Text

theses

ETD doctoral

As evidence-based programs (EBPs) are transported to more representative clinical settings from highly controlled efficacy trials, their advantage over usual care (UC) is largely diminished. However, it is difficult to explain this phenomenon without a better understanding of the status quo in mental health care. Knowledge of the nature of UC is limited and even less is known about the typical care provided in schools. As a preliminary step towards improving knowledge of school-based services, the current study examined group counseling (GC) sessions led by school counselors for adolescents with elevated depressive symptoms. Group counseling was conducted as part of the Depression Prevention Initiative (DPI), a randomized controlled trial of Interpersonal Psychotherapy – Adolescent Skills Training (IPT-AST), a preventive intervention for adolescent depression. Forty-seven GC sessions were randomly selected for coding using the Therapy Process Observational Coding System for Child Group Psychotherapy (TPOCS-G). Self-report data from the Therapy Procedures Checklist (TPC) was also utilized to describe the range of therapeutic techniques in GC. Additionally, the current study utilized 54 IPT-AST sessions from the DPI project that were coded by a different research group. Independent samples t-tests were used to compare GC and IPT-AST conditions and linear regressions were used to examine whether therapeutic techniques utilized in GC predicted depression and functioning outcomes. School counselors were observed delivering eclectic therapeutic techniques from a variety of theoretical orientations. Shared non-specific factors (e.g., Warmth/Empathy/Validation) were used most frequently, followed by novel unsupported treatment strategies (e.g., Play/Art); evidence-based (EB) techniques were utilized least frequently. Moreover, EB strategies were implemented with low extensiveness, which is inconsistent with EB approaches. Compared to IPT-AST, EB strategies were utilized less frequently and extensively in GC. GC included significantly more non-specific and unsupported strategies than IPT-AST. Within GC, use and extensiveness of EB strategies predicted better depression and functioning outcomes and greater use of non-specific strategies predicted worse functioning outcomes. This work contributes to a growing body of research on UC and may help tailor future training and implementation efforts to meet the unique needs of the education sector.

ETD_11038

Ph.D.

Includes bibliographical references

doi:10.7282/t3-5xs8-5829

The author owns the copyright to this work.