Teaching Sizeism: Integrating Size into Multicultural Education and Clinical Training

Abstract

Multicultural education, training, and practice have traditionally focused primarily on race/ethnicity with gradual inclusion of gender, sexual orientation, social class, and age. Issues of size, which intersects with racism, sexism, and classism, have been notably absent from diversity discussions. Psychologists have typically framed size issues around obesity and adopted a medicalized, individualized perspective that belies data that show traditional approaches to weight management, such as dieting and exercise, are largely ineffective and non-maintainable. Here, we offer a rationale for including body size as an issue relevant to a multicultural curriculum. Strategies for training psychologists and therapists are delineated.     

Recognizing the Fundamental Right to be Fat: A Weight-Inclusive Approach to Size Acceptance and Healing From Sizeism

Abstract

Sizeism permeates and shapes how scientific and professional communities—including therapists—perceive, understand, and behave toward anyone considered fat. In this article, we use scientific evidence to argue for the recognition and establishment of fat acceptance to subvert sizeism. We first critically review the Weight Normative Approach, which dominates scientific discourse on weight, despite being based on sizeist assumptions that are discredited by data. We then articulate the tenets of the Weight Inclusive Approach, which honors size diversity and the promotion of wellness within a social justice framework. We end with strategies for therapists to align their practice with the Weight Inclusive Approach.     

The Future of Training and Credentialing in Group Psychotherapy

High-quality group psychotherapy training is seen as more important than ever in the current health care environment. The training opportunities available at present are assessed. It is argued that there is a body of knowledge about generic group psychotherapy that can and should be taught, and that there are appropriate people to teach it. Credentialing is discussed, and it is suggested that the assessment of actual work in clinical situations must be emphasized if such efforts are to be meaningful.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

Preinternship Preparation of Clinical and Counseling Students in Psychological Testing, Psychotherapy, and Supervision: Their Readiness for Medical School and Nonmedical School Internships

Internship directors have been critical of students' preinternship preparation in test-based assessment and psychotherapy but have not, until recently, expressed their quantitative expectations for this training. Using data from the Association of Psychology Postdoctoral and Internship Centers application form, this study investigated the quantitative statements of 96 counseling and 238 clinical students regarding their preinternship testing, psychotherapy, and supervision training, comparing findings to medical school and nonmedical school directors' quantitative expectations. Results generally demonstrated adequate psychotherapy training but suggested deficiencies in testing training, particularly as related to medical school directors' expectations. Counseling students received more training in individual therapy with adults but not in other forms of therapy. Clinical students produced more integrated test-based reports. Both groups received similar amounts of supervision.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

Doing Psychotherapy with Patients with Genital Herpes: Issues and Interventions

Abstract

This article presents issues that the psychotherapist is likely to have to deal with in treating patients with genital herpes. A review of medical issues, clinical manifestations and pharmacotherapy of herpes infections is presented. Common psychological reactions and psychopathology related to herpes simplex virus infection, a discussion of the patient's dilemma of disclosing his or her herpes simplex positive status to others and a list of cognitive-logical distortions often encountered in, and negatively affecting, patients with genital herpes are presented in detailed examples. A practical model (SANE) conceptualizing psychotherapy for patients with genital herpes in 4 intervention stages (Stabilization-crisis intervention, Acceptance, Normalization and social-personal Empowerment-evolution) is suggested for use. The use of cognitive-behavioral therapeutic strategies in facilitating the patient's assumption of a healthier psychosocial perspective in each stage is comprehensively detailed. Ethical and legal concerns in working with herpes simplex positive patients are also discussed.     

Online Cognitive Behavioural Therapy Training for Therapists: Outcomes,Acceptability, and Impact of Support

The objectives of the present study were to assess the effects of online cognitive behavioural therapy (CBT) training for therapists on measures of CBT knowledge, skills, confidence, and utilisation; to determine what differences might exist between a group supported by regular telephone contact and an independent group who undertook online training without additional support; and to determine the acceptability of CBT online training among rural and remote mental health professionals. Mental health practitioners were randomly allocated to a supported training group (six sessions of 15‐min support) or an independent group. They undertook a 12‐week online CBT training program. The two groups showed similar gains on an objective test of knowledge of CBT, and on self‐report measures of knowledge, skills, confidence levels, and utilisation of skills. However, the supported training group had a significantly higher program completion rate than the independent group. Participants evaluated the program favourably. The results suggest that online CBT training represents a promising and cost‐effective approach to training the mental health workforce, and may be particularly attractive for those who live in regional, rural, and remote communities. A challenge is to determine the most cost‐effective ways to enhance program completion rates and trainee skills.     

