Jumping to conclusions: Implications for reasoning errors, false belief, knowledge corruption, and impeded learning

In schizophrenia research, patients who "jump to conclusions" in probabilistic reasoning tasks tend to display impaired decision-making and delusional belief. In five studies, we examined whether jumping to conclusions (JTC) was similarly associated with decision impairments in a nonclinical sample, such as reasoning errors, false belief, overconfidence, and diminished learning. In Studies 1a and 1b, JTC was associated with errors stimulated by automatic reasoning, oddball beliefs such as conspiracy theories, and overconfidence. We traced these deficits to an absence of controlled processing rather than to an undue impact of automatic thinking, while ruling out roles for plausible alternative individual differences. In Studies 2 and 3, JTC was associated with higher confidence despite diminished performance in a novel probabilistic learning task (i.e., diagnosing illnesses), in part because those who exhibited JTC behavior were prone to overly exuberant theorizing, with no or little data, about how to approach the task early on. In Study 4, we adapted intervention materials used in schizophrenia treatment to train participants to avoid JCT. The intervention quelled overconfidence in the probabilistic learning task. In summary, this research suggests that a fruitful crosstalk may exist between research on psychopathology and work on social cognition within the general public. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Applied ambulatory assessment: Integrating idiographic and nomothetic principles of measurement

Ambulatory assessment (AA; also known as ecological momentary assessment) has enjoyed enthusiastic implementation in psychological research. The ability to assess thoughts, feelings, behavior, physiology, and context intensively and repeatedly in the moment in an individual's natural ecology affords access to data that can answer exciting questions about sequences of events and dynamic processes in daily life. AA also holds unique promise for developing personalized models of individuals (i.e., precision or person-specific assessment) that might be transformative for applied settings such as clinical practice. However, successfully translating AA from bench to bedside is challenging because of the inherent tension between idiographic and nomothetic principles of measurement. We argue that the value of applied AA will be most fully realized by balancing the ability to develop personalized models with ensuring comparability among individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Incorporating neurophysiological measures into clinical assessments: Fundamental challenges and a strategy for addressing them

Recent scientific initiatives have called for increased use of neurobiological variables in clinical and other applied assessments. However, the task of incorporating neural measures into psychological assessments entails significant methodological challenges that have not been effectively addressed to date. As a result, neurophysiological measures remain underutilized in clinical and applied assessments, and formal procedures for integrating such measures with report-based measures are lacking. In this article, we discuss major methodological issues that have impeded progress in this direction, and propose a systematic research strategy for integrating neurophysiological measures into psychological assessment protocols. The strategy we propose is an iterative psychoneurometric approach that provides a means to establish multimethod (MM) measurement models for core biobehavioral traits that influence functioning across diverse areas of life. We provide a detailed illustration of a MM model for one such trait, inhibitory control (inhibition-disinhibition), and highlight work being done to develop counterpart models for other biobehavioral traits (i.e., threat sensitivity, reward sensitivity, affiliative capacity). We discuss how these measurement models can be refined and extended through use of already existing data sets, and outline steps that can be taken to establish norms for MM assessments and optimize the feasibility of their use in everyday practice. We believe this model-oriented strategy can provide a viable pathway toward effective use of neurophysiological measures in routine clinical assessments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Polygenic Risk Scores in Clinical Psychology: Bridging Genomic Risk to Individual Differences

Genomewide association studies (GWASs) across psychiatric phenotypes have shown that common genetic variants generally confer risk with small effect sizes (odds ratio < 1.1) that additively contribute to polygenic risk. Summary statistics derived from large discovery GWASs can be used to generate polygenic risk scores (PRS) in independent, target data sets to examine correlates of polygenic disorder liability (e.g., does genetic liability to schizophrenia predict cognition?). The intuitive appeal and generalizability of PRS have led to their widespread use and new insights into mechanisms of polygenic liability. However, when currently applied across traits they account for small amounts of variance (<3%), are relatively uninformative for clinical treatment, and, in isolation, provide no insight into molecular mechanisms. Larger GWASs are needed to increase the precision of PRS, and novel approaches integrating various data sources (e.g., multitrait analysis of GWASs) may improve the utility of current PRS.

