Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

Countertransference reactions toward specific client populations: a review of empirical literature

Countertransference reactions can either benefit or hinder mental health professionals during the therapeutic process. An awareness of countertransference reactions can aid clinicians in understanding and anticipating their own specific emotional responses toward certain client populations. Recent empirical research suggests that common countertransference reactions may occur in mental health professionals when relating to certain client types. Since a literature review indicated that more numerous and reliable tests have been developed to measure countertransference during the past decade, as well as better research designs, this article reviews and summarizes all empirical research studies on countertransference reactions toward specific client populations during the past 10 years, from 1990 to 2001.     

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.     

Couples with Schizophrenia "Becoming like Others" in South Korea: Marriage as Part of a Recovery Process

Very little is known about the married life of couples with schizophrenia. In this paper, authors report perceptions and experiences of 5 married couples with schizophrenia on their strategies in forming and maintaining healthy marriage. Our data reveal that participants had realistic expectations of marriage, and recognized benefits as well as obstacles in their marriages with respect to their recovery. This paper examines the importance of extended family members, mental health professionals, and the larger society's attitudes toward marriage as a factor in the recovery process for persons with schizophrenia. The authors identify implications for mental health professionals regarding the respect of client dignity and the applicability of a strengths perspective when working with couples with schizophrenia. The authors argue that mental health professionals' decisions regarding the balance between respecting a client's self-determination and protecting a client from risks associated with cohabitation and marriage should no longer be a dilemma for those working with people with mental illness.     

Mental health professionals and assisted death: perceived ethical obligations and proposed guidelines for practice

I have three purposes in this article: (a) to briefly review the legal obligations a mental health professional has when working with a client who is talking about taking some action that could lead to his or her death, (b) to clarify the positions of the 4 major national mental health organizations regarding the acceptable roles of their members with clients who are discussing the possibility of receiving assisted death, and (c) to propose a set of guidelines for practice for mental health professionals working with clients who are considering assisted death that comport with the various laws and codes of ethics.     

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 Association Between Implicit Racial Bias and Mindfulness in Mental Health Practitioners

The mental health research literature on implicit bias is limited (Boysen, 2009), and little is known about how factors that are associated with self‐perceived multicultural counseling awareness, such as mindfulness, relate to implicit racial bias in practicing mental health professionals. Using a correlational research design, we examined the association between mental health practitioners' implicit bias, self‐perceived multicultural counseling competence, facets of dispositional mindfulness, and mindfulness practices. A total of 137 mental health professionals completed an online questionnaire. Results revealed a negative relationship between the observing component of dispositional mindfulness and the implicit racial preference associating White and “good” words. In addition, results indicated that the frequency of engaging in mindfulness practices negatively predicted implicit racial preference associating White and good. Implications for counselor training, practice, and future research are discussed.     

Delivering Diagnoses: Parents as Translators and Withholders of Children’s Mental Health Diagnoses

There is a lack of research on how mental health diagnoses are delivered and explained to children and the effectiveness of these strategies. This qualitative study examines how emerging adults recall the delivery of mental health diagnoses in childhood and how they suggest these diagnoses should be delivered to children. Semi-structured interviews were conducted with 42 emerging adults (aged 18–22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depressive disorders, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Findings reveal that parents, rather than mental health professionals, often inform children of their diagnoses. The data suggest that parents often act as translators of diagnostic information, acting as liaisons between mental health professionals and their children. The paper explores ways in which parents and mental health professionals withhold diagnoses from children, and how this affects children’s experiences. Drawing on their own experiences, participants offer suggestions regarding the best ways to deliver diagnoses to children. Findings suggest that adults should share mental health diagnoses openly with children. Implications for social workers and other allied health professionals who support families when children are diagnosed are discussed.     

Styles of Suicide Intervention: Professionals' Responses and Clients' Preferences

As the rates of suicide in America continue to rise, suicide recently has been declared to be a national public health concern. The crisis intervention model, which has dominated the treatment of suicidal individuals in America since the 1950s, is currently believed to be the most effective model for suicide intervention. This study examined this belief by taking a more complex look at professionals' responses to suicidal clients both by investigating the existence of different ways in which professionals interpret the crisis intervention model. In one interpretation (the "fight" response), the professional takes power and agency away from the client and does what is perceived to be "best" for the client. An alternate interpretation, the "ideal" response, allows for a respectful engagement with the client. Professionals also can act contrary to the model (i.e., the "flight" response). In addition, based on the humanistic notion that clients are the experts of their own experience and that their voices are a very valuable part of evaluating the treatment process, this study investigated which response style clients report to be most helpful and most desired. The results suggest that while the typical response of mental health professionals to suicidal clients is most characteristic of the "fight" response style, clients overwhelmingly report that the contrasting "ideal" response style is most helpful. The findings are discussed along with implications for practice, research, and training.     

Regulating Research for the Decisionally Impaired: Implications for Mental Health Professionals

Mental health professionals, in fulfilling their different roles, often become involved with research protocols involving decisionally impaired current or prospective human subjects, many of whom are elderly. The opening section of this paper briefly describes the present regulatory environment regarding human subjects research, followed by an overview of the Institutional Review Board (IRB) process. There then ensues an enumeration of some of the general criticisms of the current regulatory scheme that have been enunciated recently. Particular concerns concerning decisionally impaired persons as research subjects are then addressed, referring when applicable to the recommendations made by the National Bioethics Advisory Commission (NBAC) in its 1998 report on this subject and the implications of those recommendations for mental health professionals.     

