Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

A naturalistic study of the effectiveness of time-limited counselling with low-income clients

The role of counselling and psychotherapy services in relation to the needs of economically disadvantaged individuals has been largely neglected in the recent research literature. Although a small number of theoretical papers and case analyses have been published, there is an absence of studies that examine the effectiveness of counselling with this client group. The present paper reports on a naturalistic outcome study of the effectiveness of time-limited counselling (seven sessions) with low-income clients. Analysis of pre-counselling, postcounselling and follow-up measures of mental health and problem ratings indicated levels of change equivalent to those achieved in controlled studies of counselling and psychotherapy with other client groups. Factors influencing the effectiveness of counselling included gender and employment status. Qualitative client reports suggested that the main benefits experienced by clients were in the areas of self-understanding and self-belief. For illustrative purposes, data from low-income clients are compared with results from employee counselling clients receiving a similar service. The implications of these findings for further research are discussed.     

Social Services with Cancer Patients and Their Families:

Two hundred and forty-seven cases from a specialized agency providing social services to cancer patients and their families were studied. Characteristics of those utilizing services and associations between clients' social risk factors and the extent of social work outpatient interventions were explored. Younger, divorced and single/widowed female cancer patients received greater amounts of service. Supportive counseling was the service most needed by a majority oF the clients. Implications for independent social work practitioners are discussed.     

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.     

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 Effects of Assertive Training on Sex Role Concept in Female Agoraphobics

Agoraphobia in women has often been associated with a restricted, "overly-feminine" sex role definition. We investigated whether assertiveness training from a female therapist would benefit agoraphobic women not only by teaching skills but incidentally by modeling a broader feminine gender role. Of 14 clients from an agoraphobic treatment program seven received assertiveness training as an adjunct to regular therapy. Sex role definition and assertiveness attitudes were measured with the Personal Attributes Questionnaire (Spence, Helmreich, & Stapp, 1974) and the Rathus Assertiveness Schedule (Rathus, 1973), administered before and following a 7-week treatment period. All the agoraphobics initially had significantly lower Masculinity scores on the PAQ than did large normative samples. T-tests performed on the data indicated that the assertiveness group's Masculinity scores increased after treatment to the level of the normative samples, while the comparison group did not change. Results supported the clinical observation that many agoraphobic women have limited gender role definitions, and indicated that this limitation consists of a deficit of masculine traits rather than a surplus of feminine ones.     

Pilot test of a measure to assess clients’ perceptions of their home visitors

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients’ perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.     

A Retrospective Examination of Child Protection Involvement Among Young Adults Accessing Homelessness Services

Childhood maltreatment is associated with a variety of young adult adversities including homelessness. This study used linked administrative records to develop a population‐level, epidemiological characterization of the child protection histories of young adults accessing homelessness services. The records of all 17‐ to 24‐year‐olds receiving homeless services between 2011 and 2014 in San Francisco County, California (n = 2241) were probabilistically linked to statewide child protective service (CPS) records. Findings document that 50.0% of young adults had been reported for maltreatment at least once during childhood, yet the prevalence of past CPS involvement varied across demographic and child welfare characteristics. Homeless female youth were significantly more likely to have a CPS history than male youth (58.1% vs. 41.5%). Nearly twice as many Black clients accessing homelessness services had a CPS history as did White clients (59.8% vs. 31.8%). Roughly half (47.3%) of those with a childhood history of reported maltreatment had been last reported for maltreatment in another California county. Targeting services that address past trauma and instability among homeless young adults may be justified given the prevalence of CPS history in this population.     

Cultural values and attitudes towards guidance and counselling services in one secondary school in Malaysia: the role of a school cultural system

This narrative ethnographic study aims to explore students' attitudes towards guidance and counselling services in one secondary school in Malaysia. Semi-structured individual interviews, group interviews and observations were conducted with school students of different racial backgrounds. They were identified as referred clients, self-referred clients, and those not deemed to be involved in counselling. The data were analysed using the constant comparative analysis grounded theory approach. The findings indicate that there were different attitudes among the three groups of participants concerning counselling services. The study highlights the role of a school system in elucidating attitudes towards guidance and counselling services. It poses implications for understanding counselling services within the school system.     

Intrafamilial physical victimization and externalizing behavior problems: Who remain the ‘forgotten’ children?

Over the past few decades, researchers have documented positive associations between direct child maltreatment and exposure to interpersonal violence (including intimate partner violence, community violence, school violence, and media violence) and children's externalizing behavior problems. However, current family violence literature largely ignores the effects of child abuse on other children in the family. A handful of studies have focused on exposure to child abuse and documented the behavioral effects on siblings, and these studies lend support for broadening scholarship focused on this type of family violence. This article presents empirical research and theories that focus on the relationships between child physical abuse and exposure to intimate partner violence and children's externalizing behavior problems. Using this literature as a foundation, an argument is made for the need to focus on children's exposure to child physical abuse. This article presents information from the few studies that have focused on children who were exposed to the physical abuse of a sibling and offers theoretical frameworks, including social learning theory and psychological proximity, as a foundation for future research. The article concludes with a discussion of services that may be necessary for children who have been exposed to the physical abuse of a sibling, including services focused on safety and mental health.     