Connecting with suicidal patients in psychiatric wards: Therapist challenges

In this qualitative interview study, the authors investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists' connections with suicidal individuals. They conducted semistructured interviews of 4 psychiatrists and 4 psychologists and analyzed the data by means of thematic analysis. The findings suggest that high emphasis on diagnostics and standardized suicide risk assessments, limited direct care of suicidal patients, and fragmented mental health services may challenge therapists' connections with suicidal patients.

Treating the binge or the (fat) body? Representations of fatness in a gold standard psychological treatment manual for binge eating disorder

This article reports the results of a Foucauldian-informed discourse analysis exploring representations of fatness embedded within an empirically based psychological treatment manual for binge eating disorder, a condition characterized by overvaluation of weight and shape. Analyses indicate that the manual prioritizes weight loss with relatively less emphasis placed on treating the diagnostic symptoms and underlying mechanisms of binge eating disorder. We raise critical concerns about these observations and link our findings to mainstream psychology's adoption of the medical framing of fatness as obesity within the "gold standard" approach to intervention. We recommend that psychology as a discipline abandons the weight loss imperative associated with binge eating disorder and fat bodies. We recommend that practitioners locate the problem of fat shame in society as opposed to the individual person's body and provide individuals with tools to identify and resist fat stigma and oppression, rather than provide them with tools to reshape their bodies.

A Survey of Psychological Assessment Feedback Practices

There have been no previous studies on how often psychologists conduct feedback and whether they view this practice as a useful component of assessment. To explore psychologists' feedback practices and their perception of the effects of feedback on their clients, the authors examined survey data from 719 psychologist members of the International Neuropsychological Society, the National Academy of Neuropsychology, and the Society for Personality Assessment who regularly conducted assessments as part of their professional activities. The results indicated that the majority of respondents (71%) frequently provided in-person assessment feedback to their clients and/or their clients' families. Furthermore, most respondents (72%) indicated that clients found this information to be helpful and positive. Factors contributing to perceived positive feedback effects, including graduate training and feedback session length, were also examined. Last, differences in the feedback practices of psychologists predominantly practicing neuropsychology versus those predominantly practicing personality assessment were sampled and discussed.

Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries

PURPOSE

Whilst formal coercion in psychiatry is regulated by legislation, other interventions that are often referred to as informal coercion are less regulated. It remains unclear to what extent these interventions are, and how they are used, in mental healthcare. This paper aims to identify the attitudes and experiences of mental health professionals towards the use of informal coercion across countries with differing sociocultural contexts.

METHOD

Focus groups with mental health professionals were conducted in ten countries with different sociocultural contexts (Canada, Chile, Croatia, Germany, Italy, Mexico, Norway, Spain, Sweden, United Kingdom).

RESULTS

Five common themes were identified: (a) a belief that informal coercion is effective; (b) an often uncomfortable feeling using it; (c) an explicit as well as (d) implicit dissonance between attitudes and practice-with wider use of informal coercion than is thought right in theory; (e) a link to principles of paternalism and responsibility versus respect for the patient's autonomy.

CONCLUSIONS

A disapproval of informal coercion in theory is often overridden in practice. This dissonance occurs across different sociocultural contexts, tends to make professionals feel uneasy, and requires more debate and guidance.

Doing fence sitting: a discursive analysis of clinical psychologists' constructions of mental health

A growing body of research indicates that the way health care professionals conceptualize mental health might have important clinical implications. We adopted a discursive psychology approach to explore clinical psychologists' accounts of mental health and its effects. Semistructured interviews were conducted with 11 clinical psychologists in the East Midlands region of the United Kingdom. The participants constructed mental health through building up biological factors and psychosocial aspects as opposite ends of the same spectrum, and then positioned themselves as distant from these extremes to manage issues of stake and accountability. A discourse of moral concern for service users was used to negotiate the implications of having different views of mental health from service users, enabling clinicians to manage issues of accountability and demonstrate their ability to be helpful. This suggests that clinicians should be mindful of the effects of their use of language and make the contingent nature of their knowledge explicit.

