Andrew S. McClintock

Helping Skills Training for Undergraduate Students Who Should We Select and Train

We examined the effectiveness of the Hill model of helping skills training for 191 undergraduate students in six sections of a semester-long course. Students completed self-report, performance, and nonverbal measures at the beginning; they conducted one 20-min helping session at the beginning and another toward the end of the semester; and they completed self-efficacy measures at the end of the semester. Students’ helping skills improved over the course of the semester, as evidenced by higher helper- and volunteer client–rated session quality, reduced proportion of words spoken in sessions, increased proportion of exploration skills used in sessions, and increased self-efficacy for using helping skills. Self-reported empathy predicted four of the five helping skills criteria at the beginning-of-semester assessment. Facilitative interpersonal skills predicted end-of-semester self-efficacy in helping skills when controlling for retrospective prelevels and instructor effects. Implications for training and research are presented.

Enhancing psychotherapy process with common factors feedback: A randomized, clinical trial.

In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergraduates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU + CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU + CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU + CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms.

Mindfulness Therapy for Maladaptive Interpersonal Dependency: A Preliminary Randomized Controlled Trial.

Existing treatments for maladaptive interpersonal dependency and dependent personality disorder do not meet basic scientific standards for effectiveness. The present investigation tested the efficacy of a mindfulness-based approach: mindfulness therapy for maladaptive interpersonal dependency (MT-MID). Forty-eight participants who reported consistently high levels of maladaptive dependency (i.e., scored higher than 1 standard deviation above the mean on the Interpersonal Dependency Inventory at two separate assessments) were randomized to either 5 sessions of MT-MID or a minimal contact control. Five self-reported outcomes (mindfulness, maladaptive interpersonal dependency, helplessness, fears of negative evaluation, and excessive reassurance seeking) were assessed at pretreatment, posttreatment, and a 4-week follow-up. Intent-to-treat analyses indicated that MT-MID yielded greater improvements than the control on all 5 outcomes at posttreatment (median d=1.61) and follow-up (median d=1.51). Participants assigned to MT-MID were more likely than control participants to meet criteria for clinically significant change at posttreatment (56.5% vs. 0%) and follow-up (42.9% vs. 0%). There was also evidence that increases in mindfulness mediated the dependency-related improvements. These results provide preliminary support for the efficacy of a mindfulness-based approach for treating the symptoms of maladaptive dependency.

Working Alliance, Interpersonal Problems, and Depressive Symptoms in Tele-Interpersonal Psychotherapy for HIV-infected Rural Persons: Evidence for Indirect Effects

OBJECTIVE Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear. METHOD Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy-five patients received up to 9 sessions of telephone-administered IPT (tele-IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele-IPT vs. control) and another included the working alliance as independent variables. RESULTS The first model found an indirect effect whereby tele-IPT reduced depression via decreased social avoidance. There was a direct effect between tele-IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele-IPTs influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems. CONCLUSION Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone.

Empathy from the client's perspective: A grounded theory analysis

Abstract Although empathy is one of most robust predictors of client outcome, there is little consensus about how best to conceptualize this construct. Objective: The aim of the present research was to investigate clients’ perceptions and in-session experiences of empathy. Method: Semi-structured, video-assisted interpersonal process recall interviews were used to collect data from nine clients receiving individual psychotherapy at a university psychology clinic. Results: Grounded theory analysis yielded a model consisting of three clusters: (1) relational context of empathy (i.e., personal relationship and professional relationship), (2) types of empathy (i.e., psychotherapists’ cognitive empathy, psychotherapists’ emotional empathy, and client attunement to psychotherapist), and (3) utility of empathy (i.e., process-related benefits and client-related benefits). Conclusions: These results suggest that empathy is a multi-dimensional, interactional process that affects—and is affected by—the broader relationship between client and psychotherapist.

Development and Validation of a Six-Item Version of the Interpersonal Dependency Inventory.

The Interpersonal Dependency Inventory (IDI) is a frequently used, 48-item measure of maladaptive dependency. Our goal was to develop and psychometrically evaluate a very brief version of the IDI. An exploratory factor analysis of the IDI in Study 1 (N = 838) yielded a six-item IDI (IDI-6), with three items loading on an emotional dependency factor (IDI-6-ED), and the other three items loading on a functional dependency factor (IDI-6-FD). This factor solution was validated by confirmatory factor analysis in Study 2 (N = 916). The IDI-6-ED and IDI-6-FD demonstrated good convergent and divergent validity in Study 3 (N = 100). In Study 4 (N = 22-43), the IDI-6-ED and IDI-6-FD were generally stable over 4-week and 8-week intervals and were found to be responsive to the effects of psychological treatment. These results have implications for dependency conceptualizations and support the IDI-6 as a brief, psychometrically sound instrument.

Lack of emotional clarity and diminished self-efficacy as core problems in functional dependency: A structural equation modeling analysis with a college student sample

BACKGROUND High levels of functional dependency appear to be deleterious to psychological and physical health. The goal of this research was to identify factors responsible for the association between functional dependency and negative health outcomes. METHODS Self-report data were collected from 149 undergraduate students. Structural equation modeling was used to test a model in which functional dependency has indirect effects on three negative psychological outcomes (negative affect, functional impairment, and dissatisfaction with life) through two variables: lack of experiential awareness and diminished self-efficacy. RESULTS The model provided a good fit to the data and five of the six indirect effects were statistically significant. LIMITATIONS Limitations include self-report and cross-sectional nature of the data. CONCLUSIONS These results help to shed light on the core pathology in functional dependency and implicate specific interventions in treating problems associated with this personality trait.

An investigation of client mood in the initial and final sessions of cognitive-behavioral therapy and psychodynamic-interpersonal therapy.

Abstract Objective: Our aim was to examine client mood in the initial and final sessions of cognitive-behavioral therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and to determine how client mood is related to therapy outcomes. Methods: Hierarchical linear modeling was applied to data from a clinical trial comparing CBT with PIT. In this trial, client mood was assessed before and after sessions with the Session Evaluation Questionnaire-Positivity Subscale (SEQ-P). Results: In the initial sessions, CBT clients had higher pre-session and post-session SEQ-P ratings and greater pre-to-post session mood change than did clients in PIT. In the final sessions, these pre, post, and change scores were generally equivalent across CBT and PIT. CBT outcome was predicted by pre- and post-session SEQ-P ratings from both the initial sessions and the final sessions of CBT. However, PIT outcome was predicted by pre- and post-session SEQ-P ratings from the final sessions only. Pre-to-post session mood change was unrelated to outcome in both treatments. Conclusions: These results suggest different change processes are at work in CBT and PIT.

Mindfulness Training for Emotional and Cognitive Health in Late Life

Purpose of ReviewThere is a growing interest in psychosocial interventions that can enhance emotional and cognitive health in older adults, both to treat psychopathology and/or cognitive decline and to prolong optimum functioning in healthy individuals. Mindfulness-based interventions (MBIs) have been proposed as an accessible and effective means of promoting emotional and cognitive health. This article reviews recent clinical trials of MBIs in older adults.Recent FindingsThere is growing support for MBIs as a means to address mild to moderate clinical concerns, including depression, anxiety, sleep, and subjective memory or other cognitive complains but little evidence that MBIs improve functioning in already healthy individuals.SummaryMBIs may be effective for older adults with mild to moderate emotional and cognitive dysfunction. Future longitudinal work is needed to test if MBIs are an effective means of prevention of emotional or cognitive decline.