In the course of psychotherapy, psychologists need to make important clinical decisions regarding treatment goal selection, measurement procedures, and treatment methods. These decisions can be made without regard to the epistemic and ethical responsibilities that accompany professional status. Epistemic duties are obligations to obtain and have knowledge, while ethical duties are obligations to apply this knowledge accurately. We argue that these epistemic and ethical responsibilities are invoked and can be adequately addressed in the informed consent process. When the informed consent process is violated or done poorly, our epistemic and ethical responsibilities are not met and the client may be harmed. We argue that what the public assumes it is buying from us (and what we purport to sell) are specialised knowledge and skills; when psychologists are not meeting their epistemic duties, what our clients are receiving instead is intuition and performance art. We discuss errors that occur in the course of psychotherapy, as well as how we as professionals must seek to reduce or eliminate them.

Difficulties in settling children to sleep and night waking are common problems faced by parents with young children. The effectiveness of parent-managed behavioural intervention is examined in this study of four children which employs a multiple-baseline-design across subjects. Components of the intervention included: establishing regular bedtime routines; paying attention to the children before bed in the living areas and staying with the children only briefly when settling them in bed; adopting procedures for ignoring disruptive bedtime behaviour and night waking; and giving praise for appropriate behaviour. Complete success in settling the three children who were difficult at bedtime was achieved in five to fourteen days. Persistent night waking in all four children was eliminated in five to thirteen nights.

Objective: The effects of contingency management to induce physical activity levels were examined in seven non-obese physically inactive undergraduate students by providing monetary payments using a multiple baseline, changing-criterion procedure. Methods: Participants attended a baseline phase, a subsequent intervention phase consisting of three exercise sessions per week for 4 weeks, and a follow-up session 2 weeks post intervention. A total of $145 was available for attendance and exercise contingency payments. Results: Results indicate that all participants significantly increased exercise during intervention from inactivity at baseline to exercising three 30-minute sessions per week. Participants maintained some gains during follow-up. Limitations: The study employed a small and homogenous sample size and required participants to exercise in a lab setting thus limiting external validity. Conclusions: These findings suggest that incentive-based interventions are an effective and viable means for inducing exercise.

Cognitive theories and therapies of emotional dysfunctions are based on the premise that the affective, behavioural, and cognitive response repertoires are fused and highly interdependent. Such views have been criticised with the argument that affect and cognition are relatively independent and that there is a much more direct and stronger link between affect and behaviour. In an attempt to clarify potential differences in the interplay between affect, behaviour, and cognition in unipolar depression and phobic anxiety, a quantitative review of the relative efficacy of performance-based (behavioural) versus cognitive intervention for these disorders was conducted. The relative superiority of cognitive over performance-based interventions in the treatment of unipolar depression supports the notion of a reasonably direct link between cognition and affect for this disorder providing a fairly effective pathway for treatment. On the other hand, the relative success of performance-based techniques in the treatment of phobias suggests that for these disorders the link between behaviour and affect is more direct and much stronger than the link between cognition and affect. It is concluded that the relative effectiveness of cognitive and performance-based intervention techniques depends on and points to differences in the specific type of affect-behaviour-cognition interface that underlies and is controlling depression and phobic anxiety.

In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.

Classroom management rates highly as one of the major concerns and problems experienced by techers. Unfortunately, evidence of the extent and nature of management problems, particularly data related to behaviourally and emotionally disturbed children in classrooms is conflicting. The result is that differences in opinion exist as to the complexity and magnitude of the interventions required to deal with such children. This study investigates the proposition that extreme behaviour problems are rare in primary classrooms and that procedures for preventive management are sufficiently powerful to alleviate most classroom behaviour disturbances.

