This chapter begins by discussing the concept of validity in measurement and identifies criterion validity as central to the assessment and evaluation of clinical problems. The limitations of standardised measures with respect to criterion validity are identified and idiographic measurement is defined and introduced. Several types of idiographic measures are discussed, including self-report and observational measures. The importance of reliability in these measures is highlighted and methods for obtaining reliable observations are given. The chapter highlights the advantage of personal questionnaire methodology for measuring subjective states.
We were tasked with establishing treatment integrity for the SHIFT trial. In this article we discuss the concepts of treatment adherence and competence; arguing that the design of the trial, in particular the flexibility of the manual and the training and supervision of qualified systemic therapists, guarantees some level of treatment integrity. Despite this we decided, on the basis of a systematically informed literature review, that a post hoc evaluation of therapy tapes was in line with best practice. Our literature review found no measures that were appropriate for the needs of the trial, so we used the literature to guide our development of a SHIFT adherence measure (SAM). We outline our experience of constructing SAM in the hope of increasing transparency in this complex area of psychotherapy research. We also consider whether SAM can be transported into practice and outline future areas of research. 构建SHIFT附着量表：对SHIFT尝试和一个家庭治疗整合量表的发展 摘要: 我们的任务是为SHIFT尝试构建干预整合。在本文中我们讨论了干预附着和效能感的概念；主张这一尝试的设计尤其是手册以及培训和督导合格系统治疗师的灵活性, 保证了某种程度上的干预整合。 尽管如此, 我们决定在系统性地文献综述的基础上, 把治疗磁带的后期评估和最好的实践放在一起。我们的文献综述发现没有量表满足尝试的需要, 于是我们应用文献在指导我们对SHIFT附着量表的发展。我们概括了我们在构建SAM时候的经验以希望增加心理治疗研究这一复杂领域的透明度。我们还考虑把SAM转化成实践并列出了未来研究的领域。 关键词：心理治疗整合, 手册, 附着, 效能感
The study aims to examine how therapists trained in motivational interviewing (MI) respond to resistance and whether this has an impact on subsequent client speech.Fifty recorded Motivational Enhancement Therapy sessions were examined using a sequential behavioural coding method for speech. Client counter-change talk formed the baseline for coding and categorizing subsequent therapist speech and the following client speech. Transitional analysis identified the probable occurrence of specific therapist and client utterances at each stage.Following client expressed resistance or counter-change talk, MI consistent therapist utterances were most commonly observed. A moderate to strong predictive relationship was found between MI-consistent therapist speech and subsequent client change talk. A moderate predictive relationship was found between therapist MI-consistent behaviours and client ambivalence. A moderate to strong predictive relationship was found between MI-inconsistent therapist speech and subsequent client counter-change talk and a weak negative predictive relationship was found between MI-inconsistent therapist speech and client expressed ambivalence.In the face of initial expressed resistance to change, MI-consistent therapist speech appears to increase subsequent client utterances regarding intentions to change drinking behaviour.
Abstract The added value of using photographs to explore experiences has been embraced in research methods such as photo-elicitation and Photovoice. Despite evidence that photographs aid communication and understanding, there is little research investigating photograph use within cognitive behavioural therapy. This project explores participant experiences of taking and sharing photographs within a dialectical behaviour therapy (DBT)-informed emotional coping skills group intervention. Five service users were recruited from groups that had implemented the taking and sharing of photographs as a feature of homework tasks and feedback. Semi-structured interviews were conducted, using the photographs taken for the group as prompts, and interpretive phenomenological analysis was used to develop themes. Group evaluation data were used to support the analysis. Participants were positive about the impact of the photographs, despite initially experiencing anxieties regarding sharing them. The task supported them to express themselves in ways that added value to verbal feedback, which had benefits for group relationships and for the therapeutic tasks such as mindful observing. Further research is indicated, given the small sample and participants all being white, working-age females. However, the findings suggest that using photographs as homework tasks could support communication and the exploration of experiences that may be difficult to express using words. Key learning aims (1) Photographs may be an excellent tool for the communication of meaning and emotion in therapy. (2) Photographs taken on smartphones are likely to be a user-friendly, familiar and effective addition to homework recording tools. (3) Sharing photographs may have particular benefit for service users who struggle to be open about or express their feelings. (4) Photographs can provide a prop to help service users share experiences in a non-verbal way, which may help when working with people who struggle to describe their emotional experiences. (5) Sharing photographs can lead to a deeper connection with others, although some negotiation about what types of images can be captured will need agreement in a group setting.
