Addressing Coparenting in the Delivery of Psychological Services to Children

In this article we highlight recent changes in fathers’ roles and argue that research on parenting has focused disproportionately on the role of mothers. We then describe ways that fathers may be overlooked in psychological services providing parent training and summarize preliminary evidence that the inclusion of fathers may enhance long-term effectiveness of parenting interventions. Compared to intact couples, separated and divorced parents may require additional support in working together to address children’s problems. We outline a strategy inspired by mediation that is designed to promote coparenting in separated and divorced families and illustrate it with a case example.     

Children’s behavioral patterns, the Five-Factor model of personality, and risk behaviors

Although relations between children’s personality and health behaviors have been identified, previous research has relied primarily on survey assessments. The present study used behavioral observations to examine children’s (n = 94, mean age = 10.07 years) behavioral patterns in relation to their participation in risk behaviors 1 year later. Results contribute to previous reports linking specific personality traits to children’s likelihood of participation in risky behaviors. Specifically, girls’ participation in risky behavior was related to the expression of behavioral patterns associated with neuroticism, introversion, and disagreeableness, while boys participation in risk behaviors was related to behavioral patterns associated with extraversion and disagreeableness. Findings are discussed in terms of their potential for contributing to health promotion efforts aimed at identifying children most at risk for adopting unhealthy behaviors.     

Surfing for Salvation

I demonstrate that despite the enormous amount of religion on the Internet, a general classification can be developed based upon the religious participation occurring at the various websites. I recognise these classifications as ‘religion-online’ and ‘online-religion’. Religion-online presents information about religion. It is a controlled environment. The site has been structured to limit participation. In contrast, online-religion provides an interactive religious environment for the web practitioner. Because of this difference, individuals and organisations have different perceptions concerning how the Internet should be used for religious purposes. In many cases there is an active form of religious participation occurring. Rituals are conducted, prayers are posted and even communion is carried out on this medium. In other situations the Internet presents material concerning religion to a passively receptive audience. Despite these levels of control, the web surfer is exposed to an enormous number of belief systems and also varying levels of online religious participation.     

Treatment of a Case Example With PTSD and Chronic Pain

This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this framework, the commentary includes a focus on the treatment of PTSD with an eye toward generalizing the therapeutic strategies to chronic pain problems. Psychoeducation, imaginal exposure to the traumatic event, in vivo exposure to avoided activities, and cognitive interventions including coping self-statements, correction of logical errors, decatastrophizing and developing alternative explanations are all included in the recommendations as part of a standard cognitive behavioral treatment for PTSD. Added to this standard PTSD protocol is the suggested use of interoceptive exposure to address GH’s feared bodily sensations. In the assessment domain, standard measures for pain and PTSD assessment are suggested along with tracking of depression and anxiety sensitivity. Some recognition of more recent approaches to cognitive behavioral therapy (e.g., Acceptance and Commitment Therapy) is given in considering potential obstacles to treatment.     

A social neuroscience perspective on adolescent risk-taking

This article proposes a framework for theory and research on risk-taking that is informed by developmental neuroscience. Two fundamental questions motivate this review. First, why does risk-taking increase between childhood and adolescence? Second, why does risk-taking decline between adolescence and adulthood? Risk-taking increases between childhood and adolescence as a result of changes around the time of puberty in the brain’s socio-emotional system leading to increased reward-seeking, especially in the presence of peers, fueled mainly by a dramatic remodeling of the brain’s dopaminergic system. Risk-taking declines between adolescence and adulthood because of changes in the brain’s cognitive control system—changes which improve individuals’ capacity for self-regulation. These changes occur across adolescence and young adulthood and are seen in structural and functional changes within the prefrontal cortex and its connections to other brain regions. The differing timetables of these changes make mid-adolescence a time of heightened vulnerability to risky and reckless behavior.     

Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.     

Is Urban Fathers’ Religion Important for Their Children’s Behavior?

