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The chapter describes how to manage ruptures in the therapeutic alliance. It opens by outlining a conceptual model to understand the ruptures and proceeds to consider the ways that ruptures may manifest at different points in psychotherapy. One way to respond to some ruptures in alliance in via enhancing motivation and therefore the technique of Motivational Interviewing is described in detail; outlining the steps of expressing empathy, developing discrepancies (between actual and desired outcomes), avoiding argumentation, rolling with resistance and supporting self-efficacy. The chapter reviews ways to manage the assignment and review of homework exercises so that they are a productive element in clinical psychology practice. The chapter concludes with a close examination of psychotherapeutic process; defining what “process” is, and how to work with transference and countertransference.
Despite increased research interest in smartphone mental health applications (MHapps), few studies have examined user engagement and its determinants. MoodMission is a MHapp that targets low mood and anxiety via evidence-based techniques including behavioural activation (BA).
The present study aimed to investigate (i) whether BA interventions delivered with visual psychoeducation had greater engagement than BA interventions delivered with solely written psychoeducation, (ii) whether BA interventions targeting mastery would have greater engagement than those targeting pleasure, and (iii) the relationship between level of engagement and MHapp benefit.
Participants downloaded MoodMission and completed activities and within-app evaluations over a 30-day period. Data from 238 MoodMission users were analysed via multi-level modelling and linear regression.
The average number of app-based activities completed was 5.46 and the average self-reported engagement level was in the low to moderate range. As hypothesized, higher levels of engagement significantly predicted more positive activity appraisal.
The results suggest that BA technique beliefs are involved in MHapp engagement and future research examining user appraisals of techniques is warranted.
The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI).
The audio recordings of 177 CBT-ABI sessions representing 31 therapist–client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework.
Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms.
CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.
Homework assignments are generally viewed as an important factor of cognitive behaviour therapy (CBT).
This study examined whether perfectionists procrastinate homework assignments.
Thirty-eight university students attended two sessions, 7 days apart from each other. After completing perfectionism scales at the first session, they were asked to complete homework tasks from a self-help wellbeing booklet and return the booklet at session 2.
Only maladaptive facets of perfectionism correlated with most of the behavioural measures of procrastination. Moreover, those high in maladaptive perfectionism set and completed fewer planned activities to improve their mood.
These findings suggest that perfectionism may affect how clients set their homework, and perfectionism may interfere with the homework assignments of CBT.
A high level of parental involvement is widely considered to be essential for optimal child and adolescent development and wellbeing, including academic success. However, recent consideration has been given to the idea that extremely high levels of parental involvement (often called ‘overparenting’ or ‘helicopter parenting’) might not be beneficial. This study used a newly created overparenting measure, the Locke Parenting Scale (LPS), to investigate the association of overparenting and children's homework. Eight hundred and sixty-six parents completed online questionnaires about their parenting beliefs and intentions, and their attitudes associated with their child's homework. Parents with higher LPS scores tended to take more personal responsibility for the completion of their child's homework than did other parents, and ascribed greater responsibility for homework completion to their child's teacher. However, increased perceived responsibility by parents and teachers was not accompanied by a commensurate reduction in what they perceived was the child's responsibility. Future research should examine whether extreme parental attitudes and reported behaviours translate to validated changes in actual homework support.
Background: This study examined reasons parents endorsed/provided for not completing homework tasks during their participation in a group-based behavioural parent training (BPT) intervention. Method: Eighty single mothers anonymously completed a questionnaire at the end of each of eight BPT sessions to ascertain reasons for not completing assigned homework. Results: Data suggests that there are varied reasons for poor HW completion that are related to various aspects of the homework process, but most notably the implementation phase of homework. Conclusions: Therapists should utilise various strategies to support homework completion, with special attention focused on methods for ‘in-vivo’ support for parents.
A repeated measures design, with randomly assigned intervention and control groups and multiple sources of information on each participant, was used to examine whether changing the method of delivery of a school's homework program in order to better meet the students’ needs for autonomy, relatedness and competence would lead to more positive student attitudes to homework, and whether there would also be a positive change in overall motivation. The participants were 104 male students aged 10 to 12 years who attended a single sex high school. There was no overall intervention effect on motivation; however, the intervention appeared to have a protective effect on the quality of motivation.
This study examined the relationship between levels of group cohesion, defined as whole group relationships, and between-session therapeutic homework adherence in a multi-family group therapy (MFGT) for people with schizophrenia. Participants from 18 consenting families attending MFGT groups completed weekly homework adherence ratings, group cohesion and spontaneous between-session activity measures. Levels of group cohesion at each session were compared with measures of scheduled and spontaneous homework adherence reported at the next session. It was hypothesised that higher levels of group cohesion would be related to homework adherence and other spontaneous between-session therapeutic activity completed by group members. Results show higher levels of group cohesion were associated with higher rates of spontaneous between-session therapeutic activity. However, contrary to expectations no significant relationship between cohesion and scheduled homework completion was found. The implications of the findings for group processes and homework adherence are discussed.
The aim of this study was to explore the relationship between the quantity and quality of self-monitoring and per cent fat loss in overweight and obese adolescents participating in a weight-loss intervention. Participants were 55 (33F) over-weight and obese adolescents taking part in a 20-week cognitive–behavioural intervention aimed at improving eating and physical activity behaviours. Food and physical activity self-monitoring from the first 9 weeks of the intervention was coded using 24 components assessing the quantity (20) and quality (4) of self-monitoring. Those who completed treatment (n = 42) were split into groups: Losers (n = 30) and Gainers (n = 12) of per cent body fat as measured by DXA. Group analyses showed that Losers and Gainers could be differentiated by both quantitative and qualitative measures of self-monitoring. The strongest associations were with the classifications of food and drink items into food groups. The number of days monitored and the average number of items recorded did not differentiate the groups. Quantity and quality measures of self-monitoring completed early in treatment could also differentiate those who completed treatment and those who did not complete treatment (n = 13), and the strongest associations were with the amounts of food and drink items recorded, an association not found with treatment outcome. The results indicate that both quantity and quality of self-monitoring may be important predictors of both treatment completion and outcome. Based on these findings a framework of self-monitoring requirements is offered to reduce homework burden while maximising treatment efficacy.
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