This study investigates the effectiveness of short-term psychodynamic psychotherapy (STPP) for depression in a naturalistic setting utilizing a hybrid effectiveness/efficacy treatment research model. Twenty-one patients were assessed pre- and post-treatment through clinician ratings and patient self-report on scales representing specific DSM-IV depressive, global symptomatology, relational, social, and occupational functioning. Treatment credibility, fidelity, and satisfaction were examined, all of which were found to be high. All areas of functioning assessed exhibited significant and positive changes. These adaptive changes in functioning demonstrated large statistical effects. Likewise, changes in depressive symptoms evaluated at the patient level utilizing clinical significance methodology were found to be high. A significant direct process/outcome link between STPP therapist techniques and changes in depressive symptoms was observed. Alternative treatment interventions within STPP were evaluated in relation to subsequent improvements in depression and were found to be nonsignificant. The present results demonstrate that robust statistical and clinically significant improvement can occur in a naturalistic/hybrid model of outpatient STPP for depression.
This study investigates the effectiveness of short-term psychodynamic psychotherapy (STPP) for depression in a naturalistic setting utilizing a hybrid effectiveness/efficacy treatment research model. Twenty-one patients were assessed pre- and post-treatment through clinician ratings and patient self-report on scales representing specific DSM-IV depressive, global symptomatology, relational, social, and occupational functioning. Treatment credibility, fidelity, and satisfaction were examined, all of which were found to be high. All areas of functioning assessed exhibited significant and positive changes. These adaptive changes in functioning demonstrated large statistical effects. Likewise, changes in depressive symptoms evaluated at the patient level utilizing clinical significance methodology were found to be high. A significant direct process/outcome link between STPP therapist techniques and changes in depressive symptoms was observed. Alternative treatment interventions within STPP were evaluated in relation to subsequent improvements in depression and were found to be nonsignificant. The present results demonstrate that robust statistical and clinically significant improvement can occur in a naturalistic/hybrid model of outpatient STPP for depression.
This study examined the reliability and validity of the DSM-IV Major Depressive Episode (MDE) symptoms in a sample of outpatients based on clinician ratings of assessment interviews, videotape of these interviews, and chart information. A group of 44 patients admitted to a university based outpatient community clinic were rated by trained clinicians on the nine MDE symptom criteria (A1-A9). Patients also completed a self-report measure of depressive symptomatology. Interrater reliability was found to be highest between the interview and videotape ratings. Conversely, when comparing chart ratings with those made from either interview or videotape, reliability for many of the individual criteria were found to be in the poor range of reliability. Good internal consistency was found for both the interview and videotape ratings, while internal consistency was less adequate for chart-based ratings. However, the three MDE ratings converge on a single dimension in a similar manner regardless of which source (i.e. interview, videotape, or chart) provided the rating. Additional analyses revealed a consistent relationship between the three MDE ratings (interview, videotape, and chart) with measures of patient reported depressive symptoms that exceeded the relationship between these scores with global levels/severity of psychopathology. The effects of longer interviews as well as examining depressive symptoms within the context of interpersonal functioning is discussed regarding the reliable assessment of depressive symptomatology in the mild to moderate range of severity. (Int J Psych Can Pract 2004; 8: 3-10).
Objective: The aims of this commentary are to: (a) provide an overview of the current sociopolitical context experienced by transgender and gender diverse (TGD) youth and caregivers, (b) summarize the research that has been conducted about how the sociopolitical context impacts the mental health and wellbeing of TGD youth and caregivers, (c) discuss the clinical implications of these findings, and (d) identify steps mental health providers can take to be advocates for TGD youth and their families. Methods: Authors include a psychologist and adolescent medicine physician working within a multidisciplinary gender program for youth and a psychologist in independent practice who specializes in working with LGBTQ+ (lesbian, gay, bisexual, transgender, and/or queer) youth, especially TGD youth. Clinical implications and advocacy steps were informed by our synthesis of the research literature as well as our own experiences working within the field of TGD health. Results: TGD youth and families have identified a range of stressors and coping strategies associated with the sociopolitical climate. Existing guides to clinical practice with TGD people can be adapted to incorporate these findings. We propose a “menu” of advocacy steps for providers to consider. Conclusions: Awareness of the larger sociopolitical context is crucial to providing high quality care to TGD youth and their families. By participating in advocacy efforts, mental health providers can have a unique and meaningful impact on the social and structural factors that impact the mental health and wellbeing of this population. Ethical principles within the field of psychology highlight how advocacy efforts are an important component of practice.
To identify core components of parent/caregiver integration into evidence based child trauma treatment models, specifically those parents/caregivers who have experienced trauma themselves. The Parent/Caregiver Trauma and Healing Coordinating Group (PCTHCG) of the National Child Traumatic Stress Network examined existing scholarly literature, gathered input from clinical experts and parent partners, and assessed child trauma treatments. Eleven core components were identified through pooled sources of the available literature, clinical and parent/caregiver partner expertise, and information from existing evidence-based child trauma treatment models. Core components identified: engagement of parent/caregiver, assessment, parenting, coregulation, attachment, relationship repair, support of parent/caregiver, emotional coaching, addressing parent/caregiver trauma history and symptoms, and parent/caregiver appraisal and meaning making. To further validate these core components, the PCTHCG invited child trauma treatment model developers (N ϭ 11) to indicate the presence of these components in their models and describe how their models attend to parent/ caregiver trauma. Subsequently, a Core Components of Trauma Informed Child Treatment Models Related to Parent/Caregiver Trauma Grid (Core Components Grid) was developed. Despite general consensus that it is beneficial, few studies thoroughly explore the impact of parent/caregiver inclusion, specifically those who have experi-
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