Bulimia nervosa: online interventions

INTRODUCTION

Up to 1% of people in the community may have bulimia nervosa, characterised by an intense preoccupation with body weight, binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa are of normal weight or are overweight, making the condition distinct from anorexia nervosa. After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of online interventions for people with bulimia nervosa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found eight studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: applications (apps) or online programmes used as an adjunct to face-to-face therapy, delivery of self-help online, and delivery of therapy online.

Letter to Editor. An innovative program of assistance to people with personality disorders

bez streszczenia

[Clinical pharmacopsychology]

The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology (Kraepelin, Pichot, Kellner, Di Mascio, Shader, Bech) is outlined, with critical review of its most representative expressions and reference to current challenges of clinical research. Clinical pharmacopsychology is concerned with the application of clinimetric methods to the assessment of psychotropic effects of medications (including behavioral toxicity and iatrogenic comorbidity) and the interaction of drugs with specific and non-specific treatment ingredients. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Research in this area deserves high priority.

Twenty years of the Journal of Clinical Psychology in Medical Settings: we hope you will enjoy the show

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.

[Differences in effectiveness of intensive programs of treatment for neurotic and personality disorders. Is it worth to monitor the effectiveness of the therapeutic team?]

OBJECTIVES

To test whether three different intensive programs of treatment for neurotic and personality disorders are effective in decreasing neurotic symptoms and traits of neurotic personality and whether there are differences between them in clinical outcome.

METHOD

The sample consisted of 105 patients (83% female, mean age 35) diagnosed with neurosis and personality disorders that were treated in three therapeutic wards under routine inpatient conditions. The therapeutic programs are designed for patients with neurotic and personality disorders. They consist of 6-12 weeks of approximately 5 hours of eclectic group treatment (group psychotherapy, psychodrama, psychoeducation etc.). Participants filled in Symptoms' Questionnaire KS-II, and Neurotic Personality Questionnaire KON-2006 at the beginning and at the end of the course of psychotherapy.

RESULTS

The treatment proved to be effective in diminishing neurotic symptoms (d Cohen = 0.56). More detailed analysis revealed that there was a significant interaction between the three analysed therapeutic wards and the effectiveness (12 = 0.09). The treatments offered in two institutions were effective (d Cohen = 0.80) while one of the programs did not lead to significant improvement of the patients. None of the therapeutic wards proved to be effective in changing the neurotic personality traits.

CONCLUSIONS

There are significant differences in effectiveness of the intensive programs of treatment for neurotic and personality disorders. In the light of the literature, one can assume that the differences are more connected with the characteristics of therapeutic teams than with the methods used. The need for standard methods of effectiveness monitoring is discussed.

What makes offenders with an intellectual disability ready to engage with psychological therapy? A qualitative study

Although there are established links between measures of readiness for psychological therapy in offenders and subsequent reduction in recidivism rates there has been a lack of theoretical research considering this process within the intellectual disability (ID) offender population. Grounded theory methodology was used to explore the process by which offenders with ID are seen and see themselves as ready to engage with psychological therapy. Twelve participants; offenders with ID, clinical psychologists and nurses across two secure inpatient services participated in the study. The resulting model highlighted a temporal process with interlinking elements including 'stability/predictability', 'development of relationships with staff', 'reassurance about progress' and 'realising that change is needed'. The model represented participant's shared perceptions and signified the journey of offenders with ID to perceived readiness. The current model is discussed and clinical implications and future research directions suggested.

Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework

Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment.

