Katerine Osatuke

Patterns of alliance development and the rupture-repair hypothesis: Are productive relationships U-shaped or V-shaped?

The authors attempted to replicate and extend D. M. Kivlighan and P. Shaughnessys (2000) findings of (a) 3 distinctive patterns of alliance development across sessions and (b) a differential association of one of these, a U-shaped quadratic growth pattern, with positive treatment outcome. In data drawn from a clinical trial of brief psychotherapies for depression (N = 79 clients), the authors distinguished 4 patterns of alliance development. These matched 2 of Kivlighan and Shaughnessys patterns, but not the U-shaped pattern, and none was differentially associated with outcome. However, further examination of the data identified a subset of clients (n = 17) who experienced rupture-repair sequences-brief V-shaped deflections rather than U-shaped profiles. These clients tended to make greater gains in treatment than did the other clients.

Civility, Respect, Engagement in the Workforce (CREW): Nationwide Organization Development Intervention at Veterans Health Administration

This article presents a description and preliminary evaluation of a nationwide initiative by the Veterans Health Administration (VHA) called Civility, Respect, and Engagement in the Workforce (CREW). The goal of CREW is to increase workplace civility as assessed by employee ratings of interpersonal climate in workgroups. Once endorsed by the VHA leadership and adopted by the leaders of particular VHA hospitals, CREW was conducted by local facility coordinators who were trained and supported by the VHA National Center for Organization Development. This article explains the conceptual and operational background of CREW and the approach used to implement the initiative, presents results from two CREW administrations with a total of 23 sites, and reports significant preintervention to postintervention changes in civility at intervention sites as compared to no significant changes at comparison sites within each administration. It discusses these findings in the conceptual (theoretical) and operational (intervention evaluation) context of interventions targeting civility.

Temporal patterns of improvement in client-centred therapy and cognitive-behaviour therapy

Psychotherapys equivalence paradox refers to clients achieving similar degrees of overall improvement in different treatment approaches, despite the non-equivalent processes. The current intensive qualitative study described and compared how different processes brought about their respective outcomes in one case of client-centred therapy (CCT) and one of cognitive-behaviour therapy (CBT). The assimilation model of psychotherapeutic change was used to compare processes of change and patterns of improvement in these two demographically and diagnostically similar clients, who had equally favourable outcomes on post-treatment measures. We applied the method of assimilation analysis to both therapies, and compared the assimilation account of client change with the theoretical models used in the two treatments.

Creative consensus on interpretations of qualitative data: The Ward method

Abstract The Ward method (1987) offers an iterative approach to consensus building that encourages the development and consideration of each contributors unique perspectives. Collaborators begin by orienting to the method and project-specific goals and then engage in an iterative process, cycling between individual creative work and group meetings. Meetings serve as opportunities to share ideas within a noncritical atmosphere. Paradoxically, much of the work of reaching consensus occurs while collaborators are working independently; across iterations, versions tend to converge as collaborators adapt and adopt what they like of one anothers ideas. This article, which was itself written using the Ward method, describes the method, its strengths, and challenges associated with its use.

Problematic Internal Voices in Clients with Borderline Features: An Elaboration of The Assimilation Model

The assimilation model is an empirically researched account of psychotherapy process, focusing on stages of clients’ change. According to the model, traces of a persons experiences are manifested as agentic internal voices, and personality is understood as a community of such voices. This study focuses on how unassimilated voices appear clinically, and it applies the assimilation model to clients with borderline or dissociative disorders. We introduce the notion of subcommunities of voices, i.e., constellations of voices that appear unassimilated to each other. They are manifested as drastic shifts in self-states and availability of personal resources. We propose five distinctions and illustrate them with clinical examples: Voices or subcommunities (1) may be dominant or nondominant and (2) included in a community to different degrees. They (3) may express broader or more limited segments of experience, which (4) may be processed more or less thoroughly. Finally, (5) they may be avoided or engaged by the community to varying degrees.

The Relationship between Organizational Climate and Quality of Chronic Disease Management

OBJECTIVE To test the utility of a two-dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. DATA SOURCES/STUDY SETTING Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. STUDY DESIGN Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross-sectional study. DATA COLLECTION/EXTRACTION METHODS All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient-level data. PRINCIPAL FINDINGS Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. CONCLUSIONS The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate.

Insight, quality of life, and functional capacity in middle-aged and older adults with schizophrenia

The quality of life (QOL) for individuals with schizophrenia is determined by a number of factors, not limited to symptomatology. The current study examined lack of insight as one such factor that may influence subjective QOL or functional capacity. It was hypothesized that insight would significantly interact with symptom severity to influence subjective QOL. Insight was not expected to influence the relation between symptom severity and functional capacity.

Numbers in assimilation research

We describe the assimilation model, a developmental theory of psychological change that focuses on interpretive study of people’s experience in therapy. Assimilation research relies on methods that are simultaneously interpretive and quantitative, and uses them in mutually complementary ways. We explain how quantitative techniques have been useful in research on the model. We give examples of numeric techniques and their uses in specific studies that included helping establish reliability of interpretive accounts of clients’ change, investigating substantive issues of theoretical interest, testing hypotheses about the model, and formulating clinical implications of assimilation concepts. These procedures quantify our understanding of people’s subjective experience of change in therapy and rely on contextual interpretation of meanings. These examples illustrate and advocate the use of numeric properties for the purposes of contextual interpretive inquiry.

The effects of personality and spirituality on workplace incivility perceptions

The relationships between negative affectivity (NA), locus of control, agreeableness, and workplace spirituality were tested with workplace incivility perceptions. Hundred and two part-time and full-time college students, 90 of whom were aged 25 and older, completed measures of the previous variables; measures of remaining Five Factor Model traits, civility, and social desirability were administered for supplemental purposes. Significant relationships were found between NA and incivility, agreeableness and incivility, and workplace spirituality and incivility. Workplace spirituality provided a unique contribution in the prediction of incivility perceptions. The spirituality measure was factor analyzed to test factors’ relationships with incivility when controlling for the related construct of civility. Spirituality components of meaning and spiritual blocks were found to predict incivility perceptions independently of civility scores. Results suggest that spirituality levels affect incivility perceptions above and beyond that of traditional personality variables.

Accounting for Variation in Technical Quality and Patient Satisfaction The Contribution of Patient, Provider, Team, and Medical Center

Background:The delivery of healthcare depends on individual providers, coordination within teams, and the structure of the work setting. We analyzed the amount of variation in technical quality and patient satisfaction accounted for at the patient, provider, team, and medical center level. Methods:Data abstracted from Veterans Health Administration patient medical records for 2007 were used to calculate measures of technical quality based on adherence to best practice guidelines in 5 domains. Outpatient satisfaction was obtained from a 2007 standardized national mail survey. Hierarchical linear models that accounted for the clustering of patients within providers, providers within teams, and teams within medical centers were used to partition the variation in technical quality and satisfaction across patients and components of the system (ie, providers, teams, and medical centers). Results:Providers accounted for the largest percent of system-level variance for all technical quality domains, ranging from 46.5% to 71.9%. For the single-item measure of patient satisfaction, medical centers, teams, and providers accounted for about the same percent of system-level variance (31%–34%). For the doctor/patient interaction scale providers explained 59.9% of system-level variance, more than double that of teams and medical centers. For all the measures, the residual variance (composed of patient-level and random error) explained the largest proportion of the total variance. Conclusions:Providers explained the greatest amount of system-level variation in technical quality and patient satisfaction. However, in both of these domains, differences between patients were the predominant source of nonrandom variance.