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Understanding why parents seek psychotherapy for their children is important for new therapists wishing to optimize the treatment process and outcomes. The development of an effective partnership with the child client's parents seems to be critical to treatment success although little research has explored the congruence of expectations between parents and therapists. Premature termination of therapy has been found to relate to differences in goal and outcome expectations between therapists and family members of clients. In the present study, responses of therapists and parents were compared using a between-subjects design in order to determine differences between these groups in terms of the way they conceptualize the objectives of therapy. Between-group t-tests of a sample of 67 parents and 12 therapists revealed significant differences relating to the objectives of normalization and behavior change. Therapists emphasize the importance of behavior change, while parents view normalization as more crucial than behavior change. Results are presented and discussed. Contains 15 references. (Author/EMK)

Research has indicated that premature termination of therapy is sometimes due to a conflict in goal and outcome expectations between therapists and family members of clients. The present study requested both therapists and parents of child clients to complete questionnaires to determine if there is congruence between therapist and parental expectations. The questionnaire was designed to measure the similarity in expectations for both parties or if lack of congruence is present that may possibly lead to premature termination of therapy for the child client. Also included in the study were responses from adult clients and therapists of adult clients. Within subject t-tests of a sample of 63 parents, 18 therapists, and 43 adult clients produced significant findings. Therapists and parents of child clients attached greater significance to the behavior change sub-scale, while adults rated the five sub-scales as equally important. Appendix A contains the Parent Attitude Questionnaire with a discussion of "Parents' Motivations for Seeking Treatment for Their Children." Appendix B provides the Client Attitude Questionnaire and a discussion of "Clients' Motivations for Seeking Treatment." More than 130 references are listed. (Author/EMK)

Training therapists effectively requires familiarizing them with the modal expectations that clients bring to the therapeutic encounter. Ways in which therapists can be apprised of clients' expectations of therapy are discussed. Accurate understanding of clients' attitudes permits development of appropriately focused therapy goals and is generally associated with higher client satisfaction at the end of treatment. Congruence between therapist and client objectives also reduces premature termination. Reasons for client termination have been studied primarily by use of therapists' retrospective assessment. In this study, it is hypothesized that one underlying factor for early termination may be an incongruence between client and therapist expectation of therapy. In order to assess congruence, 100 randomly selected mental health care professionals and prospective psychotherapy clients were surveyed regarding client expectations and goals of therapy prior to the onset of treatment. Areas of client therapist congruence are examined, and their implication for the conduct of effective psychotherapy are explored. Appendices include the Client Attitude Questionnaire and Client Motivations for Seeking Treatment. Contains 90 references. (Author/MKA)

Conflict over appropriate treatment boundaries has been an issue since the time of Freud. To better understand these boundaries, some traditional, humanistic and feminist models which range from conservative, strict boundaries to more liberal or relaxed boundaries are considered here. The ethical considerations and implications of nonsexual touch, post-treatment friendship, and therapist self-disclosure are addressed under the common theme of boundary construction. The goal of this work is to provide a framework for designing and understanding boundary violations. Current literature is reviewed briefly to highlight opposing views as well as to facilitate a working knowledge of the nature of the ethical dilemmas raised in boundary construction. Finally, an alternative theoretical approach for decision-making is proposed. (Contains 24 references.) (EMK)

This paper describes the outcomes of a study that explored the significance of the Severity of Illness Rating Scale (SIRS) as a tool for utilization review and program evaluation. The SIRS was first introduced in March 1993 and soon became the centerpiece for the Arthur Brisbane Child Treatment Center's Utilization Review Plan. Since its implementation, the monthly average in-house lengths of stay at Arthur Brisbane (an intermediate to long-term state psychiatric hospital) have decreased 142 days, from 234 days in March 1993 to 92 days in February 1996. The SIRS study involved 63 adolescents (ages 11-17) admitted and discharged between August 1, 1994 and July 31, 1995. The average admissions' SIRS scores, discharge settings, and the adolescents' ages proved to be reasonably good predictors of length of stay. Adolescents with higher SIRS scores, who were placed residentially and who were younger, had longer stays. The SIRS scores supported the appropriateness of admissions and, to a lesser extent, program assignments. The SIRS scores also reported improvement from the point of admission to discharge in 7 out of 8 categories of functioning. (CR)