From new vistas to life lines: psychologists' satisfaction with supervision and confidence in supervising

This study aimed to provide the first detailed survey of Irish psychologists' supervision practices as well as to identify what is related to satisfaction with supervisory support and to confidence in providing supervision. An online survey was distributed nationwide to Irish psychologists. Participants were mostly clinical and counselling psychologists. Three-quarters of the participants constituted 51% of the total population of Irish health service psychologists, the remainder working in various non-health service settings. The results showed that most Irish psychologists attend supervision but at a low frequency, typically once monthly. One-third were dissatisfied with their supervision, greater satisfaction being related to having more frequent clinical supervision and having external individual clinical supervision. Having a safe and trustworthy relationship with supervisors was a dominant issue, and two-thirds of psychologists wanted separation of their clinical and line management supervision. Although 70% were supervisors, only 40% were confident in their supervisory skills and just 16% had formal supervisor training. Independent predictors of supervisory confidence were experience as a psychologist, having formal supervisor training, experience as a supervisor and confidence as a therapist. A novel finding was that longer experience of personal therapy was related to greater confidence as a supervisor. This study indicates the need for access to more frequent clinical supervision to be facilitated for psychologists and for there to be clear separation of line management and clinical supervision. It is also essential that more resources are put into training supervisors.

KEY PRACTITIONER MESSAGE

While most psychologists are engaged in supervision, frequency of attendance is low, with more satisfied psychologists having more frequent supervision. Most psychologists want separation of their clinical and line management supervision and have a preference for external supervision, safe and trustworthy relationships with supervisors being their primary concern. Only 16% of psychologists had formal training in supervision but having such training significantly contributed to greater confidence as a supervisor, indicating an urgent need to provide more supervisor training for psychologists.

Ambulatory assessment

Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients' everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.

Proportionate responses to life events influence clinicians' judgments of psychological abnormality

Psychological abnormality is a fundamental concept in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person's current behaviors? The appropriate role of life-event context in assessment has long been the subject of intense debate and scrutiny among clinical theorists, yet relatively little is known about clinicians' own judgments in practice. The authors propose a proportionate-response hypothesis, such that judgments of abnormality are influenced by whether the behaviors are a disproportionate response to past events, rendering them difficult to understand or explain. Licensed, practicing clinical psychologists (N = 77) were presented with vignettes describing hypothetical people's behaviors (disordered, mildly distressed, or unaffected) that had been preceded by either traumatic or mildly distressing events. Experts' judgments of abnormality were strongly and systematically influenced by the degree of mismatch between the past event and current behaviors in strength and valence, such that the greater the mismatch, the more abnormal the person seemed. A separate, additional group of clinical psychologists (N = 20) further confirmed that the greater the degree of mismatch, the greater the perceived difficulty in understanding the patient. These findings held true across clinicians of different theoretical orientations and in disorders for which these patterns of judgments ran contrary to formal recommendations in the DSM-IV-TR (American Psychiatric Association, 2000). The rationality of these effects and implications for clinical decision science are discussed.

Implementation of AF-CBT by community practitioners serving child welfare and mental health: a randomized trial

The Partnerships for Families project is a randomized clinical trial designed to evaluate the implementation of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT), an evidence-based treatment for family conflict, coercion, and aggression, including child physical abuse. To evaluate the effectiveness of a training program in this model, 182 community practitioners from 10 agencies were randomized to receive AF-CBT training (n = 90) using a learning community model (workshops, consultation visits) or Training as Usual (TAU; n = 92) which provided trainings per agency routine. Practitioners completed self-report measures at four time points (0, 6, 12, and 18 months following baseline). Of those assigned to AF-CBT, 89% participated in at least one training activity and 68% met a "training completion" definition. A total of 80 (44%) practitioners were still active clinicians in the study by 18-month assessment in that they had not met our staff turnover or study withdrawal criteria. Using an intent-to-train design, hierarchical linear modeling analyses revealed significantly greater initial improvements for those in the AF-CBT training condition (vs. TAU condition) in CBT-related knowledge and use of AF-CBT teaching processes, abuse-specific skills, and general psychological skills. In addition, practitioners in both groups reported significantly more negative perceptions of organizational climate through the intervention phase. These significant, albeit modest, findings are discussed in the context of treatment training, research, and work force issues as they relate to the diverse backgrounds, settings, and populations served by community practitioners.

