This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed.
The findings support the view that psychosocial factors may play a role in facilitating good community adjustment for individuals diagnosed as having serious mental illness.
The nonverbal autistic child exhibits a persistent and characteristic feature known as gaze aversion. Since gaze interaction between the autistic child and the clinician [or adult] is a requisite experience in therapeutic learning, procedures that modify gaze behavior in autistic children serve an important clinical function. The present research was designed to investigate three kinds of adult-child interaction that differentially affected changes in gaze behavior. The interaction procedure in which the experimenter imitated the autistic child's object and action performances resulted in the greatest change in the frequency and the duration of gaze behavior. An analysis of these methodologies reveals information concerning contextual and therapeutic variables that affected the gaze behavior in six autistic children.
The present research compared the effect of three play procedures upon the frequency and duration of object manipulation by six autistic children. The three interaction play procedures varied in the degree of similarity between the adult's and the child's performances. In procedure 1, the experimenter imitated the subject's movements with her duplicate object. In procedure 2, the experimenter performed a different movement with her duplicate object. In procedure 3, the experimenter performed a different action on a different object. The interaction procedure, in which the experimenter imitated both the material and the method of play chosen by the autistic child, resulted in greater frequency and duration of object manipulation.
In this article we examine intuitive dimensions of personal cancer risk likelihood, which theory and empirical evidence indicate may be important elements in the risk perception process. We draw on data from a study of risk perceptions in three social groups, university students, men living in the community, and primary care patients living in urban area. The study took place in 2007-2011, in New York State (Garden City and New York City) and Boston, Massachusetts. This study used items developed from categories identified in prior qualitative research specifying emotions and attitudes activated in cancer risk determination to examine perception of cancer risks. Across three samples - university students (N=568), community men (N=182), and diverse, urban primary care patients (N=127) - we conducted exploratory factor and construct analyses. We found that the most reliable two factors within the five-factor solution were Cognitive Causation, tapping beliefs that risk thoughts may encourage cancer development, and Negative Affect in Risk, assessing negative feelings generated during the risk perception process. For these factors, there were high levels of item endorsement, especially in minority groups, and only modest associations with established cancer risk perception and worry assessments, indicating novel content. These items may prove useful in measuring and comparing intuitive cancer risk perceptions across diverse population subgroups.
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