c&bp8.1

Treatment of School Refusal Behavior in Children With Mixed Functional Profiles
Christopher A. Kearney, Courtney Pursell, and Krisann Alvarez, University of Nevada, Las Vegas

Many children refuse school for multiple reasons, although this complex type of absenteeism has not been largely addressed in the literature. This article presents two cases that were treated for complex school refusal behavior. Each case was subjected to funcitonal analysis to determine what reasons were primarily maintaining the behavior. Following this process, a multicomponent prescriptive treatment appreach was used to reintroduce the children to school. Treatment was effective, even at 1-year follow-up. Challenges in treating cases of complex school refusal behavior are discussed.

Problems and Interventions of a Pediatric Psychology Clinic in a Medical Setting: A Retrospective Analysis
Amanda B. Sobel and Michael C. Roberts, University of Kansas, and Michael A. Rapoff and Martha U. Barnard, University of Kansas Medical Center

This article provides descriptive information of an outpatient pediatric psychology clinic in a major medical center in a metropolitan area. The characteristics of 250 patients were coded from archived files, representing a random sample of 10% of all cases referred. The majority of patients were boys between 2 and 12 years of age and the most frequent presenting problems were externalizing problems, such as noncompliance, attention problems, hyperactivity, and aggression. Behavioral treatments were administered for the majority of the patients. This study demonstrates what are the practice patterns of a psychology unit in a pediatric setting. The findings belie a characterization of the field of pediatric psychology as only medically related applications, but point to issues of successfully fulfilling the needs of referral sources and expanding marketing niches.

The Influence of Comorbid Risk Factors on the Effectiveness of Cognitive-Behavioral Treatment of Depression
Robert P. Gelhart and Heather L. King, Pepperdine University

Response levels of 92 depressed subjects to a standardized small group CBT intervention were examined. Data on differing comorbid factors and clinical variables were assessed for differential treatment effects. Findings are based on combined groups wherein adults participated in 12, 2-hour skill-building sessions. Participants were assessed for levels of depression, hopelessness, anxiety, and social adjustment at pre- and posttest and 5 follow-up intervals. The intervention was effective in the treatment of unipolar depression for all groups and comorbid and clinical variables were found to have various significant functional relationships with treatment outcome.

SPECIAL SERIES

Facilitating Rational Emotive Behavior Therapy by Including Religious Beliefs
Harold B. Robb, III, Pacific University
Though the vast majority of clients will profess religious beliefs and practices, many behavior therapists may be reluctant to include such beliefs and practices in their treatments because they view them as referring to supernatural events and essences that are beyond the scope of the natural, empirical philosophy claimed as the basis for behavior therapy. This is unfortunate because many clients are willing to take therapeutically useful actions based on these beliefs. It is also unnecessary because beliefs about supernatural events, like beliefs about anything, are empirically reportable and functionally testable, even if the events and essences about which these beliefs are held are claimed to be beyond the bounds of naturalistic, empirical inquiry. This paper outlines some potentially useful interventions combining the principles and practices of Rational Emotive Behavior Therapy and religious beliefs.

Accommodating Religion and Integrating Religious Material During Rational Emotive Behavior Therapy
Stevan Lars Nielsen, Brigham Young University

Rational Emotive Behavior Therapy (REBT) proposes that irrational beliefs evident as absolutistic evaluations cause most self-defeating distress. Absolutistic evaluations are not present in most religious traditions allowing for accommodation of clients' religious beliefs during REBT. Religious doctrine usually includes material that contradicts absolutistic evaluations, allowing for integration of religious material with rational-emotive interventions. Brief excerpts from sessions that demonstrate both accommodating and integrating religious belief during REBT are presented. A project seeking to develop a catalog of religious material for integration with REBT is also briefly described.

To Dispute or Not to Dispute: Ethical REBT With Religious Clients
W. Brad Johnson, United States Naval Academy

Disputation of irrational beliefs is the most commonly utilized therapeutic strategy among therapists practicing from a Rational Emotive Behavior Therapy (REBT) framework. Very little attention has been given to the unique ethical concerns that arise when REBT practitioners treat devoutly religious clients or clients presenting with uniquely religious problems. Ignoring client religious variables altogether or directly challenging and disputing specific religious beliefs both appear ethically problematic . This paper offers a summary of the changing perspective on the compatibility of REBT and religion and an exploration of the ethics of disputing with religious clients. Finally, the author offers a preliminary model for both general and specialized use of disputational techniques with religious clients.