Previous research suggests that many men increase their religious involvement after the birth of a new child. Using data on low-income urban fathers from the Fragile Families and Child Wellbeing Study (FFCW), this study extends this research by examining whether fathers maintain a higher rate of religious participation as children get older and how fathers’ religiosity may influence children’s behavior. Results suggest that although many urban fathers slightly increase their religious involvement after the birth of a child, most fathers attend religious services at a fairly consistent rate during the early years of their child’s life. Although there is only limited evidence suggesting that fathers’ religious involvement directly influences children’s behavior, there is evidence that fathers’ religiosity moderates the influence of other family characteristics on children; parental relationship quality and mothers’ religiosity are associated with fewer problem behaviors among children when fathers believe that religion is important to family life. Results also suggest that having a Black Protestant father is associated with fewer externalizing problem behaviors among young children. Overall, this study suggests that religion may be a source of support that encourages urban fathers to be engaged in their family life and promote positive development among children.     

Integrating Homework Assignments Based on Culture: Working with Chinese Patients

Cognitive therapy as espoused by A. T. Beck (A. T. Beck, Rush, Shaw, & Emery, 1979) is increasingly used as a therapeutic modality and applied to a variety of cultural groups throughout the world. However, the majority of the literature on empirical and clinical practice has been focused on the use of cognitive therapy for Western cultures. In this article, we discuss Chinese patients’ adherence to therapy homework assignments in terms of Chinese cultural values and practices, their customary problem-solving process, and other traditional beliefs. Through the use of a case study, we illustrate how some of these culturally specific beliefs can influence the process of integrating homework assignments into the course of therapy. This resource on supervising practitioners’ treatment of Chinese patients with cognitive behavior therapy is offered as a contribution to the emerging literature on CBT for non-Western cultures.     

Understanding dropout and prolonged engagement in adolescent competitive sport

Objectives: The purpose of this study is to gain understanding of training patterns and roles of significant others (i.e. coaches, parents, peers, and siblings) in adolescent swimmers’ sport participation patterns. Design: The developmental model of sport participation [Côté, J., Baker, J., & Abernethy, B. (2003). From play to practice: A developmental framework for the acquisition of expertise in team sport. In J. Starkes, & K. A. Ericsson (Eds.), Recent advances in research on sport expertise (pp. 89–114). Champaign, IL: Human Kinetics; Côté, J., & Fraser-Thomas, J. (2007). Youth involvement in sport. In P. R. E. Crocker (Ed.), Introduction to sport psychology: A Canadian perspective (pp. 266–294). Toronto: Pearson Prentice Hall] was used as a framework.Method: Ten dropout and 10 engaged swimmers, matched on key demographic variables participated in a semi-structured qualitative interview.Results: Groups had many similar experiences (e.g. early training, supportive and unsupportive coaches, involved parents). However, only dropouts spoke of early peak performances, limited one-on-one coaching, pressuring parents during adolescence, lack of swimming peers during adolescence, and sibling rivalries. In contrast, only engaged athletes spoke of clubs’ developmental philosophies, coaches’ and parents’ open communication, school friends’ support, and siblings’ general positive influences.Conclusions: Findings highlight the importance of appropriately structured programs and the fragility of athletes’ relationships with significant others during the adolescent years. Implications for sport programmers, coaches, and parents are discussed.     

Malpractice Arising From Negligent Psychotherapy: Ethical,Legal, and Clinical Implications of Osheroff v. Chestnut Lodge

This article reviews key philosophical and legal underpinnings of mental health professionals' obligation to obtain informed consent from consumers of their services. The basic components of informed consent are described, and strategies for clinically and ethically appropriate methods of obtaining informed consent are discussed. Emerging issues in informed consent involving duty to assess and protect against client dangerousness, obligations to third parties, and issues of deception are considered as well. The article proposes that part of the process of obtaining informed consent is the cultivation of a treatment environment that emphasizes beneficence and client autonomy.     