Predicting the evolution of counseling psychology in the United States: results from a Delphi poll of academic training directors

What might the field of counseling psychology in the United States of America look like 10 years from now? In a Delphi Poll, an expert panel, consisting of 28 training directors from APA-accredited counseling psychology programs, made predictions regarding the future of counseling psychology 10 years from now in relation to three domains (core features, research and training, and professional training) and 32 specific areas within those domains. The strongest core feature of counseling psychology was viewed as a continuing commitment to issues of diversity (M = 4.64, SD = .63); the research and training theme predicted to attract the most attention in the next 10 years was a commitment to evidence-based practice (M = 4.71, SD = 1.20); and the professional training theme predicted to gain the greatest focus was attention to professional competence (M = 4.43, SD = .65). Results were compared with a previous Delphi Poll conducted in 2001, and recommendations are outlined for future research designed to contribute to the ongoing development of the field of counseling psychology.     

Child and Caregiver Dropout in Child Psychotherapy for Trauma

This study focused on the identification of variables collected at baseline assessments that predict children and caregivers who are at risk for dropout from treatment. A sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress was utilized for this study. Multinomial logistic regression analyses indicated that caregiver and child age, the child's externalizing behaviors, and the child and caregiver's acknowledgment of posttraumatic stress symptoms significantly predicted premature dropout from treatment. Clarification of child and caregiver characteristics that increase the risk of dropout allows for the identification of families in need of additional support to stay in treatment.     

When Training Becomes Incentive for Generative Living and Working Together in Organizations

This article has come about from two considerations: on one hand, living together in a work environment is becoming more and more challenging; on the other, training professionals at work represents a used and relevant action incentive in order to support and improve individual, group, and organizational development. In light of the fact that organizations are asking more and more complex questions, this work aims at developing a reflection on how adopting a certain perspective and educational method is particularly suitable to support the organization to achieve substantial outcomes, such as developing generative living and working together in organizations. In this article, we will analyze two illustrative cases, underlining evolution and learning process with a particular focus on the consequences of living and working together in organizations.     

Emerging Practices of Counseling and Psychotherapy in China: Ethical Dilemmas in Dual Relationships

A qualitative study was conducted with 48 Chinese counselors and psychotherapists who were interviewed in 2006 and an independent sample of 50 participants who responded to a survey in 2014. This study aims to explore how the new emerging expansion of mental health practice is related to issues and challenges of dual role relationship and how the well-engrained values and social characteristics of Chinese culture influences perceptions and resolution of ethical dilemmas. The participants identified similar dual relationships in 2006 and 2014: (a) Incidental boundary crossings, a sexual or romantic relationship, a dual social relationship, and a professional dual relationship were the most frequently reported types of dual relationships encountered by Chinese practitioners, and (b) the socioeconomic and cultural context and the development trajectory of counseling and psychotherapy in China play a significant role in shaping practitioners’ behaviors. The comparison of the data in 2006 and 2014 indicated that practitioners in psychotherapy and counseling have an improved awareness and understanding of ethical issues, evidenced by the decreasing cases of romantic and sexual relationships and increasing cases of social dual relationships influenced by the interrelatedness of traditional Chinese culture.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base

While the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and young people.     

Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis

Movement psychotherapy (MP), and dance/movement therapy (DMT), are body-orientated psychotherapy approaches that use movement for the integration of emotional, cognitive, physical, social and spiritual aspects of self (European Association Dance Movement Therapy, 2010). It is distinctively a combination of moving and sensing the body with verbal self-reflection (Bloom, 2006). Several papers have presented DMT as a treatment in general medical care and cancer care, but there is still a paucity of evidence-based studies. The authors describe a clinical case illustrative of many of the situations in which facing death was particularly tormenting. The emotional pressure can produce a barrier of communication with the risk of rupturing the therapeutic relationship. The movement therapist’s function is to clarify the elements of body language and this has important implications for clinical practice because the end-of-life decisions are difficult, like palliative sedation therapy (PST). Even if procedural guidelines for PST help physicians and care teams through the decision-making process and make them more comfortable when responding to physical suffering, physicians more frequently report an emotional pressure when their patients experience psychological symptoms, with the risk that PST could become a potential “counterphobic defence to treat”.     

精神科住院患者团体心理治疗准备性会谈与治疗后访谈初探

精神科住院患者团体心理治疗较门诊患者团体心理治疗存在临床情境的特殊性,本研究探索将准备性会谈与治疗后访谈纳入治疗计划,治疗前向患者普及住院治疗、心理治疗的知识,澄清团体心理治疗的形式、目标、内容,了解患者对团体心理治疗的疑问、期望,允许患者做出是否参加治疗的决定,并在治疗后的访谈中强化疗效因子。