Tribute to Dr. Gene Pekarik
BHI (formerly known as CROPP, The Center for Research on Psychological Practice) was founded by Dr. Gene Pekarik, who directed BHI until his untimely death in 2001. We are deeply indebted to his creative vision for BHI and plan to carry on in the proud tradition that he initiated. During his tenure, BHI focused on Dr. Pekarik’s interest in psychotherapy effectiveness in community settings. For example, Dr. Pekarik and his students determined that clients drop out of therapy not just because they are unmotivated or dissatisfied, but also because of treatment barriers and symptom abatement (contrary to common clinical wisdom). BHI also explored how training therapists to provide brief therapy could result in better outcome, satisfaction, and maintenance of gains.
The Dr. Gene Pekarik award was founded in memory of Dr. Pekarik. BHI continues to fulfill the vision of Dr. Pekarik by mentoring students’ involvement in community service and by prioritizing student research.
Jim Fauth, PhD, was hired to direct BHI in Fall 2002. Dr. Fauth has continued to honor BHI’s tradition of conducting applied research in community service settings by collaborating with agencies and caregivers throughout the region.
Dr. Gene Pekarik Memorial Award for Research on Psychological Practice Purpose
This award is intended to recognize excellence and innovation in student research within one or more of the following areas:
- Program evaluation, including assessment of mental health needs or outcomes.
- Studies of mental health policy, as it affects service utilization or access.
- Development of novel treatments or delivery strategies.
- Development of methods or measures for mental health practice research.
Theodore Austin, PsyD (2011)
A Task Analysis of Metacommunication in Time-Limited Dynamic Psychotherapy
This study examined how successful metacommunication unfolded in time-limited dynamic psychotherapy (TLDP) using the task-analytic paradigm developed by Greenberg (2007). Specifically, the purpose of the study was to discern the elements, themes, and temporal sequences that were common to effective metacommunication. In accordance with the paradigm, this was accomplished by the creation of a rational model, which combined existing theoretical literature on metacommunication and anecdotal clinical evidence. Next, the distilled components of metacommunication in six high-quality (HQ) sequences were contrasted to the distilled components of six low-quality (LQ) sequences in order to generate an empirical model. These sequences were selected from 66 audiotaped TLDP training sessions and selected for analysis via an aggregate score on several client- and therapist-completed process measures. The empirical model was then integrated with the initial rational model to generate the final rational-empirical model, which can be viewed as a five-component series of essential “tasks” that the therapist-client dyad must complete. The most important client task was clients’ ability to identify their own contributions to, or feelings about, their depictions of thematically repeated interpersonal conflict. The most important therapist tasks involved allowing for the emergence of a pattern in clients’ interpersonal difficulty before making the metacommunicative statement, as well as establishing an empathic, encouraging tone throughout the metacommunicative sequence. The presence of client-therapist mutuality (a shared sense of regard and working together) was deemed to be an essential component of successful metacommunication as well. Study findings suggest that therapists practice “patience” in allowing clients’ depictions of interpersonal or relational conflicts to become thematically established before offering a metacommunicative statement; additionally, therapists should incorporate supportive and encouraging elements into these statements. Lastly, therapists should be cautious of using metacommunication to explore clients’ self-criticism in the context of a poor therapeutic alliance. The absence of a reliable measure of metacommunication with which to select metacommunicative instances for analysis, as well as the possibility of difficult client interpersonal styles which might negatively impact therapists’ metacommunicative attempts are discussed as limitations to the study. Finally, a personal reflection is offered on a misguided metacommunicative intervention.
