Problem-solving theory and research were selectively reviewed for possible applications in behavior modification. Problem solving was defined as a behavioral process which (a) makes available a variety of response alternatives for dealing with a problematic situation and (b) increases the probability of selecting the most effective response from among these alternatives. Five stages of problem solving were identified: (a) general orientation or "set," (b) problem definition and formulation, (c) generation of alternatives, (d) decision making, and (e) verification. Training in problem solving was conceptualized as a form of self-control training, that is, the individual "learns how to solve problems" and thus discovers for himself the most effective way of responding. General guidelines are presented for clinical application with cases characterized by a deficit in effective behavior and its emotional consequences.

The ability of several process variables to predict therapy outcome was tested with 30 depressed clients who received cognitive therapy with or without medication. Two types of process variables were studied: 1 variable that is unique to cognitive therapy and 2 variables that this approach is assumed to share with other forms of treatment. The client's improvement was found to be predicted by the 2 common factors measured: the therapeutic alliance and the client's emotional involvement (experiencing). The results also indicated, however, that a unique aspect of cognitive therapy (i.e., therapist's focus on the impact of distorted cognitions on depressive symptoms) correlated negatively with outcome at the end of treatment. Descriptive analyses that were conducted to understand this negative correlation suggest that therapists sometimes increased their adherence to cognitive rationales and techniques to correct problems in the therapeutic alliance. Such increased focus, however, seems to worsen alliance strains, thereby interfering with therapeutic change.Despite support for the effectiveness of cognitive therapy for depression, researchers are still confronted with a high degree of uncertainty about its underlying processes of change (Whisman, 1993). As recently noted by Beck and Haaga (1992), the refinement of our understanding of the mechanisms of action in the treatment of depression will take a predominant place in the future of cognitive therapy. The present study is an attempt to better understand the process of change in cognitive therapy for depression.As recommended by several workers in the field (e.g., Kazdin, 1986;Lambert, Shapiro, & Bergin, 1986), two types of processes were investigated: variables that are unique to cognitive

These findings suggest potential mechanisms through which experiences of discrimination influence well-being among sexual minorities, which has important implications for research and clinical practice with these populations.

On the basis of recent evidence suggesting that gay men are particularly likely to fear interpersonal rejection, the authors set out to extend the rejection sensitivity construct to the mental health concerns of gay men. After establishing a reliable and valid measure of the gay-related rejection sensitivity construct, the authors use this to test the mediating effect of internalized homophobia on the relationship between parental rejection of one's sexual orientation and sensitivity to future gay-related rejection. The present data support this mediational model and also establish rejection sensitivity's unique contribution to unassertive interpersonal behavior in the context of internalized homophobia and parental rejection. The authors conclude that gay-related rejection sensitivity is a useful construct for clinicians working with gay men given the impact that past gay-related rejection can have on their gay clients' present cognitive-affective-behavioral functioning. The authors discuss the possibility of revising rejection-prone schemas in clinical work with gay men. Future research is necessary to further examine the internal processing and interpersonal functioning of gay men by using existing constructs (or modifications of them) that are likely to be particularly relevant to the unique concerns of this population.

Although the gap between psychotherapy practice and research has been present for some time, recent pressures for accountability from outside the system-managed health care and biological psychiatry-necessitate that we take steps to close this gap. One such step has been for psychotherapy researchers to specify a list of empirically validated therapies. However, as researchers who also have a strong allegiance to clinical practice, we are concerned that the conceptual and methodological constraints associated with outcome research may become clinical constraints for the practicing therapist. We firmly believe that, more than ever before, the time is ripe for us to develop a new outcome research paradigm that involves an active collaboration between researcher and practicing clinician.

There is a growing discontent among therapists of varying orientations.Psychoanalytic, behavioral, and humanistically oriented clinicians are starting to raise serious questions about the limits of their respective approaches and are becoming more open to contributions from other paradigms. This article documents this trend within the field, which resembles a Kuhnian-type crisis, noting some of the political, economic, and social forces apt to affect our likelihood of ever reaching a consensus within the field and presenting an approach to the delineation and study of commonalities across various orientations.The author is grateful to those colleagues and friends who offered their rnost valuable feedback and comments on an earlier version of this article and who generally provided support and encouragement to develop many of the ideas described in it.Requests for reprints should be sent to Marvin R. Goldfried,

Lesbian, gay, and bisexual (LGB) women and men utilize therapy at rates higher than the general population

No abstract