Survivor mission: Do those who survive have a drive to thrive at work?

Are helping professionals who have experienced the same types of struggles as their clients more engaged at work? In the current investigation, we examine this question in samples of police detectives (with and without a history of violent victimization) and mental health workers (with and without a history of mental illness). Our results indicate that police detectives who have experienced violent victimization and mental health professionals who have experienced the same mental illness as their clients do indeed exhibit greater work engagement than their colleagues who lack these parallel life experiences. The link between a professional’s firsthand experience of his/her client’s hardships and work engagement appears to be partially explained by higher levels of grit among police detectives and by a greater sense of life-narrative continuity among mental health professionals.     

The false consensus bias as applied to psychologically disturbed adolescents

In order to examine whether the false consensus bias applied to psychologically disturbed adolescents, outpatients at a rural mental health center who described themselves as very depressed or suicidal, and nondisturbed teenagers (who had no history of psychological treatment and were not at that time seeking psychological treatment), were asked to read a newspaper article about either a child's suicidal or viral illness death. Both groups of adolescents, like adults in previous research, viewed the suicidal child and the surviving family more negatively than they did the child and survivors of a viral illness death. Further, consistent with the false consensus hypothesis, adolescent clients viewed either child as more psychologically disturbed than did nonclients. Also, clients, as compared to nonclients, viewed both parents as more psychologically disturbed prior to either child's death. Results somewhat support the hypothesis of a false consensus bias which operates for depressed, suicidal adolescents when they view the tragedy of a child's death, but not when they are making recommendations about psychological help for the surviving family. Results are interpreted as suggesting that adolescent outpatients either view therapy as not particularly beneficial or as not particularly appropriate for bereaved individuals.     

Treating Elders With Compulsive Hoarding: A Pilot Program

Hoarding among elderly clients can have serious health and safety consequences, including death. Because medications and standard behavioral treatments have yielded limited benefits for people with serious hoarding problems, we employed a specialized cognitive behavioral treatment (CBT) based on Frost and colleagues' model of hoarding problems. Of 11 elderly clients who met screening criteria for hoarding at a community mental health center, 6 completed an average of 35 sessions of therapy administered by a B.A.-level therapist trained and supervised in CBT methods. Treatment consisted of weekly home visits that included motivational interviewing, organizing and decision-making skills, cognitive therapy regarding hoarding and related beliefs, and practice sorting, discarding, and not acquiring. Modest improvement was evident in ratings of clutter, risky situations in the home, and functioning. Clients were generally satisfied with treatment. Challenges in treating hoarding in elderly clients include health and safety risks as well as reduced physical capacity that required problem-solving strategies.     

Clinician competencies: Strengths and limitations for work with transgender and gender non-conforming (TGNC) clients

Individuals who identify as transgender or gender nonconforming (TGNC) face a number of health disparities compared to individuals who identify as cisgender (those who self-identify with the sex they were assigned at birth). For example, TGNC individuals experience heightened rates of clinical depression, anxiety, general psychological distress, suicidal ideation, and suicide attempts. Despite these troubling disparities, many TGNC individuals report hesitance to seek mental health services due to concerns regarding culturally insensitive or even overtly discriminatory services from providers. In addition to decreasing service utilization among TGNC populations, discriminatory services impair intervention effectiveness even when TGNC individuals persist in seeking mental health services. The American Psychological Association (APA) and the World Professional Association for Transgender Health (WPATH) provide guidelines for culturally competent work with TGNC clients; however, research indicates a profound lack of TGNC-specific training and resources among mental health care providers. To address this gap, the present investigation utilized a mixed-method design to assess training experiences, understanding of terminology, and TGNC competence among mental health care providers at various training levels. Participants were current mental health clinicians across the United States. Implications for improving reported and demonstrated weaknesses are discussed.     