In 1990 a number of regionally based Behaviour Intervention Support Teams (BISTs) were established in Victoria to assist agencies providing support to persons with an intellectual disability who exhibited challenging behaviour. A primary function of the BISTs was to conduct intensive interventions for clients with severe challenging behaviours. A cost-benefit analysis of these interventions was carried out. It was found that the existence of a severe challenging behaviour resulted in an additional cost to the service system of an average $40,510 per annum. In contrast, the cost of a single intensive intervention conducted by a BIST was $5,725. Allowing for the fact that not all intensive interventions were successful, it was still concluded that the interventions conducted by the BISTs were cost efficient. Methodological difficulties associated with the cost-benefit analysis are discussed.

Accessibility, stigma and adverse effects of self-reliance can hinder the receipt of psychological treatments, especially in people living with chronic illness or disability. The aim of this study was to develop and pilot a flexible online psychological treatment using CBT and positive-psychology based techniques, for individuals with spinal cord injury (SCI) who also lived with depression or both depression and anxiety. A multiple case study approach provided in-principle evidence of the acceptability of the Electronic Personal Administration of Cognitive Therapy: ePACT. Three adults living with SCI completed pre- and post-intervention interviews and multiple modules of ePACT. The interviews used the Structural Clinical Interview for DSM Disorders (SCID/-N/P) for diagnosis and the standardised survey instruments: Depression Anxiety and Stress Scale — short version (DASS-21), Personal Wellbeing Index 4th edition (PWI) and the Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ v1 Australia). The results indicated that the online program was acceptable, and they all showed some improvement in symptoms. All participants indicated that they would not have sought face-to-face therapy for reasons of access and stigma. They all had a strong sense of independence and felt this would have been questioned if they sought therapy.

Based on findings from subclinical OCD checking samples (Cuttler & Graf, 2007; 2008), Cuttler and Graf (2009) suggested that checking may develop to compensate for prospective memory failures. The present study provides the first evidence of prospective memory problems in a clinical sample of OCD checkers (n = 26) compared to a group of healthy controls (n = 26). Consistent with earlier work with subclinical samples, the OCD checkers performed more poorly on an event-based, but not a time-based, prospective memory task. However, the OCD checkers did not report more subjective prospective memory failures than controls and their confidence in prospective memory accuracy was higher than that of controls. An explanation of the inconsistent findings with regard to metamemory in clinical and subclinical OCD checking is provided. Further research assessing both subjective memory performance and the strategies understood to support memory is needed to clarify the contribution of prospective memory to OCD checking.

Despite the continuing development of effective cognitive and behavioural interventions for Generalised Anxiety Disorder (GAD) less attention has been paid to the important issue of improving treatment accessibility and affordability. Self-management approaches that utilise the convenience of the Internet may provide a means by which more people can avail themselves of effective treatments. To date, studies examining the effectiveness of such approaches for GAD lag behind the work conducted with other clinical problems. This study describes the response of three individuals with a primary diagnosis of GAD to an Internet-based treatment completed at their own pace. The intervention (‘What? Me Worry!?!; Saulsman, Nathan, Lim, and Correia, 2005) combines several cognitive and behavioural components with the inclusion of a significant metacognitive component. All participants achieved clinically significant improvement on measures of worry, GAD symptomatology, and metacognitions. Moreover, none of the participants met the diagnostic criteria for GAD at the completion of the study. A larger randomised controlled trial of this intervention is indicated.

Nighttime fear, including fear of monsters and the dark, is common. For most children and adolescents, nighttime fears are transient. However, approximately 10% experience severe nighttime fear that negatively impacts sleep, adjustment, and family life. Research conducted in the 1980s indicates that cognitive-behavioural therapy can reduce nighttime fear in as few as three sessions. The aims of the present study were to replicate and extend earlier research by evaluating a cognitive-behavioural treatment package for children's severe nighttime fear, and address methodological issues in previous studies. A manualised, multi-component treatment package was developed, based on current evidence-based practice for the treatment of children's anxiety. Interventions included graded exposure, muscle relaxation, cognitive restructuring, and social and material reinforcement. Treatment was individually tailored and delivered via weekly modules. A multiple baseline across-subjects design was utilised. Four ‘families’ — one parent and one child — participated; children's ages ranged from 6 to 10 years. Families attended five weekly intervention sessions and a 1-month follow-up. Multiple outcome measures were administered pre- and post-treatment. All children displayed changes consistent with reduced nighttime fear following treatment, including fewer phobic symptoms, reduced general fear, and improved nighttime and general behaviour. These changes were maintained at follow-up. Parents reported a high degree of satisfaction with the program and would recommend it to other families. The results support the effectiveness of manualised, parent-assisted treatment for nighttime fear in as few as three sessions. In cases of severe nighttime fear, therapist support is recommended. Treatment implications for children with complex presentations are discussed.

