Home and laboratory dreams: four empirical studies and a conceptual reevaluation.

Four empirical studies were presented on how the setting in which dreams are collected may influence the reporting and content of dreams of children on REM awakenings. In these studies it was shown that (1) with constant dream-sampling procedures, home and laboratory did not differ in the degree to which dream reports could be elicited from 4/5 year old children; (2) the rate of truly spontaneous reporting of dreams at home by 6/7 year olds is so minimal as to render these dreams an unfit base for generalization to typical dream life at these ages; (3) with constant dream sampling procedures, home and laboratory reports were not significantly different in content for 10/11 year olds; (4) results typically observed in uncontrolled home versus laboratory studies are replicable at the child level (ages 12/13), but probably reflect biased recall at home rather than effects of REM-monitoring procedures in the laboratory. The extant literature on home versus laboratory dream differences was reviewed, and it was concluded that even for normative dream studies, the REM-monitoring procedure is the method of choice.     

Narrative research in psychotherapy: A critical review

Purpose . This paper is a review of studies which utilise the notion of narrative to analyse psychotherapy. Its purpose is to systematically present this diverse field of research, to highlight common themes and divergences between different strands and to further the development and integration of narrative research in psychotherapy. Methods . The paper reviews studies which employ an applied textual analysis of narratives produced in the context of psychotherapy. Criteria for inclusion of studies are, firstly, the analysis of therapeutic and therapy‐related texts and, secondly, the adoption of a narrative psychological perspective. The studies were examined on the basis of the notion of narrative they employ and the aspects of client narratives they focus on, and were grouped accordingly in the review. Results . The majority of the studies reviewed assume a constructivist approach to narrative, adopt a representational view of language, focus primarily on client micro‐narratives and relate to cognitive‐constructivist and process‐experiential psychotherapeutic approaches. A smaller group of studies assume a social constructionist approach to narrative and a functional view of language, focus on micro‐narratives, highlight the interactional and wider social aspects of narrative and relate to postmodern trends in psychotherapy. Conclusions . The range of conceptualisations of narrative in the studies reviewed, from a representational psychological view to a constructionist social view, reflects tensions within narrative psychology itself. Moreover, two trends can be discerned in the field reviewed, narrative analysis of therapy, which draws from narrative theory and utilises the analytic approaches of narrative research to study psychotherapy, and analyses of narrative in therapy, which study client narratives using non‐narrative qualitative methods. Finally, the paper highlights the need for integration of this diverse field of research and urges for the development of narrative studies of psychotherapy which employ a broader social understanding of narrative production and transformation.     

Posttraumatic stress disorder following cancer. A conceptual and empirical review

Life-threatening illness has recently been recognized as a stressor that can precipitate posttraumatic stress disorder (PTSD). This development has raised questions over the extent to which the PTSD diagnosis is applicable to the psychological reaction to being diagnosed with cancer. This paper identifies the core conceptual issues pertaining to cancer-related PTSD, critically reviews the empirical literature on PTSD following cancer, and considers the possible mechanisms and course of PTSD following a diagnosis of cancer. Specific issues that need to be considered in the assessment and treatment of cancer-related PTSD are reviewed. This review highlights that there is a need for stronger empirical base to guide clinical management of PTSD in cancer patients.     

A review of meta-analyses conducted on psychotherapy outcome research

Meta-analysis is a newly developed means of reviewing large collections of literature concerning any general topic which has been subjected to empirical study. It is a quantitative approach which relies upon the numerical aggregation of many studies to draw conclusions about the topic under scrutiny. It is often considered to be less prone to the subtle biases which may be inevitably present in more traditional qualitative literature reviews. To date, six meta-analyses have been published using the psychotherapy outcome research: Smith and Glass (1977); Smith, Glass, and Miller (1980); Landman and Dawes (1982); Miller and Berman (1983); Shapiro and Shapiro (1982); and Prioleau, Murdoch, and Brody (1983). The major issue addressed by all six meta-analyses is the efficacy, or lack thereof, of psychotherapy in general, and the differential effectiveness of some schools of therapy as compared to other schools. Following a brief review of these studies, general criticisms of the meta-analytic technique are offered, with references made to those studies which best exemplify these faults. Conclusions and implications are drawn about both the meta-analytic strategy itself, and the lessons which have been learned about the practice of psychotherapy from these quantitative reviews. Suggestions for resolving persistent meta-analytic problems and for future research directions in psychotherapy are also offered.     

