Does therapists' competence matter in delivering psychological therapy?

Therapists differ in their effectiveness in the delivery of psychological therapy. Can trainees who are exposed to similar training in psychological therapy achieve the same standard of competence regardless of professional background? This is a timely question given the planned expansion of psychological therapists to treat common mental disorders in England and Wales and the Scottish initiative to increase access to psychological therapies.

The Impact of Vocational Education and Training Programs on Recidivism: A Systematic Review of Current Experimental Evidence

Although the association between unemployment and offending is well established, relatively little is known about the impact of vocational education and training programs on re-offending, with much of the previous work in this area failing to control for, or correct, selection bias. This article reports the findings of a systematic review, which considers the findings of only those studies that have used experimental or quasi-experimental designs to evaluate vocational training and employment program outcomes for adult offenders. The analysis identifies key features, based on these studies, of those programs associated with the best outcomes and recommends selection criteria for those who are most likely to benefit from prison vocational education and training.

Predictors of Consent in a Randomized Field Study in Child Welfare

PURPOSE

Randomized controlled trials (RCTs) are often viewed as the "gold standard" for proving the efficacy and effectiveness of new interventions. However, some are skeptical of the generalizability of the findings that RCTs produce. The characteristics of those willing to participate in research studies have the potential to affect the generalizability of its findings. This study examined factors that could influence consent among families recruited to participate in a randomized field trial in a real-world child welfare setting.

METHODS

This study tested the Parent Management Training Oregon Model for children in foster care with serious emotional disturbance. It employed a post-randomization consent design, whereby the entire sample of eligible participants, not just those who are willing to consent to randomization, are included in the sample. Initial eligibility assessment data and data from the federally mandated reporting system for public child welfare agencies provided the pool of potential predictors of consent. Bivariate and multivariate analyses were conducted to identify statistically significant predictors of consent.

RESULTS

Being a dual reunification family was the most significant factor in predicting consent. Unmarried individuals, younger, female parents, cases where parental incarceration was the reason for removal and cases where the removal reason was not due to their children's behavioral problem(s) were also more likely to participate.

DISCUSSION

As one of the first research studies to examine predictors of consent to a randomized field study in child welfare settings, results presented here can act as a preliminary guide for conducting RCTs in child welfare settings.

Family-Based Empirically Supported Interventions

In this article, the authors evaluate family-based counseling interventions from the perspective of the Principles of Empirically Supported Interventions (PESI). At the broadest level of evidence, both the qualitative and meta-analytic reviews provide substantial support for the general efficacy of family-based interventions. At more specific levels of evidence, family-based intervention programs that target at-risk adolescents demonstrate clinical success with a variety of clients and problems, in many locales, when delivered by a range of interventionists. Finally, the authors provide some thoughts on the current state of family-based intervention research and the value of the PESI criteria for identifying and developing effective treatments, as well as guiding future family-based research.

Some Comments on “Principles of Empirically Supported Interventions in Counseling Psychology”

In this article, the author offers his appraisal of the Principles of Empirically Supported Interventions as developed by a Special Task Group of the Division of Counseling Psychology and also of the three articles evaluating these principles with reference to family interventions, anger management, and career counseling. In general, the author responds quite favorably to the principles presented and to the critical appraisal of the guidelines published earlier by the Division of Clinical Psychology. The latter are tied to Diagnostic and Statistical Manual of Mental Disorders diagnoses and are not sensitive to important client attributes such as ethnicity, motivation for treatment, education, and the like. The counseling psychology principles also emphasize a number of other important research considerations. The author also offers some specific comments for the three areas mentioned earlier with special reference to some unmet research needs.

On Science-Practice Integration in Everyday Life

Counseling psychologists generally agree that science-practice integration is a good thing. However, most discussions of this topic are less clear about how to actually apply scientific findings to an individual client case. In this article, the author attempts to describe a philosophy for applying research to practice in counseling psychology that requires using theory as the bridge between science and practice.

Principles of Empirically Supported Interventions Applied to Anger Management

This article applies the Principles of Empirically Supported Interventions (PESI) in counseling psychology to anger management with adults. The review suggests that there is empirical support for cognitive-behavioral interventions generally and for four specific interventions (relaxation, cognitive, behavioral skill enhancement, and combinations of these three interventions). Moderate effect sizes for these interventions were found on targeted anger measures and for all measures combined. The PESI proved to be flexible, multidimensional principles against which to assess counseling interventions and from which to identify what is known and what needs to be learned.

