Examining the Alliance-Outcome Relationship: Reverse Causation, Third Variables, and Treatment Phase Artifacts

Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth and adult literatures. Despite these consistent findings, prospective associations are not sufficient to support the claim that the alliance is a change mechanism in psychotherapy. The current study examined the direction of effect of the alliance- outcome relationship, the contribution of early symptom change in treatment to the development of therapeutic alliance, and the potential for pretreatment interpersonal functioning characteristics to be third variables that account for the association between alliance and outcome. Participants were adolescents with depression and a history of interpersonal trauma that presented to a community mental health center for treatment. Findings demonstrated that a more positive therapeutic alliance predicted greater subsequent symptom improvement, even after removing symptom change occurring before the measurement of alliance. Results also suggested that early change only slightly contributed to alliance development. Finally, though pretreatment interpersonal functioning was related to the first session alliance, these pretreatment client characteristics were not related to later alliance or symptom change. Overall, results provided some support for therapeutic alliance as a mechanism of change in psychotherapy. Methodological and clinical issues are discussed.

Psychosocial Distress Screening in a Community Cancer Center: An Exploratory Study of Distress Screening Across the Cancer Treatment Continuum

Purpose: The primary goal of this exploratory study is to demonstrate that distress screening across the course of cancer treatment is possible and provides valuable information about patient needs over time. Distress screening is aligned with guidelines from national accrediting organizations and may lead to improved health-related quality of life, satisfaction with medical care, and possibly survival.Methods: Medical, surgical, and radiation oncology patients completed a screening instrument before their appointments during a six-month period. Patients indicated their level of distress on four domains (practical, emotional, health and social concerns). De-identified data was collected, aggregated and descriptive statistics were analyzed.Results: Approximately 3000 screens were collected and 1500 cancer patients were screened. Of patients who indicated distress, 54% demonstrated a distress level of five or greater. Distress level eight was the most frequent level of distress indicated. The Cancer Dietitian was the most commonly requested healthcare team provider. The Health Concern domain was most frequently endorsed.Conclusion: NCCN, IOM and COC guidelines recommend distress screening in all cancer treatment centers, however implementation has proven difficult. This study adds to the literature about distress in cancer patients, demonstrates the feasibility of repeated distress screening and provides a model program demonstrating the implementation of repeated distress screening at a community cancer center. Findings highlight the importance of supportive oncology services due to the prevalence of high levels of distress. Findings demonstrate the importance of the Cancer Dietitian in supportive cancer care. Additionally, the research reveals a potential perceived stigma in seeking psychosocial oncology services.

Utilizing Evidence-Based Psychology Practice in the University of Denver's Professional Psychology Center: A Proposal

As acceptance of the Evidence-based Psychology Practice (EBPP) model continues to grow (Pagoto, Spring, Coups, Mulvaney, Coutu, & Ozakinci, 2007), it seems pertinent to explore how this model can be applied in different settings. This topic is timely as practitioners in the field are being held ever more accountable for the efficacy of the treatments they employ (Pagoto et al., 2007). Increased scrutiny has resulted in a need to integrate research into practice in order to ensure continued relevance in the ever-changing realm of American health care (Luebbe, Radcliffe, Callands, Green & Thorn, 2007; Collins, Leffingwell & Belar, 2007; Chwalisz, 2003). This paper explores how the requirements set forth by the American Psychological Association Presidential Task Force on Evidence-Based Practice (2006) can be implemented at the University of Denver's (DU) Professional Psychology Center (PPC), a training clinic for students enrolled in the Psy.D. program at DU's Graduate School of Professional Psychology (GSPP). In doing so, the methods employed by Collins et al. (2007) at Oklahoma State University (OSU) are used as a template and modified to accommodate differences between these two institutions.