“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

Lesbian, gay and bisexual people are more likely than their heterosexual counterparts to report dissatisfaction after accessing a counselling or psychological service. Greater dissatisfaction may result from therapists who focus on psychopathology without considering cultural context. Research has demonstrated therapists' cultural competence (attitudes, knowledge and skills) may influence effective service provision to LGB people. Counsellors and psychologists (N = 10) were interviewed to determine the sources of information influencing the cultural competence and LGB cultural competence practices used by therapists in their clinical practice. Three themes were developed from semistructured interviews: (1) the importance of multiple sources of cultural competence; (2) applying cultural competence improves the therapeutic process; and (3) ensuring visual cues of affirmation are affirming, not pathologising. Theme 1 highlighted that initial professional training, cultural competence training and lived experience could be triangulated to assist therapists in improving their cultural competence. Theme 2 highlighted that cultural competence improves the therapeutic process by ensuring therapists can demonstrate affirming attitudes, knowledge about LGB people and culturally affirming skills to work effectively with LGB clients. The final theme explored the need for therapists to create an inclusive space for LGB clients. Recommendations for improving clinical practices and tools to enhance cultural competence are discussed.     

When Midlife Therapists Treat Midlife Patients

Abstract

Empathic attunement is the bedrock of self psychological treatment. In the treatment of midlifers who show underlying narcissistic vulnerability, achieving such empathy is sometimes more difficult that one might imagine, particularly since therapists, who are midlifers themselves, are often vulnerable to the impact of midlife stresses. Potential stumbling blocks may arise that stem from therapists' identification with and anxiety about patients' struggles that are similar to their own; difficulties relating to patients' problems that seem unfamiliar or alien; and assaults to therapists' own sense of self or selfobject needs.     

Reflections of Authority in Psychotherapy

Abstract

This article examines how therapists' expressions of authority affect the psychotherapeutic relationship. The article is based on the proposition that the clinical practitioner is always in a position of authority, regardless of how the role of authority is conceptualized within treatment approaches. The article includes an investigation of power and authority differentials within and across therapeutic approaches that espouse both hierarchical and egalitarian authority relationships. Process material from these approaches is analyzed to identify therapists' exercise of authority within these two approaches. It is suggested that researchers and therapists might use a heuristic research design to study the conveyance of therapeutic authority to identify whether dimensions of authority are overtly or covertly expressed, and whether or how such expression might affect practice and a client's exercise of personal authority.     

Meeting Them “Where They're At”

Abstract

Child maltreatment is associated with serious psycho-social difficulties and enormous direct and indirect societal costs. As such, it is an area for which new and promising interventions are highly important. The purpose of this exploratory research is to examine intensive school-based psychodynamic therapy for severely maltreated children experiencing significant difficulties, by obtaining perceptions of therapeutic effectiveness by the children's parents, teachers and therapists. Themes include: therapists', parents', and teachers' perceptions of child's changes; parental perceptions of therapy and relationship with the therapist; therapists' perception of relationship with parents; school as the location of therapy; teacher-therapist relationship; and the child's academic status.     

Counsellors' self-perceived multicultural competencies model

This study aimed to develop a UK instrument measure of counsellors’ multicultural competencies. Also, it intended to analyse to what extent multicultural competencies have an influence in counselling practice in terms of processes and interventions.

The study was an expansion of the American multicultural competencies model, which related cultural competence to a combination of three factors: cultural beliefs, cultural knowledge and cultural skills. Results partially supported the hypothesis, which predicted that counsellors would present high correlation rates between cultural skills, cultural knowledge and cultural beliefs when self-evaluating their levels of multicultural competence.

The study's findings present alternative three-dimensional multicultural models that indicated how counsellors perceived multicultural competence based on both societal (e.g. race, class, patriotism) and functional (e.g. family, social norms and groups). It also discusses the correlations between cultural skills, cultural knowledge and cultural beliefs and how they played a part in helping counsellors to further understand their multicultural competencies and limitations. Finally, it is proposed that future research should investigate the possibility of developing multidimensional or multi-axial models as an alternative way of further developing the counsellors’ multicultural competencies models which emerged from this study.     