Premature termination of client counseling has primarily been studied in university counseling centers and outpatient therapy settings. Findings from studies at university centers have indicated that some personality variables may be related to premature termination, including low self-esteem, low anxiety, high tolerance for ambiguity, and impulsivity. There has been little clear information obtained about the demographic and psychological characteristics of clients who are unlikely to follow through with treatment. This study investigated premature termination of treatment at a university counselor training clinic. Client demographics (age, gender, education, marital status, family income, client urgency, prior counseling experience at the clinic, and prior counseling experience elsewhere) and psychological symptoms as measured by the Symptom Check List-90-Revised were analyzed for 417 primarily Caucasian clients. Two factors emerged as statistically significant: family income and being a former client at the clinic. Clients with higher incomes tended to continue in counseling, while those with lower incomes were more likely to prematurely terminate. Clients who had received prior treatment at the clinic were more likely to continue in counseling than those who were first-time clients. (NB)

It has been estimated that, by the year 2000, 30% of the American population will hold minority status. More than 50% of minority individuals who seek counseling services terminate after the first session, compared to 30% for white clients. This study examined whether counseling technique was a relevant factor in multicultural counseling by comparing the Rogerian person-centered approach to reality therapy in counseling dyads involving a white counselor and a black client. Black undergraduate students (N=31) viewed videotaped counseling sessions that used either reality therapy or person-centered therapy and completed feedback forms expressing their degree of satisfaction with each scene. The findings revealed that black students viewed reality therapy as more beneficial than person-centered therapy. Black students viewed reality therapy more favorably than person-centered therapy on 7 of 15 statements. The counselor in the reality scene was viewed as honest by 90% of subjects, while the counselor in the person-centered scene was viewed as honest by 52% of the subjects. Only 29% of the subjects felt that the client on the videotape should return to the person-centered counselor, compared to 81% who agreed that the client should return to the reality therapy counselor. (NB)

Therapy dropout is a statistically significant problem. The causes and effects of the high dropout rate still are not known. In this study the therapists' and clients' opinions of the desirability of staying in treatment were compared. At treatment termination clients (N=176) and their therapists (N=22) independently identified clients' termination status. Measures used included the Brief Symptom Inventory; the Child Behavior Checklist; the Therapist Problem Rating; the Client Problem Rating; and Client Satisfaction Rating. Client termination reasons fell into these categories: problem improved; dislike of therapist/therapy; and environmental restraints or considerations. Outcome and satisfaction data were also gathered. There was substantial disagreement between the two (client and therapist) sets of termination classifications. While traditional outcome measures were little related to termination status, satisfaction was highly related to both client and therapist classifications and their interaction. Satisfaction was best explained as a joint function of both client and therapist classification. Results help to explain inconsistencies between client and therapist ratings of outcome. Future research would do well to try to identify client factors that are associated with satisfaction, the most robust measure employed in this study. (ABL)

The estimated median duration of psychotherapy for white clients in the United States is about 5 to 8 sessions; the estimated mean duration is about 10 to 15 sessions; and the dropout rate after one session is about 17 to 22%. A minority of patients make the majority of outpatient mental health visits. This study used a sample of nonpsychotic Chinese American outpatient clients (N=144), mostly immigrants, to test the hypothesis that ethnic minority clients would have a similar patterns of psychotherapy utilization as white clients if ethnic/cultural therapists were provided. The results supported the hypothesis that the ethnic minority clients would stay in psychotherapy or mental health treatment as long as their white counterparts if culturally responsive therapists were provided. The majority of Chinese American clients were assigned Chinese American therapists. The median treatment duration was 10 sessions, and the median duration for individual psychotherapy alone was 6 sessions. When culturally responsive treatments were provided through Chinese American therapists, the dropout rate after the first session for the Chinese American clients was 10%. When the culturally responsive treatments were provided, a minority of the Chinese American clients made the majority of outpatient mental health visits. These findings suggest that ethnic minority clients would fully utilize the mental health service to meet their needs if culturally responsive treatments were provided. (NB)