Identification of Empirically Supported Counseling Psychology Interventions

Division 17’s Special Task Group’s Principles of Empirically Supported Interventions in Counseling Psychology and their application are considered in the context of other work on empirically supported treatments, most notably that of Division 12’s Task Force on Promotion and Dissemination of Psychological Procedures. Although there are many areas of overlap, it is concluded that Division 17’s group has, in some respects, taken unique positions consonant with the discipline of counseling psychology. Although the merits of the Division 17 group’s decision to eschew lists of empirically supported interventions in favor of review articles are debated, it is concluded that Division 17’s efforts will add measurably to the empirically supported interventions movement in support of practice-science integration.

Counseling Psychology's Focus on Positive Aspects of Human Functioning

The Major Contribution aims to provide interrelated articles that examine how counseling psychology's past and the complex world we live and work in bear on our professional understanding of human strengths and positive life outcomes. In this article, the authors examine the historical underpinnings of the positive in psychology, analyze the focus on the positive in counseling psychology scholarship through the decades (via a content analysis), and review scholarship that has shaped the strength-based work of professionals throughout applied psychology. The content analysis of a random selection of 20% (N = 1,135) of the articles published in the Journal of Counseling Psychology (JCP), The Counseling Psychologist (TCP ), theJournal of Career Assessment (JCA ), and theJournal of Multicultural Counseling and Development (JMCD) revealed that about 29% have a positive focus. This article calls attention to the positive in counseling psychology, and the authors encourage its members to reaffirm its unique positive focus by focusing more on strength in practice and research.

Evidence-Based Practice:

A consensus has long existed that the scientist-practitioner model has failed to reflect what was envisioned by the Boulder Conference participants and endorsed by counseling psychology at the Greyston and Georgia Conferences. Counseling psychology's commitment, however, to the scientist-practitioner model has not faltered. Furthermore, developments within the health care system (e.g., managed care, empirically validated treatments, treatment guidelines) demand from psychologists increasing levels of scientific knowledge and a wider range of research skills. Psychology's current commitment to positivist explanation , scientific knowledge characterized by law-governed causal processes, is at the core of the scientist-practitioner split. To integrate scientist-practitioner ideals into a comprehensive approach to counseling psychology training, research, and practice, counseling psychologists should embrace an identity as evidence- based practitioners. Inherent in this framework is a philosophical, scientific, political, and social shift toward an expanded view of what constitutes scientific evidence.

A Multicultural Perspective on Principles of Empirically Supported Interventions

The authors evaluate the Principles of Empirically Supported Interventions (PESI) that have been recommended by Wampold, Lichtenberg, and Waehler for how well the principles promote attention to cultural issues. Their review suggests that the PESI could indicate the need to consider cultural issues when evaluating intervention research, but the authors have reservations about how well incorporation of cultural considerations will actually occur in future research based on the three applications of the PESI included in this special issue.

Application of the Principles

This article is designed to apply the Principles of Empirically Supported Interventions to the research related to career counseling and interventions. Although there is empirical support for career interventions in general, there is significant variation in effectiveness among different treatment approaches. The most effective interventions are individual career counseling and career classes, whereas workshops/structured groups and career classes are the most efficient method of providing services to the largest number of clients. Although the findings are somewhat tentative, there is preliminary support for the inclusion of five critical ingredients in all types of career interventions. Additional research, however, is needed to identify which clients benefit from which interventions under what circumstances.

The More Things Change, the More They Stay the Same

The results of the clinical versus statistical prediction meta-analysis support the longstanding finding that statistical methods are superior to clinical methods in making predictions. In this reaction, the authors discuss the findings from the perspective of the context of discovery and the context of justification, the client model-building process, bias in clinician judgment, and evidenced-based practice, and they speculate about why more clinicians have not made statistical methods part of their practice.

Where is the Dialogue? A Social Constructionist View of Empirically Supported Treatments

Since the publication of the list of empirically supported treatments by the American Psychological Association in 1995 a controversy has resulted between those who view positive psychotherapeutic outcome as resulting from the use of specific (listed) techniques and those who lean towards the so-called common or relationship factors rather than particular techniques as necessary for such outcomes. This paper examines the controversy and shows that both sides follow the same objectivist/empiricist and reductionist epistemology. In contrast, the paper adopts a social constructionist perspective and shows that the idea of therapeutic outcome as linearly determined by either technical or common factors or a combination of these is a misleading oversimplification which fails to account for the dialogue which is the core of psychotherapy. Rather, positive outcome is viewed as mutually constructed in a unique dialogue which encompasses both common and technical factors. This takes the form of the conversational development of a new understanding or reframe of the problem followed by action which is deemed appropriate to the new understanding. This view is illustrated by practical examples.

