Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance.

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.

Infidelity in Dating Relationships: Gender-Specific Correlates of Face-to-Face and Online Extradyadic Involvement.

This study examined the gender-specific correlates of face-to-face and online extradyadic involvement (EDI) in dating relationships. The sample consisted of 561 women (M age = 23.19 years) and 222 men (M age = 23.97 years), all of whom reported being in an exclusive dating relationship for an average of 35 months. Participants completed the following self-report measures: Extradyadic Behavior Inventory, Attitudes toward Infidelity Scale, and Investment Model Scale. During the current relationship, men were more likely than women to report engagement in face-to-face physical/sexual EDI (23.4 vs. 15.5 %) and online sexual EDI (15.3 vs. 4.6 %). Both men and women with a history of infidelity in a prior relationship were more likely to engage in EDI. More positive attitudes toward infidelity, lower relationship satisfaction, lower commitment, and higher quality of alternatives were significantly associated with EDI, regardless of gender. Women reporting infidelity of a partner in a prior relationship were more likely to engage in face-to-face and online emotional EDI; a longer relationship and a younger age at the first sexual encounter were significant correlates of the engagement in face-to-face emotional EDI. Women with higher education were approximately three times more likely to engage in online sexual EDI. Although men and women are converging in terms of overall EDI, men still report higher engagement in physical/sexual extradyadic behaviors, and the correlates of sexual and emotional EDI vary according to gender. This study contributes to a comprehensive approach of factors influencing the likelihood of EDI and encourages future research in this area.

Why some mental health professionals avoid self-care.

This article briefly discusses reasons why some mental health professionals are resistant to self-care. These reasons include the savior complex, avoidance, and lack of collegial assiduity. Several proposed solutions are offered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Collaboration in cognitive-behavioral therapy.

Collaborative empiricism, which involves a systemic process of therapist and patient working together to establish common goals in treatment, has been found to be one of the primary change agents in cognitive-behavioral therapy (CBT). This article focuses on the development of a therapeutic relationship and implementation of collaborative empiricism along with the elements that lead to success in treatment. This method is used to uncover patients' automatic thoughts and underlying beliefs in treating an array of emotional and behavioral disorders. The role of the therapist is discussed in developing, promoting, and maintaining therapeutic collaboration and what is constituted by the empirical process. A case study illustrates the use of collaborative empiricism with a patient suffering from panic disorder. The article concludes with a series of clinical practices that will enhance collaborative empiricism and collaboration in CBT, and thereby treatment outcomes.

Definitions of homework, types of homework, and ratings of the importance of homework among psychologists with cognitive behavior therapy and psychoanalytic theoretical orientations.

A random sample of 827 psychologists were surveyed to assess their definitions of homework, use of homework tasks, and perceived importance of homework. Theoretical orientation distinguished practitioners' responses. Cognitive-behavioral therapists defined homework as being closer to empirically supported therapy, whereas psychodynamic therapists rated homework as less characteristic of a process that embraces client responsibility and adaptive skills. Cognitive-behavior therapists did not limit their choices to activity-based tasks, and psychodynamic therapists reported using behavioral tasks "sometimes." Monitoring dreams and conscious thought were also used among the entire sample surveyed. Psychodynamic therapists rated homework as "somewhat" or "moderately" important, whereas cognitive-behavior therapists more often rated homework as "very important." Data suggest some homework may be common to different psychotherapeutic approaches. Findings are discussed in the context of recent theoretical work on homework in psychotherapy and recommendations for future research.

Commentary: the future of forensic functional brain imaging.

In "Functional MRI Lie Detection: Too Good to be True?" in this issue of The Journal, Joseph Simpson reviews the merits and the limitations of using fMRI to detect deception. After presenting the gaps in experimental data that stand in the way of translating the laboratory proof of concept to a field application, Simpson surveys the legal, regulatory and ethics concerns facing fMRI, should it emerge as a technologically robust method of lie detection. In our commentary, we update and interpret the data described by Simpson, from the points of view of an experimental scientist and a forensic clinician. We conclude that the current research funding and literature are prematurely skewed toward discussion of existing findings, rather than generation of new fMRI data on deception and related topics such as mind-reading, consciousness, morality, and criminal responsibility. We propose that further progress in brain imaging research may foster the emergence of a new discipline of forensic MRI.

Does patient reluctance towards exposure and psychologists' attitudes about evidence based practice influence treatment recommendations for panic disorder? An experimental investigation.

This study examined the effects of patient reluctance towards exposure on practitioners' subsequent treatment recommendations. Participants (N=236) were doctoral level psychologists who received a vignette of a patient with panic disorder, which either did (experimental group) or did not (control group) mention patient reluctance towards exposure. Evidence Based Practice (EBP) attitudes were also assessed and taken into account. A significant main effect of reluctance, averaged across all levels of EBP attitudes, and theoretical orientations was obtained (OR=2.85, 95% CI=[1.51, 5.39], p=0.001, RR=1.46), with controls 1.46 times more likely to recommend exposure. A significant main effect of EBP attitudes was also obtained (p<0.001). The odds of recommending exposure increased by 11% with each increase of positive EBP attitudes, across both levels of patient reluctance and theoretical orientation.

A pilot Rasch scaling of lawyers' perceptions of expert bias.

How seriously do attorneys consider the biases of their retained mental health experts? Participants in this pilot study included 40 attorneys, randomly selected from a pool of members of the Pennsylvania Bar Institute, who rated-for their biasing potential-several situations that might affect the behavior of an expert. A Rasch analysis produced a linear scale as to the perceived biasing potential of these different items from most to least biasing. Among other results, the study suggests that attorneys do view mental health experts who work on both sides of cases as being more balanced in their testimony. However, they also indicated that they have a preference for using individuals who repeatedly testify for one side. Working for only one side in both civil and criminal cases yielded large scaled values. Additional comments offered by respondents indicated that: (1) an opposing expert also serving as the litigant's treater and (2) an opposing expert being viewed as a "hired gun" (supplying an opinion only for money) were viewed by subjects as not being very biased. A discussion of the results raises the need for future research in this area.

