Ways to Bolster Resilience in Traumatized Clients: Implications for Psychotherapists

This study aims to further theoretical and clinical discussions regarding the therapy of psychosis from a dialogical perspective and to contribute to the contemporary research literature that works toward developing methods for studying the dialogical processes in therapy. Three videotaped sessions of a therapy with a heterosexual couple, in which both partners had psychotic experiences, were analyzed using the Dialogical Investigations of Happenings of Change, a method developed with an aim to capture the dialogical qualities of multiactor conversations. The analysis illustrated shifts in the dialogical characteristics of the conversation through the sessions and associated shifts in the clients’ positioning, toward increased agency, as well as enrichment of the narratives regarding their difficulties. The gradual development toward more dialogical conversations, evidenced mainly in increased sharing of dominance and therapist responsiveness and participation, seemed to facilitate the joint construction of new words and meanings, the expression of strong feelings, the narration of difficult experiences, and increased agency. The findings support the view that a client's sense of agency, which can be particularly impoverished in psychosis, can be reconstructed in the context of dialogue, in which clients have a central place in telling their story.     

The self-narrative and acute psychosis

The aim of this study was to apply the narrative approach in analyzing family therapy meetings in cases of acute psychosis. The self-narrative is essential in acute psychosis since it is either collapsed or not coherent enough. The results indicate that it is important to create concrete practices that produce stories concerning the patient in relation to others. The self-narrative must be re-authored by the patient even though it is socially constructed. This is achieved by creating multiple perspectives of self-narratives in so-called therapy meetings with the patient, family members, and staff members representing different professionals.     

A study of families' satisfaction with a family interventions in psychosis service in Somerset

Although research has shown the efficacy of family interventions in psychosis, there has been little research into families' own experience of services in routine clinical settings. Fifteen of the first twenty-two referrals to a Somerset Family Interventions Service agreed to take part in semi-structured interviews regarding family satisfaction and clinical outcome. High levels of engagement and satisfaction with the service were reported in spite of initial apprehension regarding family sessions. Family members thought that the sessions had helped them deal more effectively with problems and relatives' symptoms. They valued the opportunity for open discussion, developing new perspectives and problem-solving, as well as liaison/closer working with mental health services. Positive therapeutic qualities/skills (e.g. empathic, non-judgemental approach; mutually agreed goals) were highlighted. This study also indicated that successful engagement in family work requires referral at an early stage. The findings of this study, particularly those relating to the therapeutic relationship, are discussed, including their relevance for future research.     

The limits of interfaith? Interfaith identities,emerging potentialities,and exclusivity

Interfaith movements within the United States are currently attempting to integrate nonreligionists – agnostics, unaffiliated, humanists, and atheists for example – into their dialogical spaces. We argue that this attempt to further inclusivity within interfaith movements, although well-intended, is impeded by what we refer to as the interfaith identity paradigm. This paradigm focuses on concretised religious identities through a confessional model, which powerfully circumscribes intended efforts to engage with multi-layered experiences and radical inclusiveness. As such, we utilise contemporary anthropological theories regarding subjectivity to demonstrate that the interfaith identity paradigm results in limited participation by nonreligionists. Based on several months of participant observation at multiple interfaith meetings, this article intends to initiate a conversation among interfaith practitioners endeavouring to cultivate inviting and open spaces for religionists and nonreligionists alike. The objective of this article is not to offer solutions, but to point out a constraining practice prevalent within interfaith meetings within the United States.     

Borrowing from Sleep to Pay Work and Family: Expanding Time‐Based Conflict to the Broader Nonwork Domain

We extend cross‐domain research by examining sleep, a domain within the larger nonwork domain that competes for time with work and family domains. We draw from scarcity theory and research on slack resources to contend that, because people cannot increase the amount of time they have, they borrow time from sleep in order to spend more time working and with family. Utilizing a Bureau of Labor Statistics survey of 10,741 participants, we find nonlinear and interactive effects of time spent working and time spent with family on sleep time, suggesting that the negative effects of work and family on sleep time are especially strong when demands for work and family are high. In an experience sampling field study of 122 working adults, we similarly find a nonlinear effect of work time on sleep time as well as an interaction between work time and family time in predicting time spent sleeping. Both studies indicate that as slack time resources become increasingly scarce, time spent working and time spent with family have increasingly powerful negative effects on time spent sleeping. Contrary to our expectations, we found no support for gender as a moderator of these effects.     