Research without Consent: Exception from and Waiver of Informed Consent in Resuscitation Research

The ethical concept of Informed Consent provides individuals with the right and the opportunity to approve of events that will occur regarding his or her own person. In medicine, informed consent is obtained for treatment and for research participation. However, under some circumstances, prospective informed consent cannot be obtained because of the devastating clinical condition of the patient. In emergency circumstances, treatment is never withheld if obtaining informed consent from a critically ill person is not possible or if a delay while seeking surrogates would further endanger life. In emergency research circumstances, waiving informed consent for study participation is fraught with additional ethical considerations. This article will review a presentation given at the June 2, 2006 conference entitled “The Ethics of Research in Emergency Medicine”. An earlier version of this paper was presented at: The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Conceptualizing Patient Barriers to Nonadherence with Homework Assignments

Nonadherence with homework assignments and, by implication, “barriers” to homework assignments are a frequent occurrence in the practice of standard cognitive therapy (Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press). The clinical examples in this article illustrate some of the ways in which environmental, patient, task, and therapist factors can serve as barriers to homework completion. Although these classes of barriers may be discussed independently, they are actually overlapping processes and are more helpful when discussed in tandem. This article illustrates how the therapist’s ability to conceptualize can serve as the context for making sense of the patient’s perceived ability to undertake an activity, the patient’s beliefs about the specific task, and how our ability to use the conceptualization to anticipate barriers is part of evaluating our own therapeutic skills. Several clinical case examples are discussed.     

Quality and Individualization in Wraparound Team Planning

In children’s mental health, collaborative, team-based individualized service planning is most commonly known as wraparound, and has become one of the primary strategies for improving services and outcomes for children with the highest levels of need. We report on analyses of data gathered at 72 wraparound team meetings from communities around the United States. We describe the composition of the teams and the quality of the planning process they engaged in, and explore the extent to which these factors were associated with team member satisfaction and the individualization of plans. Teams in our study were numerically dominated by professionals. Parents attended a large majority of meetings, participation by youth and family advocates was frequent, participation by other family members infrequent, and participation by other members of the family’s informal or natural support networks rare. Observed teams varied considerably in the quality of their planning process and the degree of individualization of plans. Higher-quality planning was significantly associated with increased individualization of plans and with team member satisfaction with meeting productivity.     

Psychology’s Adaptation to Medical Schools,Teaching Hospitals,and Academic Medical Centers: The Role of Academic Medicine Organizations

Psychologists in medical schools, teaching hospitals, and academic medical centers are comparatively small in number, and are often undervalued and denied full practice privileges. As a profession, psychologists must therefore adapt to the realities of a physician-driven, physician-controlled environment. Psychologists’ adaptation to academic medical settings has been considered from several vantage points. An overlooked aspect of adaptation is psychologists’ knowledge of and participation in academic medicine organizations that regulate medical education and specialization. These organizations significantly influence teaching hospital and medical school environments and the psychologists and academic physicians who work in those environments. This paper focuses primarily on three academic medicine organizations, the Liaison Committee on Medical Education (LCME), the Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS), which together shape and regulate medical education across all levels and specialties. Knowledge of the evolution and workings of these organizations is useful information for psychologists, but beyond that, such information is a framework that provides benchmarks for understanding psychology’s evolving system of education and specialization.     

Hide-and-seek or show-and-tell? Emerging issues of informed consent

This article reviews key philosophical and legal underpinnings of mental health professionals' obligation to obtain informed consent from consumers of their services. The basic components of informed consent are described, and strategies for clinically and ethically appropriate methods of obtaining informed consent are discussed. Emerging issues in informed consent involving duty to assess and protect against client dangerousness, obligations to third parties, and issues of deception are considered as well. The article proposes that part of the process of obtaining informed consent is the cultivation of a treatment environment that emphasizes beneficence and client autonomy.     

The 2003 Survey of Academic Medical Center Psychologists: Implications and Outlook

This paper offers commentaries on Pate and Kohout’s (2005) report of data from the 1997 and 2003 surveys of psychologists in medical school settings. The commentaries reflect upon the significance of the survey findings and implications for psychology’s role in medical school and academic health science settings. Though the response rate to the survey was disappointing, the data indicate that psychologists are moving up in academic rank, and have made substantial gains in salary. The data also indicate that among psychologists who are medical staff members, who constitute half the 2003 sample, an increasing proportion are functioning autonomously as reflected in gains in the percentage having admitting privileges, staff voting privileges, and authority to write orders. Research continues to be a major focus for psychologists in academic medical centers. Overall, the findings indicate that psychologists can have productive, satisfying careers in medical school/academic health center settings—though there is one troubling sign, a sizeable drop in the number of positions being created for younger, more recently trained psychologists. Methodological enhancements are described that could improve the quality, scope, and usefulness of data from future studies, both for understanding long-term trends and for conducting salary negotiations. High quality data provide a solid foundation for advocating for psychologists’ full participation in the life of medical schools and academic health centers.     