Personhood of the Therapist in Couples Therapy

SUMMARY

Integrity Therapy (Lander, 1986; Lander & Nahon, 1992a, 1995a; Mowrer, 1961b, 1964a) views the personhood of the therapist as the very essence of therapy. By meeting the deepest part of the therapist with the deepest self of individuals in therapy, a healing process unfolds which opens up the healing potential of both the individuals and the couple. This article offers couple therapists and other mental health professionals an Integrity Therapy perspective of the personhood of the therapist and its therapeutic potential for helping couples in distress to reclaim their personhood. Two aspects of the Integrity Therapy approach which play a critical role in enhancing therapists' use of their personhood in the therapeutic process are explored: (a) the use of therapist self-disclosure, and (b) therapists' awareness and therapeutic use of counter-transference issues.     

Does Depression Affect Clinical Practice?

Abstract

While recent autobiographical accounts of women psychotherapists with depressive illnesses have provided vivid and compelling portraits of therapists' experiences in therapy (e.g., Jamison, 1995; Manning, 1995), further research is needed to clarify the impact that depression and its treatment have upon both collegial relationships and clinical practice. A subset of the membership of the Association for Women in Psychology (AWP) was surveyed concerning therapists' experiences with depression and its treatment. Of 220 respondents, 76% reported some form of depressive illness. Eighty-five percent of respondents indicated that they participated in personal therapy. When evaluating their clinical work, respondents reported both positive and negative consequences resulting from their depression. While some respondents noted improvement in collegial relationships, many felt judged and avoided.     

Elementary schoolchildren's perceived competence and physical activity involvement: the influence of parents' role modelling behaviours and perceptions of their child's competence

ObjectivesTo study the influence of fathers' and mothers' physical activity involvement and perceptions of their children's physical competence upon children's perceptions of competence and children's time spent in physical activity. Two forms of parental socialization influence were assessed: the direct influence of parents' actual physical activity (PA) behaviour (role modelling) on children's physical activity and the indirect influence of parents' beliefs systems about their children's PA competence on children's physical activity through children's self perceptions.MethodsLongitudinal, with data from 152 French children (M=9.5 yrs, SD=0.8 yrs) and their parents collected at two times over a 12-month period and examined through structural equation modelling (SEM).ResultsSEM indicated that mothers' role modelling behaviour had a direct effect on children's time spent in PA and that mothers' beliefs about their child's competence had an indirect effect on children's PA by influencing children's perceived competence which, in turn, contributed to children's level of physical activity involvement. Fathers' beliefs directly influenced their child's PA as did the children's own self-perceptions of competence.ConclusionsParents can affect their children's PA involvement in direct and indirect manners through their role modelling of physical activity and through their beliefs about their child's competence. Furthermore, the influence of fathers and mothers may be manifested in different ways. Father and mother could influence their child's PA by different processes.     

Actual Versus Perceived Knowledge of Child Development in a Therapeutic Context: A Survey of Therapists

The present study investigates the relationship between therapists' perceived knowledge level in the area of child development and their actual knowledge level, as measured by an assessment instrument developed to measure child development knowledge within a therapeutic setting. Results revealed that respondents felt that they were knowledgable in the area of child development, as well as comfortable working with children in a therapeutic context. However, as a group, the respondents only averaged 68% on the child development assessment scale. Implications of the study's findings, as well as recommendations for clinical training programs and future research, are discussed.     

The first to know: A systemic analysis of confidentiality and the therapist's family

Abstract

One of the most common yet unrecognized breaches of confidentiality occurs when family therapists share confidential information with their own families. For many therapists, the boundaries between professional and private seem unclear, especially pertaining to disclosing clients' confidential information. Therapists are encouraged to examine their own practices concerning sharing confidential information with their families. Therapists' families have their own rules, patterns, boundary issues, and power struggles which affect therapists' behaviors. Therapists can discuss this issue with their families and develop postures that insure clients' privacy.     

