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Aims The study aims to examine how therapists trained in motivational interviewing respond to resistance and whether this has an impact on subsequent client speech. Methods Fifty recorded Motivational Enhancement Therapy sessions were examined using a sequential behavioural coding method for speech. Client counter-change talk formed the baseline for coding and categorising subsequent therapist speech and the following client speech. Transitional analysis identified the probable occurrence of specific therapist and client utterances at each stage. Results Following client expressed resistance or counter-change talk, motivational interviewing consistent therapist utterances were most commonly observed. A moderate to strong predictive relationship was found between MI-consistent therapist speech and subsequent client change talk. A moderate predictive relationship was found between therapist MI-consistent behaviours and client ambivalence. A moderate to strong predictive relationship was found between MI-inconsistent therapist speech and subsequent client counter-change talk and a weak negative predictive relationship was found between MIinconsistent therapist speech and client expressed ambivalence. Conclusions In the face of initial expressed resistance to change, MI-consistent therapist speech appears to increase subsequent client utterances regarding intentions to change drinking behaviour. Short summary Recordings of alcohol treatment were examined for the identification of resistance to change, therapist responses and the nature of subsequent client utterances. Following client counter-change talk, motivational interviewing consistent therapist utterances were most commonly observed. MI-consistent therapist speech appears to increase subsequent client utterances regarding intentions to change drinking behaviour. UKATT Research Team (2005a). Effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT). BMJ, 331: 541-544.

Aims: Recent evidence regarding over-estimation of the efficacy of antipsychotics and under-estimation of their toxicity, as well as emerging data regarding alternative treatment options, suggest it may be time to introduce patient choice. However, only a small number of studies have reported on the efficacy of interventions for psychological interventions such as cognitive therapy. Early results suggest that cognitive therapy may be an effective, well-tolerated treatment for people who choose not to take antipsychotics. We report on the rationale and design for a multi-site randomised, controlled trial of cognitive therapy for people with a schizophrenia spectrum diagnosis who choose not to take antipsychotics. Methods: The study employs a single-blind design in which all participants receive treatment as usual, and half are randomised to up to 30 sessions of cognitive therapy for up to 9 months. Participants will be followed-up for a minimum of 9 months and to a maximum of 18 months. Results: We report the characteristics of the final sample at baseline (N = 74). Conclusions: Our study aims to expand the currently limited evidence base for best practice in interventions for individuals with psychosis who choose not to take antipsychotics. IntroductionIt is evident that in mental health services worldwide there is an over-reliance (or, at times, sole reliance) on antipsychotic medication in the treatment of schizophrenia and related disorders. There has typically been little or no choice offered to service users who meet criteria for such diagnoses (Warner, Mariathasan,

Although school-aged children living in foster care have been identified as a high-risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high-risk group for mental health and developmental disorders. Without age-appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.

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