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Objective: Many patients drop out of treatments for posttraumatic stress disorder (PTSD); some clinicians believe that trauma-focused treatments increase dropout. Method: We conducted a meta-analysis of dropout among active treatments in clinical trials for PTSD (42 studies; 17 direct comparisons). Results: The average dropout rate was 18%, but it varied significantly across studies. Group modality and greater number of sessions, but not trauma focus, predicted increased dropout. When the meta-analysis was restricted to direct comparisons of active treatments, there were no differences in dropout. Differences in trauma focus between treatments in the same study did not predict dropout. However, trauma-focused treatments resulted in higher dropout compared with present-centered therapy (PCT), a treatment originally designed as a control but now listed as a research-supported intervention for PTSD. Conclusion: Dropout varies between active interventions for PTSD across studies, but variability is primarily driven by differences between studies. There do not appear to be systematic differences across active interventions when they are directly compared in the same study. The degree of clinical attention placed on the traumatic event does not appear to be a primary cause of dropout from active treatments. However, comparisons of PCT may be an exception to this general pattern, perhaps because of a restriction of variability in trauma focus among comparisons of active treatments. More research is needed comparing trauma-focused interventions to trauma-avoidant treatments such as PCT. (Contains 2 figures.)

Children with ADHD symptoms often display social competence deficits, yet mechanisms for their social difficulties remain unclear. Using data from the normative sample of non-intervention respondents (N = 387; 50% male; 49% non-European-American; age at initial assessment: M = 6.5 years, SD = 0.48) in the Fast Track project (Lochman and CPPRG "Journal of Consulting and Clinical Psychology" 63:549-59, 1995), the social-information processing ability of accessing responses for social situations was modeled across four time points from kindergarten to third grade. Teacher-rated aggression and ADHD symptoms were included as predictors of the intercept and slope. Low ADHD symptoms were associated with a decline in aggressive responses across childhood, whereas high ADHD symptoms were linked to an increase in aggressive responses that decelerated between second and third grade. Regarding competent responses, low ADHD symptoms predicted increases in competent responses, but this increase decelerated between second and third grade. High ADHD symptoms were also associated with a slight increase in competent responses into first grade, but competent responses decreased from first to third grade. Neither aggression nor the interaction of ADHD symptoms and aggression accounted for a significant amount of variance in aggressive or competent responses. Future research should identify if differences in response access associated with high and low ADHD symptoms link to difficulties making and keeping friendships.

Although there are established links between measures of readiness for psychological therapy in offenders and subsequent reduction in recidivism rates there has been a lack of theoretical research considering this process within the intellectual disability (ID) offender population. Grounded theory methodology was used to explore the process by which offenders with ID are seen and see themselves as ready to engage with psychological therapy. Twelve participants; offenders with ID, clinical psychologists and nurses across two secure inpatient services participated in the study. The resulting model highlighted a temporal process with interlinking elements including "stability/predictability", "development of relationships with staff", "reassurance about progress" and "realising that change is needed." The model represented participant's shared perceptions and signified the journey of offenders with ID to perceived readiness. The current model is discussed and clinical implications and future research directions suggested. (Contains 1 figure and 1 table.)

This study investigated both negative and positive staff perspectives of service user involvement on two clinical psychology training courses as part of an ongoing process of service evaluation. Ten clinical psychology staff from two training courses were interviewed over the telephone by a current trainee clinical psychologist using a semi-structured interview method. Data were coded into textual units of meaning and then analysed using content analysis. The categories most cited by participants regarding the positives of service user involvement were that service user involvement "develops trainees learning" and "challenges power differences". For opportunities of service user involvement to provide benefits to the training courses, most participants cited "meaningful versus tokenistic involvement", followed by "strategic involvement". Regarding negatives and barriers, those most cited were "differences of opinion or agendas" and "lack of resources". Whilst the findings suggested that the service user involvement initiatives on both courses have been well received, research is needed into how service users also experience the process. Interventions that facilitate staff reflection and processing of multiple perspectives were also recommended, particularly with regards to negative experiences of service user involvement.

