale courante et simplicité de recueil. Dans le cadre de cette thèse, nous avons proposé d’étudier l’intérêt de la persistance des traitements comme critère de mesure d’impact, angle peu exploré jusque là, la persistance étant usuellement considérée comme paramètre d’exposition. Aussi, dans le Chapitre 1, nous avons précisé à quels niveaux la persistance des traitements entre dans le champ de l’évaluation de l’impact. Puis, à partir de trois études de terrain, nous avons évalué l’intérêt de la mesure de la persistance au sein de deux niveaux d’impact. La persistance comme mesure directe de l’utilisation et du respect des recommandations est illustrée dans le Chapitre 2 (prévention secondaire du post-infarctus du myocarde). La persistance comme mesure indirecte de l’efficacité en vie réelle est illustrée : dans le Chapitre 3 où la persistance signe l’échec thérapeutique (traitement curatif de la sinusite aigue) puis dans le Chapitre 4 où la persistance est considérée comme un succès thérapeutique (traitement suspensif de l’épilepsie). Pour finir, nous avons discuté l’intérêt des résultats issus de ces travaux au regard du contexte actuel des demandes d’étude requises par les Autorités de Santé avec la perspective de la mise en place de la nouvelle législation européenne d’évaluation du médicament. / Pharmacoepidemiological studies requested by French Health Authorities to assess impact of treatment in real-life medical practice are performed in a restricted context, in the absence of a national health care databases. The choice of evaluation criteria for field studies is thus crucial. Direct impact measure criteria (mortality, morbidity, quality of life) are sometimes difficult to obtain on a large scale, therefore, the use of indirect criteria is often required. Treatment persistence is a criterion that combines several advantages: reflection of real-life medical practice and ease of collection. In this thesis, we studied persistence of treatment as a measure of impact, an original point of view as persistence is usually considered as a parameter of exposure. In Chapter 1, we have detailed at which level persistence of treatment is part of the field of impact evaluation. Thereafter, using three field studies, we assessed measure of persistence within two aspects of impact. Persistence as a direct measure of use and respect of recommendations is illustrated in Chapter 2 (secondary prevention in post-myocardial infarction). Persistence as an indirect measure of effectiveness is illustrated: in Chapter 3 where persistence is a sign of treatment failure (curative treatment of acute sinusitis) then in Chapter 4 where persistence is considered as treatment success (long-term treatment in epilepsy). In conclusion, we have discussed the results of this work with regards to the current context of studies requested by Health Authorities and with the forthcoming implementation of new European pharmacovigilance legislation.

Abstract The current study aimed to investigate the relationship between (a) racial/ethnic matching between African American clients and their counselors (i.e., Black, White, and non-Black racial/ethnic minority counselors) and therapeutic outcomes (i.e., change in symptoms, treatment length, and premature termination), (b) while also controlling for the potential influences of client (i.e., initial distress level, family and social support, and socioeconomic status) and counselor (i.e., experience level) characteristics. Change in symptomology on specific domains of functioning (i.e., Depression, Generalized Anxiety, Academic Distress, and Distress Index) was assessed using the Counseling Center Assessment of Psychological Symptoms-34 (i.e., CCAPS-34; Locke et al., 2012). The change in symptomology was classified into one of three categories (i.e., improvement, no change, and deterioration). An archival data set that consisted of client data from the 2011-2012 academic year contributed by 120 university and college counseling centers in the U.S. that were participating members of the Center for Collegiate Mental Health was used. The sample sizes for the analyses were: 348 clients for change in functioning analyses, 1,418 clients for treatment length analyses, and 2,024 clients for premature termination analyses. The findings indicated that after controlling for the covariates, clients who were matched with White counselors were more likely to experience deterioration in overall distress symptoms, rather than no change in symptoms, compared to those who were matched to Black counselors. Also, those clients who were matched with White counselors were more likely to prematurely terminate their counseling sessions, compared to those who were matched to Black counselors or non-Black racial/ethnic minority counselors. The findings from this study may assist researchers and university counseling center staff in understanding the potential influence of ethnic matching on outcomes and service utilization for African American clients. Keywords: ethnic match, African American, outcome research, university counseling center, Counseling Center Assessment of Psychological Symptoms