Utilization and implementation of trauma-focused cognitive-behavioral therapy for the treatment of maltreated children

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is one of the most researched and widely disseminated interventions for maltreated children. This study describes the findings of a survey of 132 mental health clinicians in children's advocacy centers (CACs) across the United States to determine the percentage of clinicians who are trained in and utilize TF-CBT and the frequency with which TF-CBT components are implemented. A total of 103 (78%) of the clinicians reported being trained in and utilizing TF-CBT on a regular basis; however, only 66% of these clinicians (58% of the full sample) reported being likely to use each component. The most preferred components were teaching relaxation skills and providing psychoeducation, whereas teaching caregiver child behavior management skills, developing a trauma narrative, and cognitive restructuring were less preferred. Results are discussed in the context of continued dissemination efforts and implications for improving clinical practice.

The place of implementation science in the translational medicine continuum

There is a growing consensus that the transfer of knowledge from biomedical discoveries into patient and public benefit should be accelerated. At the same time there is a persistent lack of conceptual clarity about the precise nature of the phases of the translational continuum necessary to implement this. In this paper, we: (i) propose an integrated schema to understand the five sequential phases that link basic biomedical research with clinical science and implementation; (ii) discuss the nature of three blocks along this translational pathway; (iii) outline key issues that need to be addressed in removing such barriers. The five research phases described are: (0) basic science discovery; (1) early human studies; (2) early clinical trials; (3) late clinical trials; (4) implementation (which includes adoption in principle, early implementation and persistence of implementation). This schema also sets out three points at which communication blocks can occur. The application of 'implementation science' is in its early stages within mental health and psychiatric research. This paper therefore aims to develop a consistent terminology to understand the discovery, development, dissemination and implementation of new interventions. By better understanding the factors that promote or delay knowledge to flow across these blocks, we can accelerate progression along translational medicine pathways and so realize earlier patient benefit.

[The clinical interview in psychiatry in the elderly]

In psychiatry in the elderly, the clinical interview requires the psychologist to be able to adapt to a population in search of narcissism. This unique type of interview is a place of sharing and mutual investment on the part of the patient and therapist.

The diagnosis of mental disorders: the problem of reification

A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based on accreting problems with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modern DSM system, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward.

Comparison of traditional and trial-based methodologies for conducting functional analyses

Functional analysis represents a sophisticated and empirically supported functional assessment procedure. While these procedures have garnered considerable empirical support, they are often underused in clinical practice. Safety risks resulting from the evocation of maladaptive behavior and the length of time required to conduct functional analyses may deter practitioners from using models of assessment with considerable empirical support. The current study evaluated a trial-based model of functional analysis that limited opportunities to engage in problem behavior and used 1-2 min sessions to shorten analysis time. The results from the trial-based analysis were then compared to the results of traditional functional analyses. Correspondence between both models of assessment was strong. Exact correspondence was observed for 4 of the 5 participants. In addition, the trial-based procedure did not require the repeated reinforcement of maladaptive behavior and results were obtained in 84.8% less time.

On the value of homogeneous constructs for construct validation, theory testing, and the description of psychopathology

The authors argue for a significant shift in how clinical psychology researchers conduct construct validation and theory validation tests. They argue that sound theory and validation tests can best be conducted on measures of unidimensional or homogeneous constructs. Hierarchical organizations of such constructs are useful descriptively and theoretically, but higher order composites do not refer to definable psychological processes. Application of this perspective to the approach of the Diagnostic and Statistical Manual of Mental Disorders to describing psychopathology calls into doubt the traditional use of the syndromal approach, in which single scores reflect the presence of multidimensional disorders. For many forms of psychological dysfunction, this approach does not appear optimal and may need to be discarded. The authors note that their perspective represents a straightforward application of existing psychometric theory, they demonstrate the practical value of adopting this perspective, and they provide evidence that this shift is already under way among clinical researchers. Description in terms of homogeneous dimensions provides improved validity, utility, and parsimony. In contrast, the use of composite diagnoses can retard scientific progress and hamper clinicians' efforts to understand and treat dysfunction.