Megan Phillips, PsyD (2010)
Therapist-trainee Attempts at Alliance Rupture Repair in Time-limited Dynamic Psychotherapy
This study examined how therapist-trainees and clients handled ruptures in the therapeutic alliance within time-limited dynamic psychotherapy (TLDP) training sessions. The purpose of the analysis was to determine whether therapist-trainees were making use of rupture repair processes as outlined in the stage-process model of rupture repair (Samstag, Safran, & Muran, 2006), and any association that this may have had with session outcome. Observers rated 42 TLDP training sessions containing noticeable rupture markers using the Rupture Resolution Scale (RRS; Samstag, Safran, & Muran, 2006). The intention of the study was to help inform therapist training in the TLDP model through the integration of the transtheoretical psychotherapeutic factor of rupture resolution and to add to the growing body of literature examining the process and effects of rupture resolution. The study found that therapeutic alliance ruptures were common among training sessions and that the most frequent type of rupture, Walling Off and Avoiding, is a subtle phenomenon that may often be overlooked by therapist-trainees. It was found that TLDP therapist-trainees made use of rupture resolution behaviors, though on a relatively superficial level that made less use of here-and-now interpersonal process than might be expected. Results of the study also suggested that the use of rupture resolution behaviors is not necessarily associated with improvement in client perception of therapeutic process. There was no significant positive relationship between the use of rupture resolution behaviors and session outcome, measured as client ratings of aspects of the therapeutic alliance and therapist-trainee and client emotional reactions to sessions, though several aspects of the rupture resolution process were negatively associated with session outcome. Overall, the results of the study suggest that the rupture resolution process is a complex endeavor that both therapist-trainees and clients may find somewhat disruptive and uncomfortable. Implications of the findings for training in TLDP and therapeutic alliance rupture resolution are offered. In addition, comparisons of the findings to earlier research using the RRS are discussed, as well as limitations of the study and suggestions for further research.
Frances Berry-Worcester, PsyD (2010)
An Examination of Multicultural Competency in Northern New England School Psychologists
The author conducted a needs assessment and exploratory study of multicultural competence in Northern New England school psychologists. The author sampled Maine, New Hampshire, and Vermont school and clinical psychologists with masters, specialist, and doctoral degrees who do assessment work with school children. Results from this study will be shared with regional leaders to start local and regional conversations about school psychologists’ multicultural competencies in assessment and their training needs, and to contribute to future systemic changes in both employment settings and graduate training programs. Participants completed the School Psychology Multicultural Competency and Needs Survey (SPMCN), which was developed by the author. Descriptive statistics, inferential statistics, and content analysis were used to assess psychologists’ traditional and multicultural (MC) assessment practices, self-reports of multicultural awareness and client-therapist relationship, and extent of diversity training. Pearson correlations, one-way analyses of variance, and simultaneous multiple regression analyses were conducted to determine the degree of relationships and differences among demographic variables, MC assessment practices, MC self-awareness and relationship, and disparity-discomfort related to preparedness for MC work in school settings. Pearson correlations indicated that older psychologists, those who had worked more years, worked in larger school districts, and had more graduate and post-graduate diversity trainings were using more multicultural educational resources and conducting more multicultural assessments. Individuals who reported greater disparity between their current practices and preparedness to evaluate multicultural children also reported greater discomfort. Males reported more MC assessment practices than females. Those with masters’ or specialist degrees conducted more MC assessments. The youngest and oldest groups reported a higher level of disparity and discomfort with regard to their MC practices versus the middle-age group. Similarly, those with the least years and those with the most years of experience reported higher levels of MC self-awareness and relationship.
Sarah Gates, PsyD (2009)
The relationship between supervisor leadership qualities and home-based clinician burnout
Research suggests that mental health agencies providing therapy to children and families in their home experience high levels of clinician turnover. It is assumed that innate challenges of the job, such as complex mental health problems, dangerous settings, inconsistent work environment, and lack of colleague support, lead to lower job satisfaction and ultimate clinician burnout. Types of supervision, particularly those involving a transformational leadership style, have been linked to job satisfaction in other professional industries. This study was designed to explore the factors related to job satisfaction for home-based clinicians, and specifically to explore how supervisor leadership style may relate. Surveys were completed anonymously by home-based clinicians working at agencies throughout the United States. Participants completed measures on demographics, job satisfaction, burnout, and supervisor leadership styles, including the Multifactor Leadership Questionnaire. Descriptive statistics revealed that participants reported a high level of job satisfaction. Correlations suggested that transformational style of leadership held a strong relationship with several underlying components of job satisfaction, which implied that this type of supervisory leadership style may be useful when trying to retain clinicians in the home-based setting. Further research is needed to explore the potential causal nature of this relationship and the possible benefits of trainings for supervisory staff.