Cultural competency and humanistic psychology

Abstract

Developing cultural competence is increasingly important for humanistic psychologists in our ethnoculturally diverse society. In the past, training in ethnocultural issues involved learning about the cultural values and characteristics of a small number of cultural groups. Today, cultural competence requires that the psychologist become aware of their own ethnocultural values and their own ethnocentrism. This process of self‐examination can be emotionally challenging. This paper addresses some of the problems encountered on the path to increasing cultural sensitivity and the effect of unexamined cultural values upon the therapeutic interaction. Psychologists are encouraged to become aware of the privilege associated with European American culture, with the cultural values embedded within psychological theory in general, and with cultural values of humanistic psychology.     

Does level of motor competence affect the associations between identity health and self-perceptions in adolescents?

BackgroundAdolescence is a particularly important time for the development of self-perceptions and identity as many environmental and personal factors are influential. One relatively unexplored factor is level of motor competence.AimTo examine the relationship between identity health and self-perceptions in male and female adolescents with low motor competence (LMC) compared to typically developing (TD) adolescents.MethodAdolescents (N = 160, 64.4% males, M_age = 14.45 yrs., SD = 0.75) completed the Adolescent Motor Competence Questionnaire (AMCQ), Assessment of Identity Development in Adolescence (AIDA), and Harter's Self-Perception Profile for Adolescents (SPPA). Based on the AMCQ score, the sample was grouped into LMC and TD. Pearson's product moment correlations between the AIDA and SPPA subscales were derived for gender, competence groups, and gender x competence sub-groups.ResultsOverall, males had lower AIDA scores (healthier identity) than the females and significant associations with all self-perception domains. For females, only scholastic and social competence, physical appearance, behavioural conduct, close friendship and Global Self-worth (GSW) domains were significantly related to their AIDA score. The adolescents in the LMC group had higher AIDA scores (less-healthier identity) and fewer self-perception domains [scholastic competence, physical appearance, behavioural conduct, close friendships and GSW] were associated to their AIDA scores. For the TD group, all self-perception domains were significantly correlated with their AIDA scores. When grouped by gender and motor competence, the TD males had the healthiest identity scores which were strongly associated with all self-perception subdomains. For males with LMC, only scholastic competence, behavioural conduct and GSW domains were significantly related with their identity score. Females from both competence groups reported significant associations between physical appearance, close friendships, behavioural conduct, and social competence domains with their identity scores. Scholastic competence was also significantly associated with identity only for females with LMC.ConclusionPositive self-perceptions across a range of domains are associated with a healthier identity, but differ according to level of motor competence and gender. For those with LMC, the self-perception subdomains unrelated to physical activity and sport, such as school-based aspects were associated with a healthier identity. These findings should guide school based interventions to provide support in these domains in order to strengthen self-worth and identity health.     

Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care

ObjectiveThree studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.MethodsIn 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).ResultsBoth surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.ConclusionThis study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.     

Therapists' perspectives on home-based family therapy

Abstract

As a result of the passage of Public Law 96-272, home-based family services have proliferated throughout the United States, with family therapy playing a vital role. Voices of therapists providing these services have been absent from literature. Ten therapists participated in this study; each had experience providing home-based and clinic-based family therapy. A qualitative strategy was used to explore therapists' perspectives on factors regarding home-based family preservation services. Four themes emerged from semistructured interviews: the home environment, safety, context preference, and efficiency and effectiveness. Three recommendations are drawn from results and discussed.     

Legal and Ethical Issues in the Court-Mandated Treatment of Batterers

Summary

In the following article, we will explore the nature of the therapeutic relationship as it relates to batterers' treatment programs. We will consider the impact of obligations created by forces outside the relationship, such as those imposed by legal proceedings. We will discuss the concepts of confidentiality, privilege, and agency and their impact on the therapeutic relationship and the extent to which the therapists' understanding of the role these concepts play may be altered by court orders that impose treatment on a client/patient. Finally, we examine the issues and choices a therapist must make when engaging in court-ordered treatment of batterers, and the implications of those choices for both therapist and client; we will also suggest guidelines to help therapists sort through the often conflicting goals of therapy and the legal process.     

