First impressions : a Study of the Relationship Between Presenting Problems and Clinical Perception

Processes involved in clinical perception typically result in tangible outcomes of interest to clients and practitioners (e.g., diagnoses). In developing an overall impression of clients, practitioners integrate information related to target problems clients present. Substance abuse counselors, in particular, are increasingly being asked to assess clients for co-occurring problems. Domestic violence has been identified as a particularly salient co-occurring problem associated with substance abuse. This dissertation draws on theory by Solomon Asch (1946, 1952) to examine how presenting problems such as domestic violence shape clinical outcomes and processes in substance abuse assessment interviews. Most clinical interactions occur, however, under confidential conditions. Designed as an added component to a study funded by the National Institute on Drug Abuse, the dilemma of confidentiality was circumvented by using a standardized patient. Standardized patients (SPs) are actors trained to simulate a set of symptoms across multiple clinical encounters, allowing researchers to investigate therapeutic interactions. Eighteen participating substance abuse counselors conducted one mock assessment interview each with a SP who alternated her presenting problem between (a) a problem with violence in a domestic setting and (b) a problem with methamphetamine use. Post interview questionnaires and transcribed videotaped interactions were analyzed using frequency counts, t-tests, content analysis, blind ratings of questionnaires on particular dimensions and narrative analysis. Results include a serendipitous finding that counselors substantially referenced the SP\u27s maternal role and associated status throughout analyses. However, divergent patterns in impression formation processes and outcomes occurred for the two groups, providing evidence that a dynamic interaction occurred between the SP\u27s maternal status and her presenting problem in perception formation processes for counselors. Findings support Asch\u27s (1946, 1952) assertions on dynamic processes involved in interpersonal perception, drawing attention to implications of socially salient roles, including associated expectations, in clinical contexts. Social psychological theory as well as practice related to substance abuse counseling and domestic violence intervention benefit from identifying how socially defined information presented initially shape clinical encounters. The dissertation suggests lines of inquiry for future research on impression formation from multiple methodological perspectives using standardized patients, a combination supportive of bridging the gap between research and practice

Implementation of Evidence-Based Practices for Treatment of Alcohol and Drug Disorders: The Role of the State Authority

The current climate of increasing performance expectations and diminishing resources, along with innovations in evidence-based practices (EBPs), creates new dilemmas for substance abuse treatment providers, policymakers, funders, and the service delivery system. This paper describes findings from baseline interviews with representatives from 49 state substance abuse authorities (SSAs). Interviews assessed efforts aimed at facilitating EBP adoption in each state and the District of Columbia. Results suggested that SSAs are concentrating more effort on EBP implementation strategies such as education, training, and infrastructure development, and less effort on financial mechanisms, regulations, and accreditation. The majority of SSAs use EBPs as a criterion in their contracts with providers, and just over half reported that EBP use is tied to state funding. To date, Oregon remains the only state with legislation that mandates treatment expenditures for EBPs; North Carolina follows suit with legislation that requires EBP promotion within current resources

Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation.

Background and aimsTherapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF).MethodsRaters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy and global session performance.ResultsTherapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions.ConclusionsResults have implications for therapist selection, training and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills

Therapist predictors of treatment delivery fidelity in a community-based trial of 12-step facilitation.

Background and aimsTherapist characteristics may be associated with variation in consistency, quality and effectiveness of treatment delivery. We examined associations between treatment fidelity and therapist education, experience, treatment orientation and perceived skills in a randomized, multi-site trial of Twelve Step Facilitation (TSF).MethodsRaters scored audio-recorded, TSF sessions (n = 966; 97% of TSF sessions) from 32 community-based, trained therapists for adherence, competence, empathy and global session performance.ResultsTherapists with graduate degrees had significantly higher adherence and global performance fidelity ratings. Therapists reporting more positive attitudes toward 12-Step groups had lower adherence ratings. Being in recovery was associated with lower fidelity in univariate tests, but higher adherence in multivariate analysis. Fidelity was higher for therapists reporting self-efficacy in basic counseling skills and lower for self-efficacy in addiction-specific counseling skills. Fidelity was also superior in group relative to individual TSF sessions.ConclusionsResults have implications for therapist selection, training and supervision in community-based, effectiveness trials and community implementation of evidence-based treatments. To obtain high fidelity and improve outcomes, it may be preferable to choose masters level therapists who are open to learning new treatments and have good, general counseling skills