This study examines whether young migrants, differentiated by cultural background, (a) vary in their experience of cultural adjustment, emotional distress, levels of self-esteem, and coping ability, and (b) how they compare with Australian students on measures of self-esteem and coping ability. One hundred and seventy-three students differentiated by cultural origin (former-Yugoslavian, Chinese, Mixed-culture, and Australian) and school level (primary and high school) were recruited at random from public schools in South East Queensland. Students completed measures of cultural adjustment (Bicultural Involvement Questionnaire), anxiety and trauma (Revised Children's Manifest Anxiety Scale, Trauma Symptom Checklist), self-esteem (Coopersmith Self-Esteem Inventory, Rosenberg Self-Esteem Scale), and coping ability (Coping Scale for Children and Adolescents). The main findings from this study indicate that culturally diverse groups residing in Australia vary in their experience of cultural adaptation, level of self-esteem, and symptoms of emotional distress, illustrating culture-specific strengths and weaknesses among young non-English speaking (NESB) students. This study reveals information on how culturally diverse migrants acculturate, the type and severity of symptoms they experience, and their capacity to cope in stressful situations. The need for culture-specific early intervention and prevention programs is discussed.

Recently, the American Psychological Association (APA; 1993) Division of Clinical Psychologists (Division 12) established a task force to define empirically validated treatment and make recommendations in relation to methods for educating mental health professionals, third-party payors, and the public about effective psychotherapies. Predictably, the task force report has a somewhat controversial status but continues to be an influential blueprint for the improvement of clinical psychology in various countries including Australia. The role of the Australian Association for Cognitive and Behaviour Therapy (AACBT) is highlighted in relation to accreditation and mandatory professional development (Australian Psychological Society).

Behaviour therapy is now beginning to assess the social validity, along with efficacy, of its treatments. Literature dealing with the social validity of parent-training programs is reviewed. The aim of this investigation was to obtain acceptability ratings of the “time out” procedure from the perspective of behaviour problem and non-problem children. The study looked at acceptability ratings of five maternal behaviours/disciplinary techniques (permissiveness, physical punishment, directed discussion, quiet time, time out) across four different situations (non-compliance with an initiating instruction, aggression toward others, non-compliance with a terminating instruction, non-compliance with known rule) by samples of clinical (problem behaviour) children and control children. Both groups were alike in rating permissiveness as less acceptable than any of the other behaviours across most situations and rating it as unacceptable in absolute terms. Time out was rated equally acceptable with physical punishment, directed discussion and quiet time. The results support previous findings that young children prefer interventionist to permissive parents, including the use of exclusionary time out. In a second study, ratings were taken from two clinical groups, treatment and waitlist, both at pre- and post-treatment. Despite large individual differences in the treatment group, no change in acceptability ratings was found at post-treatment. Thus, experiencing time out did not change the children's evaluation of this procedure. Possible reasons for these findings and their practical implications are discussed.

CBT guided self-help (CBTgsh) can produce treatment outcomes comparable to therapist-administered CBT (CBTta) for the treatment of anxiety and depression. The efficacy of CBTgsh compared to gold standard CBTta, however, remains to be examined. The current article addresses this issue, as well as how CBTgsh may have unique benefits over CBTta. It further highlights ways in which CBTgsh may be used for disorders of increasing severity, using eating disorders and personality pathology for illustrative purposes. A literature review of PsycINFO, PsyARTICLES, and PubMED was conducted to identify relevant studies published since 1990. Studies directly comparing CBTgsh to gold standard CBTta for anxiety and depression, as well as bulimia nervosa, revealed no significant differences between the two interventions. Furthermore, CBTgsh may have unique benefits by encouraging continued improvement over time. Innovative eating disorder studies also show that CBTgsh can be used for more severe disorders as a supplementary treatment, and produces treatment outcomes superior to CBTta or treatment as usual alone. Based on these findings, CBTgsh applications to personality pathology are suggested. Traditional stepped care models, as they pertain to CBTgsh, may gain to be broadened both in their focus and methods of delivery.

