Faculty Bibliography

This study investigated self-partner agreement on a measure of interpersonal problems as well as the relationship between discrepancy in self-partner ratings and self-reported symptomatology. Both partners of 49 young adult couples rated themselves and their partners on the Inventory of Interpersonal Problems(IIP Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988). The results demonstrated that couples generally evidenced significant agreement in characterizing the interpersonal problems of each target person, suggesting that the substantial self-partner agreement previously reported for personality traits generalizes to the domain of interpersonal problems. Results also indicated that the relationship between self-partner discrepancy and symptomatology depended on the target person's gender. Finally, the data provide preliminary evidence of the psychometric properties of an observer form of the IIP, including its circular structure.

This paper attempts to examine and compare prevalence rates and symptom patterns of DSM substance-induced and other mood disorders. 243 cocaine-dependent outpatients with cocaine-induced mood disorder (CIMD), other mood disorders, or no mood disorder were compared on measures of psychiatric symptoms. The prevalence rate for CIMD was 12% at baseline. Introduction of the DSM-IV diagnosis of CIMD did not substantially affect rates of the other depressive disorders. Patients with CIMD had symptom severity levels between those of patients with and without a mood disorder. These findings suggest some validity for the new DSM-IV diagnosis of CIMD, but also suggest that it requires further specification and replication.

Transference interpretations have been considered an important technique in models of short-term dynamic psychotherapy. This article explored the role of transference interpretations in the early sessions of 29 patients (mean age 37 yrs) treated with Supportive-Expressive (SE) psychotherapy for depression. Hierarchical multiple regressions were used to evaluate the relationship between proportion of transference interpretations and treatment outcome measured across levels of quality of interpersonal relationships. High levels of transference interpretations were significantly associated with poor treatment outcome for patients with poor interpersonal functioning. The results suggest that transference interpretations should be used sparingly in the early sessions of SE psychotherapy with patients who demonstrate a poor quality of interpersonal relationships prior to treatment.

252 cocaine dependent outpatients were randomly assigned to 1 of 3 individual treatments (cognitive, dynamic therapy, or drug counseling) as part of the training phase of the National Institute of Drug Abuse Cocaine Collaborative Treatment Study. Patients and therapists completed the Helping Alliance and the California Alliance Scale, which documented generally high alliance. Although patient reports of the alliance did not predict outcome on drug-related measures at the 6th mo assessment, it did at the 1-mo assessment. Alliance, however, predicted improvement in depressive symptoms at 6 mo. Overall, therapist ratings of the alliance were less often predictive of outcome than patient ratings. Results were similar across the completer and the intent-to-treat samples. The California Alliance Scale predicted attribution. There was preliminary evidence that higher alliance predicted more change in depressive symptoms in patients who remained for a longer time in treatment than for those who remained for a shorter time in treatment.

The Addiction Severity Index (ASI) is a reliable and valid measure of problem severity among addicted patients. Concerns have been raised about the reliability of the Interviewer Severity Rating (ISR), a summary score for each of 7 domains. As part of an effort to build a computer-administered ASI, regression equations were developed to predict the ISR. Repeated resampling of a large dataset, consisting of 1,124 ASIs conducted by trained interviewers, permitted derivation of stable regression equations predicting the ISR for each ASI domain from patients' answers to preselected interview items. The resulting 7 Predicted Severity Ratings (PSRs) were tested on 8, standardized vignettes, with "gold standard," expert-generated ISRs. Reliabilities compared well with those of intensively trained interviewers. The PSRs could provide an alternative to potentially unreliable interviewer ratings, enhancing the ASI's role in treatment planning and treatment matching and make possible a computer-administered version of the ASI.