Understanding posttraumatic nightmares: an empirical and conceptual review

Posttraumatic nightmares (PTNMs) are a highly prevalent and distressing symptom of posttraumatic stress disorder (PTSD), yet have been subject to limited phenomenological investigation. As a result, the parameters of the symptom required to meet diagnostic criterion for PTSD are unclear and their relationship with normal dreams following trauma is not known. A categorical distinction between PTNMs and normal dreams has been assumed, explicitly within dreaming theories and perhaps implicitly within the PTSD field, but lacks empirical support. This paper reviews the current understanding of PTNMs and normal dreams following trauma within the PTSD and dreaming fields respectively. It is argued that models of PTSD can readily account for repetitive PTNMs that accurately replay the traumatic event, but not those that are symbolic of the traumatic event. On the other hand, theories of dreaming that propose a psychologically adaptive function of dreams can account for both replay and symbolic nightmares that evolve over time, but not those that are stuck in repetition. It is concluded that there is no adequate explanation for the range of dreams following trauma including the PTNM of PTSD that is both symbolic and repetitive. Three alternate explanatory models are proposed that draw on existing knowledge within both the PTSD and dreaming fields to explain the full range of nightmares following trauma.     

Emotion in psychotherapy: a practice-friendly research review

This article reviews the process and outcome research on emotion in psychotherapy. Four distinct types of emotion processes are identified in the literature as useful in therapy, depending on a client's presenting concerns: emotional awareness and arousal; emotional regulation, active reflection on emotion (meaning making), and emotional transformation. Research findings are summarized to highlight the practical implications of these different emotion processes to psychotherapy. A range of selected treatments from different therapeutic orientations are addressed collectively as different types of emotion-focused, experiential therapies and are compared on the basis of how they work with emotion in session.     

Psychosocial impact of parental cancer in adulthood: a conceptual and empirical review

This article reviews recent literature on the psychosocial aspects of parental cancer in adulthood. Overall, studies have shown that a sizable minority of adult children of cancer patients experience psychological distress in terms of anxiety, depression, and posttraumatic stress symptoms. Most research to date has focused on the first-degree female relatives of breast cancer patients, many of whom are daughters. Although distress reactions in this population are well documented, restrictive assumptions reflecting a vulnerability/deficit model of women limit scientific progress. In addition, the critical role of grown offspring caregivers of cancer patients deserves further investigation. Future research should examine the relations between intrapsychic and contextual factors that may influence psychological adjustment to parental cancer.     

A systematic review of empirical research into ethics in general practice.

Much of the bioethical literature addresses the problems of tertiary medicine, with little attention to the daily concerns of general practitioners (GPs). The present review assesses the current state of research into the range and nature of ethical issues for GPs, looking specifically at the content of the research, the methods employed, and the philosophical framework of the research. A systematic search of MEDLINE, CINAHL, and Sociofile identified nine articles which form the basis for this review. The majority of the research reviewed here is quantitative in nature, using hypothetical cases with closed questions and categorical responses. No consistently significant variables were identified. Decisions appear to be inconsistent in terms of theoretical models and moral psychology. Ethical issues of concern to GPs differed from those commonly reported in the bioethical literature. There is a paucity of research into the ethical concerns of general practice. The existing body of research is quantitative in nature, leaving many unanswered questions concerning the reasons behind the decisions of GPs. There is a need for qualitative studies to further our understanding of this area.     