Foreign‐Born Therapists: How Acculturation and Supervisors' Multicultural Competence Are Associated With Clinical Self‐Efficacy

The authors examined the associations between acculturation, supervisors' multicultural competence, and clinicians' self‐efficacy in a sample of 153 immigrant therapists currently practicing in the United States. Participants completed a demographic questionnaire and 3 additional questionnaires that examined their levels of acculturation, perceived supervisors' multicultural competence, and clinical self‐efficacy. Results suggested that perceived prejudice, not level of acculturation, was significantly associated with foreign‐born therapists' clinical self‐efficacy. Perceived supervisors' multicultural competence was significantly associated with therapists' clinical self‐efficacy. Recommendations for supervisors working with foreign‐born therapists are provided. Los autores examinaron las asociaciones entre aculturación, competencia multicultural de los supervisores y autoeficacia de los profesionales clínicos en una muestra de 153 terapeutas inmigrantes actualmente en activo en los Estados Unidos. Los participantes completaron un cuestionario demográfico y tres cuestionarios adicionales que examinaron sus niveles de aculturación, la competencia multicultural percibida de sus supervisores y la autoeficacia clínica. Los resultados sugieren que los prejuicios percibidos, no el nivel de aculturación, están asociados de forma significativa con la autoeficacia clínica de los terapeutas nacidos en el extranjero. La competencia multicultural percibida de sus supervisores está asociada significativamente con la autoeficacia clínica de los terapeutas. Se proporcionan recomendaciones para supervisores que trabajan con terapeutas nacidos en el extranjero.     

Perceptions of coordinated movement

BackgroundHumans are highly social creatures who use others' movements to evaluate their social competencies. Smooth movement specifically signals an attractive, trustworthy or competent person. Those with Developmental Coordination Disorder (DCD), have peer relationship difficulties and lower sociometric preference scores. However, the relationship of perception of poor movement coordination to stereotyping has not been directly demonstrated.AimWe aimed to describe typically developing individuals' social stereotyping of individuals with and without DCD from minimal visual cues.Method3D motion capture tracked the movement of four ‘targets’ (two adult males with DCD and two male controls) in a variety of everyday scenarios. Kinematic footage of the target's movements was presented as a point-light-display to 319 typically developing adults who used The Rating Scale of Social Competence to report perceptions of the target's social competencies.ResultsTargets with DCD were rated as having significantly lower social competence (M = 3.37, SD = 0.93) than controls (M = 3.46, SD = 0.89) t(269) = −5.656; p < 0.001, Cohen's d = 0.34.DiscussionHumans incorporate minimal information on movement fluency to evaluate others' social competencies, including individuals with DCD. Such stereotyping may be automatic and may be an ill-understood mechanism sustaining persistent rejection by peers for individuals with DCD and higher rates of loneliness, isolation and mental disorders. In addition, our study expands research on competence-based stereotyping to a new applied domain, confirming the minimal cues needed to initiate stereotyping of the competencies of others.     

The effect of video observation on warmth and competence ratings of individuals with a disability

ObjectivesThis study examined whether a video featuring an adult with a physical disability engaging in either sport, exercise, or an activity of daily living (ADL) can mitigate negative stereotypes of disability held by people without a disability.DesignThis study used a pre-post design, involving three participant groups.MethodsParticipants (n = 212) read a vignette describing an adult with a disability (target). Consistent with the stereotype content model, participants judged the target's warmth and competence. One week later, participants viewed a video of the target participating in sport, exercise, or an ADL and judged the target's warmth and competence.ResultsJudgements of competence but not warmth changed over time. The greatest increases occurred in the sport condition. At follow-up, the typical high warmth low competence stereotype of disability was reversed; the character was judged as being more competent than warm especially in the sport condition.ConclusionVideos of adults with a disability engaging in physical activity, particularly sport, have potential to mitigate negative stereotypes of disability.