Teaching an interdisciplinary approach to the treatment of chronic mental illness: challenges and rewards

OBJECTIVE

National policy makers and psychiatric educators have established the goals of teaching and promoting interdisciplinary care as high priorities. This article describes the implementation of an interprofessional seminar for which the dual aims were to provide a knowledge base for treating individuals with serious mental illness and to teach how to work collaboratively with other disciplines.

METHOD

A seminar, the "Treatment of chronic or recurrent mental illness: recovery, rehabilitation and interdisciplinary collaboration," was developed in an academic community mental health center. Pre- and postseminar surveys were administered in order to test the hypothesis that the seminar would have a positive impact on trainees' attitudes about working with the seriously mentally ill and within an interdisciplinary team. A combination of 5-point Likert scales and open-ended questions were used to gather the data. Paired samples t tests were conducted to test for significant differences between the pre- and postmeasures.

RESULTS

The seminar participants included 24 students from psychiatry, nursing, social work, and psychology with a wide range of experience. Complete pre- and postseminar data were obtained from 14 participants. Although participants valued the seminar experience, they reported that the actual interdisciplinary work with the seriously mentally ill was less gratifying than expected. They described several advantages and challenges of care-oriented collaboration and shared learning.

CONCLUSION

Bringing together a diverse group of graduate and postgraduate trainees to learn together and to learn about each other's disciplines appeared to be a successful venture, but the authors were not able to detect a positive impact on their actual work life during the course of the year. Further development of strategies to inspire professionals to engage in and promote interdisciplinary care of the seriously mentally ill is needed.

Racial microaggressions in everyday life: implications for clinical practice

Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. A taxonomy of racial microaggressions in everyday life was created through a review of the social psychological literature on aversive racism, from formulations regarding the manifestation and impact of everyday racism, and from reading numerous personal narratives of counselors (both White and those of color) on their racial/cultural awakening. Microaggressions seem to appear in three forms: microassault, microinsult, and microinvalidation. Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance. Suggestions regarding education and training and research in the helping professions are discussed.

Consent and confidentiality in clinical work with young people

Consent and confidentiality are increasingly important in clinical practice. However, the dilemmas faced by mental health practitioners can be highly complex and difficult to resolve. This difficulty is compounded by the fact that consent and confidentiality are subject to several different types of legislation based on different principles, and many of the policies which are formulated for general medical practice may not fit well with the mental healthcare context. The ethical principles, evidence base, legal context, developmental considerations and clinical context relevant to each situation must all be integrated, in consultation with children and adolescents and their parents, in order to arrive at a treatment plan which is sensitive to the views of all, developmentally appropriate for the children and adolescents, and responsive to changes in the situation or attitudes. We offer some practical approaches, including clinical practice algorithms, to consider the issues of consent and confidentiality in the child and adolescent mental healthcare setting.

Six months in Aceh

OBJECTIVE

Brief case histories are presented of people with schizophrenia treated in the Indonesian province of Aceh, where the author worked as a clinical psychologist for Medecines Sans Frontieres in 2005. Aceh was severely affected by the December 2004 tsunami, with significant destruction and loss of life.

CONCLUSIONS

The case studies highlight the needs of patients and the current opportunities to establish more effective mental health services. The role of culture as a significant consideration and a possible barrier to accessing care is also discussed.

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.

Racial microaggressions in everyday life: Implications for clinical practice

Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. A taxonomy of racial microaggressions in everyday life was created through a review of the social psychological literature on aversive racism, from formulations regarding the manifestation and impact of everyday racism, and from reading numerous personal narratives of counselors (both White and those of color) on their racial/cultural awakening. Microaggressions seem to appear in three forms: microassault, microinsult, and microinvalidation. Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance. Suggestions regarding education and training and research in the helping professions are discussed.