This chapter covers the basic AB design and several experimental single-case designs: ABAB, changing criterion, multiple baseline and alternating treatment designs. The logic of each design is articulated and assessed against standard threats to validity. Several issues pertaining to the design of single-case experiments are discussed, including the challenges that arise in clinical practice. These include the stability of baselines, and criteria for deciding when to start and change treatment conditions.
Abstract Objective The evidence is that therapy only works for some. This study aimed to explore clients' subjective experience of non‐improvement; specifically how do participants who feel they have not benefitted from psychological therapy describe the experience and make sense of their therapy? Method Eight people from a National Health Service Psychological Therapies Department in the UK who felt their therapy had not resulted in improvement took part in semi‐structured interviews, later analysed using interpretative phenomenological analysis. Results Participants described a process, beginning with their difficulties, negative feelings about themselves, and initial hopes and anxieties for therapy. Once in therapy, participants described overwhelming fears of losing control and being judged. They described attempts to manage this, using self‐censoring and compliance. After therapy, while most could identify some gain, they felt disappointed and that they were having to ‘make do’. The sense of not having succeeded or being sufficiently deserving of further input, in turn, reinforced participants' initial negative self‐beliefs. Conclusion Although participants identified themselves as not having improved through therapy, the accounts suggested more complexity. All participants reported detrimental effects and accounts contained qualified, thoughtful descriptions of these experiences: participants acknowledged some gains, even though they felt that therapy had not met their expectations.
Abstract There is growing evidence regarding the effectiveness of mindfulness-based interventions offered to diagnostically diverse groups of participants. This study examined the feasibility and effectiveness of adapted Mindfulness-Based Cognitive Therapy (MBCT) groups offered to NHS patients in a secondary-care Psychology and Psychotherapy Service. The group was run as an adjunct to individual therapy and accepted referrals from all therapists in the service, so participants had experienced a range of therapeutic approaches prior to attending the group. The nine groups run during the project also included staff participants, as part of a capacity-building strategy. Results indicate high levels of acceptability, with low drop-out rates. Standardized outcome measures were used to examine the effectiveness of the group, and patient participants demonstrated improvements which were statistically significant. Qualitative feedback from group participants and referrers was positive. The findings support implementation of MBCT as part of a package of psychological therapy interventions. Further research regarding this form of MBCT is discussed.
Approximately 3-5% of women experience post-traumatic stress disorder following birth; positive experiences that can follow traumatic birth are under-researched.To explore how women experience post-traumatic growth following a traumatic birth.Interpretative Phenomenological Analysis was used to explore experiences of women who self-identified as having found positive benefits through coping with a traumatic birth. Eight women who had birthed in the past five years in the UK were recruited online and interviewed face-to-face.Three superordinate themes were developed: 'The total opposite to what I'd expected' (participants' struggle to understand and integrate their birth experience in the postnatal period); 'I see it a bit differently now' (processes experienced in coming to a place of growth); and 'A much better place' (experienced growth 'outcomes').Faced with shattered assumptions whereby their birth experiences contrasted with their expectations, participants felt their identities as women and mothers were challenged. In overcoming these challenges, participants described actively striving to cope and make sense of their experience. Multiple factors facilitated this, notably partner support, telling their birth story, acknowledging the impact and developing a compassionate narrative. Although growth was experienced in ways commonly reported by survivors of challenging life events, some aspects appeared pertinent to birth trauma.Widening our understanding of the range of experiences following traumatic birth and making these narratives public may offer hope for some women and families and inform health professionals' education and practice. Further research would be needed before advocating interventions to foster post-traumatic growth.
This study evaluated CBT teaching on a clinical psychology programme by exploring changes in trainees’ knowledge and self-rated competency. Improvements in CBT knowledge and perceived skills occurred across the first year of training, which trainees attributed to classroom-based teaching.
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