This article reviews several approaches used to teach psychopharmacology for graduate clinical psychology students. In order to promote engagement and increase student interest, students were broken up into groups and were asked to demonstrate their understanding of the material through a variety of interactive games (i.e., game-based learning, or GBL). Games used to teach this course included Quiz Bowl, Family Feud, Rounds, Potions, Brainopoly, and Puzzles. Results indicated that most students completed the reading prior to each class, were engaged with their team members, and appeared more confident in their understanding of the material over the course of the semester. Additionally, student satisfaction surveys revealed that most students greatly enjoyed these games and reported that they were useful to advancing their understanding of the material.

Legislative advocacy is an important and long-standing skill in social work. However, this role cannot be left solely to social workers who specialize in macro and policy practice. Rather, clinical social workers who assist clients as they face "private" troubles (Mills, 1959) also need to face the structural barriers that contribute to these concerns. The effect of proposed bills on the practice and welfare of clients is another reason for clinical social workers to advocate within the legislative process. This article proposes the Advocacy Week model, which prepares clinical students for the National Association of Social Workers-sponsored Advocacy Day, an event that represents a statewide collaboration of policy and clinical faculty members and National Association of Social Workers-Illinois staff members.

The purpose of this article is to provide school psychologists and other educational professionals with important information regarding the epidemiology, etiology, assessment, and treatment of early onset schizophrenia (EOS). The central aim herein is to bring science to practice by succinctly highlighting key considerations for school psychologists and other educational professionals. A review of recent research and relevant literature is presented reflecting the current knowledge regarding EOS during childhood. This paper emphasizes the importance of understanding the multidimensional character of EOS. With regard to EOS, the developmental psychopathology perspective explores how these behaviors emerge, considering sociocultural, biogenetic, personality, family, emotional, cognitive and behavioral domains. School psychologists are in a critical position to facilitate the academic achievement and healthy development of individuals who meet criteria for EOS. To help accomplish these aims, several web sites are included for professionals who use the internet as a resource. This paper provides school psychologists with the tools and foundation knowledge needed to be the most effective advocates and collaborators for students and families facing the challenges of EOS.

The purpose of this article is to provide school psychologists with a synthesis of important information regarding the epidemiology, etiology, assessment, and treatment of childhood depression. A review of the recent research and relevant literature is summarized reflecting the contemporary knowledge regarding depression during childhood and adolescence. In addition, reputable websites are included for professionals who use the internet as a resource. This article emphasizes the importance of understanding the multidimensional etiology of depression. With regard to depression, a developmental perspective emphasizes how these conditions emerge, considering the dynamic interplay of sociocultural, biogenetic, personality, family, emotional, cognitive and behavioral domains. School psychologists are in a critical position to facilitate the academic achievement and healthy development of youth who are suffering from depression. This article provides school psychologists with the foundation, knowledge and resources that are needed to be the most effective advocates and collaborators for students and families facing the challenges of depression.

The issue of diversity in both physical and epistemological access to programmes in higher education is an important concern worldwide. In South Africa, as elsewhere, access to professional clinical psychology training programmes is extremely competitive, and there is an important imperative to diversify the student profile. Perspectives of black students on access to clinical psychology training in South Africa have been extensively studied, but the views of white students are minimally documented. We interviewed four white professional clinical psychology trainees on their views about the role race plays in selection for professional training. Four major themes arose from the participants' responses: uncertainty versus transparency; internal shame versus external blame; race versus socio-economic status and language and relevance versus irrelevance. Participants expressed discomfort with selection procedures, and though there are several limitations to this study, such as the small sample size, the need to open the door to discussions on the frightening topic of race is essential for a socially responsible approach to future equity, diversity and representativeness in professional training in higher education in South Africa.

Scholars have noted PBL is consistent with John Dewey's educational theories and with constructivist philosophies. This paper explores the similarities between the assumptions within Howard Barrows' principles for the PBL tutor's actions with Dewey's theories that address teacher behaviors and with Carl Rogers's conceptual frameworks that support the therapeutic behaviors of the client-centered therapist. In doing so it recognizes Barrows' integration of the educational and cognitive psychology concepts of two psychologists who have influenced the psychology of education and provides an additional conceptual and theoretical anchor for PBL tutor facilitation skills.

