Digital Commons Network^™

The Implications, Magnitude, And Development Of Traumatic Brain Injury For Individuals Undergoing Treatment For Opioid Use Disorder, Hannah G. Mitchell

Electronic Theses and Dissertations

There is an established bidirectional relation between substance use and traumatic brain injuries (TBIs). Despite the high rate of prescribing opioids for pain management following a TBI and the epidemic of opioid use disorder (OUD) in the United States, scarce research has specifically analyzed the association between TBI and OUD. In a series of three interrelated manuscripts, the present study will first examine the prevalence and features of TBIs among persons seeking treatment for OUD. Next, the present study will evaluate the association between TBI and indicators of risky health behaviors and OUD severity, including the risk of overdose and …

Psychotherapist Awareness And Competence Managing Social Media Concerns, Jing Wen Ong

Electronic Theses and Dissertations

Social media use increased substantially in recent years, spurring the growth of research focused on its association with mental health. Previous research examined the relationship between positive and negative aspects of mental health and social media use. Other studies explored the relevance of social media to professional practice of psychologists including the use of social media to reach populations with limited access to mental health services and ethical dilemmas arising from social media use; however, there is limited understanding of the pertinence of social media to concerns that clients discuss in therapy and therapist competence in handling these discussions. The …

The Effects Of Cultural Responsiveness And Therapy Duration On Black Americans’ Therapy Preference, Katilyn M. Ashley Treem

Electronic Theses and Dissertations

Marginalized groups are less likely to seek out mental health services than non-marginalized groups. There are various reasons why marginalized groups, such as Black Americans, are less likely to seek out mental health services, one of which is the cultural barriers between a clinician and client. Research suggests that Black Americans feel that clinicians struggle to overcome these cultural barriers. Therefore, it is important for clinicians to actively receive training on how to serve clients with diverse backgrounds. Cultural responsiveness, an extension from cultural competence, is the active application of the knowledge and skills obtained in training. Examining people’s therapy …

Using A Three-Dimensional Theoretical Orientation Matching Model To Predict Therapeutic Outcomes, Daniel Rhodes

Electronic Theses and Dissertations

Matching helpers and clients in a therapeutic setting is inefficient and ineffective. So far, there are no significant and enduring variables that reliably match helpers and clients that lead to positive therapeutic outcomes. This study attempts to match helper and client using theoretical orientation. It uses a quantitative methodology to predict therapeutic outcomes given match quality in the therapeutic dyad. Participants were 30 dyadic pairs—consisting of one helper and one client—who had a pre-existing therapeutic relationship. Each was given an assessment tool, used to measure their theoretical orientation to psychotherapy. Results showed no statistically significant relationships between theoretical orientation match …

Working Through Lingering Anger Following Interpersonal Grievances: Examining Mechanisms Of Change In Rumination, Reappraisal, And Identification Of Unmet Needs, Michael Arend Strating

Electronic Theses and Dissertations

Many clients present to psychotherapy with lingering feelings of anger, bitterness, or resentment in response to interpersonal grievances. The current project sought to compare the effects of cognitive reappraisal and needs identification interventions on lingering anger while determining whether intervention effects occur through shared or distinct mechanisms of change. Using an experimental, therapy-analogue design, 197 undergraduate participants (Study 1) completed a brief, self-guided online intervention involving either anger rumination (comparison condition), cognitive reappraisal, or needs identification. This design was replicated in a clinical sample of 31 participants (Study 2) who were recruited from local mental health clinics using the same …

A Phenomenology Of Challenging Psychedelic Experiences: From Relational Trauma To Relational Healing, Leland Guthrie

Electronic Theses and Dissertations

Psychedelic medicine is a re-emerging therapeutic paradigm with potentially significant clinical applications. This study contributes to an understanding of the aspects of challenging psychedelic experiences that may contribute to therapeutic outcomes. Interview and written data from five participants about their challenging Ayahuasca experiences was analyzed using Interpretative Phenomenological Analysis (IPA). The results of this analysis revealed a phenomenological structure of challenging psychedelic experiences consisting of a change process that moved the participants from a sense of disconnection to a sense of connection with themselves, others, nature and the cosmos. Findings from the study suggest that challenging psychedelic experiences may be …

