Counseling This Study Explored the Research Paper

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Procedures. All patients, regardless of whether they were participating in the study or not, received treatment as usual (TAU) for the first six months of the study. Measurement for this initial six-month period followed this sequence: A standard suite of measurements was administered at session one, session 6 and session 12; ORS and SRS assessments occurred at every treatment session for identified patients (IP) only. During this initial six-month period, counselors only received training in the use of the ORS and SRS as instruments to be added to the standard suite of outcome measures.

In the second six-month period, training in the client-directed outcome-informed approach to therapy was provided to all the counselors. The training components included the following: (1) 16 hours of formal introduction to theory of change according to the Duncan and Miller framework; (2) in-depth training on the use of ORS and SRS for obtaining client feedback and monitoring progress in therapy; (3) assessment of counselors' levels of understanding of CDOI therapy; (4) mastery of CDOI implementation by counselors; and (5) weekly meetings of the research study coordinators to discuss, workshop and resolve any emerging issues related to CDOI. Six counselors were involved in the entire study, and one new counselor was added for treatment of the second cohort.

Results

Data were analyzed through repeated measures using an Analysis of Variance (ANOVA). Outcome measures of behaviors, impairments, symptoms, and social functioning of the children and adolescents participating in the study were obtained through administration of the HoNOSCA. For the HoNOSCA, the means of the treatment groups (Treatment as Usual or TAU and Client-Directed Outcome-Informed or CDOI) were compared for three sources of variation: Treatment, interaction, and time. A significant effect was found for Treatment (F (1,201) = 206, p<.001), which accounts for 25.4% of the variance. Time also showed a significant effect (F (2,201) = 174, p<.001), which explained 42.9% of the variance. A significant effect was also found for Interaction Effect (F (2,201) = 28.5, p<.001), which accounted for 7.0% of the variance. Both the TAU and the CDIO group improved over time independent of treatment. The CDIO group improved to a greater degree and more quickly than the TAU group.

Two scores were reported for the SDQ: Difficulties and Prosocial Skills. Assessment of behavioral attributes occurred at session 1, 6, and review. ANOVA analyses of the mean scores of the treatment groups (Treatment as Usual or TAU and Client-Directed Outcome-Informed or CDOI) were compared for three sources of variation: Treatment, interaction, and time.

ANOVA analysis of the mean scores at review points for the SDQ Difficulties generated the following results. A significant effect was found for Treatment (F (1,201) = 23.3, p<.001), which accounts for 5.83% of the variance. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 73.8, p<.001), which explained 36.94% of the variance. A significant effect was also found for Interaction Effect (F (2,201) = 13.9, p<.001), which accounted for 6.94% of the variance. Both the TAU and the CDIO group improved over time independent of treatment. As in the HoNOSCA, measure, the CDIO group improved to a greater degree and more quickly than the TAU group. The effect size of the differences between the treatment groups across time was small, though it was significant.

ANOVA analysis of the mean scores at review points for the SDQ Prosocial Skills measure gave the following results. The effect for Interaction was not significant. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 84.8, p<.001), which explained 41.63% of the variance. A significant effect was also found for Treatment (F (1,201) = 27.9, p<.001), which accounted for 6.85% of the variance. There was no significant interaction effect between the two treatment groups. The CDIO group improved more quickly but the difference between the two groups with regard to measures of prosocial skills were not as marked at the time of the last review point as they were at the middle review point.

ANOVA analysis of the mean scores at review points for the F-APGAR measure gave the following results. The effect for Treatment was not significant. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 223, p<.001), which explained 63.56% of the variance. A significant effect was also found for Interaction (F (2,201) = 25.6, p<.001), which accounted for 7.29% of the variance. The respondents for this measure were the mothers of the identified patients. There was no significant treatment effect for the two groups for this measure of satisfaction with family transactions. Higher mean scores on the F-FAPGAR indicate greater satisfaction with family transactions. The mean scores at the review points showed a decline for both groups, with the CDIO group actually showing the lowest possible score by the third review point. While there was some interaction effect, time was the element that had the largest effect size on change in the F-APGAR scores.

ANOVA analysis of the mean scores at review points for the ORS Summary Assessment measure generated the following results. A significant effect was found for Treatment (F (1,201) = 94, p<.001), which accounts for 12.36% of the variance. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 196, p<.001), which explained 51.62% of the variance. A significant effect was also found for Interaction (F (2,201) = 36.4, p<.001), which accounted for 9.58% of the variance. Both the TAU and the CDIO group improved over time with a small degree of treatment effect. The CDIO group improved to a greater degree and more quickly than the TAU group. As measured by the ORS Summary Assessment, improvement for the CDIO group in life satisfaction and well-being shows a strong upward trend line with a final mean score spread of 14 points.

ANOVA analysis of the mean scores at review points for the SRS Summary Assessment measure generated the following results. A significant effect was found for Treatment (F (1,201) = 83.4, p<.001), which accounts for 15.19% of the variance. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 57.7, p<.001), which explained 21.04% of the variance. A significant effect was also found for Interaction (F (2,201) = 74.5, p<.001), which accounted for 21.04% of the variance. The positive perceptions of therapeutic alliance as measured by the SRS Summary Assessment increased for the CDOI group, whereas the TAU group showed very little change on this measure. Time, treatment, and interaction effects were all strong in this measure, collectively accounting for roughly 63% of the variance.

ANOVA analysis of the mean scores at review points for the ORS Session by Session measure generated the following results. A significant effect was found for Treatment (F (1,201) = 518, p<.001), which accounts for 19.57% of the variance. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 104, p<.001), which explained 43.17% of the variance. A significant effect was also found for Interaction (F (2,201) = 16.3, p<.001), which accounted for 6.78% of the variance. This measure of satisfaction with therapeutic sessions showed much a faster and greater increase for the CDOI group than the TAU group. The effect size for time was markedly high and a strong effect size was demonstrated for treatment. Over time, the CDOI group rated their therapeutic sessions more favorably than did the TAU group.

ANOVA analysis of the mean scores at review points for the SRS Session by Session measure generated the following results. A significant effect was found for Treatment (F (1,201) = 345, p<.001), which accounts for 17.38% of the variance. Of the three sources of variance, Time showed the most significant effect (F (2,201) = 23.5, p<.001), which explained 12.99% of the variance. A significant effect was also found for Interaction (F (2,201) = 52.4, p<.001), which accounted for 29.02% of the variance. This snapshot measure of therapeutic attribution showed a more modest increase in positive ratings by the CDOI group than the TAU group. The trend line was not as deep or as steep for the SRS Session by Session measure as it was for the ORS Session by Session.

Discussion

Considerable congruence exists among the various outcome measures used in this study. Overall, clients in the CDOI group were better able to achieve their therapeutic goals, showing much improvement over a relatively short period of time. Moreover, the clients in the CDOI group indicated that they were more satisfied with the therapy sessions and the therapeutic alliance.

The limitations of this study are naturally those of any quasi-experimental research. Causality is not definitive and as a result, generalizability of the results is constrained. Moreover, measures were apparently not conducted in other contexts in order to verify that behavior change was occurring in tandem with the therapy (Ardelt & Eccles, 2001; Miller, 1995). The scores on the F-APGAR signal the need…

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