Exploratory in-session process research in individual psychotherapy: a review

The goal of exploratory process research is to describe what occurs within psychotherapy sessions, eventually leading to the development of theories based on the accumulation of replicated results. Several areas in which exploratory methods are currently being used are described: therapist techniques, client behavior, covert processes, process models, interactions between therapists and client, and therapy events. Additionally, several areas in which exploratory methods would be useful for future research are described: the links between client personality characteristics, therapy process, and outcome; the timing and quality of therapist interventions; and client readiness for the therapist interventions.     

Online health research and health anxiety: A systematic review and conceptual integration

Using the Internet to obtain health information (“online health research,” OHR) is commonplace. This article provides a systematic narrative review of evidence concerning the relationship between OHR and health anxiety. We conclude that health anxiety is associated with more frequent self‐reported OHR, heightened distress after OHR, and increased doctor visits post‐OHR. Evidence suggests that OHR often has a reassurance seeking function and can relieve anxiety, but that it can also cause alarm and become a distressing, compulsive behavior. We present a novel model that integrates these perspectives and existing research within a single explanatory framework that distinguishes between problematic OHR and compulsive OHR, and describes the role of positive and negative metacognitions in their respective development.     

Psychotherapy research with ethnic minorities: empirical, ethical, and conceptual issues

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered.     

Disclosing incidental findings in genetics contexts: A review of the empirical ethical research

The disclosure of incidental findings, also called unsolicited findings, unexpected results, and secondary variants, is increasingly recognised as an issue in clinical and research genetics contexts. The rise of next generation sequencing methods has only intensified the issue, increasing the likelihood of incidental findings appearing. This review focuses on empirical research on the ethical issues involved. Electronic databases were searched for articles covering quantitative and qualitative research on the ethical issues involved in the disclosure of incidental findings in clinical and research genetics contexts. 16 articles were ultimately accepted for review. Data was extracted and synthesised on the factors that should be taken into account during the decision-making process surrounding the disclosure of an incidental finding in a genetics context. These factors include the possibility of disclosure, various practical and technical factors, and various ethical factors. We suggest the development of a decision-making tree, involving an exploration of the practical and ethical concerns raised by the studies. This is in our view the best way of handling the wide variety of both possible incidental findings and parties interested in the disclosure of incidental findings.     

Cognitive-behavior modification: A conceptual review

Conceptual issues regarding cognitive-behavior modification are presented, beginning with an analysis of the basic terms of cognition, behavior modification, and behaviorism. Five controversies in the relevant literature that stimulated increased interest in cognitive factors among behavior therapists are reviewed: (a) symbolic control in classical and operant conditioning; (b) Breger and McGaugh's (1965) critique of behavior therapy; (c) cognitive factors in systematic desensitization; (d) the debate regarding cognition in the first issue of Behavior Therapy (1970); and (e) Ledwidge's (1978) Psychological Bulletin critique of cognitive-behavior modification. An analysis of several conceptual issues emerging from the literature results in the following conclusions: cognitive-behavior modification is a “revolutionary” development only insofar as it extends beyond mediational behaviorism to a truly cognitive view that includes internal cognitive structures; cognitions are not behaviors, but can be studied in their effects on behaviors as is done with drugs and genetics; a unifiedinteractive approach that incorporates cognition, behavior, and affect represents the logical future development in psychotherapy research and practice.     