The Relative Efficacy of Psychotherapy: Reassessing the Methods-Based Paradigm

Because the efficacy of behavioral interventions is central to applied psychology, the relative merits of competing approaches to an intervention are important. Many comparative studies examine the differential outcomes of alternative methods of psychotherapy. This paper addresses the issue of impact differences among rival intervention methods by focusing on treatment outcome research that emphasizes the relative (or comparative) efficacy of different psychotherapies. The paper has 4 components. First, it explores the concept of relative efficacy. Second, it reviews the extensive evidence on relative efficacy, which is generally consistent with the null hypothesis. Third, it offers a 3-part explanation of the negative evidence on relative efficacy: (a) a statistical argument about how relative efficacy is bound by a modest upper limit; (b) a research design argument about how relative efficacy studies are confounded by multiple factors, which make it difficult to demonstrate differences in treatment effects; and (c) a theoretical argument about how therapists’ contributions to treatment outcomes depend more on their clinical abilities than the therapy methods they implement. The final section of the paper outlines questions for future research.

Empirically Supported Treatments: the Deconstruction of a Myth

This article summarizes recent findings from analyses and meta-analyses of psychotherapy research that show that so-called empirically supported treatments (ESTs) are no more effective than are traditional psychotherapies. In addition, the findings show that specific modalities and techniques have little, if anything at all, to do with therapeutic benefits and that client improvement and therapeutic outcome are instead the result of other factors in the therapeutic situation such as the alliance, the therapist, the relationship, and other contextual factors. The article shows how these findings deconstruct the whole notion of ESTs and make the current debate about them meaningless. Finally, the article discusses implications of the findings and urges humanistic psychologists and other proponents of traditional psychotherapies to shift the debate away from modalities and techniques and to focus on the factors that are actually responsible for therapeutic benefits.

Evidence-based practice in psychology

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.

Resource-oriented music therapy for psychiatric patients with low therapy motivation: protocol for a randomised controlled trial [NCT00137189]

BACKGROUND

Previous research has shown positive effects of music therapy for people with schizophrenia and other mental disorders. In clinical practice, music therapy is often offered to psychiatric patients with low therapy motivation, but little research exists about this population. The aim of this study is to examine whether resource-oriented music therapy helps psychiatric patients with low therapy motivation to improve negative symptoms and other health-related outcomes. An additional aim of the study is to examine the mechanisms of change through music therapy.

METHODS

144 adults with a non-organic mental disorder (ICD-10: F1 to F6) who have low therapy motivation and a willingness to work with music will be randomly assigned to an experimental or a control condition. All participants will receive standard care, and the experimental group will in addition be offered biweekly sessions of music therapy over a period of three months. Outcomes will be measured by a blind assessor before and 1, 3, and 9 months after randomisation.

DISCUSSION

The findings to be expected from this study will fill an important gap in the knowledge of treatment effects for a patient group that does not easily benefit from treatment. The study's close link to clinical practice, as well as its size and comprehensiveness, will make its results well generalisable to clinical practice.

Development of the Motivational Interviewing Supervision and Training Scale

The movement to use empirically supported treatments has increased the need for researchers and supervisors to evaluate therapists' adherence to and the quality with which they implement those interventions. Few empirically supported approaches exist for providing these types of evaluations. This is also true for motivational interviewing, an empirically supported intervention important in the addictions field. This study describes the development and psychometric evaluation of the Motivational Interviewing Supervision and Training Scale (MISTS), a measure intended for use in training and supervising therapists implementing motivational interviewing. Satisfactory interrater reliability was found (generalizability coefficient p(2) = .79), and evidence was found supporting the convergent and discriminant validity of the MISTS. Recommendations for refinement of the measure and future research are discussed.

Evidence-based practice for marriage and family therapists

The purpose of this article is to integrate science into clinical practice by introducing marriage and family therapists to the ideas of evidence-based practice (EBP). Evidence-based practice, which originated in the medical field, refers to the process of using research to make clinical decisions that best meet the needs of each client. Included in the description is a brief history of EBPs and ideas about learning EBPs. Suggestions are also made about the use of EBPs in MFT training programs, and resources are provided to enable clinicians to use EBPs in clinical practice.