Raymond DiGiuseppe

Developing the therapeutic alliance in child-adolescent psychotherapy

Abstract The psychotherapy process research on the therapeutic alliance in child and adolescent psychotherapy is alarmingly scarce. Findings from the adult therapeutic alliance literature and from the few existing studies on child and adolescent therapeutic alliance are reviewed. Bordins 1975 model of the working alliance and Prochaska and DiClementes (1988) stages of change model are employed to evaluate existing strategies for building alliances with child and adolescent clients and to develop proposed strategies. The facts that (a) children are most often not self-referred and (b) frequently come to therapy in a resistant, precontemplative stage of change are presented as the major obstacles to forming effective alliances with children and adolescents. Traditional child and adolescent psychotherapies may fail to develop effective alliances due to their primary focus on the development of the bond and neglect in achieving agreement on the goals and tasks of therapy. Multimodal strategies for building therapeutic alliances with children and adolescents incorporating techniques from emotional script theory, social problem-solving theory, motivational interviewing, and strategic family systems theories are presented.

Factors Associated With Formal Service Use by Family Members of Patients With Dementia

Thes study investigated actual service use by 152 dementia patients and used the Anderson model to examine factors associated with the use of in-home and out-of-home services. On the whole, practical issues tied to patient care were most powerfully related to the use of formal services in patients with relatively advanced dementia. Family caregiver appraisal, coping, and emo tional adjustment were not substantively tied to service use.

Rational-emotive therapy in the 1990s and beyond: Current status, recent revisions, and research questions

Abstract Rational-emotive therapy (RET) is an evolving theory of psychopathology and form of psychotherapy. In three main areas — theory of psychopathology, assessment, and practice of therapy — we present initial RET assumptions, a statement regarding current scientific status, recent developments and revisions, and recommendations for future research priorities.

Anger, Aggression, and Irrational Beliefs in Adolescents

This study examined whether a combination of anger, hostility, and irrational beliefs, i.e., intolerance of rules frustration, intolerance of work frustration, demands for fairness, and self-downing would predict physical, verbal, and indirect aggression and peer ratings of aggression. Follow-up analysis tested gender as a moderator of the relations between irrational beliefs and aggression, and anger and aggression. One hundred thirty-five high school-aged adolescents completed measures of irrational beliefs, anger, hostility, and aggression. Results demonstrated that gender, anger, and an irrational belief of intolerance of rules frustration predicted physical aggression, while anger and irrational belief of intolerance of rules frustration uniquely predicted indirect aggression. Anger alone predicted verbal aggression. Males were more likely to report higher rate of physical aggression and were voted to be more aggressive by their peers. However, gender did not moderate the relations between cognition and aggression, and anger and aggression. Treatment and research implications are discussed.

The nature of irrational and rational beliefs: Progress in rational emotive behavior theory

This paper discusses some limitations of Elliss Rational Emotive Behavior Therapy. It is suggested that the present definition of irrational and rational beliefs is inadequate. The present theory is unclear whether irrational beliefs are exaggerated negative evaluations or empirical distortions of reality. It is proposed that irrational beliefs are core schemes, and that the concept of schema replace the present definition of beliefs. Elliss position that demandingness is at the center of irrational thinking and emotional disturbance is examined. Research has failed to support this theory. It is proposed that demandingness and self-downing may be separate types of core irrational schemes. Research strategies are suggested that could test Elliss position on the centrality of demandingness and on the nature of irrational beliefs in general.It is also suggested that irrational beliefs differ on their level of abstraction. The present REBT theory fails to identify which level of abstraction is necessary to cause disturbance, at which level of abstraction therapists should seek change, and whether a therapist should intervene first at higher or lower levels of abstract beliefs. It is suggested that a therapist only seek change to the level of abstraction that matches the clients concerns and that therapists begin to intervene at lower levels of abstraction and move up to more abstract cognitions as therapy progresses.