The restructuring of family schemas: a cognitive-behavior perspective.

Cognitive-behavior therapists define schemas as cognitive structures that organize thought and perception. Schemas are also viewed as having an integral influence on emotion and behavior In this article, I examine the role of schema in family conflict and the specific interventions used in restructuring them during the course of family therapy. Further discussion highlights the concepts of attributions, assumptions, and family standards, and the role they play in schemas, as well as the overall family dynamics. Finally, a series of steps are suggested for facilitating the process of schema analysis and thought restructuring during the process of family therapy.

Introduction to the special section: The role of cognitive-behavioral interventions in couple and family therapy.

Marriage and family therapists' perspectives on cognitive-behavior family therapy (CBFT) have seen major changes over the years. The focus on cognitions and behaviors in treatment is now widely embraced by marriage and family therapists because of the effectiveness of the approach and its flexibility and integrative potential. This article provides an introduction to the special section and a brief history and overview of the application of CBFT to the field and some of the benefits it can provide to the growing and ever-challenging area of couples and family therapy.

The divide between "evidenced-based" approaches and practitioners of traditional theories of family therapy.

Evidenced-based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence-based treatments and suggest a broader, more clinically palatable view of evidenced-based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher-clinician divide in the best interest of all concerned.

Enhancing cognitive behavior therapy with logotherapy: techniques for clinical practice.

Logotherapy is a meaning-centered approach to psychotherapy, which is compatible with cognitive behavior therapy. Its basic tenets have the potential to increase both the efficacy and effectiveness of the therapeutic process. This article describes the main techniques of logotherapy and provides specific and practical examples of how they may be incorporated into a cognitive behavior framework. The article concludes with a proposal for future research to validate integrative treatment protocols, and to provide an empirical base for logotherapy-enhanced cognitive behavior therapy.

Formal training in forensic mental health: psychiatry and psychology.

The field of forensic mental health has grown exponentially in the past decades to include forensic psychiatrists and psychologists serving as the primary experts to the court systems. However, many colleagues have chosen to pursue the avenue of serving as forensic experts without obtaining formal training and experience. This article discusses the importance of formal education, training and experience for psychiatrists and psychologists working in forensic settings and the ethical implications that befall those who fail to obtain such credentials. Specific aspects of training and supervised experience are discussed in detail.

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists.

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy.

Case studies within a mixed methods paradigm: toward a resolution of the alienation between researcher and practitioner in psychotherapy research.

This article addresses the long-standing divide between researchers and practitioners in the field of psychotherapy, regarding what really works in treatment and the extent to which interventions should be governed by outcomes generated in a "laboratory atmosphere." This alienation has its roots in a positivist paradigm, which is epistemologically incomplete because it fails to provide for context-based practical knowledge. In other fields of evaluation research, it has been superseded by a mixed methods paradigm, which embraces pragmatism and multiplicity. On the basis of this paradigm, we propose and illustrate new scientific standards for research on the evaluation of psychotherapeutic treatments. These include the requirement that projects should comprise several parallel studies that involve randomized controlled trials, qualitative examinations of the implementation of treatment programs, and systematic case studies. The uniqueness of this article is that it contributes a guideline for involving a set of complementary publications, including a review that offers an overall synthesis of the findings from different methodological approaches.

Does the case study have a future in the psychiatric literature?

Case studies (that is, case-based research) and their status in contemporary psychiatric literature are the main focus of this article. In essence, it evaluates the validity of such research to determine whether or not it will continue to be useful as a viable tool in light of the current emphasis on empirically validated research in the field of psychiatry. Various implications of the role of case studies are considered, including the ways in which the research might be designed to be more rigorous so that it can serve as the basis for drawing causal inferences in clinical cases. A discussion section highlights the future direction of case-based research in the professional literature and how it may be used to best advantage as a learning tool.

Differentiating cognitive impairment from symptoms of anxiety in postcoronary artery bypass grafting encephalopathy: a case report.

Post-coronary artery bypass grafting encephalopathy (CABGE) is associated with cognitive decline in a significant number of post-cardiac surgery cases. Patients may experience this condition as a result of being maintained on a heart-lung machine, which is referred to as the "pump". The pump is used to circulate oxygenated blood during heart or valve surgery and may contribute to complication with oxygen flow to the brain. In some cases, the emotional traumatic effects of CABGE may produce symptoms of anxiety that can often mimic the cognitive decline associated with cardiac bypass and use of the pump. When this is the case, cognitive-behavioral assessment may be useful in helping patients to differentiate symptoms generated by anxiety from those produced by the effects of the pump. A discussion section addresses further implications of such overlapping symptoms and therapeutic strategies for treatment and remediation, along with the potential adverse effects that may occur through psychotherapy.

Homework assignments in couple and family therapy.

Homework has been cited as an integral part of a number of theoretical orientations and therapy formats; unfortunately, very little has been written about its use with couples and families. This is despite the fact that many couple and family therapists espouse the use of homework or out-of-session assignments in order to help the effects of therapy jell. This article reviews some of the empirical literature on homework assignments and their effectiveness in the domain of therapy for families and couples. It also highlights the effectiveness of and the need for out-of-session assignments in treatment. A case illustration is used to demonstrate how homework assignments may be used as a significant change agent in couple and family treatment.