Current theoretical approaches to understanding emotional difficulties are dominated by the medical model of mental illness, which assumes that emotional dysfunction can be viewed the same way as physical dysfunction. To examine the relationship between psychotherapy clients' beliefs about the medical model of psychotherapy and their behavior during treatment, 39 clients at a student mental health service were administered a measure of acceptance of the medical model at the outset of psychotherapy, and indicated their expectancies for therapeutic improvement. Eight weeks later or at termination, which ever came first, therapists rated their clients' behavior. Results showed that, as predicted, psychotherapy clients who were more accepting of the medical model reported higher initial expectancies for therapeutic gain, controlling for the value of making those gains, and terminated prematurely from treatment more often. Paradoxically, they were rated by their therapists as making more active attempts to address their problems both in and outside of treatment sessions. Clients who were more accepting of a responsibility/control orientation were judged as making less active attempts to address their emotional problems and as more dependent on their therapists; some discussion is given to this unexpected observation. The findings suggest that clinicians need to be sensitive to their patients' mental health ideology. (JAC)

Inconsistent use of contraceptives or discontinuance of family planning services places women at risk of unintended pregnancies. Dropping out of family planning clinics also could mean interrupting gynecological care. Nonetheless, approximately 20% of adolescent family planning patients and nearly 25% of adult patients do not return for a second visit. This study examined reasons for clinic discontinuance by conducting telephone surveys of 628 women more than 2 years after their last clinic visit at one of 62 clinics. Two reasons cited most frequently by respondents were dissatisfaction with the clinic care and the inconvenience of the clinic's hours, location, or transportation. Relationships were found between reasons for discontinuation and the individual covariables of age, years of education, income, use of public assistance, and number of live births. Relationships were found between reasons for discontinuation and the clinic covariables of number of different staff seen by a patient, seeing the same medical care provider, convenience to public transportation, and number of visits by patients with incomes less than 150% of poverty level. During the period following clinic discontinuation, 89% of the women went to another place to get gynecological care or a pelvic examination and 35% went specifically to get family planning services. These findings have both programmatic and policy implications. (NB)

Considerable research has focused on counselor variables related to clients' willingess to continue in psychotherapy. Investigators have studied the effects of a variety of factors influencing counseling dropouts, including administrative policies, client characteristics, and therapist characteristics. This study examined willingness to return as a function of the nature of the clients' presenting problem. Subjects were female college students (N=226). Three scripts, which differed with respect to intimacy and were adapted from actual interviews were used as stimuli. Using a 2 (two counselors) x 3 (low versus moderate versus intense levels of problem intimacy) analogue, these pseudoclients reported more favorable dispositions toward therapy solely as a function of the intimacy of the presenting problem. Generally, when clients' presenting concerns were highly intimate in nature, therapists were viewed as less attractive and trustworthy. Results seem to validate the clinical observations that following significant self-relevations, clients have a tendency to pull back. Since the findings may not be completely generalizable to the clinical situation, further research is needed. (Author/ABL)

Most research on premature termination from therapy has focused on client attitudes. This study examined therapists' attitudes toward their own behavior and toward their clients at intake in relation to premature termination. Premature termination was studied after different numbers of sessions to determine the relationship of therapist attitudes at intake to client premature termination at different phases of treatment. Six psychotherapy practicum trainee therapists served as therapists; 208 college students who sought help at a counseling center served as clients. After initial interviews, therapists completed the Therapist Personal Reaction Questionnaire (TPRQ), assessing therapist feelings toward the client and toward how well the therapist conducted the interview. Scores were analyzed relative to the premature termination of 64 clients, of whom 24 left after 1 session, 35 after 2-9 sessions, and 5 after 10 or more sessions. TPRQ responses indicated that therapists felt they had not understood or been as helpful to their premature terminating clients as to their normal terminating clients during the first session. Therapists felt particularly ineffective with clients who terminated prematurely after only one session. These findings highlight the importance of the initial interview to the course of treatment as assessed by the manner of client termination and number of sessions. (NB)

