Clive G. Long

Within-program factors as predictors of drinking outcome following cognitive-behavioral treatment

The relationship between a variety of within-treatment factors and the outcome of treatment for alcoholism was examined. One hundred and twenty-eight male and 68 female participants (consecutive referrals with an ICD-10 diagnosis of alcohol dependence syndrome) were followed at 12 months following in- and day-patient cognitive behavioral treatment on an addiction unit. Within-treatment factors (of self-efficacy, psychological symptoms, expectations for treatment, treatment satisfaction, treatment climate, therapeutic alliance, and treatment evaluation), were assessed to determine their relationship to global outcome categorization into abstinent, nonproblem drinker, drinking but improved, and unimproved participant groups. A logistic regression analysis identified five variables that were predictive of a more favorable outcome: higher self-efficacy in positive social situations, greater treatment program involvement, a lower perception of staff control, a greater perception of treatment as helpful, and a reduction in psychological symptoms during treatment. Findings confirm previous research that pinpoints the importance of self-efficacy as a treatment variable of significance in treatment planning and delivery. It also highlights the prognostic significance of a reduction in psychological distress and, thus, the value of dynamic predictors of treatment outcome. The failure of the therapeutic alliance to predict outcome is discussed. It is concluded that time-limited alcoholism treatment programs need to give equal emphasis to within-treatment change via the promotion of patient confidence and the perception of helpfulness, as well as to skill-based relapse prevention strategies.

Over-exercising in anorexic and normal samples: Behaviour and attitudes

Exercise, attitudes, motivation and behaviour were compared in groups of female anorexic patients and groups of males and females without eating disorders. The anorexic group were significantly more hyperactive, exercised more frequently and engaged in a wider variety of exercise behaviours. They were also more likely to exercise in secret and were more compulsive about exercising. They displayed a ‘negative addiction’ to exercise, and gave control of their negative mood states as their major reason for undertaking it. The theoretical and clinical implications of these results are discussed.

Social climate along the pathway of care in women's secure mental health service: Variation with level of security, patient motivation, therapeutic alliance and level of disturbance

BACKGROUND Social climate has been measured in a variety of therapeutic settings, but there is little information about it in secure mental health services, or how it may vary along a gender specific care pathway. AIM To assess social climate in womens secure wards and its variation by level of security and ward type, therapeutic alliance, patient motivation, treatment engagement and disturbed behaviour. METHOD Three-quarters (80, 76%) of staff and nearly all (65, 92%) of patients in the two medium-security wards and two low-security wards that comprised the unit completed the Essen Climate Evaluation Schema (EssenCES) and the California Psychotherapy Alliance Scale (CALPAS); patients also completed the Patient Motivation Inventory (PMI). Pre-assessment levels of disturbed behaviour and treatment engagement were recorded. RESULTS Social climate varied according to ward type and level of security. EssenCES ratings indicative of positive social climate were associated with lower levels of security; such ratings were also associated with lower behavioural disturbance and with higher levels of motivation, treatment engagement and therapeutic alliance. CONCLUSION This serial cross-sectional survey indicated that use of the EssenCES alone might be a good practical measure of treatment progress/responsivity. A longitudinal study would be an important next step in establishing the extent to which it would be useful in this regard.

Dealing with Feelings: the effectiveness of cognitive behavioural group treatment for women in secure settings.

BACKGROUND Women in secure psychiatric settings have gender specific treatment needs. The current study examined the feasibility of a Dealing with Feelings Skills Group training for dual diagnosis women admitted to a medium secure setting. METHOD A pre-test--post-test design was used to evaluate a group programme adapted from dialectical behaviour therapy skills training. RESULTS Most patients had a primary diagnosis of personality disorder. Treatment completers (n = 29) were compared with non-completers (n = 15). Clinically significant changes in treatment completers were apparent on coping response measures of positive reappraisal, problem solving and alternative rewards; on measures of anxiety and suicidality; on self-reported ability to engage in activities to reduce negative mood and to recognize mood changes. Self-harming and aggressive behaviours also reduced in the 3 months following group treatment. CONCLUSION An adapted coping skills component of DBT benefit many dual diagnosis patients: issues related to treatment drop-out and failure to benefit are discussed.

Social problem-solving interventions in medium secure settings for women.

Problem-solving interventions are a feature of overall medium secure treatment programmes. However, despite the relevance of such treatment to personality disorder there are few descriptions of such interventions for women. Beneficial effects for women who completed social problem-solving group treatment were evident on a number of psychometric assessments. A treatment non-completion rate of one-third raises questions of both acceptability and timing of cognitive behavioural interventions.

Women referred for medium secure inpatient care: a population study over a six-year period

The need to map women’s secure hospital services in terms of patient population and service needs over time is acknowledged given: the increase in forensic and medium secure beds nationally; and limited gender specific analysis in previous studies. Data is presented relating to 65 consecutive admissions (over a 6-year period) to a women’s medium secure unit at three (14-month) time periods. Trends noted in population statistics include a decline in special hospital referrals and an increased proportion of prison referrals with an index offence of arson in the past two years in association with a lower level of cognitive functioning, and a higher level of assaultative behaviour. In accord with the responsivity principle (Ogloff & Davis, 2004 ) the implications for treatment and service planning for this changing population are discussed.

Tracking Risk Profiles and Outcome in a Medium Secure Service for Women: Use of the HoNOS-Secure

Female forensic mental health patients are a highly selected group who present exceptional clinical and behavioral challenges along with highly complex treatment needs. St. Andrews Healthcare Womens Service offers a ‘best practice’ psychosocial treatment program in conditions of medium security. The outcomes of 60 women residents between 2003 to 2008 are described in terms of risk, behavior, symptomatology, and social functioning using HoNOS-secure. The instrument was sensitive to change in this population, including the security scale, which captured highly significant clinical improvements. Some of the challenges associated with measuring outcomes for this group are discussed. The needs of women in secure services can be effectively addressed, enabling movement to less secure settings and further improvement.

The Scientist–Practitioner Model in Clinical Psychology: A Critique

The scientist‐practitioner philosophy of clinical practice is first placed in its historical context. The history of the scientist‐practitioner stance is marked by an enduring struggle between advocates and opponents of a research-based profession of clinical psychology. The criticisms of the scientist‐practitioner stance are discussed alongside counterarguments in support of that position. Making the conceptual distinction between theoretical preference and philosophical position, three philosophies to underpin clinical psychology are outlined. It is concluded that the fundamental research to decide on the optimum stance for effective practice, and hence to inform training, is sadly lacking. # 1997 by John Wiley & Sons, Ltd.

Aggression in specialist secure and forensic inpatient mental health care: incidence across care pathways

Purpose – The purpose of this paper is to describe how aggressive and violent incidents differ across specialist gender, security and mental health/learning disability pathways in specialist secure care.Design/methodology/approach – The paper uses a retrospective survey of routinely collected incident data from one 207‐bed UK independent sector provider of specialist medium and low secure mental health care for male and female adults with primary diagnosis of mental illness or intellectual disability.Findings – In total, 3,133 incidents involving 184/373 (49.3 per cent) patients were recorded (68.2 per cent other‐directed aggression, 31.8 per cent self‐harm). Most incidents occurred in the medium secure wards but more than half of the most severely rated self‐harm incidents occurred in low security. Men were disproportionately involved in incidents, but a small number of women were persistently involved in multiple acts. Incidents were most common in the intellectual disability pathway.Research limitation...

Women in medium secure care: tracking treatment progress for changes in risk profiles and treatment engagement

The treatment and risk management programmes in a womens medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research.