We consider the potential utility of the methods described by Eells (2010) and Edwards (2010) for... more We consider the potential utility of the methods described by Eells (2010) and Edwards (2010) for guiding case conceptualization and treatment process in the area of men's mental health. As a relatively new field, men's mental health has been concerned with the clinical implications of understanding how masculine gender socialization influences the variety of ways different men experience, express, and respond to problems in their lives. Eells (2010) and Edwards (2010) have developed pragmatically driven research strategies that may help researchers and clinicians interested in working with men to (a) integrate gender in meaningful ways into case conceptualizations, and (b) develop effective ways of being therapeutically responsive to some of the specific challenges in working with more "traditional" men.
IMPORTANCE Depression is a common disorder that may go untreated or receive suboptimal care in pr... more IMPORTANCE Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. OBJECTIVES To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion.
Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cog... more Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective: To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). Methods: A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. Results: In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conven...
Background To bridge the gap between symptoms and treatment, constructing case formulations is es... more Background To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad, a case formulation must convey valid information concerning the patient, as well as being a reliable source of information regardless of the clinician’s theoretical orientation. The first aim of the present study is to explore the completeness of unstructured psychodynamic formulations, according to four components outlined in the Case Formulation Content Coding Method (CFCCM). The second aim is to estimate the reliability of independent formulations and their components, using similarity ratings of matched versus mismatched cases. Methods This study explores psychodynamic case formulations as made by two or more experienced clinicians aft...
A psychotherapy case formulation is essentially a hypothesis about the causes, precipitants, and ... more A psychotherapy case formulation is essentially a hypothesis about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal, and behavioral problems. The author begins with a working definition of psychotherapeutic case formulation, then reviews major historical and contemporary influences on the form and content of a psychotherapy case formulation. The author then proposes 5 tensions that influence the psychotherapy case formulation process. Finally, the author discusses the psychotherapy case formulation as a tool for scientific study. The author uses the term "formulation" analogously with "assessment," "explanation," or "hypothesis." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Journal of psychotherapy practice and research, 1999
An important question debated by health care experts concerns the so-called medical offset effect... more An important question debated by health care experts concerns the so-called medical offset effect of psychotherapy. The question is whether costs incurred in providing mental health services, and psychotherapy specifically, are offset by reduced costs elsewhere in the health care system, primarily in the general medicine and surgical sectors. An influential meta-analysis by Mumford and colleagues1 found that 85% of 58 studies examined reported a decrease in medical utilization following psychotherapy. Across 22 controlled studies reviewed, hospital stays for individuals who underwent psychotherapy were 1.5 days less than the control group mean of 8.7 days. Although influential during its time, this study is largely obsolete today because of cost controls brought on by managed care. One effect of decreased hospital stays, reduced reimbursement rates, and increased utilization review, among other recent changes in health care economics, may be the elimination of a medical offset. To examine evidence for a medical offset effect in the current health care environment, I conducted a literature search for relevant journal articles published since 1996. Using PsychINFO, the online database of the American Psychological Association, I requested articles containing the words “medical offset” in any field of an article's database record. In selecting the articles reviewed below, I used a broad conception of “offset.” Instead of restricting myself to articles examining an offset of nonpsychiatric medical costs, I included two that examine possible offsets of alternative or additional mental health services and two that investigate possible cost reductions to society as a consequence of psychotherapy. Although the narrower definition of “medical cost offset” is of primary interest to health insurance organizations, the broader definition that incorporates societal costs better addresses the interests of policy makers.
... TRACY D. EELLS ... are the formulation model for cognitive analytic therapy (Bennett and Parr... more ... TRACY D. EELLS ... are the formulation model for cognitive analytic therapy (Bennett and Parry, 2004a) and cognitive-behavioural (CB) methods of case formulation (Kuyken et al., 2005; Mumma and Smith, 2001; Persons and Bertagnolli, 1999; Persons, Mooney and Padesky ...
Psychotherapy case formulation - history and current status, Eells the traditional psychoanalytic... more Psychotherapy case formulation - history and current status, Eells the traditional psychoanalytic approach to case formulation, Messer and Wolitzky the core conflictual relationship theme - a basic case formulation method, Luborsky cyclical maladaptive patterns - case formulation in time-limited dynamic psychotherapy, Levenson and Strupp the plan formulation method, Curtis and Silberschatz the idiographic conflict formulation method, Perry configurational analysis - states of mind, person schemas and the control of ideas and affect, Horowitz and Eells case formulation in interpersonal psychotherapy of depression, Markowitz et al interpersonal case formulation - describing and explaining interpersonal patterns using the structural analysis of social behaviour, Henry plan analysis, Caspar case formulation in cognitive analytic therapy, Ryle and Bennett cognitive behavioural case formulation, Persons and Tompkins case formulation in dialectical behaviour therapy for borderline personality disorder, Koerner and Linehan case formulation in behaviour therapy - problem-solving and functional analytic strategies, Nezu et al.
