Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Primary Prevention: Beginning at the Beginning

The growth and development of infants and children is examined from the perspective of parenting. White presents research evidence on early childhood development to substantiate his claim that educators and mental health specialists ignore these findings in their intervention approaches. The author sees the family as the first educational delivery system for the child, and presents concrete suggestions to aid educators and mental health specialists in their role. White concludes by favoring an educational approach to parenting over traditional social service work.     

The common sense of counseling psychology: introducing the Common-Sense Model of self-regulation

Abstract

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.     

Working with Low-income Families: Lessons Learned from Basic and Applied Research on Coping with Poverty-related Stress

Poverty and low socioeconomic status create tremendous amounts of physical and psychosocial stress that compromise health and well-being. This paper explores how the stressors created, exacerbated, and maintained by living in poverty lead to compromised mental health, and at the same time present significant challenges to participating in and benefitting from traditional psychotherapy. This paper summarizes the strong research evidence supporting the causal role of poverty-related stress in contributing to mental (and physical) health problems, discusses the physiology that underlies this process and how it affects clients’ ability to make use of psychotherapy, and presents recommendations for incorporating a multi-faceted approach to coping in clinical work with low-income clients and families. Addressing the pernicious effects of economic stress with a multi-step approach to effective coping can serve to prepare low-income clients to better engage in and get the most out of psychotherapy.     

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Abstract

Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals.

Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired).

Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals.

Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.     

Understanding Islamic Perspective of Mental Health and Psychotherapy

This paper is an attempt to provide foundational information about Islamic perspective of mental health and psychotherapy. It further highlights the historical contribution of Muslim philosophers and physicians to the field of psychotherapy. In the aftermath of the 9/11 and 7/7 tragedies, there has been a growing need to understand the Islamic perspective of mental health and gain insight into the followers of this faith otherwise perceived as ‘mysterious and Far Eastern’. A case example illustrates how counselors/therapists can effectively incorporate religious-cultural aspects of Islam in their work with Muslim clients so that they could work more effectively with their Muslim clients in the post 9/11 climate. Health care professionals must be sensitive to and fully aware of the unique religious traditions, cultural norms and gender sensitive values of their Islamic psychiatric patients so that they could introduce modern therapeutic interventions with less resistance from their clients.     

Mental health symptoms,well-being and experiences of the COVID-19 pandemic: A mixed-methods practice-based study

The COVID-19 pandemic necessitated abrupt and substantial changes in daily life, and public health strategies intended to protect physical health can negatively affect mental health and well-being, especially for individuals with pre-existing mental health challenges. For this study, we surveyed a sample of clients (N = 94) in the summer of 2020 from a community mental health clinic in the northeast United States. A mixed-methods, concurrent triangulation design was used to (a) identify client subgroups on indicators of mental health (i.e. anxious and depressive symptoms) and emotional, psychological, and social well-being using latent profile analysis (LPA), and (b) within these subgroups, examine qualitative, thematic patterns in self-described challenges, benefits and learning related to the pandemic. The LPA revealed five distinct subgroups with various levels of symptoms and well-being, including Stagnant (moderate symptoms/moderate well-being), Languishing (high symptoms/low well-being), Flourishing (low symptoms, high well-being), Fortitudinous (high symptoms, moderate well-being) and Mobilized (moderate symptoms, high well-being). These divergent subgroups support the need to conceptualise mental health symptoms apart from well-being and assess for heterogeneous constellations of such constructs among psychotherapy clients. Thematic analysis offered additional insight into pandemic experiences within each subgroup, including attention to psychological, emotional, behavioural/lifestyle, relational, physical and ecological/contextual dimensions of self-experience, as well as the ways clients had adjusted to the pandemic's circumstances. Findings support nuanced conceptualisations of positive mental health and offer insight into coping and adaptation during this public health crisis.     

Cooperation Patterns of Israeli Mental Health Practitioners

Abstract

The cooperation patterns of Israeli mental health practitioners were examined. Psychiatrists, psychologists, and psychiatric social workers were asked to fill out a questionnaire for a study investigating the influence of therapists' authoritarianism and ideology on their therapeutic attitudes. The cooperation level in mental health clinics was higher than that in psychiatric hospitals, student counseling centers, and psychiatric departments of general hospitals. In all three professions, the trainees were more cooperative than the experts. The cooperation level of the psychiatrists was the lowest, and women were generally more cooperative than men, although there was a significant Gender × Profession interaction. The fact that the psychologists and social workers were more cooperative may be attributed to their training, which places more emphasis on the therapist's personality and attitudes. The high cooperation level in the mental health clinics may be explained by the almost exclusive focus on psychotherapy, which encourages introspection.     

Making Space for Every Body: Ending Sizeism in Psychotherapy and Training

Abstract

The importance of addressing weight bias as a social justice issue in psychotherapy and psychology education and training is introduced. The history of the development of fat studies is briefly reviewed. Current coverage of size and sizeism in psychology is critically examined and contrasted with the increasing adoption of the medical model of “obesity.” Fat shaming in the practice of mental health professionals is examined as a barrier to clients’ physical and mental health. Alternatives to medicalized weight management and fat shaming are introduced. Models that emphasize size acceptance and resist negative embodiment are encouraged. The potential for a future that makes space for every body is assessed.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

The 5th Annual psyche awards: celebrating excellence in scholarship

The Psyche Awards were developed to recognize the best journal articles published during the previous year. Each award confronts a specific topic within the field of mental health care, identifying articles that integrate the science and practice of psychology. For the current awards, 161 journals were screened, and 223 relevant articles were identified. The papers were then narrowed down to 46 papers distributed across 11 award categories. A panel of four expert judges read each article and rated all papers for their contribution to the field. The current award categories highlight some of the best articles published during 2021, capturing important information about psychological assessment, treatment of depression, working with suicidal clients, technology-assisted psychotherapy, the impact of Covid-19 on mental health, lessons from a review of history, recent innovations in the field, and strategies to expand the integration of science and practice.