Trainee Attitudes Toward Social Class As Predictors Of Clinical Decision Making: Exploring The Effects Of Classism In Psychotherapy, Jeremy J. Coleman

Electronic Theses and Dissertations

The current study examined the effects of classist beliefs on trainee attitudes toward their client based on perceived social-class status. This study sought to determine whether classist attitudes contribute to meaningful differences in clinical decision making. A sample of mental health trainees (n = 147) attending graduate-level programs in the U.S. were recruited and randomly assigned to one of two clinical vignette conditions. Both vignette conditions included identical data regarding a hypothetical client’s presenting concerns (e.g., sleep disturbance, worry, rumination, loneliness), but differed on indicators of client socioeconomic status (SES). Results showed statistically significant between-group differences on ratings of clinical …

Psychological Factors That Impact White Counseling Trainees’ Responses To Cultural Ruptures, Emma Freetly Porter

Electronic Theses and Dissertations

In the field of counseling and clinical psychology, the last several decades have been characterized by a strengthened recognition of the importance of cultural factors in psychotherapy. While this has been impactful, there is evidence that cultural ruptures, microaggressions, and racial/ethnic disparities in psychotherapy outcomes persist. Aversive racism theory, which provides explanations for the racist tendencies typically associated with progressive White individuals, postulates that a conflict between explicit egalitarian beliefs and implicit negative racial biases impedes White individuals from adequately addressing and acknowledging underlying biases. Therefore, it was hypothesized that psychological factors, such as defense mechanisms, professional selfdoubt and self-compassion, …

Without Words: Relational Neuropsychology And Creative Arts Therapies With People Managing Aphasia, Autumn Marie Chilcote

Electronic Theses and Dissertations

Aphasia describes the broad experience of disrupted language production or comprehension acquired after structural changes in the brain. These changes, usually associated with stroke, tumor, or cortical degeneration, are often co-occurring with other symptoms, such as emotional dysregulation, partial paralysis, and difficult social, occupational, and community relationships. Common approaches to research and rehabilitation with persons managing aphasia highlight conversation and semantic retrieval, with a lack in literature considering the diversity of symptoms and responses. Questions arise as to the ways that psychotherapies, typically language- centered, can be adapted to collaborative, low-verbal approaches that attend to the range of individual symptoms …

Therapeutic Rupture Repair In Treatment Of Military Adolescents., Brent Anthony Luebcke

Electronic Theses and Dissertations

Ruptures in the therapeutic alliance have shown to be a significant predictor of therapy outcomes, with non-repaired ruptures resulting in increased dropout rates of therapy, and repaired ruptures resulting in positive therapy outcomes. This study investigated the impact of alliance ruptures on outcomes of therapy among youth and adolescents, with a specific focus on military youth and adolescents. A sample of 5,640 military adolescents who were treated by 101 therapists were selected for analysis based on inclusion criteria of: a) being aged 13 to 19 years old; and b) attending more than one session of therapy. Each session, clients completed …

Targeting Self-Critical Thoughts In The Treatment Of Non-Sucidal Self-Injury In Adolescents: Accentuate The Positive, Eliminate The Negative, William Ramsey

Electronic Theses and Dissertations

The primary purpose of this investigation was to examine the added benefit of directly targeting self-critical thoughts in the treatment of non-suicidal self-injury (NSSI) in youth undergoing Dialectical Behavior Therapy for Adolescents (DBT-A). This was a randomized study of 40 adolescents with recent engagement in NSSI at a partial hospitalization program using DBT-A. This study utilized an additive component treatment design with randomization to either DBT-A or DBT-A Plus. All study participants received the full DBT-A protocol, and those randomized to the DBT-A Plus condition received a brief cognitive intervention developed to decrease self-critical thoughts in adolescents. Of the 40 …

The Inheritance Of This Moment: An Exploration Of Temporality, Subjectivity, And Liberation In Non-Dual Contemplative Practice And Psychotherapy, Jeremy Axelrad

Electronic Theses and Dissertations

This dissertation considers the meaning of “present-moment awareness” and its role in psychological healing and transformation. The current conversation around mindfulness, a secularized practice with roots in Buddhist contemplative traditions, has largely unfolded within a dualistic framework in which subject and object are separate from one another as well as from a discrete entity called a moment. While widely appreciated for its capacity to foster well-being and insight, mindfulness as construed above remains disconnected from Buddhist psychology’s non-dualistic view of experience, which radically challenges our ordinary understandings of subjectivity and temporality. In the current project, I sought to explore this …