Attachment, Support Seeking, and Adaptive Inferential Feedback: Implications for Psychological Health
Roseanne DeFronzo and Catherine Panzarella, MCP Hahnemann University, and Andrew C. Butler, University of Pennsylvania and The Beck Institute for Cognitive Therapy

The purpose of this study was to examine differences between attachment groups in support-seeking behavior; ability to benefit from adaptive feedback, a subtype of social support; and identity of preferred supportive figure. Two hundred and sixty-eight undergraduates completed a questionnaire packet containing measures of attachment, depressive symptoms, hopelessness, anxiety, and social support. As expected, securely attached individuals engaged in more support-seeking behavior than people with an avoidant attachment style. Contrary to previous literature, social support benefited people with an avoidant attachment style: adaptive inferential feedback was associated with fewer depressive and anxious symptoms. Furthermore, attachment groups did not differ in the rate at which they turned to primary supporters for guidance. The clinical implications of these findings are discussed.

Moderation Training for Problem Drinkers: Treatment Techniques and Clinical Considerations
Marsha Vannicelli, Harvard Medical School

Moderation approaches for the treatment of problem drinkers differentiate the treatment needs of alcohol abusers from those who are alcohol dependent (alcoholics), thereby offering a treatment alternative to many individuals who have not been effectively reached via traditional abstinence-based models. The purpose of moderation approaches is to help individuals who have problematic patterns of drinking to moderate their use of alcohol and thereby to lessen the negative consequences associated with excessive or problematic use. This paper describes one such approach (Moderation Training), detailing treatment techniques (including assessment measures and informed consent form) and highlighting the way in which the therapist interacts with the patient, the metaphors that are used, and what patients are taught that will support their ongoing success with moderation.

Cognitive Therapy of Obsessive Thoughts
Mark H. Freeston, Centre de recherche Fernand-Seguin, and Eliane Léger and Robert Ladouceur, Université Laval

Six people with obsessive thoughts without overt compulsions received cognitive therapy based on a comprehensive cognitive-behavioral account of obsessive-compulsive behavior using techniques developed specifically for OCD (Freeston, Rhéaume, & Ladouceur, 1996). They were treated within a multiple-baseline, experimental single-case design supplemented by a standardized assessment battery using both clinician assessment and self-report. The treatment targeted faulty beliefs specified by the model in a flexible manner based on a case-formulation approach. Participants did not receive instructions or practice in systematic exposure and response prevention. They were encouraged to act in a way that was coherent with their new understanding of obsessive thoughts. Participants received an average of 16.2 sessions of therapy. Follow-up assessment was conducted at 6 and 12 months following the end of treatment. Using a double criteria for clinically significant change, 4 participants (66%) were improved on the Yale-Brown Obsessive-Compulsive Scale at posttreatment, and 5 (83%) were improved at 6- and 12-month follow-up. These results indicate that alternative strategies to structured exposure and response prevention can be effective. The possibility of integrating structured exposure techniques within this treatment framework is discussed.

Treatment of Scrupulous Obsessions and Compulsions Using Exposure and Response Prevention: A Case Report
Jonathan S. Abramowitz, The University of Pennsylvania School of Medicine

Cognitive-behavioral therapy by exposure and response prevention (EX/RP) is an effective treatment for obsessive-compulsive disorder (OCD). However, patients who have religious obsessions and compulsions (scrupulosity) introduce concerns not commonly encountered when treating individuals with other types of OCD symptoms. The present case history describes the successful use of EX/RP for a patient with scrupulosity. Behavioral and cognitive symptoms of OCD responded to treatment and remained improved at 6-month follow-up. Special considerations in presenting the rationale for using exposure-based interventions, and in developing exposure exercises for these types of symptoms, are discussed in detail.

Empirically Informed Consultation to Parents Concerning the Effects of Separation and Divorce on Their Children
Catherine M. Lee and John Hunsley, University of Ottawa

Divorcing parents are faced with concerns about the well-being of the children and the need to establish a new coparenting relationship with the former partner. Traditionally, psychologists have assisted divorcing families with a number of services, including psychotherapy, custody evaluations, and mediation services. The focus of the current article is on the provision of psychological consultation in which parents are provided empirically informed information on the effects of separation and divorce on children. We describe the principles of empirically informed divorce consultation and the professional issues involved in the consultation, the format of the services, and a review of the common themes covered in the consultation (e.g., conflict, shared parenting, dealing with children's needs and emotions, parental distress, developmental considerations). Cognitive behavioral techniques used in the consultation process are identified and strategies for the evaluation of this approach are provided.