Faculty Bibliography

During the 1989 San Francisco earthquake, Red Cross disaster personnel were involved in providing services that put them at risk for developing stress reactions, including posttraumatic stress disorder (PTSD). This article describes the disaster relief effort made by Red Cross workers and the debriefing that was provided to these personnel. J. Mitchell's (1986) model for critical incident stress debriefing was modified to fit the broad spectrum of needs and stresses experienced by disaster relief personnel. The multiple stressor debriefing model (MSDM) that evolved from this experience is discussed, with specific recommendations for mental health workers involved in debriefing Red Cross and other emergency personnel who face multiple stressors over an extended period of relief operations.

Research on the assessment and diagnosis of posttraumatic stress disorder (PTSD) has rather quickly expanded from relatively small studies in clinical settings into the realm of community epidemiology, increasingly relying on population-based or 'community' studies. This article highlights some of the key challenges and opportunities associated with assessing PTSD outside of treatment settings by reviewing the results of some recent efforts to develop, test, and use diagnostic measures of PTSD among samples of Vietnam veterans in the community, including in particular the recently completed National Vietnam Veterans Readjustment Study. Prevalence rates emanating from these different studies are compared; a comprehensive effort to account for some of the more major discrepancies is described; and a general strategy for assessing PTSD in the community--one based on comprehension assessment of multimethod and multisource information--is suggested.

Presents a model for brief dynamic psychotherapy of posttraumatic stress disorder (PTSD) that helps the patient who has been derailed from a normal psychological recovery process to return to an adaptive working-through during and after brief therapy. Brief therapy is most applicable for individuals who present with PTSD several years after traumatic stress events. The success of brief therapy depends on the ability of the patient and therapist to enter quickly into a collaborative working process. The impact of a traumatic event on the PTSD patient's self-concept serves as an organizer for treatment. Working through problematic weak and strong self-concepts and countertransference responses to traumatized patients are discussed, along with termination. Case examples illustrate these issues.

The first several decades of psychotherapy process research have produced advances in measure development and substantive findings of process-outcome relations. A recent paradigm shift toward sequentially patterned, significant change episodes is described, emphasizing segmentation of process by meaningful patterns wherever they occur. Theoretical, psychometric, and data analytic dilemma are reviewed. Strategies are offered that may enhance future research efforts. These include greater attention to construct validity of measures, the relation of process to phase-specific outcome criteria, and the continuing development of multivariate data analytic strategies that take into account Patient X Treatment interactions as well as the sequential dependency of process data. The development of a national archive of significant change events is recommended to advance modeling of the change process, segmentation, construct validation of measures, integration of qualitative and quantitative approaches, and development of a cross-theoretical language for therapy process

Older adults who met criteria for major depressive disorder were randomly assigned to behavioral, cognitive, or brief dynamic therapy. Symptoms were equally reduced across the three treatment conditions. Early in treatment, alliance ratings were obtained from both therapists and patients and were related to outcome. We calculated one therapist alliance composite score and five patient alliance factor scores. In general, no agreement was found between therapists' and patients' judgments of alliance. Levels of alliance were found to be not significantly different across the three treatment conditions. For the sample as a whole, only the patient factor of Patient Commitment was found to be associated with depressive symptoms after treatment, with the strongest findings in the cognitive therapy condition. The Patient Commitment factor uniquely contributed to outcome over and above the contribution of initial symptomatology and symptomatic change at midpoint in therapy. Expected trends of association with outcome were observed for the therapist alliance composite score in brief dynamic therapy and for the patient factor of Patient Working Capacity in both cognitive and brief dynamic therapy. Findings are discussed in terms of their theoretical and clinical implications

Used archival data from a study by L. Thompson et al (see record 1987-32037-001) to examine the association between patient expectations of various change processes (ECPs) and outcome across behavioral, cognitive, and brief dynamic therapy. 56 elderly patients (mean age 67.18 yrs) with major depression received from 16 to 20 sessions of individual psychotherapy. Outcome was assessed on the Hamilton Rating Scale for Depression and the Young Loneliness Inventory. Confirming patient ECPs sometimes had a beneficial impact on both symptomatology and interpersonal functioning outcome variables, while disconfirming patient ECPs sometimes was associated with a detrimental effect.

Proposes the generalized least squares method, a time-series multiple-regression analysis, to simultaneously assess treatment efficacy and process correlates of outcome and to test alternative hypotheses of treatment efficacy. This approach can be applied to small samples by capitalizing on repeated measurements. Criteria for qualitative analysis are presented in an attempt to provide guidelines for the identification of significant therapeutic change events and the generation of hypotheses regarding factors involved in therapeutic change.