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Couples typically do not seek counseling resources until a crisis occurs. Many times during an intake interview with a counselor, couples report communication issues as a presenting problem. However to date, no best practices or treatment manuals in correspondence with a therapeutic system to improve interpersonal communication skills exist for helping couples recognize the barriers. This article reviews an approach to helping couples understand and make choices about their communication barriers and challenges. An informed philosophical direction, skills, and tools are needed for counselors to navigate the wants, direction, evaluation, and planning (WDEP) along with promoting positive outcomes in couples counseling. This article further outlines an integration of a communication model with the reality therapy WDEP tenets for use in establishing alliances, processing insights, and maintaining a therapeutic environment with couples. Further, counselors may utilize the WDEP method as a brief intervention framework to aid couples who have communication issues with insight acquisition, catharsis, self-disclosure, and goal setting to promote positive outcomes in counseling.

Objective: This study examines the effect of an ecological and contextually responsive approach, during initial intake call, on engagement for multistressed families seeking child mental health services in an urban setting. Methods: Using a randomized design, parents were allocated to phone Intake As Usual (IAU) or Enhanced Engagement Phone Intake (EEPI). IAU consisted of a lengthy mandated standardized phone intake interview. EEPI, wrapped around the standard intake, was a flexible approach, attuning to the parent’s concerns, help-seeking experience, and stressors and incorporating problem-solving and motivational interviewing. Results: Controlling for child gender, child age, income, and marital status, parents in the EEPI condition were 3 times more likely to attend their initial face-to-face agency appointment and subsequent treatment services. Conclusions: This study contributes to building the evidence base for early engagement approaches responsive to families’ broader ecological context to ensure that vulnerable children and families access and receive benefits of treatment.

Background Participant attrition from randomized controlled trials reduces the statistical power of the study and can potentially introduce bias. Early identification of potential causes of attrition can help reduce patient attrition. We performed secondary analyses of two trials involving cancer patients. Purpose To identify predictors of attrition during two early phases, i.e., from consent to screening (Phase-1), and from screening to intake interview (Phase-2) in two clinical trials. Methods Cancer patients undergoing chemotherapy were asked to enroll in one of two clinical trials. In each trial the benefits of a cognitive behavioral intervention were compared with a psycho-educational intervention to assist patients to manage cancer and treatment-related symptoms. Following consent patients were screened for their symptoms' severity to determine their eligibility. Results Of the 885 consenters 785 completed screening and of the 782 eligible for participation, 713 completed intake interview. In the first phase, longer delays between consent and first contact attempt, lower levels of patient education, minority race, and prolonged duration of screening increased the likelihood of dropping out with a significantly stronger effect on minorities than white patients. In the second phase, low education, being a minority, longer screening delays, and impact of symptom severity on enjoyment of life significantly increased probability of attrition. Limitations Participant reported causes of attrition were not modeled; however, exclusion of patients who died during the time period of this research meant that most patients leaving the study made a conscious decision to do so. Conclusions To assure preservation of external validity, the time between consent and randomization into the arms of a trial must be held to a minimum. Delays between contacts and run in time, that may include screening patients to assure they will benefit from a trial, must be balanced against rates of attrition. Compressing intervals between contacts is particularly important to retain minorities. Clinical Trials 2008; 5: 328—335. http://ctjsagepub.com

IN SEPTEMBER 1997, the Ridgewood, New Jersey, school district placed J.N., then age 11, in the Windsor School, per the IEP (individualized education program) team's identification of his special needs for structure, safety, and security. As a state-approved private special education school, Windsor signed an agreement with Ridgewood for the academic year. That first year went well. However, when J.N. returned to Windsor the following year, things went awry. J.N. did not like his new teacher. His parents made frequent telephone calls to school personnel, and J.N. was absent a lot. On December 16, feeling that these circumstances were making progress on J.N.'s IEP goals impossible, Windsor's co-owner and co-executive director, Daniel Greco, decided to terminate J.N.'s placement in the school. At the district's request, Greco agreed to continue J.N.'s enrollment until December 23, when the holiday break began, but insisted that the boy could not return when the second semester started on January 4. He confirmed this decision in a December 21 letter to the district's special education director, John Campion. At about the same time, the parents directed a letter to Campion asking what he planned to do in response to "Windsor's irrational and inhumane treatment" of their son. He forwarded their letter to Greco. On December 22, Campion faxed the parents a letter informing them that the IEP team chair had proposed an "excellent" placement at another special school. The letter was accompanied by authorizing forms, which Campion requested the parents to sign and return ASAP. The parents returned the forms and visited the proposed school. However, on January 4, the parents faxed Campion a series of demands. First, as a prerequisite for any termination plan, they demanded that he convene an IEP team with participants from both Ridgewood and Windsor School. Second, they demanded that Ridgewood provide one-to-one tutoring, with transportation, during the interim between the beginning of the new semester and J.N.'s transfer to the new school. Campion faxed back a letter recounting the recent events and informing them that an intake interview was expected that week and that the IEP case manager was going to make immediate arrangements with them to revise the IEP on an interim basis and to provide instructional services in the home during the short transition. He cc'd the letter, without the parents' authorization, to Greco. J.N. did not receive the home services. On January 25, after Campion had provided the parents with information about several other schools, J.N. began to attend one of them per a new, agreed-upon IEP. He made satisfactory progress at the new school, completing his placement there three years later, in December 2001. He then received one-to-one instruction, which took place at the Ridgewood Library, for the rest of that school year. After that, the IEP team, including his parents, determined that he could enter the high school. Meanwhile, on 1 February 1999, the parents filed for a due process hearing, claiming that the district and Windsor had terminated J.N.'s placement in violation of IDEA and related state regulations and that during the interim before the new placement the family had had to contract for adult supervision and a psychiatrist. Soon thereafter, they filed a complaint with the state education department. On June 3, the hearing officer issued a decision that found that Windsor had violated state regulations by not providing written notice at least 15 days prior to termination and that the district had violated state regulations by not quickly convening an IEP meeting, including representation from the private school. However, she concluded that the gap of 17 school days between placements did not warrant compensatory education under the Third Circuit's standards. She also rejected the requested reimbursements for the adult supervision and psychiatrist as having "nothing to do with the provision of [free appropriate public education]. …