The Efficacy Of Equine Assisted Therapy In The Treatment Of Autism Spectrum Disorders, Amy Hofmann

Electronic Theses and Dissertations

This study examines the effects of equine-assisted psychotherapies in children with an autism spectrum disorder. The CARS-2 and Children’s Sleep Habits Questionnaire parent-report questionnaires were used for evaluation, as well open-ended questions. A single researcher contacted and visited many PATH-certified centers in the United States. Facilities that participated were all located in the Mid-Atlantic to Northeast region. There were 16 participants, from 11 different farms, that completed both the initial and follow-up questionnaires which were given 7 weeks apart. A $25 Amazon gift card was used as an incentive to increase participation. Participating facilities also completed a questionnaire.

Overall, results …

The Impact Of Sudden Gains And Deteriorations On The Psychotherapy Process, Joanna Mary Drinane

Electronic Theses and Dissertations

Within the field of psychotherapy research, there has been significant evidence to suggest that people change and improve because of treatment (Lambert & Ogles, 2004). One common phenomenon that has been observed when looking more closely at outcome trajectories has been termed sudden gains/deteriorations. These are defined as sudden changes in outcome (either positive or negative) of 25% or more from the pre-change level of symptoms that are in turn sustained over time (Tang & DeRubeis, 1999). Although there are data regarding how people who experience sudden gains end up after treatment, no studies have examined the impact that sudden …

Are Psychotherapies With More Dropout Also Less Effective?, Catherine Marie Reich

Electronic Theses and Dissertations

Psychotherapy dropout is often regarded as an indicator of treatment failure. However, this assumed relationship between dropout and outcome has not been well established. The current research consisted of three meta-analytic studies, the results of which found (a) greater dropout from one treatment relative to another was predictive of the greater effectiveness of that treatment for the completers, (b) individuals who dropped out of therapy were more distressed at posttreatment than individuals who completed therapy, and (c) individuals who dropped out began treatment more distressed than those who completed therapy. The issue of continued ambiguity in the meaning of dropout …

A Meta-Analytic Review Of The Relationships Between The Therapeutic Alliance, Empathy, And Genuineness In Individual Adult Psychotherapy., Jacob B. Nienhuis

Electronic Theses and Dissertations

This dissertation explored the relationship between the therapeutic alliance and perceptions of therapist empathy and genuineness through a systematic review and meta-analysis. Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. Prior meta-analyses demonstrated that alliance, empathy, and genuineness each had a moderate relationship to therapy outcome. No previous analysis has explored how therapist empathy and genuineness contribute to the therapeutic alliance. Studies for this analysis were obtained through a multi-part search strategy. Out of 2,141 obtained abstracts, 46 studies contained enough data for inclusion in the meta-analysis. Thirty-six studies reported alliance/empathy relationships, six studies reported alliance/genuineness …

Primitive Defenses And Unilateral Termination Of Psychotherapy: Are The Lerner Defense Scales Useful In Predicting Premature Termination In Psychotherapy?, Teal Fitzpatrick

Electronic Theses and Dissertations

This study explored whether a predictive relationship exists between primitive defense scores on the Lerner Defense Scales and premature termination from psychotherapy. A review of literature that described the history and development of the construct of primitive defense, as well as the purpose and formation of the Lerner Defense Scales was conducted in order to provide a context for the relevance of this study. Using achieved patient files from the Duquesne University Psychology Clinic, subjects were chosen for this project based on properly archived Rorschach Protocols (which are used to score the Lerner Defense Scales) and descriptive Final Summaries that …

Emotional Processing In Self-Narratives As A Predictor Of Outcome In Emotion Focused Therapy For Child Abuse Trauma (Eftt), Shayna Hannah Nussbaum

Electronic Theses and Dissertations

The present study is the first to test a model of emotional change processes in self-focused sessions of emotion-focused therapy for trauma (EFTT), whereby early expressions of distress (e.g., fear, shame) shift to Advanced Meaning Making (AMM) states (e.g., assertive anger, grief) in later sessions. Archival data (videotaped sessions, self-report measures) from a previous study (Paivio, Jarry, Chagigiorgis, Hall, & Ralston, 2010) were utilized. Emotional processing was rated using the Classification of Affective Meaning States (CAMS; Pascual-Leone & Greenberg, 2007). Result of odds ratio analyses revealed increases in expression of AMM in late sessions compared to early sessions. Results of …