Journal of Consulting and Clinical Psychology, 2005
Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapist... more Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training.
Journal of Clinical Psychology in Medical Settings, 2008
The data and discussion contained in this invited paper are based on the opening plenary by the f... more The data and discussion contained in this invited paper are based on the opening plenary by the first author whose paper titled "The Status of Ph.D.s in US Medical Schools" was presented at the 3rd national conference of the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. The significant growth of the number of Ph.D.s in clinical departments is described, as is their distribution. The roles they play; the barriers they face in terms of leadership opportunities, promotion and tenure; and the concerns they voice that are specific to this population are also discussed. Salary differentials between Ph.D.s on main and medical school campuses are provided. Recommendations for future investigation of disparate treatment and for faculty development opportunities specifically aimed at this group are found at the conclusion of the paper.
Of 77 second-year medical students, the 27 who were randomly assigned to problem-oriented instruc... more Of 77 second-year medical students, the 27 who were randomly assigned to problem-oriented instruction (POI) in interviewing skills rated themselves as better prepared and more successful in interviews of psychiatric patients, compared with students receiving lecture only or no classroom instruction in interviewing skills. POI-trained students also rated themselves as better in focusing on nonverbal aspects, effective questioning, and exploring feelings. The POI involved hierarchically organized, skills-focused role-plays in which students rotated through the roles of "doctor," "patient," and "observer." The method enhances the similarity between the instructional environment during training and the problem-solving processes necessary at the time of transfer to a new problem. Supervisors who observed the interview did not rate the three groups differently on interviewing skills.
In 1994, the University of Louisville board of trustees mandated that each school develop a metho... more In 1994, the University of Louisville board of trustees mandated that each school develop a methodology for post-tenure review. Ten years after implementation, this article provides an update on the process and its outcomes.
We consider the potential utility of the methods described by Eells (2010) and Edwards (2010) for... more We consider the potential utility of the methods described by Eells (2010) and Edwards (2010) for guiding case conceptualization and treatment process in the area of men's mental health. As a relatively new field, men's mental health has been concerned with the clinical implications of understanding how masculine gender socialization influences the variety of ways different men experience, express, and respond to problems in their lives. Eells (2010) and Edwards (2010) have developed pragmatically driven research strategies that may help researchers and clinicians interested in working with men to (a) integrate gender in meaningful ways into case conceptualizations, and (b) develop effective ways of being therapeutically responsive to some of the specific challenges in working with more "traditional" men.
IMPORTANCE Depression is a common disorder that may go untreated or receive suboptimal care in pr... more IMPORTANCE Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. OBJECTIVES To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion.
Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cog... more Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective: To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). Methods: A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. Results: In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conven...
Background To bridge the gap between symptoms and treatment, constructing case formulations is es... more Background To bridge the gap between symptoms and treatment, constructing case formulations is essential for clinicians. Limited scientific value has been attributed to case formulations because of problems with quality, reliability, and validity. For understanding, communication, and treatment planning beyond each specific clinician-patient dyad, a case formulation must convey valid information concerning the patient, as well as being a reliable source of information regardless of the clinician’s theoretical orientation. The first aim of the present study is to explore the completeness of unstructured psychodynamic formulations, according to four components outlined in the Case Formulation Content Coding Method (CFCCM). The second aim is to estimate the reliability of independent formulations and their components, using similarity ratings of matched versus mismatched cases. Methods This study explores psychodynamic case formulations as made by two or more experienced clinicians aft...