The purpose of this study was to evaluate the convergent and discriminant validity of counselor and client ratings of common presenting problems at a counseling center for unviersity employees. Each subject was asked to complete the Employee Problem Appraisal Form (EPAF) at three points in time: during the intake interview (N = 306); after eight weeks of counseling (N = 114); and at termination after 16 or more counseling sessions (N = 80). The counselor for each client also completed a parallel form of the EPAF at each time interval. Five scales on the EPAF were selected for multitrait-multimethod analysis on the basis of internal-consistency estimates. Non-zero convergent validity values (correlations between independent measures of the same trait) ranged from .27 to .66. That four of these non-zero convergent validity values were higher than correlations between independent measures of different traits (heterotrait-heteromethod values) provided some evidence of discriminant validity. Elevations of correlations between repeated measures of different traits (heterotrait-monomethod values) were indicative of shared method variance in both counselor and client ratings. Although non-zero convergent validity values in this study were not large, they increased over time and compared favorably with measures of similar psychological variables based on independent ratings of the same trait (Campbell and Fiske, 1959). These results were discussed relative to improvement of the EPAF, and suggestions were offered for further research using this instrument.

This paper raises questions about the ways in which social workers try to "explain" or make sense of their practice in interviewing. It is concerned with the ways that they "construct reality" in their day to day work and how they ascribe order or patterns to this reality. The discussion is based on a tape recorded transcript of a social worker — applicant interview and a transcript of a talk between the social worker and the writer about the interview. It seems that "theory" and "practice" are regarded as discrepant as theoretical knowledge is lost sight of in the action setting of the intake team where taken for granted routines take precedence.

The expressions of requests of 120 patients who came to the Walk-In Psychiatric Clinic of a general hospital were examined to determine whether patients verbalized specific requests during the intake interview. As 63% of the patients verbalized a specific request, 37% emitted and 27% elicited ones, we concluded that many patients could have been more specific but felt restrained by their role. To evaluate the effect of the patients' attitudes and interviewers' behavior on the expression of requests, in a two-by-two factorial design, we varied the number of patients taking the Patient Request Form and/or being probed for a request during a standardized pre-intake interview. These two procedures did not affect significantly the number expressing requests: experimental groups 73% versus control group 63%. Completing the form elicited more requests. The interviewer variables of number and wording of probes for requests significantly facilitated expression of requests. In the discussion we attempted to evaluate factors influencing patient's resistance to the expression of requests and to place the meaning of requests in the context of more effective clinical functioning, particularly a negotiated approach to the treatment of patients.

A model for an intake interview is proposed that can be applied flexibly and selectively by different workers in different settings

The present study assessed the effects of rationales for therapy on perceptions of a problem of clinical depression by 46 male and 38 female college students who were randomly assigned to one of three experimental groups varied as to the therapeutic rationale presented for a problem of severe non-reactive depression in a middle-aged woman. One rationale was in accord with classical psychoanalysis with the cause of the depression described in terms of unresolved unconscious conflicts and the recommended treatment involving insight. The second rationale was tailored according to rationalemotive therapy depicting long-standing habits of faulry thinking as the cause of the problem and describing the necessity of learning more reasonable interpretations of events as the recommended treaunent. The third experimental group was exposed to a norationale condition. All subjects listened to an audio recording of the case hiscoty and a simulated intake interview between the client and the treating psychologist (JPW). Neither rationale was labeled as psychoanalysis or rational-emotive therapy in the audio recordings or in subsequent rating scales although each had been reviewed and modified by a licensed clinical psychologist of that orientation. Following these taped presentations, subjects completed 28 Likert-type rating scales pertaining to the client's problems and adjustment and in the two therapeutic groups nine additional ratings concerning the rationales and treating psychologist. In a posttest-only control-group design data were analyzed via one-way analyses of variance and Newman-Keuls tests for significant differences, among means. A considerable number of significant resulrs emerged (all ps < .05 or .01). In scoring the questionnaires, various ratings pertaining to similar areas were combined. In all, of a total of 27 comparisons made, 14 attained statistical significance. In general subjects exposed to a treaunent rationale tended to view the client's problem as more understandable than subjects hearing no rationale. While both treatments were perceived favorably, subjects hearing the rationale of rational-emotive therapy indicated more faith in ueatment, saw the client as more likely to improve and likely to improve in a significantly shorter time period than did subjects hearing a psychoanalytic rationale. While clients undergoing actual ueatment might perceive these rationales differently, these results are consistent with others (1, 2) which demonstrate that rationales for therapy influence credibility and expectanq regarding treatment.