Marilyn Lousie Turcotte, PsyD (2007)
High school climate: Perceived safety and belonging of students, faculty, and parents
Schools are experiencing increasing incidences of violence (Bower, 2001; Mayer, 2001; Mayer & Leone, 1999; Owen, 1999; Skiba & Peterson, 2000). This national problem prompted the author to study public high school students’ perception of school safety. School safety was defined as protection from violence, threats, unfair treatment, and alienation. The author investigated what constitutes school safety through quantitative and qualitative procedures. She examined how students’ perceptions of school climate features, such as fairness, positive relationships, belonging, and disruptive behaviors, were related to their understanding of safety/security. The study was a secondary analysis of archived survey data on school climate (Roysircar, 2001) completed in 2001-2002 by students, teachers, and parents of a regional New England high school. The variables Safety/Security, Positive Relationships, and Fairness correlated positively with each other and negatively with Disruptive Behaviors (all correlations at p < .01). Student data ( n = 399) were examined for differences by sex, grade, and sending school. Ninth grade girls perceived the highest degree of safety ( p < .05), and girls overall experienced less physical aggression than boys ( p < .05). No significant differences were found by sending school (i.e., rural versus town). Qualitative data from 3 open-ended questions from students ( n = 20), teachers ( n = 20), and parents ( n = 20) elicited various meanings about school climate, as construed by the 3 school constituencies. The short answers, analyzed with the Consensual Qualitative Research (CQR) method (Hill, Thompson, & Williams, 1997), fell in 9 broad domains: Safety/Security, Morale, Communication, Physical Environment, Well-Being, Belonging/Not Belonging, Curriculum, Organizational Policies, and Diversity/Sensitivity. The majority preferred tougher enforcement of rules and more security personnel to increase safety. More than half of the participants thought morale, communication, and physical environment were important to school climate. Administrative concerns, well-being, belonging/not belonging, and diversity were endorsed by fewer than half of the participants as important. Using the study’s findings, the archived survey, and the current literature, a revised School Climate Questionnaire for Middle/High School Students, Sections I and II was developed by the author and is included in the dissertation. Recommendations are proposed for improving school climate, i.e., adding communication and social skills courses to the curriculum, enforcing school rules consistently, embracing diversity, and increasing parent involvement. Implications for future research are suggested.
Gilbert S. Macvaugh III, PsyD, 2005
Outcomes of court intervention and diversionary programs for domestically violent offenders
Over the last several decades, arrests and prosecutions for domestic violence offenses have increased dramatically across the United States. As a result, courts are more frequently referring domestically violent offenders to treatment programs in order to address the problem. However, the question of which type of batterer treatment program, if any, is effective in reducing partner violence remains largely unanswered and the subject of much controversy. The purpose of this retrospective study was to measure outcomes of court intervention and diversionary programs for a large sample of male domestically violent offenders in Central Massachusetts. Using archival data extracted from official criminal records for a sample of 1,150 offenders, recidivism rates (measured by re-arrest) were calculated and compared at a five year follow-up period across eight different groups which were formed according to case dispositions and sentencing outcomes. Groups consisted of offenders who following an arrest either: (1) received arrest only with no additional sanctions (i.e., charges were dismissed); (2) received only probation; (3) were incarcerated; or were court ordered to complete; (4) a certified batterers’ intervention program; (5) an anger management program; (6) substance abuse evaluation or treatment; (7) other counseling, unspecified; or (8) were ordered to complete a treatment program but failed to do so and were later incarcerated. Recidivism was measured based on both the number of re-offenders within each group, as well as the number of re-offenses for each offender across groups. The results indicated that offenders who completed the anger management group were both less likely to re-offend and also had fewest number of re-offenses by the follow-up period compared to any other group; although, these differences were statistically significant only when compared to treatment non-completers and those who received only traditional criminal justice system sanctions.