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Submitted by William Justo Figueiro (williamjf) on 2015-07-27T21:36:49Z No. of bitstreams: 1 12d.pdf: 2303688 bytes, checksum: b00af738d3624732d6c3ebf9624e1114 (MD5) / Made available in DSpace on 2015-07-27T21:36:49Z (GMT). No. of bitstreams: 1 12d.pdf: 2303688 bytes, checksum: b00af738d3624732d6c3ebf9624e1114 (MD5) Previous issue date: 2014-02-27 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Essa Dissertação de Mestrado em Psicologia Clínica teve como foco a análise das mudanças ocorridas no primeiro ano de psicoterapia psicanalítica de uma criança e do processo psicoterápico deste mesmo período. A análise das mudanças foi realizada com base no Método de Rorschach e o processo psicoterápico com base no Child Psychotherapy Q-set (CPQ). No enfoque da psicoterapia psicanalítica foi realizado um estudo pautado pela abordagem descritivo longitudinal, adotando-se o procedimento de estudo de caso único e sistemático. Participaram deste estudo um menino de 7 anos de idade, acompanhado em psicoterapia durante o período de um ano e sua terapeuta. Para avaliar as mudanças ocorridas o Rorschach foi aplicado ao iniciar a psicoterapia, após seis meses de tratamento e após um ano. O CPQ foi aplicado em duas sessões do início da psicoterapia, duas sessões após três meses, duas sessões após seis meses, duas sessões após nove meses e duas sessões após um ano de tratamento, para identificar as características do processo psicoterápico ao longo do tempo. Os resultados revelaram a efetividade da psicoterapia psicanalítica, evidenciando, através do Método de Rorschach que houve mudanças significativas em diferentes níveis e dimensões da organização e do funcionamento da personalidade. O uso do CPQ permitiu uma caracterização do processo terapêutico, no que diz respeito às atitudes da criança, do terapeuta e da interação entre ambos, como também possibilitou o acompanhamento de mudanças na dinâmica de interação paciente-terapeuta ao longo do tempo. / This Psychology Master Dissertation has focused on the change´s analysis in the first year of a child psychoanalytic psychotherapy and the psychotherapeutic process. The change´s analysis was performed based on the Rorschach Method and the psychotherapeutic process’ analysis was based on the Child Psychotherapy Q-Set (CPQ). A study guided by the longitudinal descriptive approach was made, adopting the Systematic Case Study procedure. Participants were a 7-year-old boy and his therapist. The boy was treated in psychoanalytic psychotherapy. To evaluate changes Rorschach was applied at the beginning of the psychotherapy, after six months and after one year of treatment. The CPQ was administered in two sessions in beginning the of psychotherapy, in two sessions after three months, in two sessions after six months, in two sessions after nine months and in two sessions after one year of treatment, to evaluate the features of the psychotherapeutic process over time. The main findings showed the effectiveness of psychoanalytic psychotherapy, displaying through the Rorschach Method that were significant changes at different levels and dimensions of the organization and functioning of the personality. The use of the CPQ allowed the therapeutic process characterization, regarding to the child’s attitudes, the therapist’s ones and the interaction between them. It also enabled the monitoring of changes in the patient-therapist’s interaction over time.

The purpose of this study was to explore and describe the use of Gestalt therapy as an alternative assessment technique with two primary school girls who have been sexually abused. The empirical study of limited extent, was qualitative in nature and conducted from the interpretivist paradigm. I used two indepth clinical case studies situated within the context of psychotherapy outcome research as research design. I developed and implemented alternative assessment based on Gestalt therapy and employed observation, interviews, informal discussions, analysis of documentation, a reflective diary, field notes and visual data (photographs and original media) as data collection and documentation methods. I purposefully selected two primary school girls who have been sexually abused as participants in the study. The findings of the study were, firstly, that Gestalt therapy could be used as an effective alternative assessment technique with the target participants as it seemingly provided a safe setting to express emotions, fears and needs related to the trauma of sexual abuse. In this regard, a finding was that the primary participants had to deal with challenging emotions including anxiety, fear, aggression, anger, hatred, rage, sadness and depression. A related finding was that they experienced a need for love, unconditional acceptance, support and protection. Similarly, the study found that they also displayed negative behaviour such as inadequate social behaviour, restlessness and withdrawal from challenging social situations. Most importantly, utilising this mode of assessment rendered insight into the defence mechanisms they employed such as denial, avoidance, suppression and escapism. Secondly, alternative assessments based on Gestalt therapy seemed to have a positive effect on both participants, as indicated by change during and after the process of assessment in terms of emotions, behaviour and the use of defence mechanisms. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2008. / Curriculum Studies / unrestricted