     

Toward a Bahá'í Concept of Mental Health: Implications for Clinical Practice

The author highlights the emerging interest in understanding religious beliefs as a resource for more fully conceptualizing clients' psychological functioning. Although various authors have explored religious theories of mental health in an effort to increase understanding of clients' problems, there is a dearth of information on the Bahá'í client and how this particular religion conceives of mental health. The purpose of this article is to create an initial formulation for a Bahá'í concept of mental health and to discuss its clinical implications to aid in counseling Bahá'í clients.     

Paraprofessionals as group psychotherapists

This paper defines and describes the characteristics, education and training of paraprofessionals who work in the fields of mental health and substance abuse. There are wide variations in the amount of education and training which paraprofessionals possess but many are drawn from the same cultural background as their clients or have experienced the same problems. The types of group psychotherapy which paraprofessionals are qualified to lead are discussed. Most groups fall into the categories of activity or short-term problem-oriented groups. The literature is reviewed and some major training demonstrations are described.     

A healing relationship: Clients’ experiences of the long-term relational significance of the horse in horse assisted psychotherapy

Horse assisted psychotherapy is a type of treatment for mental ill-health in which the client forms a relationship with a horse. Research suggests that the relationship to a horse is very helpful to clients, but how the horse is experienced many years after the end of treatment has not been investigated. The aim of the present study was thus to investigate how former clients from horse assisted psychotherapy experienced the horse several years after treatment was completed. Former clients (n = 5; all females) from one and the same treatment center were interviewed and the data was analyzed with an inductive thematic approach. The analysis showed that many years after completion of treatment, the horses were still remembered as the most important individuals in the informants’ lives during the time of treatment. This was captured by the core category ‘A healing relationship’. These findings are in line with previous research that found that patients in horse assisted psychotherapy and their family members attributed improvements from treatment to the patients’ relationship to the horses, but adds that the clients also keep these views at follow-up several years after termination of treatment.     

Internal cohesion psychotherapy: The nature,principles and application

Psychotherapy is widely used to treat different mental health disorders and emotional difficulties. The main objective of psychotherapy is to help clients become aware of and have control over their thoughts, moods, feelings and behaviours, as well as create healthy strategies to respond to challenging situations. Since the existing psychotherapy approaches and other methods of treatment are not always effective in treating mental health disorders, there is still space for new approaches to fill this gap. In this paper, we provide information about internal cohesion psychotherapy, which is a new integrative approach. This paper presents a new approach to eclectic psychotherapy, focussing on four detrimental aspects of human functioning through different time perspectives.     

Suicide and the Law

SUMMARY

The purpose of this chapter is to delineate how mental health professionals can prevent their clients from acting in a suicidal manner while protecting themselves against potential liability when a client attempts or completes suicide. In our increasingly litigious society mental health professionals can apply their understanding about the elements of legal liability in cases involving client suicidal behaviors to structure their services in a manner to meet their responsibility in treating potentially suicidal clients.     

Siblings as Selfobjects in Childhood: An Interview Study of Factors and Consequences

This study explores the factors psychotherapists working with adult clients identify as contributing to their clients' use in childhood of relationships with siblings to meet selfobject needs or the use of clients by their siblings for selfobject purposes in childhood, and the consequences of this to the children's intrapsychic development as evidenced in their adult psychotherapy. Using interviews with six psychotherapists practicing within the framework of self psychology, this research determines that the emotional and physical unavailability of parents was a common factor causing children to use their siblings for selfobject purposes. The research also explores the lasting impact of these selfobject ties on the psychological development of both the child using a sibling for selfobject purposes and the child who serves this function for another, as well as the role of psychotherapy in understanding these relationships. These findings give psychotherapists from a variety of disciplines, including social work, an enhanced conceptual framework from which to consider the role of siblings in psychological development.     

Korean Immigrant Women's Journey from Abused Wives to Self-Reliant Women

Today's adolescent girls experience sociocultural pressures and life stressors which result in negative mental health outcomes, including binge eating. The purpose of this article is to present a model of psychotherapy for adolescent girls who engage in binge eating. The components in this model include: (a) Feminist Therapy to emphasize client empowerment and the importance of sociocultural context in understanding girls’ concerns; (b) Cognitive Behavior Therapy to help clients to eliminate dieting and to cope with pressures for attaining the beauty ideal; (c) Dialectical Behavior Therapy to assist clients in coping with emotions; and (d) Interpersonal Therapy to help clients improve relational transitions and disputes.     

Somatization in Chinese American clients: Implications for psychotherapeutic services

Chinese Americans have a tendency to somatize, or complain of physical discomforts, when they experience psychological or emotional problems. Differentiating whether these clients have a mental health problem or a physical ailment is a critical diagnostic and treatment issue. In addition, psychogenic somatic complaints need to be addressed in a culturally congruent manner in the context of psychotherapy. This paper examines the somatic symptoms commonly reported by Chinese American clients. Ways to address these issues in differential diagnosis and in treatment will be discussed along with case examples.Portions of this paper were presented at the 100th Annual Convention of the American Psychological Association, Washington, D.C., August, 1992.