Despite a clear need, few resources exist to guide field-based multicultural internship supervision practices in school psychology. This article draws on literature from counseling and clinical psychology and related disciplines to ground and define multicultural internship supervision within the context of school psychology professional practice. We delineate factors that influence the quality of multicultural supervision relationships--particularly those between interns of color and White supervisors--including power, racial microaggressions, relational safety, supervisory working alliance, and intern empowerment. We also identify implications for field-based internship supervisors who endeavor to initiate and maintain research-supported multicultural supervision practices with their interns.

This is the official listing of accredited psychology doctoral programs. It reflects all Commission on Accreditation decisions through July 22, 2012. (Contains 15 footnotes.)

Strengths assessments focus on the individual's talents, abilities, resources, and strengths. No systematic review of strengths assessments for use within mental health populations has been published. The aims of this study were to describe and evaluate strengths assessments for use within mental health services. A systematic review identified 12 strengths assessments (5 quantitative, 7 qualitative). The Strengths Assessment Worksheet (SAW) was the most widely utilized and evaluated qualitative assessment. Psychometric properties of the assessments were assessed against set quality criteria. Data on psychometric properties were available for 4 measures. The Client Assessment of Strengths, Interests and Goals (CASIG) had the strongest psychometric evidence. The SAW and CASIG assessments can be tentatively recommended within clinical practice, although the evidence for all strengths assessments is currently limited. To describe the content of the strengths assessment, the items used to operationalize the concept of strengths in each assessment were extracted and themed. Twenty-four themes were identified and organized into 3 overarching categories: individual factors, environmental factors, and interpersonal factors. These categories form the basis of an empirically based definition of strengths that could be used as a conceptual foundation for new clinical assessments. (Contains 1 figure and 3 tables.)

A view of human functioning is presented in which functioning is seen as integrating head and heart, emotion and reason, in a process by which people are constantly making sense of their lived emotional experience to form narratives of told experience. Because much of the processing involved in the generation of emotional experience occurs independently of and prior to conscious thought, therapeutic work on a purely cognitive level of processing is unlikely to produce enduring emotional change. The questions especially relevant to psychotherapy are how we can best facilitate change in emotions rather than only changes in cognition or behavior. A theory of emotional change is presented in which change in emotion is seen as requiring that first emotions be felt and then they both be exposed to new emotional experience and be reflected on to create new meaning. The process of emotional change thus involves both new experience and new understanding. At times, people also need to protect themselves from being overwhelmed by emotions. They need to be helped to tolerate and regulate them so that emotions inform their lives rather than control them. The importance of both emotion awareness and emotion regulation in therapeutic change is thus highlighted. The article ends by reviewing research on the role of emotional processing in therapeutic change and presents six empirically based principles of emotional processing that will help move the field toward psychotherapy integration in a manner that clearly recognizes emotion as a key component of functioning and change.

In contrast to dyslexia and autism, specific language impairment (SLI) is a neglected condition not only in research, but also in debates about policy and practice. A recent analysis of research publications and grants confirmed this impression, showing that SLI attracted far less research funding and led to fewer publications than many other conditions of comparable frequency and severity. At the end of 2011, the authors decided to take action and formed a group with the name RALLI, standing for "raising awareness of language learning impairments." This group consists of four academics, two of whom trained as speech and language therapists and two as clinical psychologists, together with a practicing speech and language therapist. They decided that what was needed was a campaign to put accessible materials on the internet in a form that would attract attention from the general public. Their aim was not to raise money or to improve provision, but simply to improve the recognition of children's language impairments. In this article, the authors describe the background and rationale of the internet campaign to raise awareness of language learning impairments (RALLI).