Parentification and mental health symptoms: mediator effects of perceived unfairness and differentiation of self

Existing research indicates that parentification can result in positive and negative outcomes for individuals; however, little is known about the mechanisms that account for the variability. This study tested a theoretical model of the relation between parentification tasks and mental health symptoms, with perceived unfairness and differentiation of self (DoS) as mediators. The results supported the proposed model in a sample of 783 college students. A significant total indirect effect existed between the latent construct of parentification and that of mental health symptoms. Significant specific indirect effects were observed between parentification and mental health symptoms with perceived unfairness as a mediator; between parentification and DoS with perceived unfairness as a mediator and between perceived unfairness and mental health symptoms mediated by DoS. Implications for clinical work with adult clients who have experienced parentification in their family of origin are addressed.     

African American Counselors‐in‐Training,the Black Church,and Lesbian‐, Gay‐, and Bisexual‐Affirmative Counseling: Considerations for Counselor Education Programs

This article examines the challenges that may be particular to African American counseling students who identify as Christian in learning to provide competent and affirming counseling to lesbian, gay, and bisexual (LGB) clients. The role and importance of the Black Church, race survival consciousness, and cultural constructions of sexuality and mental health may present unique barriers for these students in affirming LGB clients. Recommendations for counselor education programs are discussed.     

Time‐limited therapy in a Community Mental Health Team setting

This study examines time‐limited therapy in a Community Mental Health Team (CMHT) setting. This work is a key tension for CMHTs who are under pressure to focus on clients with a serious mental illness as a priority as opposed to clients who might be deemed the ‘psychologically distressed’. The development of CMHTs in the UK is described. Limited research on time‐limited therapy in a CMHT setting is identified. Results suggest that time‐limited therapy has a positive impact on the mental health needs of clients referred to a CMHT by GPs. It is concluded that it is appropriate to justify the use of time‐limited therapy in a CMHT‐based setting. Suggestions for further research are made.     

Group Treatment with French-Speaking African Survivors of Torture and Its Effects on Clinical Engagement: Can Hope Be Operationalized?

This study examines the clinical engagement of French-speaking African survivors of torture by measuring how often they utilize adjunctive programmatic services (i.e., mental health, social, and legal services) in relation to their involvement with the Francophone support group. Thirty-two clients who attended at least five Francophone group therapy sessions were identified and matched with their counterparts who never attended the Francophone group. We compared the number of services the clients in the Francophone group and the control group utilized, controlling for the number of services the clients utilized before attending the Francophone group. We found that the Francophone group showed significantly greater overall programmatic engagement. For the types of services utilized, the Francophone group sought out more mental health services, but there was no significant difference in social and legal services. These findings suggest that involvement with the Francophone group can be linked to increased levels of programmatic engagement.     

Evaluating the efficiency and community safety goals of the Broward County Mental Health Court

Mental health courts have developed as one response to persons with mental illness who are involved with the criminal justice system. This study investigated the efficiency and safety goals of one such court in Broward County, FL. Mental health court (MHC) clients spent significantly fewer days in jail for the index arrest associated with study enrollment than a comparison group. MHC clients had similar survival time to re-arrest up to one year after study enrollment. MHC clients did not significantly differ from the comparison group in self-reported aggressive acts over an 8 month follow-up period, while they did self-report significantly fewer acts of violence than the comparison group at the 8 month follow-up. These findings suggest that some of the benefits associated with the MHC reported in prior studies were not achieved at the expense of efficiency and safety.     

The Buddhist Spiritual Path: A Counselor's Reflection on Meditation,Spirituality, and the Nature of Life

The author describes her spiritual path from the perspective of a person who was raised in a Buddhist tradition and trained in a Western mental health profession. A foundation for the Buddhist concept of mental health is presented, and the relationship among counseling. Western developmental theory, and the development of a spiritual path is discussed. Strategies are presented for assisting clients with their search for spiritual development.     

Revisiting relationships between sex-related variables and continuation in counseling

This study examined the relationships between three sex-related variables (client sex, therapist sex, and dyad matching on sex) and continuation in counseling. 245 college students who were clients at three university counseling centers participated. Consistent with previous studies, women comprised 68.2% of the clients seeking services at these counseling centers. Clients' sex was significantly related to counseling duration, explaining 2.2% of the common variance. Female clients, on the average, attended 1.8 more sessions than male clients. However, neither the therapists' sex nor dyad matching on sex was significantly related to the duration of counseling. None of the sex-related variables correlated with premature termination of counseling. The results have implications for providing counseling and outreach services to male students. Despite relatively equivalent rates in the incidence of mental health problems, female students continue to comprise the majority of clients. Therefore, university counseling centers need to communicate their services better to male students in need of mental health services.     

