While previous research on deterioration has focused on identifying individuals at risk for negative outcomes, little is known about the nature or pattern by which deterioration occurs. The problem of deterioration is especially salient in training clinics; a setting in which higher deterioration rates have been reported. Two studies were designed to test the applicability of the phase model to deterioration in a training clinic and to replicate the model with a training clinic referral-base sample. In Study 1, the course of therapy was monitored for 135 clients. For the 38 clients who deteriorated during therapy, a model where increased symptoms (demediation) reliably preceded both decreased functioning (dehabilitation) and decreased well-being (demoralization) was found. In Study 2, the same three phases were prospectively monitored for 914 undergraduate students on a weekly basis throughout a single semester. For the 158 individuals who deteriorated during this time, a model where demediation reliably preceded dehabilitation, which preceded demoralization was found. These results have clinical implications for the use of tailored intervention strategies focusing on the deterioration phases.

The Trauma Outcome Process Assessment (TOPA) is a theoretical model, based on a large body of empirical research establishing key variables that consistently are associated with a range of outcomes following traumatic events. Although most who experience a traumatic event will initially experience symptoms of distress, most will subsequently recover without intervention. Those responding to the needs of trauma survivors are unable currently to predict at early stages who might benefit from assistance and where to devote resources. In this model, individual variables (e.g., personality) are considered within the context of ecological factors (e.g., family dynamics, social support) to explain mental health outcomes (e.g., recovery, various forms of distress) following traumatic stressor exposure. Analyses in this study revealed the expected relationships among study measures and found that the measures mapped well onto the hypothesized latent constructs of the TOPA model. Using structural equation modeling (SEM) the TOPA performed well, suggesting that the TOPA has utility as a theoretical basis for the identification and treatment of differential mental health outcomes following exposure to a traumatic stressor and lend support to key variables that might be considered to better understand trajectories of recovery and illness.

Limitations of the study and further implications for treatment outcome research are discussed.

The current study investigated a particular aspect shared by a number of theories of depression under the common heading of object relations theory (ORT), namely that depression is associated with a continuing pattern of poor attachment that is laid out in childhood and continues into adulthood. The study examined the relationship between attachment (both parental and peer) and depressive symptoms in young adults (N ϭ 85) of Northern Ireland. Results provided support for the continuity of perceptions of attachment styles across the life span and revealed that perceptions of early attachment experiences, as well as continuing peer attachment styles, appeared to be predictive of current depressive symptoms. More specifically, the analyses revealed a statistically significant positive correlation between perceived quality of current peer attachment and symptoms of depression, as well as a statistically significant negative correlation between self-reported childhood maternal care and symptoms of depression. However, other self-reported measures of childhood attachment were not found to be significant predictors of depressive symptoms (i.e., paternal care, maternal overprotection, paternal overprotection). Taken together, the findings lend some support for this important element of a number of object relations theories, as they pertain to depression. Further empirical research is indicated.

Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.