A recent meta-analysis of 103 studies Burt ("Clinical Psychology Review," 29:163-178, 2009a) highlighted the presence of etiological distinctions between aggressive (AGG) and non-aggressive rule-breaking (RB) dimensions of antisocial behavior, such that AGG was more heritable than was RB, whereas RB was more influenced by the shared environment. Unfortunately, behavioral genetic research on antisocial behavior to date (and thus, the research upon which the meta-analysis was based) has relied almost exclusively on the classical twin model. This reliance is problematic, as the strict assumptions that undergird this model (e.g., shared environmental and dominant genetic influences are not present simultaneously; there is no assortative mating) can have significant consequences on heritability estimates when they are violated. The nuclear twin family model, by contrast, allows researchers to relax and statistically evaluate many of the assumptions of the classical twin design by incorporating parental self-report data along with the more standard twin data. The goal of the current study was thus to evaluate whether prior findings of etiological distinctions between AGG and RB persisted when using the nuclear twin family model. We examined a sample of 312 child twin families from the Michigan State University Twin Registry. Results strongly supported prior findings of etiological distinctions between AGG and RB, such that broad genetic influences were observed to be particularly important to AGG whereas shared environmental influences contributed only to RB. Nevertheless, the current findings also implied that additive genetic influences on antisocial behavior may be overestimated when using the classical twin design.

A number of recent studies suggest that DNA variation in the dopamine transporter gene (DAT1) influences spatial attention asymmetry in clinical populations such as ADHD, but confirmation in non-clinical samples is required. Since non-spatial factors such as attentional load have been shown to influence spatial biases in clinical conditions, here we sought to determine whether any association between DAT1 genotype and spatial bias might be moderated by non-spatial attentional load. Healthy adults were asked to react to sudden onset peripheral targets while demand on non-spatial attention was manipulated via a central task. Participants were genotyped for a DAT1 variable number of tandem repeat (VNTR) polymorphism. The 10-repeat allele of this variant is a replicated susceptibility allele for ADHD and has been shown to associate with spatial bias. As expected, an overall leftward asymmetry/pseudoneglect was observed when the data were averaged across the entire sample. When data were stratified by DAT1 genotype, individuals lacking homozygosity for the 10-repeat DAT1 allele (non-10/10) showed a pronounced leftward bias that was significantly different from zero. In line with past reports from children with ADHD, this leftward bias was attenuated in individuals who were homozygous for the DAT1 10-repeat allele (10/10), suggestive of relatively weaker right hemisphere dominance for spatial attention. This effect of DAT1 genotype on spatial bias was not modulated by non-spatial attention load. These data confirm in healthy adult participants both the existence and the direction of the relationship previously reported between DAT1 genotype and spatial bias in children with ADHD. These data add to a growing body of evidence showing that spatial attentional asymmetry is a stable quantitative trait, with individual differences in this trait significantly predicted by common DNA variation in the DAT1 gene. (Contains 1 table and 3 figures.)

The consultant-on-duty (COD) clinical consultation model maximizes efficient use of services, is distinct from other university counseling center (UCC) services, and precedes therapy. This model enables clinicians to ensure optimal fit between client need and type of UCC services provided, including brief therapy. The 4 objectives of the COD model include quick access to initial consultation, management of treatment expectations, collaborative treatment decisions, and planning for client assistance. (Contains 1 figure.)

This article reviews the lived experiences of 4 college-age transsexual individuals. A qualitative study using grounded theory was conducted to investigate their experiences influencing their later educational persistence. Results suggested that level of discomfort, perceived social supports, level of secrecy, and academic achievement all affected participants' decision making regarding persistence. This process appeared best explained by participants' expressed hierarchy of needs. Implications for clinical practice and future research are discussed. (Contains 1 figure.)

Psychological abnormality is a fundamental concept in the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-IV-TR"; American Psychiatric Association, 2000) and in all clinical evaluations. How do practicing clinical psychologists use the context of life events to judge the abnormality of a person's current behaviors? The appropriate role of life-event context in assessment has long been the subject of intense debate and scrutiny among clinical theorists, yet relatively little is known about clinicians' own judgments in practice. The authors propose a "proportionate-response" hypothesis, such that judgments of abnormality are influenced by whether the behaviors are a disproportionate response to past events, rendering them difficult to understand or explain. Licensed, practicing clinical psychologists (N = 77) were presented with vignettes describing hypothetical people's behaviors (disordered, mildly distressed, or unaffected) that had been preceded by either traumatic or mildly distressing events. Experts' judgments of abnormality were strongly and systematically influenced by the degree of mismatch between the past event and current behaviors in strength and valence, such that the greater the mismatch, the more abnormal the person seemed. A separate, additional group of clinical psychologists (N = 20) further confirmed that the greater the degree of mismatch, the greater the perceived difficulty in understanding the patient. These findings held true across clinicians of different theoretical orientations and in disorders for which these patterns of judgments ran contrary to formal recommendations in the "DSM-IV-TR" (American Psychiatric Association, 2000). The rationality of these effects and implications for clinical decision science are discussed. (Contains 2 figures and 4 footnotes.)