“Telling tales”: Using narrative in career guidance

In this article the authors argue for the importance of narrative-based approaches in career guidance work in an uncertain, unpredictable world. This requires a paradigmatic shift in thinking that can be too difficult, at present, for some practitioners. The article reports on the first phase of a collaborative project with a group of practitioners – working in guidance in schools and with young people in public access points – to develop and evaluate narrative methods. Our analysis highlights the usefulness of the approach, but also reveals tensions derived from the working cultures of career guidance practitioners.     

Dynamically oriented group therapy with alcoholics: Making it work despite the prevailing bias

A bias exists in the psychiatric community against dynamically oriented group therapy with alcoholics. The basis for this bias lies primarily in negative experiences of practitioners who have attempted to use traditional therapy with alcoholic patients who continued to drink. At Appleton Outpatient Clinic, we have found that dynamically oriented group therapy is a highly suitable treatment modality for alcoholic patients when negative biases of treators can be addressed and when initial preparatory work is done with patients. This preparatory work includes: (a) building a working alliance around abstinence and providing adequate supports to make this possible; (b) explicit contracting that establishes clear treatment goals and consequences should the goals not be met; (c) preparatory short-termgroup experiences.This paper was presented at the 1988 annual meeting of the American Group Psychotherapy Association.     

Conversational Construction of Meaning in Family Therapy: Some Evolving Thoughts on Kelly's Sociality Corollary

Combining the ideas of constructivists in the fields of cybernetics, physics, biology, philosophy, social psychology, and family therapy with the ideas of Kelly, we offer some thoughts on the importance of the interactional construction of meaning. The implications of a dialogical perspective are explored by addressing three key issues often encountered in the initial stages of working with families: (1) identifying the relevant system for treatment, (2) codefining the problem, and (3) establishing the therapist's position. A conversational approach to constructing meaning, as outlined in this paper, assumes that the therapist must take full responsibility for his or her participation in the cocreation of social reality.     

Family interventions in psychosis: a scale to measure therapist adherence

The efficacy of family interventions in psychosis is well documented. UK and USA schizophrenia treatment guidelines advocate the practice of family interventions within routine clinical services. However, less attention has been paid to the study of treatment fidelity and the tools used in its assessment. This study reports the inter-rater reliability of a new scale: Family Intervention in Psychosis-Adherence Scale (FIPAS). This measure is designed to assess therapist adherence to the Kuipers et al . (2002) family intervention in psychosis treatment manual. Reliability ratings were based on a sample of thirteen audiotapes drawn from a randomized controlled trial of family intervention. The results indicated that the majority of items of the FIPAS had acceptable levels of inter-rater reliability. The findings are discussed in terms of their implications for the training and monitoring of the effectiveness of practitioners for family interventions in psychosis.     

Improving partnerships with families and carers in in‐patient mental health services for older people: a staff training programme and family liaison service

In spite of policies advocating the involvement of families in the care of mental health service users in the UK, there are few examples of initiatives to develop staff confidence and skills in partnership working. This article describes a whole team training initiative and family liaison service to promote family inclusive working on in‐patient wards for older people in Somerset, UK. A three‐day staff‐training programme is described and training outcomes are reported. Staff report a substantial increase in confidence and family meetings held. A pre‐and post‐ training case note audit shows increased consideration of the needs of families. To further increase face to face meetings with families a family liaison service has been established, whereby a staff member with systemic family therapy training joins ward staff to hold family meetings as part of the assessment/admission process. Evaluation of this service has shown it to be effective with positive feedback from families and staff.     

Health Practitioners' Implicit and Explicit Attitudes Toward Drug Addicts Predict Absenteeism and Extra Work

We analyzed the correspondence between implicit and explicit attitudes of health care practitioners working with drug addicts as a function of years of professional experience, and its relation with important organizational outcomes. Consistent with the hypothesis that implicit–explicit attitude inconsistency is unpleasant and people struggle to resolve it, practitioners' implicit–explicit consistency increased with years of experience. Moreover, for practitioners self-reporting positive attitudes, negative implicit attitudes led to increased absenteeism and decreased voluntary extra work. For practitioners self-reporting negative attitudes, positive automatic associations had similar effects. Strengths, limitations, and possible extensions of this research are discussed.     