A review of empirical rape research: Victim reactions and response to treatment

The purpose of the following paper is to review results of recent empirical studies on victim reactions following rape and response to treatment. Results focus on three major research projects run concurrently in Atlanta, Pittsburgh and Charleston, as well as several smaller studies. The Atlanta study is described in detail and sampling bias is discussed. Short-term reactions are described and defined as those occurring during the first 3 months post-assault. During this time, most symptoms return to normal levels in most victims. Intermediate reactions, 3 months to one year post-assault, are described under four headings: depression, social adjustment, sexual functioning, and fear and anxiety. At the end of this interval, victims still score significantly higher than nonvictims on measures of fear and anxiety. Long-term reactions, defined as those continuing longer than one year post-assault, are discussed under four headings. No firm conclusions can be drawn as to the long-term symptoms experienced by victims versus nonvictims. Section IV reviews factors associated with adjustment to the assault. Factors within the rape situation are not clearly predictive of adjustment, but psychiatric history prior to the assault and amount of social support following the assault are predictive. In section V, empirical studies of behavior therapy with rape victims are reviewed. While all these studies were successful, they suffer from methodological flaws. Difficulties in doing rape research are discussed. Lastly, section VI offers a theoretical explication which draws on crisis theory to account for short-term and intermediate reactions and differential rates of recovery, and which draws on classical conditioning theory to account for continued high levels of fear and anxiety and selective anhedonia.     

The outcomes of psychotherapy with adolescents: a practitioner-friendly research review

This article summarizes the outcome findings of psychotherapy with adolescents through an examination of the research literature. In this problem-focused review of the research literature, we consider adolescent treatment of anxiety disorders, depression, eating disorders, disruptive behavior disorders, multiple problems of adolescence, and health risk behaviors. The evidence base for the effectiveness of various psychotherapies for adolescents is mixed. Psychotherapy in general has been a ripe field in which unsupported approaches have grown, and this is certainly true for psychotherapeutic interventions with adolescents. Nonetheless, there is a growing body of evidence to support various types of interventions as effective for different presenting problems. Researchers and clinicians need to recognize the complexity of the diverse characteristics of adolescents, including variations of culture, race, ethnicity, gender, class, physical disability, family definitions and constellation, and sexual orientation. These require sensitivity, responsiveness, and competence by the therapist, but clinical research has not fully examined these considerations.     

A conceptual and empirical review of the meaning, measurement, development, and teaching of intervention competence in clinical psychology

Through the course of this paper we discuss several fundamental issues related to the intervention competence of psychologists. Following definitional clarification and proposals for more strictly distinguishing competence from adherence, we interpret Dreyfus and Dreyfus's [Dreyfus, H.L., & Dreyfus, S.E. (1986). Mind over machine: The power of human intuition and expertise in the age of the computer. New York: Free Press.] five stage theory of competence development (from novice to expert) within a strictly clinical framework. Existing methods of competence assessment are then evaluated, and we argue for the use of new and multiple assessment modalities. Next, we utilize the previous sections as a foundation to propose methods for training and evaluating competent psychologists. Lastly, we discuss several potential impediments to large scale competence assessment and education, such as the heterogeneity of therapeutic orientations and what could be termed a lack of transparency in clinical training.     

The use of psychotherapy treatment manuals: A small revolution in psychotherapy research style

In the space of just the last few years it has become a virtual research requirement to incorporate manuals in comparative psychotherapy studies. Such manuals serve to guide the training of the therapists and then the measurement of their conformity to the intended treatments. A short history of this small revolution is provided. It is followed by a review of the findings of comparative treatment studies which were manual guided versus nonmanual guided. While many of the expected differences among conceptually different treatments appear with both approaches, with manual guided studies it tends to be easier to do exact comparisons. A study comparing manual guided versus nonmanual guided treatments should be the logical next step.     

A comparison of rational versus empirical methods in the prediction of psychotherapy outcome

Recent studies have shown that providing feedback to therapists based on comparing their clients' progress to a set of rational, clinically derived algorithms delineating various categories of progress has enhanced outcomes for clients predicted to show poor treatment outcomes (signal‐alarms). One prior study indicated that an empirically derived method more accurately predicts outcome than the rational method. The present study replicated the comparison of empirical and rational methods, while adding an additional layer of effect size analyses to further clarify predictive accuracy. The two methods were approximately equivalent in their accurate detection of cases that had a final negative outcome. However, the rational method had significantly lower overall predictive accuracy due to its high percentage of false negative predictions. Further, progressively more optimistic predictions based on the empirical method were associated with greater improvement for the average client. This was not the case for the rational method. Copyright © 2006 John Wiley & Sons, Ltd.