The evidence missing from evidence-based practice

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based practice. First, the task force report did not operationalize "evidence." Second, the task force report did not address the crucial problem of iatrogenic treatments. Third, the task force report said little about the necessity for ongoing objective evaluation of clinical cases, which is critical to ethically responsible services. Current debate centers on how research findings should be factored into interventions, not on whether it is necessary to do so. Rather than waiting for the resolution of competing views on the matter, psychologists bear an ethical obligation to offer evidence-informed services. Three critical steps that were largely neglected by the task force report can go far toward helping psychologists honor that commitment: (a) providing a clearer operationalization of scientific evidence, (b) using current research to rule out the use of potentially harmful methods, and (c) using objective criteria to evaluate all of their cases on an ongoing basis. These steps, in turn, clarify the menu of options available to therapists, help protect clients from harm, and offer the advantage of allowing clinicians to contribute to the growing body of knowledge about what does and does not work in psychotherapy.

Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know

The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.

The reading grade level of common measures in child and adolescent clinical psychology

The purpose of this article is to provide easily accessible readability information for 49 parent- and 35 child- and adolescent-report measures commonly used by clinicians and researchers. There is a great deal of variability in reading ability required across measures. The majority of parent-report measures (65%) required reading ability above the 8th grade level. The average child-/adolescent-report measure required reading ability above the 6th grade level. Given the potential contribution of readability to a measure's reliability, validity, and overall utility, examining and accounting for readability should be a more common practice in test construction and administration.

Is the appendix a useful appendage? An empirical examination of depressive, passive-aggressive (negativistic), sadistic, and self-defeating personality disorders

Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.

Life review interviews on the spiritual well-being of terminally ill cancer patients

GOALS

The aims of this study were (1) to evaluate the treatment efficacy of life review interviews on the spiritual well-being of terminally ill cancer patients, and (2) to explore any differences in the responses of patients who obtained clinical benefits and those who did not.

MATERIALS AND METHODS

Structured life review interviews were conducted with 12 patients in a palliative care unit in Japan. They completed the SELT-M (Skalen zur Erfassung von Lebens qualitat bei Tumorkranken-Modified Version) questionnaire before and after the interviews. The patients were classified into two groups: effective (patients who showed an increase in the SELT-M scores after the intervention) and noneffective groups. Meaningful spoken sentences from the patients' life reviews were transcribed and correspondence analysis was conducted on the sentences using text mining software.

RESULTS

The mean overall QOL score and spirituality subscale score of the SELT-M significantly increased after the life reviews from 2.57+/-0.61 to 3.58+/-1.0 (P=0.013) and 2.57+/-0.61 to 3.14+/-2.25 (P=0.023), respectively. Three dimensions were extracted from the effective group based on the scores "Positive view of life," "Pleasure in daily activities and good human relationships," and "Balanced evaluation of life." Similarly, three dimensions were extracted from the noneffective group: "Worries about future caused by disease," "Conflicts in family relationship problems," and "Confrontation of practical problems."

CONCLUSION

Life review interviews may be effective in improving the spiritual well-being of terminally ill cancer patients. The potential predictors of treatment success are "positive view of life," "pleasure in daily activities and good human relationships," and a "balanced evaluation of life," while those of treatment failure are "worries about future caused by disease," "conflicts in family relationships," and "confrontation of practical problems." Further intervention trials on patients with predictors of treatment success are promising.

Variables affecting the clarity of psychological reports

Effective psychological reports are consumer-focused: They address the concerns of the referring persons, present data appropriately, communicate clearly and concisely, and include useful and appropriate recommendations. Although the importance of clear communication has been stressed repeatedly, psychologists often write reports that are very difficult for nonpsychologists to read. In this article, the author explores four reasons behind this dichotomy: (a) model reports available to psychologists in training are written at a level that is very difficult to understand; (b) psychological terms are not commonly defined; (c) the amount of time it takes to write easily understood reports is substantial; and (d) psychologists are confused about how to address multiple audiences. Methods to address each issue are discussed.

Introduction to the special section on multicultural and community psychology: clinical psychology in context

Human behavior occurs in the contexts of culture and community. Yet, clinical psychology has traditionally focused on the individual, neglecting the individual's context. The purpose of this Special Section is to address the underlying conceptual issues in integrating multicultural and community psychology within a common framework. The integration of etic and emic approaches distinguishes the research programs in these articles from others that have solely focused on universal or culture-specific approaches. Issues facing ethnic minority populations are addressed, including identification of risk and protective factors, obstacles to mental health service use, and optimal treatment effectiveness. The integration of culture and community contexts into clinical psychology is necessary for it to remain relevant in an increasingly diverse 21st century.