‘Does class count?’ Social class and counselling

This article explores the importance attached to social class by experienced practitioners taking part in a co‐operative inquiry group. A review of the literature from the last thirty years indicates that there is very little research on class in relation to counselling and psychotherapy reported in the UK. Both authors position themselves as coming from working class origins. Nine co‐researchers from both middle and working class origins joined the group. Eight meetings took place over a period of nine months. Extracts from the group's discussions are represented and integrated with ‘presentational knowing’ drawn from contemporary culture, including poetry and popular music. This study suggests that social class is a neglected aspect of diversity in the counselling field. Implications of the study have relevance for the language of counselling and psychotherapy and class based values; social class and its impact on initial education; and ongoing counselling practice and access to therapy for working class people.     

How Therapists Discuss Causality with Families in an Integrated Family Management and Therapy Service, a Qualitative Study with Focus Groups

Family therapy (FT) and family management (FM) approaches to psychosis have been distinguished by their understanding of causality. FM holds a biological understanding which could have negative consequences for the person with psychosis. FT, with its focus on interactions, has been criticised for its potential for implying that families are to blame for their relative’s psychosis. Although these two approaches have been integrated, the manner in which causality is discussed in family sessions within an integrated approach has not been researched. Qualitative research was conducted with clinicians working in an established integrated family intervention service to explore how they discuss causality. Four focus groups were conducted and a framework approach to thematic analysis used. Four themes developed from the analysis: how a shared understanding of causality is constructed; the use of an ‘explorative conversational’ therapeutic style to discuss causality; factors that limited the exploration of causality; and the challenges of working with issues of blame. The stress-vulnerability model, genograms, interactional-cycles and formulation were identified as useful tools to develop a shared understanding of causality. The therapeutic style of ‘explorative conversation’–based in FT, integrated with the stress-vulnerability model–based in FM, was identified as key to the integrated model and clinicians felt these two aspects addressed the criticisms that have been levelled at each approach. Complex family problems, abuse and illicit drug use were factors that challenged causality discussions. Families feeling blamed/blaming themselves and attempts to transform blame made up a dominant theme of the research.     

A Preliminary Investigation into the Use of Humor in Sport Psychology Practice

“Creative efforts,” such as the use of humor, have been found to be beneficial to the nurse–patient, teacher–student, and psychologist–patient alliance. Potentially humor use might benefit the working alliance in applied sport psychology, yet to date there is limited research. Sport psychology consultants (n?=?55) completed an online survey that explored humor use within their practice. Statistical analyses revealed that most participants used humor for adaptive purposes such as to facilitate the working alliance, reinforce knowledge, and create healthy learning environments. Therefore, possible client change is likely to be facilitated by practitioners’ personal qualities and skills such as humor use and humor style. Recommendations are made for sport psychology practitioners in relation to humor use and further research. Increasing recognition has been given to the importance of the professional relationship between the client and practitioner within sport psychology consultancy as a means of facilitating client change. The present study demonstrated that use of humor by practitioners is an important part of enhancing the professional relationship and therefore potentially client change.

Lay Summary: Increasing recognition has been given to the importance of the professional relationship between the client and practitioner within sport psychology consultancy as a means of facilitating client change. The present study demonstrated that use of humor by practitioners is an important part of enhancing the professional relationship, and therefore potentially client change.     