The specific phobias in children, such as night-time fears and animal phobias, should not be underestimated since they cause personal distress to the child and also much interference with daily activities. Intervention plans should be informed by multimethod assessment, using tools that are empirically sound and developmentally sensitive. This article selectively reviews a number of assessment tools including structured diagnostic interview schedules, standardised instruments such as anxiety or fear self-report questionnaires, and behavioural tasks. An overview is given of the main intervention approaches, from a behavioural perspective, including traditional behavioural intervention procedures such as systematic desensitisation and its variants, cognitive–behavioural therapy, and behavioural family therapy. The authors also present recent developments in psychodynamic treatment for phobic and anxious children. Finally, we present conclusions on the empirical standing of the various treatment approaches and also examine the important issue of treatment outcome prediction.

Behavioural avoidance tests (BATs) are a cornerstone of objective assessment of phobias. However, live BATs have several disadvantages. They are practically difficult and time-consuming to set up and are not standardised. This study examined two computer-delivered BATs (using slide and video presentations of phobic stimuli respectively): first, in respect to their ability to discriminate fearfuls from nonfearfuls, and second, in terms of convergent validity with a live BAT and the Spider Phobia Questionnaire (SPQ). Sixty-four low (n = 32) and high (n = 32) spider-fearful undergraduate participants were administered the three BATs in counterbalanced order. Results showed that subjective anxiety on all BATs was highly discriminative of low and high spider-fearfuls. The number of steps completed did not discriminate between phobics and nonphobics on the computer BATs. However, there was good convergent validity between the live BAT, the SPQ and both computer-delivered BATs on subjective anxiety. Overall, the live BAT gives a clearer indication of avoidance behaviour while the video BAT assesses subjective anxiety across a wider range of steps. The development of computer-delivered BATs that reliably measure avoidance is necessary before contemplating them as an alternative to a live BAT.

Five tutor-tutee pairs of 13-year-old students who were below average in reading participated in a program of remediated reading using the Pause, Prompt, and Praise procedures. Whereas previous research has shown that these procedures can be learned concurrently by peer tutors, this study showed that the procedures can also be learned successively. Data indicate that the five tutors readily learned to implement all components of the procedure, and that both tutors and tutees made major gains in reading accuracy and comprehension.

Studies researching psychotherapeutic interventions for treatment-resistant depression (TRD) are quite new to the field. The Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is the only model developed specifically to treat the chronically depressed patient. While empirical evidence indicates that CBASP is an effective treatment for chronic depression, little is known about its adaptation to a group modality. Treating these patients in a group approach would have the added benefits of being cost-effective and providing in vivo previously avoided interpersonal situations for practising social skills and role-plays. This single arm study asks whether CBASP adapted to a group modality can be effective. All patients received 12 CBASP group therapy sessions with two to four individual preparatory sessions before the group. Our results suggest that CBASP group treatment demonstrated positive effects on patient outcomes. Specifically, patients showed significant decreases in symptoms of depression and the use of emotion-oriented coping, as well as increases in overall social adjustment and interpersonal self-efficacy when compared to pretreatment levels. However, patients did not achieve normative levels in these areas by the end of treatment. These pilot results are encouraging and support further study of the effectiveness of CBASP group treatment with a control group.

Since the helping professions are not immune to current conditions of economic stringency, effective treatments that require reduced therapist contact should be seriously considered. A selective review of the literature is presented, and it is concluded that minimal intervention is more cost effective particularly for less severe problems. Issues related to the nature of minimal intervention therapy are discussed.