The Provision of Assistive Technology by Occupational Therapists Who Practice in Mental Health

The purpose of this study is to determine what assistive technology devices occupational therapists working in mental health settings use with their clients. Based on the literature, the authors expected that no tech and low tech assistive technology solutions are being used with clients in these settings even though high technology options are available for people with mental illness who have co-existing cognitive disabilities. The findings of the study reveal that indeed no tech and low tech interventions are most often used. Implications for professional development educational programs and further research are suggested.     

Best Practices for Counseling Clients Experiencing Poverty: A Grounded Theory

Poverty is a pressing sociopolitical issue in the United States and worldwide. Poverty experiences have a significant effect on one’s mental health and overall wellness. Therefore, the ability to effectively serve clients experiencing poverty is critically important to professional counselors. However, there are no empirical models for counseling clients experiencing poverty. The authors present the results of a constructivist grounded theory study in which 21 professional counselors who work with clients experiencing poverty were interviewed to identify best practices for working with this population. Five major best practices are identified: (a) awareness, (b) training, (c) knowledge, (d) skills, and (e) advocacy. Implications for professional counseling are included.     

Diagnoses,Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM‐5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths‐based orientations, many tensions can follow when use of the DSM‐5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM‐5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.     

Presidential Address: Team Science Across Disciplines: Advancing CBT Research and Practice on Hoarding

This presidential address focuses on the recent history of research and practice on hoarding disorder (HD) as a potential model for coordinating interdisciplinary teams of professionals within and outside mental health fields to advance scientific efforts to understand and resolve mental health problems. To identify, assess, and intervene with clients who have HD, psychologists, social workers, psychiatrists, and other service professionals are needed, including those in public health, housing, medicine, aging and protective services, fire, safety, and animal protection. Research findings and practice methods developed by many of my colleagues highlight the various skills of these diverse disciplines and fields. Of particular interest are multimethod assessments and CBT interventions that span individual, group, and family treatments, delivered in the office, at home and via the web by mental health and other professionals, as well as peers. Outcomes are positive, but there remains much work to do to improve understanding and intervention outcomes.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

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.     

The relationships among clinical depression, suicide, and other actions that may hasten death

Clinical depression and other psychological disorders have been associated with suicidal ideation, attempts, and deaths. Because of the link between suicide and mental illness, whenever discussion of "assisted suicide" arises, the possibility that major depression is affecting the decision arises. This article examines the literature on clinical depression as it relates to suicide, "assisted suicide," and other decisions that will hasten death (i.e. withholding and withdrawing treatment, terminal sedation, and voluntarily stopping eating and drinking). Ethical and legal considerations when working with individuals who are considering taking an action that would hasten death are also briefly reviewed. The article ends with practice and policy recommendations.     

Language Matters: Competent Mental Health Treatment for Latina/Latino/Latinx Undocumented Immigrants—A Comment on Alfaro and Bui

Commenting on Alfaro and Bui’s article “Mental Health Professionals’ Attitudes, Perceptions, and Stereotypes Toward Latino Undocumented Immigrants,” this article explores and confirms the importance of continued and increased attention to language and word choice regarding Latina/Latino/Latinx immigrants as well a multicultural awareness and competence training for mental health professionals. Mental health professionals must be aware of connections between social determinants of health and well-being, as well as the impact of their own cultural awareness and language use, on their implicit bias and capacity for empathy with clients who they may perceive to be different than themselves. Ethical guidelines require mental health professionals to consistently seek learning opportunities to increase their cultural awareness in order to provide competent mental health services to Latina/Latino/Latinx undocumented immigrant clients that ameliorate suffering and facilitate flourishing.     

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.