Bridgette Sacco-Laurens, PsyD 2004
Research attrition and sampling bias in psychotherapy outcome studies
Participant attrition in outcome studies threatens both conclusions about treatment effectiveness and generalizability. Many researchers do not report the number or type of participants who drop out of research. A review of the literature that did report this information revealed applied settings found demographic differences among attrition groups more often than controlled studies. The most common differences were related to social class variables, such as education, income, or socioeconomic status. This study examined the impact of research attrition on sample representativeness in outpatient private practice settings. Intake information on participants who returned all requested follow-up materials were compared to those with fewer or no response to research follow-up requests. Major findings indicated that demographic variables related to social class, for example: education, occupation, and socioeconomic status, were significantly lower for the research attrition group, A therapist rating of symptom severity at intake was the only diagnostic variable related to research attrition. Previous treatment experience and attendance patterns were also significantly different among the response groups. Research compliance was moderately predicted by previous treatment experience, years of client education, occupation status and socioeconomic status.
Greg Gard, PsyD 2003
Building practice research networks: Overcoming barriers to practitioner participation
Practice research networks are emerging in response to a variety of convergent trends including increasing demands for practitioner accountability and the need for widespread psychotherapy effectiveness research in clinical settings. Active practitioner involvement, particularly through the use of a common assessment battery including standardized outcome measures, is critical to the success of these networks. Central to the argument here is that without significant technological innovation such as the automation of routine clinical tasks through the use of clinical information systems and the integration of outcomes monitoring within those systems, practice research networks will have a difficult time overcoming numerous historical barriers to practitioner participation in practice research. A survey was conducted to explore practitioner attitudes, expectancies, and experiences that either enhance or serve as a barrier to widespread practitioner participation in practice research networks. Additionally, the survey explored whether certain features exist that might create sufficient incentives for practitioner participation. Implications for the future not only of psychotherapy research, but also behavioral healthcare delivery systems are discussed.
Melinda Mueller, PsyD 2002
Psychotherapy outcome in public and private settings: Comparing children and adults
Researchers have recently emphasized the importance of assessing psychotherapy’s impact for children and adolescents in actual practice settings (Weisz, 1992). The relatively small amount of such research available has precluded extensive outcome comparisons among client subgroups, but there has been some suggestion that standard treatment of children might be ineffective. Weisz and his colleagues, in a series of studies and reviews, have concluded that treated children fare no better than quasi (no treatment) control groups (Weisz & Weiss, 1993; Weisz, Weiss, Han, Granger, & Morton, 1995b). No published study has directly compared outcome for children and adults the same settings using the same or similar measures. The purpose of the this study was to do such comparisons at two research consortia, one of public clinics and another of private practices. Children and adults were compared directly using identical measures of satisfaction, client rating and therapist ratings and similar symptom-oriented measures (BSI and CBCL) pre- and post-treatment. Improvement was assessed using Jacobson and Truax’s Reliable Change (1992). Information gathered from public and private settings was analyzed separately. Findings revealed that in the public setting children demonstrated poorer adjustment (on symptom measures) prior to and post treatment in comparison to adults. In addition, fewer children demonstrated improvement and parents were more dissatisfied with services. In the private setting, the results were inconsistent, with adults demonstrating poorer adjustment at intake only (on Client and Therapist Ratings). Implication and future directions were suggested.