There is an ongoing debate as to whether alcoholism counselors who are non-alcoholics can be as effective with alcoholic clients as counselors who are themselves recovering from alcoholism. This study compared the impact of the recovering alcoholic counselor and the non-alcoholic counselor on alcoholic clients' perceived belongingness with treatment peers, as well as on length of stay in treatment and relapse rate in a residential treatment center. Two hundred chronic, recidivistic adult male alcoholics admitted to a 90-day all-male residential treatment program over a 4-year period were randomly assigned to one of four counselors: male alcoholic, female alcoholic, male non-alcoholic, or female non-alcoholic. Based on results of structured interviews conducted at 2-week intervals during their stay, clients were categorized at the end of treatment into either the isolate, dyad, cluster, or variant grouping. Treatment outcome was measured by length of stay in the program and rate of relapse during the program. Counselor gender did not seem to be an important factor with respect to client-perceived emotional attachment, length of stay, or relapse rate. The results suggest that a counselor's recovering status does not seem to have any more impact on the clients' perception of belongingness among their peers or on length of stay or relapse rate than that of non-alcoholic counselors. (NB)

This report, prepared pursuant to Public Law 98-183 (Child Abuse Amendments of 1984), examines the nature and extent of the practice of withholding medical treatment or nourishment from infants born with disabilities and makes recommendations to remedy deficiencies in existing law. Evidence suggests that decisions to withhold medically indicated treatment continue to occur despite being prohibited by federal law. The report discusses the effect of the relationship between parents and physicians on decisions to withhold medically indicated treatment; examines the role of quality of life assessments and economic considerations in medical nontreatment decisions; addresses whether the Child Abuse Amendments of 1984 and Section 504 of the Rehabilitation Act of 1973 have been properly implemented and enforced; reviews state laws and Constitutional issues; reports on the incidence of discriminatory denial of medical treatment; explores whether child protective services agencies and hospital infant care review committees are fully complying with the Child Abuse Amendments; and considers whether medical discrimination against children with disabilities is part of a larger problem involving discrimination in the provision of medical treatment to persons with disabilities of whatever age. Appendices contain state-by-state evaluations of child protective services agencies; replies of affected federal agencies to the report's findings; and documents relating to legislation, regulations, and court litigation. (JDD)

This study sought to identify differential psychological symptom status and demographic variability between male/female returners and non-returners to a university counseling center. Data were collected during intake interviews over a 9-month period (N=261). The information analyzed consisted of nine distinct subscale scores of the Symptomatic Checklist (SCL-90R), the five distinct subscale scores of the Psychological Screening Inventory (PSI), and demographic data. Of the 81 men in the sample, 55 returned for post-intake counseling; 26 did not. Of the 180 women, 126 returned for counseling and 54 did not. The subscale scores were analyzed by discriminant function analysis and the demographic data by chi square analysis. The results displayed unique levels of psychological symptoms between male/female returners and non-returners. Chi-square analysis illustrated demographic differences between male/female returners and non-returners. Men who returned for counseling evidenced higher levels of somatization and lower levels of anxiety than men who did not return. Women who returned for counseling showed higher levels of obsessive-compulsiveness and hostility and lower levels of anxiety and paranoid ideation than did non-returners. Findings have implications for intake procedures and for follow-up to identify potential non-returners. References are included. (TE)

An attempt to integrate the career counseling outcome literature (Spokane & Oliver, 1983) indicated that career counseling was definitely beneficial overall. Subsequent updating and additional analyses of the literature confirmed the usefulness of career counseling and led to further findings. Intensity of treatment ("time on task") was found to be a very important variable. Although individual career counseling was considered more effective per unit of time from the perspective of the individual client, group approaches were found to be generally more economical. A lack of standardized measures for many outcomes of interest was revealed, and a particular need for behavioral measures and cost-benefit and cost-effectiveness measures was found. Practitioners are encouraged to assess the outcomes of their career counseling and to follow up clients who appear to have terminated prematurely. This paper reviews the results of this research integration effort and notes some implications of the findings for enhancing career counseling interventions in the areas of diagnosis, treatment, outcome assessment, and follow-up. (Author/NB)