Online mental health treatment: concerns and considerations.

Concerns and considerations have emerged as mental health professionals contemplate the provision of mental health treatment over the Internet. This paper identifies perceptions of online mental health treatment among a national sample of 2,098 social workers, psychologists, and other professionals. These professionals were unlikely to provide online mental health treatment, although some used the Internet as an adjunct to clinical practice. They noted specific concerns related to the provision of mental health treatment online, including confidentiality of client information and liability issues. We explore these issues and discuss implications for professionals who provide mental health treatment.     

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.     

Acceptance and Commitment Therapy With Older Adults: Rationale and Considerations

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research.     

Innovation in Technology-Aided Psychotherapy Through Human Factors/Ergonomics: Toward a Collaborative Approach

Technologies are being used increasingly to aid psychotherapy and are becoming an integral part of mental health treatment. Although prior studies compared technology-aided psychotherapy (TAP) to traditional treatments, there are insufficient studies of the impact that specific design parameters and use of the technologies may have on the client and therapist, and treatment outcomes. This requires an understanding of human–technology interaction, which is the focus of the field of Human Factors and Ergonomics (HF/E). The goal of this article is to raise awareness of the importance of the human–technology interaction in TAP, and to foster collaborations between psychotherapists and HF/E professionals. Toward these aims, this article examines the implications of findings in HF/E for the use of technologies (videoconferencing, text-based communication, and virtual environments) in psychotherapy. It is suggested that the manner in which technologies are designed and used may have important effects on the therapeutic alliance and treatment outcomes, and in some cases (side effects of virtual reality) the health and safety of the client. Future research should examine effects of specific design factors on treatment including variables such as the visibility of gestures and degree of eye contact during videoconferencing, response delays during text-messaging, and presence and adverse effects when using virtual environments. Studies that compare TAP to traditional methods should report as much detail as possible about the human–technology interaction. It is essential that psychotherapists and HF/E professionals conduct research collaboratively to develop effective and innovative technologies and, ultimately, design principles for TAP.     

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.     

The Effect of a Derogatory Professional Label: Evaluations of a "Shrink"

A study was designed to examine the consequences of hearing a mental health professional referred to as a "shrink." Participants ( N  = 129) viewed a videotape of a simulated therapy session after hearing a psychologist referred to as a shrink , a psychologist , or Mr. Smith . As hypothesized, exposure to shrink lowered evaluations of the therapist. However, this was focused on specific characteristics (e.g., expertise). After hearing the label shrink , participants expressed less interest in seeking therapy from the psychologist portrayed. The commenter of the shrink label was also viewed more negatively. The findings imply that the use of the term shrink may undermine people's attitudes toward mental health professionals, a consequence with implications for the utilization of their services.     

Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients.     

The practice research network: Research into practice,practice into research

The purpose of the broader project on which this report is based was to utilize a Practice Research Network, an alternative to traditional clinical studies to 1) identify demographically one practice group, namely professional counselors in the United States, 2) describe their practice patterns, and 3) identify their client population and the efficacy of their clinical work through client outcomes based on actual client reports. This article describes the development of one such nation‐wide Practice Research Network (PRN) and provides some preliminary findings for each phase of the project. Use of the PRN model can help overcome the traditional “research to practice” gap and provide research results into community practice thus integrating outcomes measures into the daily practice of mental health professionals. During the early phases of this project, a software program was developed upon which the participating practitioners could identify the data elements within the parameters of the focus on their agreed‐upon research interests, enter data following client visits over time, and by comparing their own composite profiles and effectiveness with those of other participating practitioners who had clients presenting with similar diagnoses, could alter their own service delivery patterns, therapeutic interventions, or approaches while working with the clients and thereby improve the efficacy of their service. By participating, the practitioners benefited by access to downloadable and printable reports on profiles of 1) their specific clients, 2) their service delivery patterns, and 3) the outcomes or efficacy by their clients’ direct feedback. They were also able to compare these results with the composite data from other practitioners.     

Bias in Counselor Hypothesis Testing: Testing the Robustness of Counselor Confirmatory Bias

Explored the issue of confirmatory bias in counselors' clinical hypothesis testing. Recent research suggests that counselors are subject to a confirmatory bias when using information to test a client hypothesis. The current research tested the robustness of this finding by adding realism and accountability to the experimental situation. Two experiments examined the facts that experienced counselors recalled (a) about a coached client in a naturalistic situation, and (b) when they selected information from a client narrative when told that they would later be held accountable for their selection. In Experiment I, experienced counselors recalled more confirmatory than disconfirmatory information from a coached client's live presentation of factors. In Experiment 2, counselors-in-training selected more confirmatoty than disconfirmatory information from a case history despite the accountability implied by the experimental instructions. The authors concluded (a) that the confirmatory bias is a robust one that may be a natural part of any judgment situation and (b) that counselor education should explicitly train counselors to avoid this confirmatory bias.