Roger P. Greenberg

Premature discontinuation in adult psychotherapy: a meta-analysis.

OBJECTIVE Premature discontinuation from therapy is a widespread problem that impedes the delivery of otherwise effective psychological interventions. The most recent comprehensive review found an average dropout rate of 47% across 125 studies (Wierzbicki & Pekarik, 1993); however, given a number of changes in the field over the past 2 decades, an updated meta-analysis is needed to examine the current phenomenon of therapy dropout. METHOD A series of meta-analyses and meta-regressions were conducted in order to identify the rate at which treatment dropout occurs and predictors of its occurrence. This review included 669 studies representing 83,834 clients. RESULTS Averaging across studies using a random effects model, the weighted dropout rate was 19.7%, 95% CI [18.7%, 20.7%]. Further analyses, also using random effects models, indicated that the overall dropout rate was moderated by client diagnosis and age, provider experience level, setting for the intervention, definition of dropout, type of study (efficacy vs. effectiveness), and other design variables. Dropout was not moderated by orientation of therapy, whether treatment was provided in an individual or group format, and a number of client demographic variables. CONCLUSIONS Although premature discontinuation is occurring at a lower rate than what was estimated 20 years ago (Wierzbicki & Pekarik, 1993), it is still a significant problem, with about 1 in every 5 clients dropping out of therapy. Special efforts should be made to decrease premature discontinuation, particularly with clients who are younger, have a personality or eating disorder diagnosis, and are seen by trainee clinicians.

Advances in the assessment of object relations in the 1990s

In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of ones OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment.

He Said, She Said

Abstract Couple research has shown spousal support is associated with better treatment adherence, illness adaptation and blood sugar control in studies of individuals with diabetes. However, few studies have investigated gender differences and how they impact spousal supporting behaviors. In this study, seventy-four individuals (patients and spouses) participated in semi-structured interviews regarding spousal support relating to diabetes management. Transcripts of these interviews were rigorously coded and analyzed by a team of researchers. A sampling of quotes is provided illustrating gender differences in the areas of dietary and regimen specific support as well as perceptions of nagging behavior. Potential explanations for differences and implications for clinicians are discussed including the role of marital therapists on collaborative treatment teams.

Learning psychotherapy in the digital age.

There is substantial literature documenting the process factors that lead to effective psychotherapy. Similarly, there is now a wealth of data attesting to the effectiveness of several psychotherapy brands. Little is known about the elements that facilitate learning how to be an effective clinician. One important step, after reading about a treatment model and seeing techniques demonstrated, is having the chance to practice the approach and receiving feedback and coaching from an experienced, knowledgeable supervisor. To accomplish this efficiently, most programs rely not only on trainee accounts of what went on in their therapy sessions, but also on recordings and videos of therapeutic encounters. This article describes our experience over a 5-year period in developing the use of Webcams for training psychology interns and psychiatric residents in the delivery of psychotherapy services. Pragmatic and technical details are given about how we went about establishing a recording system that is easy to use and provides secure, confidential storage of information at a reasonable cost. Discussion addresses both the weighing of choices that need to be made and overcoming the hesitation of trainees to reveal their work during treatment sessions.

Antidepressants, Psychotherapy or their Combination: Weighing Options for Depression Treatments

Psychotherapy and antidepressant medications are the two preeminent treatment choices for depression. This article puts each of these treatments into perspective by presenting an overview of what is currently known about their effectiveness either singly or in combination. Discussion of placebos, common factors among therapies, relapse rates, depression severity, patient treatment preferences and exaggerations in pharmaceutical advertising provide guidance for clinicians in deciding on the best course of treatment. Overall, research reveals the importance of psychosocial factors, no matter what the mode of treatment, and the need for fostering a collaborative bond between clinicians and their patients. We argue that empirical evidence points to making psychotherapy the initial treatment choice for most cases of depression.