Examining The Alliance-Outcome Relationship: Reverse Causation, Third Variables, And Treatment Phase Artifacts, John Paul M. Reyes

Electronic Theses and Dissertations

Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth and adult literatures. Despite these consistent findings, prospective associations are not sufficient to support the claim that the alliance is a change mechanism in psychotherapy. The current study examined the direction of effect of the alliance-outcome relationship, the contribution of early symptom change in treatment to the development of therapeutic alliance, and the potential for pretreatment interpersonal functioning characteristics to be third variables that account for the association between alliance and outcome. Participants were adolescents with depression and a history of interpersonal trauma that presented to …

The Ethical Imagination: A Hermeneutical Study, Jeb Gordon Jungwirth

Electronic Theses and Dissertations

This research examines and describes the ways psychotherapists address ethical dilemmas through a hermeneutic analysis of how they responded to a portrayal of a therapy session represented in a television series. Interview transcripts were analyzed and assessed for both how therapists navigate difficult ethical terrain, and upon what, thematically, they tend to direct their thought and concern. Moreover, particular consideration is given to the role of imagination in the development of ethical meaning, intention, and understanding in the clinical context, which intersects with a critique of the American Psychological Association's ethics code and its underlying philosophical assumptions. Such theoretical underpinnings …

Psychotherapy As Constitutional Practice: A Detailed Interaction Analysis Of The Change Process In Psychotherapy, Cody L. Maddox

Electronic Theses and Dissertations

Psychotherapy is concerned with changing individuals: it is a practice devoted to the constitution of certain kinds of subjects. Although the various therapeutic schools have their own explanations of psychotherapeutic change, more empirical work needs to be dedicated to understanding how this process takes place. In this study, a fine grain research methodology is used to produce an account of the change process that occurred over the course of two psychotherapy sessions. The data consists of naturally occurring video recordings of a single therapist and client dyad. The goal of this research is to examine the relationship of mutual formation …

What Happens When Therapists Are More Directive? Correlating Directiveness With Psychotherapy Process And Outcome, Henry You-Chee Hua

Electronic Theses and Dissertations

This study examined the relationship between therapist directiveness and the process and outcome of psychotherapy. Fifty-two therapy sessions were coded for turn-by-turn therapist directiveness, client compliance, and overall perceived therapist directiveness. These scores were compared to ratings of therapy process and outcome, reported by clients after the session. Additional analyses controlled for client compliance, pretreatment problem severity, and the interaction of directiveness with compliance. This study found no support for directiveness having any reliable relationship with the process or outcome of psychotherapy. Possible improvements are offered for future research on this topic.

More To Gain: Sudden Gains In Experiential Therapy For Depression, Terence Singh

Electronic Theses and Dissertations

The present study involves the first attempt to identify sudden gains in a sample of clients undergoing experiential treatment for depression. "Sudden gains," or sudden, substantial improvements in depressive symptomology between consecutive psychotherapy sessions, have been repeatedly observed among depressed clients in psychotherapy. Approximately 45% of depressed clients appear to experience sudden gains, and those clients who do experience sudden gains appear to have significantly better treatment outcomes than those who do not (Tang et al., 2007). While there exists some evidence for the generalizability of sudden gains across treatment modalities (e.g., Kelly et al., 2007; Present et al., 2008), …

Does The Depth Of Client Experiencing Predict Good Psychotherapy Outcomes? A Meta-Analysis Of Treatment Outcomes , Nikita Yeryomenko

Electronic Theses and Dissertations

The Experiencing Scale (EXP), a measure of client's emotional processing, is often used in psychotherapy process research. While researchers agree that it predicts treatment outcomes, this relationship has not been systematically studied. This meta-analysis quantified the relationship between EXP and therapy outcomes using a total of 11 studies and 458 clients. Analysis indicated that peak EXP measured during the working phase was the strongest predictor of treatment outcomes, r = .236. Subgroup analyses indicated that working phase effects were moderated by the outcome measure modality. Early phase effects were moderated by the type of treatment and the treatment target. In …