Access to learning disability services in England is often governed by eligibility criteria. A semistructured questionnaire was completed by clinical psychologists in the north-west of England about service eligibility criteria and psychologists' role within the referral process to learning disability services. The survey highlighted both variations and similarities across the region in terms of definitions of learning disabilities, eligibility for accessing local services and the psychometric measures used to assess functioning. Differences in how services assess eligibility can lead to difficulties, for example when people move area. The use of standard eligibility criteria could be one means of overcoming this. (Contains 2 tables.)

Alongside the increased prevalence of autism spectrum disorders (ASD), there is a greater likelihood of clinical psychologists having a role in the treatment of children with these disorders. Population heterogeneity with respect to ASD-specific symptomatology, comorbid medical and psychiatric issues, level of cognitive functioning, and presence of adaptive behaviors, all add to the complexity of providing treatment to this population. Consequently, psychologists often find themselves in multiple roles in order to effectively manage treatment for children with ASD and their families. The purpose of this article is to increase awareness of three major roles for clinical psychologists working with this population: assisting families with treatment coordination, identifying and treating comorbid psychopathology, and addressing parental stress.

Information about the undergraduate psychology courses preferred by graduate programs is useful for a number of purposes, including (a) advising psychology majors who are interested in graduate school, (b) undergraduate curriculum planning, and (c) examining whether graduate programs' preferences reflect national guidelines for the undergraduate psychology curriculum. The authors examined the undergraduate course preferences of U.S. psychology graduate programs (N = 548). Among Clinical/Counseling (C/C) programs, PsyD programs' course preferences were more likely than those of master's and PhD programs to reflect national undergraduate curriculum guidelines. Differences also emerged among various types of training (e.g., C/C vs. Educational/School), and these are important for advisors and students to understand. (Contains 2 tables and 2 notes.)

As a distinguished scholar over the past 45 years, Michel Hersen has left an indelible mark on the field of behavior therapy and clinical psychology. One of his most enduring legacies is his early research work in the area of social skills assessment and training, with special attention to assertiveness training. His basic analogue and clinical outcome studies have served as essential building blocks for current evidence-based treatments. His long and distinguished career has significantly impacted the lives of colleagues, students, and patients alike.

The 4 years that Michel Hersen spent at the University of Mississippi Medical Center (1970-1974) are described in this article from the viewpoint of his place in the history of the development of behavior analysis and therapy. The Department of Psychiatry at the University of Mississippi Medical Center became a leader in enhancing the role of psychologists as clinician researchers within psychiatry and applying basic findings from psychology to the bedside. A vigorous research program involving psychology residents and postdoctoral students, and psychology and psychiatry faculty emerged from this integration of science and practice. Many of the faculty members, including Michel Hersen, became leaders in the field of behavior therapy. Much of what was groundbreaking at the time is now commonplace within many medical schools. (Contains 1 figure.)

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.

Objective: To compare social and behavioural outcomes between children formally diagnosed with autism spectrum disorders (ASD) with those of children who displayed autistic traits at preschool age, but remained undiagnosed as teenagers. Method: A secondary analysis of data from a birth cohort study, the Avon Longitudinal Study of Parents and Children (N = 13,944), in SW England. Children clinically diagnosed with ASD were identified from their medical records (n = 71). A comparison group, who displayed autistic traits at age 3-4, but without ASD diagnosis were also identified (n = 142). Social and behavioural outcomes in adolescence were compared between the two groups. Results: Children with ASD diagnoses were more impaired as teenagers that those in the comparison group on a range of measures of autistic-like behaviour. The developmental trajectory of prosocial behaviour showed that differences between the case and comparison groups increased dramatically in the preschool and early primary years, but that after 6 years the trajectories were similar. Conclusions: The divergence of the clinically diagnosed group and the nondiagnosed group in measures of autistic-like behaviour increased with age. This study provides evidence that it may be difficult to distinguish preschool age children who exhibit autistic-like symptoms but improve, from those who go on to develop lifelong impairment.

