Attachment and therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis

We examine associations between client attachment style and therapeutic alliance in a 3‐arm randomized controlled trial of brief motivational interviewing and cognitive–behavioural therapy compared with longer term motivational interviewing and cognitive–behavioural therapy or standard care alone. Client self‐report measures of attachment style were completed at baseline, and both clients and therapists in the treatment arms of the trial completed alliance measures 1 month into therapy. We found that insecure–anxious attachment was positively associated with therapist‐rated alliance, whereas clients with insecure–avoidant attachment were more likely to report poorer bond with therapist. There was no evidence that client attachment significantly predicted clinical or substance misuse outcomes either directly or indirectly via alliance. Nor evidence that the length of therapy offered interacted with attachment to predict alliance.     

Relational Turn and Psychotherapy Research

Psychoanalytic authors have traditionally been skeptical of nomothetic studies, in which group averages obscure the uniqueness of individual cases. Several relational psychoanalytic authors have expressed more pronounced skepticism, affirming, for example, that given the uniqueness of each therapist-patient dyad, systematic empirical research is particularly problematic. In this article we highlight the potential synergy between relational thinking and today's psychotherapy research, by exploring some of the ways in which the work of relational authors has influenced relational psychotherapy research, shifting the focus of study from validation of the models of treatment to the study of the clinical variables such as: countertransference, therapist empathy, self-disclosure, rupture and resolution in therapeutic alliance, intersubjective negotiation, and the patient-therapist attachment relationship. In conclusion, the aim of this article is to facilitate the dialogue between relational psychoanalysis and the field of psychotherapy research, by exploring ways in which these two different worlds can reciprocally stimulate and enrich one another.     

Multicultural competencies: What are we measuring?

The current study examined the validity of the client-rated version of the Cross-Cultural Counseling Inventory–Revised (CCCI-R). The first phase of this study involved a content validation of the CCCI-R by experts who had publications in the fields of multicultural competencies (MCCs) and psychotherapy research. Of the 20 items on the CCCI-R, 7 were rated as appropriate for client use. The second phase of this study utilized confirmatory factor analysis to examine construct validity by testing whether clients' perceptions of their therapists' MCCs (via the seven items validated by experts) were distinct from client-rated working alliance scores. Model fit statistics supported a theoretically based model in which MCCs were measured distinctly from working alliance, but where the two factors were related. Implications for theory and practice are discussed.     

Effects of religious vs. standard cognitive behavioral therapy on therapeutic alliance: A randomized clinical trial

Background: Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients. Objective: Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness. Method: Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups. Results: HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = ?0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of freedom = 181, t = 2.04, p = 0.043, d = 0.30). Conclusions: While RCBT produces a marginally greater improvement in TA initially compared with SCBT, SCBT soon catches up.     

Client and therapist agreement about the client's problems—Associations with treatment alliance and outcome

Objective: A shared understanding of the patient's symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patient's problems and outcome. The purpose of the present study was to analyze whether agreement in the understanding of the patient's depression and anxiety problems was important for alliance and outcome. Method: The study used data from a practice-based study using the CORE system with 846 patients who received psychological treatment in primary care. Results: The analyses indicated that although patients who were assessed by their therapists as having depression and anxiety problems scored higher on these subscales than other patients, about half of the patients reported such problems when the therapists did not, and vice versa. Agreement was not associated with better alliance or outcome. Conclusions: Productive collaboration in psychotherapy may be based on other factors than agreement about symptoms.     

经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛的效果观察

目的 探讨经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛的临床疗效.方法 应用医用半导体激光和医用臭氧,在X线引导下采用18G穿刺针经皮穿刺至髓核区,然后由穿刺针导入600μm光导纤维,用脉冲式激光切割、汽化髓核,以每个椎间盘800～1000J切割、汽化,再向椎间盘注入浓度为60μg/ml臭氧约5～8ml,共治疗74例95节腰椎间盘.结果 按照MACNAB标准评定,74例患者术后随访5～36个月,优64例,良6例,可4例,差0例,优良率94.6%.结论 经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛,疗效佳,操作简便,创伤小,安全性高,恢复快.     

医院图书馆建设的绩效探索

医院图书馆建设无论采取哪种方式与手段,最终目的都是为医务人员提供最佳信息服务,提高医务人员的科研水平,使图书馆的使用价值最大化。根据对所在医院及其集团下属医院的调查,发现医务人员对医院图书馆的资源使用率普遍偏低。本文从绩效的角度出发,根据医院图书馆的现状分析了图书馆使用率较低的原因,采取各项干预措施加强图书馆的建设以满足医务人员的更多信息需求。     

新形势下专科医院图书馆服务的创新

目的解决新形势下专科医院图书馆资源不足和现代信息能力差的问题。方法更新思想观念,改变服务意识,创新服务手段和服务方式,拓展服务内容,提高现代信息技能。结果专科医院图书馆的服务满足了新时期读者对信息的需求,能更好的为医院的医教研提供信息服务。结论在信息时代,专科医院图书馆虽然有许多不足,但只要本着为读者服务的宗旨,愿意改变,从细微出发,在新形势下一样能为医疗前线人员服务。     

我国图书情报机构舆情分析服务模式

简述了舆情分析服务模式的相关概念,结合我国图书情报机构开展舆情分析服务的典型案例,归纳总结了舆情分析服务的4种模式,指出了未来舆情分析服务模式的发展趋势,旨在为医学情报研究机构开展舆情分析服务提供借鉴.