Influences of Work-Family Interface on Job and Life Satisfaction

Research investigating the relationship between family and work domains, according to a reductionist approach, has traditionally focused on the negative aspects of the work-family relationship. However, over the past 15 years a number of studies have also focused on the positive aspects of family and work relationships and on the interactions between the work-family interface and outcomes such as job and life satisfaction. These research studies have made it possible to capture different facets of the relationship between family and working life, and to clarify the specific nature of these interactions. In the present study, we tested a model that included positive and negative interactions between work and family as predictors of job and life satisfaction. We also examined the role of some of the potential moderators (work engagement, organizational and family support) of these relationships, using a sample of 427 Italian employees working in public administration. In our analysis, we first tested the factorial structure of the work-family interface measure (Kinnunen et al. Scandinavian Journal of Psychology, 47, 149–162 2006). Factor analysis confirmed a four-factor model: negative work-to-family interface, negative family-to-work interface, positive work-to-family interface, and positive family-to-work interface. Secondly, we analyzed the relationship between the work-family interface, job satisfaction and life satisfaction. Path analysis showed that the factors involved in the work-family interface influenced directly and indirectly life satisfaction, job satisfaction and work engagement. This analysis also showed that work engagement had a direct strong effect on job satisfaction and a direct weaker effect on life satisfaction. This pattern of findings is consistent with a causal sequence in which the work-family interface (WIF) and family-work interface (FIW) can increase or reduce a satisfaction-specific domain. Our results highlight the importance of using a theoretical and empirical model that integrates and focuses on both the positive and negative aspects of the work-family relationship. Moreover, this pattern demonstrates the potential consequences of this influence on employees’ working life and general well-being.     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

Making Space for a Dialogical Notion of Religious Subjects: A Critical Discussion From the Perspective of Postsecularity and Religious Change in the West

In this article I address some topical themes from the ongoing discussion on contemporary religious change in the West and how it poses conceptual challenges to the study of religion. The academic discussion on religious change is vast and my observations are, of course, by necessity limited to my particular interest and argument in this article. On the one hand, I draw on some of the literature that has evolved within and around the concept of postsecularity and, on the other, on more general literature on contemporary religious change. Based on some selected observations, I underline the need to critically rethink how we conceptualize both religion and religious subjects. In my view, current research fosters a greater attentiveness of complexity with regard to religion, but simultaneously it requires us to take seriously a dialogical notion of religious subjects that provides a conceptual account of a subject constituted by being located within and emerging through ongoing social process. This dialogical notion provides a better tool for how current social and cultural reconfigurations of religion are simultaneously played out as a diversity of identities that challenge received categories, such as the religious and the secular.     

Linking Job Work Hours to Women’s Physical Health: The Role of Perceived Unfairness and Household Work Hours

Although the relationship between job work hours and women’s physical health has been examined, limited empirical research examines the family demand conditions that explain this relationship. Given the challenge of integrating work and family demands, we examine the boundary conditions under which job hours relate to women’s physical health by integrating the influences of household work hours, perceived unfairness of division of household labor, and traditional gender ideology. Using a large, multi-national archival dataset, our results show that women working long job hours are more likely to report decreased physical health and that this relationship is moderated by the hours and fairness perceptions of household labor: The lowest physical health was observed at high job hours and high household hours and also when women felt that they did less than their fair share of household labor. However, looking at the slopes of these relationships, the negative relationship between job hours and physical health was stronger when women worked lower household hours or felt that they contributed less than their fair share of household labor—suggesting that maintaining a contribution to household labor might be important for working women. Furthermore, these results suggest that policy and organizational interventions aimed at supporting women’s physical health could take their household labor contributions and fairness perceptions into account when assessing the negative impact of high job work hours.     

Keeping Engaged During Deployment: The Interplay Between Self-Efficacy,Family Support,and Threat Exposure

This study investigated the importance of 2 resilience resources for service members’ ability to deal with threat during deployment. Military self-efficacy and family support were measured before deployment and related to work engagement and burnout levels of service members during deployment. We hypothesized that in high threat situations, low self-efficacy would lead to unfavorable outcomes, whereas in low threat situations, high self-efficacy could have negative consequences. In addition, we hypothesized that family support would compensate for both effects. The results showed these expected 3-way interactions. We found that strong self-efficacy helped service members deal with exposure to threatening situations during deployment, leading to more work engagement and less burnout. However, having strong self-efficacy without being exposed to threat during deployment reduced service members’ work engagement and increased burnout. In addition, we found that the presence of family support compensated for these effects. Service members with low self-efficacy benefitted from family support when threat exposure was high, whereas service members with high self-efficacy benefitted from family support when threat exposure was low. As such, family support seemed to act as a compensatory mechanism for the potential negative effects of self-efficacy. This underlines the importance of studying the interplay between resources that help service members deal with deployment experiences. Practical implications relate to supporting service members’ resilience through enhancing multiple resources.