Background: Challenging and disruptive behaviour is commonly reported among children placed in the out-of-home care sector. Little is known about how stakeholders in this sector understand or manage challenging behaviour. Method: Ninety-two stakeholders in the South Australian out-of-home care sector were interviewed about their approach to supporting children with challenging behaviour. Participants were teachers, foster carers, child statutory workers, child mental health workers, and residential care workers. These semi-structured interviews were subject to thematic analysis. Results: The analysis revealed several ways of understanding challenging behaviour: behaviour as learnt, behaviour as purposeful, behaviour as a choice, behaviour arising from constant change, behaviour reflecting strong emotions, and behaviour reflecting attachment history. Conclusions: This analysis suggests that professionals seeking to engage in collaborative casework on behalf of children may need to accommodate a range of diverse views about the origin and solution to challenging and aggressive behaviour. The possible implications of these divergent understandings for placement policy and practice are discussed. These apparently disparate frameworks are discussed in terms of their underlying assumptions, and possible "common ground" is identified and highlighted. Explicating the implicit assumptions inherent in others' accounts may provide a "way forward" in more effective work on behalf of children.

Background: Psychological services are increasingly provided within a context in which third party payers impose limits on the number of sessions available to the client and therapist. Considerable research has addressed the effect of time limits on therapeutic outcomes, while effects on therapeutic process have received less attention. This article reports on research that assessed the perceived impact of externally determined time limits on therapeutic process from the perspective of practicing psychologists. Methods: This study used a concurrent triangulation mixed-methods design. Study 1 was a repeated measures questionnaire that was both qualitative and quantitative in nature, and Study 2 utilised qualitative semi-structured interviews. Twenty-seven Australian psychologists treating clients within externally imposed time limits were interviewed, and 85 completed a questionnaire to obtain their perspective on the impact of time limits on the therapeutic process. Results: Therapeutic approach was impacted by time limits, including choice of therapeutic modality, shifts in problem definition and approach, and increased directiveness, prompting concern about a focus on symptom removal over facilitating maintenance of treatment gains. Conclusions: This research contributes to an understanding of how temporal constraints influence treatment, and managed care funding policies may need to be considered in the light of this understanding.

Objective: Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). Method: Participants were 86 children (ages 6-16 years) with a primary diagnosis of OCD. Patients and their primary caregiver were administered clinician-rated measures of obsessive-compulsive severity and rage severity. Children completed the Center for Epidemiologic Studies Depression Scale and the Child Sheehan Disability Scale-Child, whereas parents completed the Rage Attacks Questionnaire, Aberrant Behavior Checklist-Irritability Scale, Children's Affective Liability Scale, and Child Sheehan Disability Scale-Parent. Results: Rage was common among youth with OCD and was associated with varied clinical characteristics. Rage severity accounted for functional impairment beyond the influence of obsessive-compulsive symptom severity; however, these relations were explained by the impact of family accommodation. Conclusions: These data suggest that rage attacks are relatively common, have a negative impact on illness presentation, and contribute to functional impairment above and beyond obsessive-compulsive symptom severity. Rage may contribute to family accommodation of symptoms, which may further affect obsessive-compulsive symptom severity and impairment. (Contains 6 tables and 2 figures.)

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. ("Clin Child Fam Psychol Rev" 14:89-109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. ("Clin Child Fam Psychol Rev" 14:89-109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.

We investigated the relationship between gender and clinician diagnosis of a depressive disorder at intake on variables reflecting depression among adolescents in residential treatment. It was hypothesized that females diagnosed with a depressive disorder would have the highest scores on measures of suicide risk, the number of symptoms of a major depressive episode, suicidal behavior, and suicidal ideation. Results indicated partial support for the predicted comparisons. Females diagnosed with a depressive disorder scored significantly higher on measures of depressive symptom count and suicidal ideation. Surprisingly, females without a diagnosis of a depressive disorder had higher suicide risk scores than the remaining groups. The results of this study highlight the importance of assessment and treatment of internalizing disorders in youth entering residential programs, particularly female adolescents.