A psychotherapy case formulation is essentially a hypothesis about the causes, precipitants, and ... more A psychotherapy case formulation is essentially a hypothesis about the causes, precipitants, and maintaining influences of a person's psychological, interpersonal, and behavioral problems. The author begins with a working definition of psychotherapeutic case formulation, then reviews major historical and contemporary influences on the form and content of a psychotherapy case formulation. The author then proposes 5 tensions that influence the psychotherapy case formulation process. Finally, the author discusses the psychotherapy case formulation as a tool for scientific study. The author uses the term "formulation" analogously with "assessment," "explanation," or "hypothesis." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Journal of psychotherapy practice and research, 1999
An important question debated by health care experts concerns the so-called medical offset effect... more An important question debated by health care experts concerns the so-called medical offset effect of psychotherapy. The question is whether costs incurred in providing mental health services, and psychotherapy specifically, are offset by reduced costs elsewhere in the health care system, primarily in the general medicine and surgical sectors. An influential meta-analysis by Mumford and colleagues1 found that 85% of 58 studies examined reported a decrease in medical utilization following psychotherapy. Across 22 controlled studies reviewed, hospital stays for individuals who underwent psychotherapy were 1.5 days less than the control group mean of 8.7 days. Although influential during its time, this study is largely obsolete today because of cost controls brought on by managed care. One effect of decreased hospital stays, reduced reimbursement rates, and increased utilization review, among other recent changes in health care economics, may be the elimination of a medical offset. To examine evidence for a medical offset effect in the current health care environment, I conducted a literature search for relevant journal articles published since 1996. Using PsychINFO, the online database of the American Psychological Association, I requested articles containing the words “medical offset” in any field of an article's database record. In selecting the articles reviewed below, I used a broad conception of “offset.” Instead of restricting myself to articles examining an offset of nonpsychiatric medical costs, I included two that examine possible offsets of alternative or additional mental health services and two that investigate possible cost reductions to society as a consequence of psychotherapy. Although the narrower definition of “medical cost offset” is of primary interest to health insurance organizations, the broader definition that incorporates societal costs better addresses the interests of policy makers.
... TRACY D. EELLS ... are the formulation model for cognitive analytic therapy (Bennett and Parr... more ... TRACY D. EELLS ... are the formulation model for cognitive analytic therapy (Bennett and Parry, 2004a) and cognitive-behavioural (CB) methods of case formulation (Kuyken et al., 2005; Mumma and Smith, 2001; Persons and Bertagnolli, 1999; Persons, Mooney and Padesky ...
Psychotherapy case formulation - history and current status, Eells the traditional psychoanalytic... more Psychotherapy case formulation - history and current status, Eells the traditional psychoanalytic approach to case formulation, Messer and Wolitzky the core conflictual relationship theme - a basic case formulation method, Luborsky cyclical maladaptive patterns - case formulation in time-limited dynamic psychotherapy, Levenson and Strupp the plan formulation method, Curtis and Silberschatz the idiographic conflict formulation method, Perry configurational analysis - states of mind, person schemas and the control of ideas and affect, Horowitz and Eells case formulation in interpersonal psychotherapy of depression, Markowitz et al interpersonal case formulation - describing and explaining interpersonal patterns using the structural analysis of social behaviour, Henry plan analysis, Caspar case formulation in cognitive analytic therapy, Ryle and Bennett cognitive behavioural case formulation, Persons and Tompkins case formulation in dialectical behaviour therapy for borderline personality disorder, Koerner and Linehan case formulation in behaviour therapy - problem-solving and functional analytic strategies, Nezu et al.
Journal of Consulting and Clinical Psychology, 2005
Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapist... more Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training.
Journal of Clinical Psychology in Medical Settings, 2008
The data and discussion contained in this invited paper are based on the opening plenary by the f... more The data and discussion contained in this invited paper are based on the opening plenary by the first author whose paper titled "The Status of Ph.D.s in US Medical Schools" was presented at the 3rd national conference of the Association of Psychologists in Academic Health Centers, Minneapolis, MN, May 2007. The significant growth of the number of Ph.D.s in clinical departments is described, as is their distribution. The roles they play; the barriers they face in terms of leadership opportunities, promotion and tenure; and the concerns they voice that are specific to this population are also discussed. Salary differentials between Ph.D.s on main and medical school campuses are provided. Recommendations for future investigation of disparate treatment and for faculty development opportunities specifically aimed at this group are found at the conclusion of the paper.
Of 77 second-year medical students, the 27 who were randomly assigned to problem-oriented instruc... more Of 77 second-year medical students, the 27 who were randomly assigned to problem-oriented instruction (POI) in interviewing skills rated themselves as better prepared and more successful in interviews of psychiatric patients, compared with students receiving lecture only or no classroom instruction in interviewing skills. POI-trained students also rated themselves as better in focusing on nonverbal aspects, effective questioning, and exploring feelings. The POI involved hierarchically organized, skills-focused role-plays in which students rotated through the roles of "doctor," "patient," and "observer." The method enhances the similarity between the instructional environment during training and the problem-solving processes necessary at the time of transfer to a new problem. Supervisors who observed the interview did not rate the three groups differently on interviewing skills.
In 1994, the University of Louisville board of trustees mandated that each school develop a metho... more In 1994, the University of Louisville board of trustees mandated that each school develop a methodology for post-tenure review. Ten years after implementation, this article provides an update on the process and its outcomes.
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Papers by Tracy Eells