A prototype approach to personality disorder diagnosis

OBJECTIVE

Virtually no research has tested alternatives to the diagnostic method used since DSM-III, which requires decisions about the presence/absence of individual diagnostic criteria, followed by counting symptoms and applying cutoffs (the count/cutoff method). This study tested an alternative, prototype matching procedure designed to simplify diagnosis. The procedure was applied to personality disorders.

METHOD

A random national sample of psychiatrists and clinical psychologists (N=291) described a randomly selected patient in their care. Clinician-provided diagnostic data were used to generate categorical and dimensional DSM-IV diagnoses (number of symptoms present per disorder). Clinicians also used one of two prototype matching systems to provide a diagnosis for the selected patient.

RESULTS

Prototype diagnosis led to reduced comorbidity relative to DSM-IV diagnosis, yielded similar estimates of validity in predicting criterion variables (adaptive functioning, treatment response, and etiology), and outperformed DSM-IV diagnosis in ratings of clinical utility and ease of use. Adding a personality health prototype further increased prediction.

CONCLUSIONS

A simple prototype matching procedure provides a viable alternative for improving diagnosis of personality disorders in clinical practice. Prototype diagnosis has multiple advantages, including ease of use, minimization of artifactual comorbidity, compatibility with naturally occurring cognitive processes, and ready translation into both categorical and dimensional diagnosis.

Negative symptoms in schizophrenia: comments from a clinical psychology perspective

The NIMH-MATRICS Consensus Statement on Negative Symptoms is covered from the perspective of Clinical Psychology. The neurobiological model implicit in the Statement can be criticized on the basis that it is scientifically restrictive and narrow and poorly serves clinical practice and service development. Aspects of the Statement relating to psychological treatments are discussed.

Mental balance and well-being: Building bridges between Buddhism and Western psychology

Clinical psychology has focused primarily on the diagnosis and treatment of mental disease, and only recently has scientific attention turned to understanding and cultivating positive mental health. The Buddhist tradition, on the other hand, has focused for over 2,500 years on cultivating exceptional states of mental well-being as well as identifying and treating psychological problems. This article attempts to draw on centuries of Buddhist experiential and theoretical inquiry as well as current Western experimental research to highlight specific themes that are particularly relevant to exploring the nature of mental health. Specifically, the authors discuss the nature of mental well-being and then present an innovative model of how to attain such well-being through the cultivation of four types of mental balance: conative, attentional, cognitive, and affective.

[Rating scales based on the phenomenological and structural approach]

A current tendency of research in clinical psychology consists in using an integrated quantitative and qualitative methodology. This approach is especially suited to the study of the therapeutic intervention where the researcher is himself part of the situation he is investigating. As to the tools of research, the combination of the semi-structured clinical interview, of psychometric scales and projective tests has proved to be pertinent to describe the multidimensional and fluctuating reality of the therapeutic relationship and the changes induced by it in the two partners. In arts therapeutic research the investigation of the artistic production or of the free expression of people may complete the psychometric and projective tools. The concept of "expressive test" is currently being used to characterise this method. In this context, the development of rating scales, based on the phenomenological and structural or holistic approach allows us making the link between qualitative analysis and quantification, leading to the use of inferential statistics, providing that we remain at the nominal or ordinal level of measurement. We are explaining the principle of construction of these rating scales and we are illustrating our practice with some examples drawn from studies we realized in clinical psychology.

Ethical considerations in writing psychological assessment reports

In this article, the author addresses the ethical questions and decision evaluators associated with the writing of psychological assessment reports. Issues related to confidentiality, clinical judgment, harm, labeling, release of test data, and computer usage are addressed. Specific suggestions on how to deal with ethical concerns when writing reports are discussed, as well as areas in need of further research.