Online counselling: a descriptive analysis of therapy services on the Internet

This study investigated the emerging practice of online counselling. Although the traditional practice of counselling involves face-to-face interaction between counsellor and client, a growing number of practitioners are providing counselling or therapy services via the Internet. In the present study, a total of 67 online counsellors completed a questionnaire exploring the backgrounds, services, fees, and communication technologies of practitioners offering online counselling to the public. Results suggest that online counselling is conducted by relatively experienced, primarily Western-based practitioners and is characterised by the use of email. Online clients are mainly female and receive relatively short-term interventions. Although the field appears to be evolving as its popularity increases, some ethical concerns raised by early research remain inadequately addressed.     

Employment and Roles of Counselors in Mental Health Agencies

The authors studied the employment of counselors with master's degrees in multiservice mental health agencies. The study focused on the types of clients seen, the direct care services provided, and the administrative duties performed. Results suggested that the employment of counselors does not differ significantly from the employment of individuals with master's degrees in psychology and social work. Also, the data indicated that counselors are delivering direct care services that traditionally have been offered in mental health centers, that clients seen by counselors demonstrate a range of mental disorders, and that counselors are responsible for fulfilling various administrative duties.     

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

GENDER AND SERIOUS MENTAL ILLNESS: A Feminist Perspective

Perhaps in reaction to criticisms of "woman as problem" formulations, psychological literature has nearly ignored women with serious mental illnesses (SMI), although epidemiological research indicates that women are overrepresented in these diagnoses. Data are presented on characteristics, functioning, and services received for a sample of nearly 2,500 SMI clients. Statistical clustering of clients with similar profiles produced four out of six clusters with significant differences in proportions of female versus male clients represented. The results indicate that the extent to which SMI clients display gender-related symptoms and behaviors is a significant factor in clinician perceptions and in service utilization. However, results also show substantial overlap in gender composition of the clusters. Discussion centers on the quality of care and appropriateness of services for female clients. Future research is suggested, utilizing a feminist understanding of women's diversity and of sociopolitical factors related to mental health.     

Web‐Assisted Career Counseling

For the past 20 years counselors have used computer‐based career information systems to assist clients with career planning and job hunting. Much of the same this information is now available on the Internet and can be accessed without the aid of a counselor. Such developments are likely to have a major impact on employment counseling practices. This article outlines selected Web‐assisted counseling issues that are likely to affect counselors over the next few years and summarizes the career services currently available on the World Wide Web.     

Stigma and Client Satisfaction in Mental Health Services

Numerous studies have revealed that stigmatization of persons with mental health problems has a large array of negative consequences. One outcome that has been largely neglected is client satisfaction. In this empirical study, the link between 3 types of stigma experiences and client satisfaction is explored in a sample of clients (N = 741) of professional mental health services in Belgium. This relationship is compared with the link between stigma and general life satisfaction; and the role of the self‐concept in these relationships is explored. The results reveal that the association depends on the dimension of stigma under study. The findings stress the importance of studying multiple dimensions of stigma experiences, in addition to multiple outcomes.     

Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service

Despite frequent informal or anecdotal acknowledgement of the usefulness of neuropsychological services within various settings, including mental health settings, few studies have formally investigated the satisfaction, perceived utility, or outcomes associated with such a service. This survey‐based study evaluated referring clinicians’ (n = 35) perceptions of the usefulness and outcomes associated with the provision of clinical neuropsychological assessment and feedback within an adolescent and young adult public mental health service in Melbourne, Australia. The results suggest that referrers perceive the neuropsychological service, including formal neuropsychological assessment report and verbal and written feedbacks, as a highly useful adjunct to their clinical practice. In addition, referrers frequently reported clinically meaningful outcomes in association with the neuropsychological service, including diagnostic changes or additions (11% of clients referred), changes to approaches in treatment (52% of clients referred), and increased or appropriate access to services, education, or work (33% of clients referred). Referrers also reported that almost 60% of neuropsychological assessment reports were forwarded to other services or clinicians involved in the client's care. The findings suggest that mental health settings are likely to benefit from routine inclusion of specialist neuropsychology services. However, future research should also examine client and family perceptions regarding the satisfaction and usefulness of neuropsychological services.     

Client Gender and Sex Role: Predictors of Counselors' Impressions and Expectations

Researchers of this study questioned: Are clients (male or female) with self-reported “masculine” versus “feminine” role orientations viewed more favorably by counselors? Which is more predictive of the counselor's impressions: the client's gender or his or her sex role orientation? Results suggested that highly masculine and highly feminine clients (regardless of gender) are perceived as more socially skilled and likely to experience a positive therapeutic outcome. Gender did not uniquely predict counselors' impressions. Highly feminine women clients, however, were viewed as more socially skilled than were highly feminine men. On average, clients were viewed as friendly and submissive.