Fathers’ Emotional Resources and Children’s Socioemotional and Behavioral Adjustment Among Children with Learning Disabilities

This study examined a cumulative model of risk/protective factors at the individual level (child’s sense of coherence; attachment with father) and family level as manifested by fathers’ emotional resources (fathers’ negative/positive affect; attachment avoidance/anxiety), to explain socioemotional adjustment among children age 8–12 years with or without learning disabilities (LD). Participants were 205 father–child dyads: 107 fathers and their children with LD; 98 fathers and their non-LD children. Preliminary analyses indicated significant group differences on all child measures. Path analysis revealed high fit between the theoretical model and empirical findings; moreover, the model’s components revealed partially different patterns of relations for the two populations. Thus, the current study suggested the potentially important role of fathers’ positive and negative affect and fathers’ avoidant and anxious attachment for children’s socioemotional and behavioral adjustment and children’s mediating variables. Discussion focused on understanding the value of these fathers’ emotional factors and their children’s characteristics for well-adjusted functioning.     

Perceived Barriers to Treatment Participation and Treatment Acceptability Among Antisocial Children and Their Families

This study examined the role of perceived barriers to participation in treatment and the acceptability of treatment among children and parents. Children (N = 144, ages 6–14) referred for outpatient treatment for oppositional, aggressive, and antisocial behavior and their families participated. The main findings were that: (a) perceived barriers to participation in treatment predicted treatment acceptability as rated by children and parents; (b) the effect was not accounted for by socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction; and (c) treatment acceptability was related to therapeutic change in the children over the course of therapy but the relation was small. Overall, the findings indicate that families vary considerably in the barriers they perceive in coming to treatment and that these barriers influence the extent to which they and their children evaluate the acceptability of the treatments they receive. The implications of treatment acceptability for evaluation and delivery of psychotherapy are discussed.     

Adolescent Perceptions of Parental Behaviors,Adolescent Self-Esteem,and Adolescent Depressed Mood

Using symbolic interaction, we developed a research model that proposed adolescent perceptions of parental support and psychological control would be related to adolescent depressed mood directly and indirectly through self-esteem. We tested the model using self-report questionnaire data from 161 adolescents living with both of their biological parents. To examine possible gender of adolescent differences, we tested two multigroup models separately for adolescents’ perceptions of mothers’ and fathers’ parental behaviors. Both the fathers’ and mothers’ models yielded (a) direct paths from self-esteem to depressed mood (for boys and girls), psychological control to depressed mood (for boys) and (b) an indirect path from support to self-esteem to depressed mood (for girls and boys) and an indirect path from psychological control to self-esteem to depressed mood (for girls). In addition, in the fathers’ model a significant direct path was found between fathers’ support and depressed mood (for girls).     

Show-That-I-Can (Homework) in Cognitive-Behavioral Therapy for Anxious Youth: Individualizing Homework for Robert

Cognitive-behavioral therapy (CBT) has been reviewed and described as an empirically supported treatment for anxious youth. One component of CBT is the use of out-of-session “Show That I Can” tasks (STIC; i.e., homework tasks). STIC tasks vary in content and are to be completed between sessions. We discuss homework in CBT for Robert, a 13-year-old boy with social anxiety. Robert experienced distressing anxiety participating in and giving presentations at school and was fearful of open-ended questions. Robert had difficulty maintaining conversations with peers and reported being preoccupied with a concern that he would say something “weird” or “stupid.” Robert avoided numerous situations, and his social anxiety affected his grades, social interactions, family, and quality of life. Robert’s initial homework tasks entailed (a) journaling and self-monitoring anxious feelings and thoughts, and (b) practicing relaxation skills. During the second half of treatment, Robert’s STIC assignments were exposure tasks, including (a) opinion discussion assignments, (b) participating in class, and (c) initiating conversations with children at the bus stop. The present discussion focuses on how homework was individualized and presented so that it was palatable and sensitive. Issues regarding out-of-session exposure tasks that elicit sufficient anxiety, resistance to high-level exposure tasks, and parent involvement are explored.