Publications: 1999
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Barkham, M., Shapiro, D.A., Hardy, G.E., & Rees, A. (1999). Psychotherapy in two-plus-one sessions: Outcomes of a randomized controlled trial of cognitive-behavioral and psychodynamic-interpersonal therapy for subsyndromal depression. Journal of Consulting and Clinical Psychology, 67, 201-211. A total of 116 clients with a range of subsyndromal depression received 3 therapy sessions: 2 sessions 1 week apart followed by a 3rd session 3 months later (the 2 + 1 model). Clients were stratified for severity on the Beck Depression Inventory (BDI) as stressed, subclinical, or low-level clinically depressed. In a 2 X 2 design, they received either cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy, either immediately or after a 4-week delay. An initial advantage for the immediate condition disappeared once the delayed-condition clients received treatment. Improvement rates at the end of treatment were 67% (stressed), 72% (subclinical), and 65% (low-level clinically depressed). There were no significant differences between CB and PI treatment methods, with the exception at 1-year follow-up, when the BDI showed a significant advantage for CB. Implications for designing very brief planned interventions are discussed.
Hardy, G.E., Aldridge, J., Davidson, C., Rowe, C., Reilly, S., & Shapiro, D.A. (1999). Therapist responsiveness to client attachment styles and issues observed in client-identified significant events in psychodynamic-interpersonal psychotherapy. Psychotherapy Research. 9, 36-53. We analyzed the influences of client interpersonal styles on therapy processes using an attachment theory framework. Ten transcripts of client identified significant therapy events were analyzed for evidence of client attachment styles (dismissing, preoccupied, or secure), attachment issues, and therapist responsiveness to attachment issues. The attachment issues identified tended to focus on three themes: concerns about loss or rejection, feelings surrounding conflict and danger, and the need for closeness or proximity. Therapist responses were categorized as either (a) providing containment, safety, and structure, (b) reflecting the client emotions and concerns, or (c) interpreting or challenging the client attachment style. It was hypothesized that therapist responses to client attachment issues would be mediated by client attachment styles. In these 10 events there was evidence that therapists responded to preoccupied attachment styles with reflection and to dismissing styles with interpretation, as had been hypothesized.
Hardy, G.E., Shapiro, D.A., Haynes, C.E., & Rick, J.E. (1999). Validation of the General Health Questionnaire-12 using a sample of employees from England's health care services. Psychological Assessment, 11, 159-165. Psychiatric interviews were carried out to validate the General Health Questionnaire-12 (GHQ-12; Goldberg, 1972) for use with staff of England's National Health Service (NHS), and to determine the appropriate threshold score to identify probable cases. In a sample of 551 NHS staff, the correlation between the GHQ-12 and the Clinical Interview Schedule-Revised (CIS-R) was found to be .70. The receiver operating characteristic showed that a 3/4 threshold, higher than used in all but one previous study, gave the best conservative estimate of minor psychiatric morbidity. This threshold gave an estimated sensitivity of the GHQ-12 of .69 and specificity of .88. It reduced case rates by between 8% and 17% as compared with lower possible thresholds. Convergent and discriminant validation of the GHQ-12 was demonstrated through comparison with other measures of mental and physical health.
Macran, S., Ross, H., Hardy, G.E., & Shapiro, D.A (1999). The importance of considering clients' perspectives in psychotherapy research. Journal of Mental Health, 8, 325-337. This paper argues that for evidential, political and conceptual reasons it is important for psychotherapy researchers to consider clients' perspectives. We discuss some of the reasons why, traditionally, researchers have tended to neglect clients' perspectives, and some of the reasons why taking clients' views is both appropriate and necessary for the development of the field. We then describe psychotherapy research at four levels of client involvement. Finally, we show some ways that researchers could enhance their research by taking clients' perspectives.
Williams, J.M.G., Stiles, W.B., & Shapiro, D.A. (1999). Cognitive mechanisms in the avoidance of painful and dangerous thoughts: Elaborating the assimilation model. Cognitive Therapy and Research, 23, 285-306. The emotional processing of problematic experiences is a central feature of psychotherapy. Stiles et al. (1990) propose an Assimilation model as a generic account of such processes. This paper focuses on two aspects of this model: the concepts of "warding off" and "unwanted thoughts", showing how a cognitive science perspective can enrich our understanding of them. We focus on the ways in which cognitive processes (particularly different sorts of memory) mediate between experience and psychopathology. Two classes of problematic experiences that can be avoided or barred from full awareness to varying degrees are distinguished. We refer to this distinction as the "pain paradigm", in which experiences are inaccessible to memory retrieval using verbal mnemonics, versus the "panic paradigm", in which experiences fail to be retrieved or reported because the person anticipates catastrophic consequences. We discuss how understanding the cognitive origins of these phenomena promises to allow researchers and therapists to generate new approaches to overcome blocks in therapy.
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