Do Reflective Responses By The Therapist Improve The Outcome Of Psychotherapy, Catherine Marie Reich

Electronic Theses and Dissertations

Although reflective listening is a technique used by a number of therapeutic orientations, there is little empiricial evidence of its causal impact on psychotherapy outcome. This randomized clinical trial examined whether reflective listening by therapists influences perceptions of empathy or therapeutic outcome. In the study, therapists at a university counseling center were trained to use either a greater or lesser number of reflective responses with clients they treated. Both clients and therapists then completed empathy and outcome measures after each of the first four sessions of treatment. Analyses failed to suggest that therapist reflection actually occurred more frequently in one …

Wisdom-Based Approaches To Psychotherapy: Challenging The Dominant Psychotherapy Culture, Elizabeth Piazza Bonin

Electronic Theses and Dissertations

This research study explores the construct of clinical wisdom and the ways in which it is enacted by psychotherapists who are seen as wise by their peers. In previous research, clinical psychologists have outperformed other professionals in wisdom-related tasks, suggesting that there is an aspect of wisdom that might be imparted by clinical training and practice. There is, however, virtually no research specifically addressing the development and enactment of wisdom in psychotherapy practice. Seventeen psychologists who were nominated multiple times by their peers as being "wise" participated in an interview on their understanding of wisdom within psychotherapy practice and training. …

Encountering Questions Of Religion In Psychotherapy: A Hermeneutical-Phenomenological Study Of Religious Patients' Experiences, Jonathan Ahern

Electronic Theses and Dissertations

This dissertation presents a hermeneutical-phenomenological investigation of having one's religious or spiritual views called into question in psychotherapy. A review of the literature revealed very few studies exploring the experiences of religious or spiritually devoted psychotherapy patients and a complete lack of studies describing the lived phenomenon of having one's religious or spiritual views called into question in psychotherapy. Three self-described "religious" or "spiritually devoted" former psychotherapy patients provided in-depth descriptions of having their religious views or practices called into question in psychotherapy. Participants' descriptions--gathered first in writing and then by way of a hermeneutic interview--comprised the empirical qualitative data …

Finding Voice: An Introduction To Philosophy And Psychotherapeutic Practice, Ryan Mest

Electronic Theses and Dissertations

Finding Voice faces the challenge of introducing therapists to philosophy and philosophers to psychotherapy in the same breath. Balancing philosophical rigor with an accessible writing style, I introduce psychotherapeutic practice by interpreting carefully selected philosophical texts as scholarship on psychotherapy. Throughout the work, I offer clinical vignettes, examples, and stories to illustrate the ideas as well as enrich the reading experience.

Part One introduces psychotherapy as an ethical treatment for moral pain. I dare to present the Kierkegaard of Fear and Trembling (1846/2006) as a good therapist for Abraham. I turn to the Derrida of "Whom to Give to (Knowing …

Vincent Van Gogh, A Formal And Psychological Analysis Of The Final Years At Arles, Saint-Remy And Auvers., Sue Ann Grey 1943-

Electronic Theses and Dissertations

This dissertation is an intensive analysis of the artworks and letters of Vincent van Gogh focusing on the final three years of his life from February 1888 to July 1890 at Arles, Saint-Rémy, and Auvers. The author is both an art historian and an art therapist, so this is an interdisciplinary dissertation. Chapter one, the introduction, provides the theoretical background for this paper, discussing the words and images of Vincent van Gogh, and setting forth the thesis statement: The thesis statement of this dissertation is that variations in the psychological state of Vincent van Gogh are discernable be psychoanalytical analysis …

Truth As Relationship: The Psychology Of E. Graham Howe, Ian Charles Edwards

Electronic Theses and Dissertations

Dr. Eric Graham Howe (d. 1975) was one of the most important psychologists in early 20th century Britain. Yet, for the most part, his work is relatively unknown. Howe was unjustly dismissed by the psychoanalytic community of his time. Howe was not only left out of the history of psychoanalysis, but also the history of psychology. Because of Howe's uninhibited eclecticism, because both the psychoanalytic and psychological literatures have ignored his work, and because he contributed to his own posthumous neglect, it was necessary to write a comprehensive survey of Howe's writings. Such a survey demonstrated the depth of his …