End piece: reflections on the treatment of anger.

Research on the nature of anger and how it differs from other emotions is reviewed. Dimensions that differentiate disturbed from normal anger are also discussed. Based on the research and results of several reviews of anger treatment, an ideal treatment package for the treatment of anger is presented. The components include: (i) addressing motivation; (ii) cultivating the therapeutic alliance; (iii) managing physiological arousal; (iv) fostering cognitive change; (v) implementing behavior change; (vi) providing environmental supports for change; (vii) teaching relapse-prevention skills; and (viii) initiating restitution and reintegration. Also, the articles describing experiential, self psychology, cognitive-behavioral, Buddhist, and systems approaches to anger are compared and contrasted. Each of these treatment approaches is compared with the ideal treatment components.

A comparative outcome study of four cognitive therapies in the treatment of social anxiety

This clinical outcome study compared four separate cognitive behavioral and one behavioral treatment for reducing social anxiety with a waiting list control. Subjects were adults who responded to advertisements for treatment. In the cognitive-behavioral conditions, subjects were trained to modify their disruptive cognitions and/or emit adaptive cognitions relevant to interpersonal behavior with the specific content and techniques determined by the particular cognitive therapy. In the behavioral condition, subjects modeled and rehearsed appropriate social interpersonal behaviors. Subjects were assessed pre and post-treatment on self-report measures of social anxiety, measures of general anxiety, clinical scales of anxiety, depression and hostility, and behavioral, and physiological concomitants of social anxiety. Subjects in all active treatment conditions showed improvement on the measures of social anxiety and the behavioral measure. However, only those in the cognitive treatment conditions, demonstrated treatment effects on general anxiety and the clinical scales. The results indicate the efficacy of both cognitive and behavioral approaches to the reduction of social anxiety. However, they fail to demonstrate clear distinctions between the various cognitive therapies.

Towards a cognitive formulation of metaphor use in psychotherapy

Abstract Characterized by many as “the language of change,” metaphor has naturally become central to psychotherapy where change is a definitive aspect. This article reviews linguistic and psychological conceptualizations of metaphor and argues against popular psychotherapeutic applications that regard metaphor as the language of the unconscious and use it as an indirect method of communication. Rather, it presents a cognitive model of metaphor that is active and directive and that accurately acknowledges the nature of metaphor as an heuristic and epistemic device. This model also recognizes the potential harm of metaphor and reiterates the importance of explicitness and shared understanding according to communication theory.

Comprehensive Cognitive Disputing in RET

Disputing irrational beliefs has always been at the heart of RET. However, my 13 years’ experience in teaching therapists to do RET has revealed that disputing is the art of the science and the hardest thing about RET to teach. Most new therapists learn how to identify the activating event, the emotional consequences, and then the irrational belief. Once the client reveals his or her irrational belief, the therapist asks, “Where’s the evidence?” The client looks confused and says, “I guess there is none.” And the therapist assumes that the client has “got it” and responds, “What other problem would you like to discuss?” As therapists develop more experience, they spend more time disputing. They somehow develop a guide to all of the possible disputes that are available to use with a specific type of problem or a specific irrational belief.

What cognitions predict state anger

This study evaluated the relationship between specific cognitions and state anger. Clinical outpatients (23%), workplace recruits (37%), and college students (40%) (N = 236, mean age = 31.68) completed a questionnaire, the Anger Episode Record (AER), which asked them to describe an experience that elicited feelings of irritation, annoyance, anger, fury, or rage. They rated the intensity of their anger, cognitions, physiological responses, behaviors, and consequences for the specific episode. A stepwise multiple regression suggests that cognitions for revenge accounted for the greatest variance in predicting state anger, R = .26, p = .00, followed by demands on event, R = .32, p = .00, self-efficacy, R = .37, p = .00, and demands of others, R = .39, p = .04, respectively. The role of these cognitions in psychotherapy and interventions for angry clients is discussed.