This Practice Parameter describes the principles of psychodynamic psychotherapy with children and is based on clinical consensus and available research evidence. It presents guidelines for the practice of child psychodynamic psychotherapy, including indications and contraindications, the setting, verbal and interactive (play) techniques, work with the parents, and criteria for termination. (Contains 1 table.)

Objective: To compare the phenomenology and course of bereavement-related depression to depression that occurred later in the course of bereavement and to depression in non-bereaved youth. Method: This sample is drawn from a cohort of parentally bereaved youth and non-bereaved controls followed for approximately 5 years. Three groups of depressed youth were compared with respect to symptoms, severity, duration, risk for recurrence, and correlates and risk factors: (1) a group with bereavement-related depression (BRD, n = 42), with the onset of a depressive episode within the first 2 months after parental loss; a group with later bereavement depression (LBD, n = 30), with onset at least 12 months after parental loss; and a non-bereaved control group with depression (CD, n = 30). Results: BRD episodes were similar to LBD and CD with respect to number of symptoms, severity, functional impairment, duration, risk for recurrence, and most risk factors and correlates. BRD, compared with both CD and LBD, were younger, exposed to fewer life events, and less likely to have experienced feelings of worthlessness. Also, caregivers of BRD showed higher rates of depression and post-traumatic stress disorder at the time of the depression compared with each of the other two groups. Conclusion: BRD is similar to both LBD and CD in phenomenology, course, and risk factors, supporting a diagnostic and therapeutic approach to BRD similar to that for non-bereavement-related depressions. In the bereaved child who presents with depression shortly after parental death, the clinician should also be alert to caregiver depression and post-traumatic stress disorder. (Contains 2 figures and 3 tables.)

Objective: Identifying risk factors for adolescent depression is an important research aim. Overgeneral autobiographical memory (OGM) is a feature of adolescent depression and a candidate cognitive risk factor for future depression. However, no study has ascertained whether OGM predicts the onset of adolescent depressive disorder. OGM was investigated as a predictor of depressive disorder and symptoms in a longitudinal study of high-risk adolescents. In addition, cross-sectional associations between OGM and current depression and OGM differences between depressed adolescents with different clinical outcomes were examined over time. Method: A 1-year longitudinal study of adolescents at familial risk for depression (n = 277, 10-18 years old) was conducted. Autobiographical memory was assessed at baseline. Clinical interviews assessed diagnostic status at baseline and follow-up. Results: Currently depressed adolescents showed an OGM bias compared with adolescents with no disorder and those with anxiety or externalizing disorders. OGM to negative cues predicted the onset of depressive disorder and depressive symptoms at follow-up in adolescents free from depressive disorder at baseline. This effect was independent of the contribution of age, IQ, and baseline depressive symptoms. OGM did not predict onset of anxiety or externalizing disorders. Adolescents with depressive disorder at both assessments were not more overgeneral than adolescents who recovered from depressive disorder over the follow-up period. Conclusions: OGM to negative cues predicted the onset of depressive disorder (but not other disorders) and depressive symptoms over time in adolescents at familial risk for depression. Results are consistent with OGM as a risk factor for depression. (Contains 1 figure and 3 tables.)

The purpose of this study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and to investigate the relationship of the embarrassing-shameful events with the therapist reactions. Ninety-three therapists participated in this study, and the most frequent events reported were having a scheduling mistake, forgetting or confusing client information, being visibly tired, falling asleep, and arriving late. Implications and need for further research, particularly concerning the effects of therapist embarrassment and shame on therapy process and outcome, are discussed. (Contains 2 tables.)

The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p = 0.036) and client's age and provider's age (p = 0.044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures. (Contains 2 tables and 1 figure.)

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing critical pedagogy, the program works with future clinicians to develop multicultural and international competencies; acquire increased Spanish language skills; engage in self-of-the-therapist work; and expand their understanding of the historical and cultural influences shaping the mental healthcare needs of Latin American clients. A report of the themes from postimmersion surveys is provided and the implications for training are discussed.