This study assessed the effects of training on the performance of 65 therapists in delivering manual-guided therapies to 202 cocaine-dependent patients. Changes in ratings of therapists' adherence and competence was assessed in 3 treatment modalities: supportive-expressive dynamic therapy (SE), cognitive therapy (CT), and individual drug counseling. Effects of manual-guided training on the therapeutic alliance were also assessed. Training effects were examined through a hierarchical linear modeling approach that examined changes both within cases and across training cases. A large effect across cases was detected for training in CT. Supportive-expressive therapists and individual drug counselors demonstrated statistically significant learning trends over sessions but not over training cases. Training in SE and CT did not have a negative impact on the therapeutic alliance, although alliance scores for trainees in drug counseling initially decreased but then rebounded to initial levels.

This study presents an initial evaluation of the psychometric properties of the Central Relationship Questionnaire (CRQ). a measure of central relationship patterns. These patterns refer to people's characteristic ways of relating to significant others in terms of their wishes, their perceptions of others' responses to them, and their own responses to both of these. The self-report CRQ is derived from L. Luborsky's (1977) clinician-rated Core Conflictual Relationship Theme. Overall, the results indicated that the CRQ components could be differentiated into meaningful subscales. These subscales were internally consistent, demonstrated significant stability over a pear, and evidenced preliminary convergent and divergent validity with measures of interpersonal problems and symptomatology. It is concluded on the basis of these promising results that the CRQ merits. further empirical development. Specific suggestions for accomplishing this are presented.

OBJECTIVE: This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among treatment-seeking cocaine-dependent outpatients and compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics. METHOD: The subjects were 122 adult cocaine-dependent outpatients participating in a treatment outcome study of psychosocial therapy. In addition to standard self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment. RESULTS: These patients experienced a large number of lifetime traumatic events (mean = 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5% of the subjects currently met the DSM-III-R criteria for PTSD; the rate of PTSD was 30.2% among women and 15.2% among men. Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics. CONCLUSIONS: These findings underscore the value of screening substance abusers for PTSD, because it can identify a small but substantial number who might require additional treatment. Further studies of the relationship between PTSD and substance abuse appear warranted.

OBJECTIVE: The Addiction Severity Index (ASI) includes items to assess patients' history of trauma (physical or sexual). The goal of this study was to assess the sensitivity and specificity of those questions in relation to the Trauma History Questionnaire (THQ), a more thorough measure of lifetime trauma and, in addition, to an actual posttraumatic stress disorder (PTSD) diagnosis. METHOD: At the start of treatment cocaine dependent outpatients (N = 110, 65.5% male) were assessed on the ASI, the THQ and a PTSD symptom checklist as part of a multisite clinical trial. RESULTS: Specificity of the ASI questions was higher than sensitivity for both sexual trauma (specificity = .96, sensitivity = .46) and physical trauma (specificity = .71, sensitivity = .50), while for PTSD the sensitivity of the ASI (.91) was higher than its specificity (.43). Other findings indicated that patients were more likely to report trauma on the THQ than on the ASI (which may be due to the self-report format of the THQ); that the ASI was better at assessing sexual than assessing physical trauma; and that the higher the number of ASI trauma items endorsed, the more likely was the PTSD diagnosis. Finally, PTSD patients had greater severity than non-PTSD patients on other ASI items (e.g., psychological severity, need for treatment). CONCLUSIONS: The ASI trauma questions show stronger utility as a screen for PTSD than for trauma. Results of the study are discussed in light of ways to modify the ASI to screen more accurately for trauma, clinical implications, and limitations of the study method.

Although psychotherapy manuals provide treatment guidelines, detailed descriptions of therapist interventions in manual-guided therapies are lacking. The purpose of the present investigation was to evaluate the types of therapist interventions in Supportive-Expressive (SE) psychotherapy for depression by using a molecular method of assessment and then to compare the results with those attained with a molar method. Four percent of therapist statements per session early in treatment were interpretations, which most often focused on the patient's parents, significant others, and self in the present time frame. This molecular method for assessing therapist interventions did converge with the molar adherence/competence method.