Data on discharge process and caregiver satisfaction were collected from 179 caregivers of hospitalized dementia patients. Findings indicate that social workers are important influences in discharge decisions especially when discharge is to a nursing home. Findings from regression analyses indicate that caregiver satisfaction is dependent on the amount of caregiver involvement in the process. (FC)

Studied discharge plans for 369 African American and white elderly patients and examined posthospital care options pursued by social workers, patients, and families. Discharge planning with African American patients and family members involved less pursuit of nursing home care and more pursuit of formal services in the home than planning with white patients and families. (Author/FC)

Twelve experienced therapists completed a questionnaire, and 8 of the 12 were then interviewed about their experiences with a therapeutic impasse that ended in therapy termination. Data were analyzed using a qualitative methodology. Results indicated most of the clients were anxious and depressed with personality disorders and interpersonal problems. Therapists perceived impasses as profoundly negative for clients and therapists. (KW)

Presents a detailed description of the process of outpatient therapy provided to 56 children who were alleged victims of a day-care sexual abuse case. Therapists utilized a wide variety of techniques, most reflecting a psychotherapeutic approach, with some educational interventions. Examines reasons for therapy termination, and discusses implications of the findings. (JPS)

Reports findings on factors associated with children who terminate psychotherapy prematurely. From a sample of 45 children with an average age of 13.5 years, it was found that children are more likely to remain in treatment if the therapist is perceived as professional and caring, and if the treatment plan is adequately explained. (Author/RJM)

Investigates the differences between 97 patients who had prematurely terminated psychotherapy and 81 who had participated in individual psychotherapy for at least 6 months and 24 sessions on selected Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Rorschach variables. Theoretical implications of interpersonal variables are discussed in relation to the termination and continuation of patients in psychotherapy. (Author/KW)

Process evaluation of a residential alcohol and drug treatment program for the homeless, the New Orleans Homeless Substance Abusers Project, found that treatment effects were in a positive direction, but were rarely significant. Retention in treatment for more than a few months was associated with more positive outcomes. (SLD)

Presents case of psychotherapist and 40-year-old female client whom he sees twice weekly in individual sessions. Describes client's symptoms and progress over 2.5 years of therapy and focuses on client's inability to pay therapy costs. Comments and advice to therapist regarding case are offered by Paul Rosen, Barent Walsh, Michael Stone, and Marsha Linehan. (NB)

Studied 180 community and nursing home clients who received psychotherapy through community mental health center program. Reviewed case records to identify factors associated with persistence in therapy and drop-out patterns. Persistence in treatment was associated with nursing home residence, religious beliefs, and receiving therapy at home; not with self-referral, type of psychiatric diagnosis, age, or gender. (Author/NB)

Examined factors that predict dropping out of therapy among children referred for treatment of oppositional, aggressive, and antisocial behavior. Several factors related to family (socioeconomic disadvantage, adverse child-rearing practice), parent (stress, life events, history of antisocial behavior), and child functioning (severity and chronicity of antisocial behavior, lower intelligence quotient, peer relations) predicted premature termination of treatment. (Author/NB)

Analyzed 145 Chinese American outpatient clients to determine how long they would stay in psychotherapy when ethnic- and language-matched therapists were provided. Results indicated that median duration of psychotherapy was 8 sessions, mean duration was 12 sessions, and drop-out rate was 12.38%. Results were comparable to those from general American public. (Author/NB)

Presents overview of clinical assessment, treatment, and management of suicidal adolescents. Discusses risk assessment as multifocal evaluation of variables. Presents treatment planning as addressing lethality and intentionality. Highlights individual psychotherapy. Examines termination issues, malpractice liability concerns, and general principles of competent practice pertaining to clinical work with suicidal adolescents. (Author/CRR)