The aim of the study was to establish the test-retest reliability, clinical significance and precision of four mobility and balance measures--the Timed 25-Foot Walk, Six-minute Walk, Timed Up and Go and the Berg Balance Scale--in individuals moderately affected by multiple sclerosis. Twenty four participants with multiple sclerosis (Extended Disability Status Score 5-6.5) were assessed on four measures of mobility and balance. The Timed 25-Foot Walk, Six-minute Walk and Timed Up and Go mobility outcome measures and the Berg Balance Scale were assessed by one assessor one week apart. Intraclass correlation coefficient (ICC) analysis was carried out to determine reliability. Minimal detectable change values were calculated to determine clinical significance; the standard error of each measurement was calculated to assess precision. All four outcome measures were found to be reliable: Timed 25-Foot Walk ICC = 0.94, Six-minute Walk Test ICC = 0.96, Timed Up and Go ICC = 0.97 and Berg Balance Scale ICC = 0.96. Minimal detectable change values were as follows: Timed 25-Foot Walk = 12.6 s, Six-minute Walk Test = 76.2 m, Timed Up and Go = 10.6 s and Berg Balance Scale = 7 points. Standard errors of measurement were as follows: Timed 25-Foot Walk = 4.56 s, Six-minute Walk Test = 27.48 m, Timed Up and Go = 3.81 s and Berg Balance Scale = 3 points. The test-retest reliability of these four outcome measures was found to be good. The calculated clinical significance and precision of these measures highlight the problems of assessing a heterogeneous clinical population.

Objective: To examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) in a clinical sample of 1,373 children and adolescents with ADHD and their 1,772 unselected siblings recruited from different countries across a large age range. Hierarchical and correlated factor analytic models were compared separately in the ADHD and sibling samples, across three different instruments and across parent and teacher informants. Specific consideration was given to factorial invariance analyses across different ages and different countries in the ADHD sample. Method: A sample of children and adolescents between 5 and 17 years of age with ADHD and their unselected siblings was assessed. Participants were recruited from seven European countries and Israel. ADHD symptom data came from a clinical interview with parents Parental Account of Childhood Symptoms and questionnaires from parents and teachers (Conners Parent and Teacher). Results: A hierarchical general factor model with two specific factors best represented the structure of ADHD in both the ADHD and unselected sibling groups, and across informants and instruments. The model was robust and invariant with regard to age differences in the ADHD sample. The model was not strongly invariant across different national groups in the ADHD sample, likely reflecting severity differences across the different centers and not any substantial difference in the clinical presentation of ADHD. Conclusions: The results replicate previous studies of a model with a unitary ADHD component and separable specific traits of inattention and hyperactivity/impulsivity. The unique contribution of this study was finding support for this model across a large developmental and multinational/multicultural sample and its invariance across ages.

Background: Structural language anomalies or impairments in autistic spectrum disorder (ASD) are theoretically and practically important, although underrecognised as such. This review aims to highlight the ubiquitousness of structural language anomalies and impairments in ASD, and to stimulate investigation of their immediate causes and implications for intervention. Method: Studies of structural language in ASD are reviewed (based on a search of the literature and selected as meeting defined inclusion criteria), and explanatory hypotheses are discussed. Results: Some individuals with ASD never acquire language. Amongst those who do, language abilities range from clinically normal (ALN) to various degrees of impairment (ALI). Developmental trajectories and individual profiles are diverse, and minority subgroups have been identified. Specifically: language is commonly but not always delayed and delayed early language is always characterised by impaired comprehension and odd utterances, and sometimes by deviant articulation and grammar. -Nevertheless, by school age an "ASD-typical" language profile emerges from group studies, with articulation and syntax least affected, and comprehension, semantics and certain facets of morphology most affected. Thus, even individuals with ALN have poor comprehension relative to expressive language; also semantic-processing anomalies and idiosyncratic word usage. It is argued that impaired socio-emotional-communicative relating, atypical sensory-perceptual processing, and uneven memory/learning abilities may underlie shared language anomalies across the spectrum; and that varying combinations of low nonverbal intelligence, semantic memory impairment and comorbidities including specific language impairment (SLI), hearing impairment, and certain medical syndromes underlie ALI and variation in individual profiles. Conclusions: Structural language is universally affected in ASD, due to a complex of shared and unshared causal factors. There is an urgent need for more research especially into the characteristics and causes of clinically significant language impairments.