Lessons Learned in Developing a Research Partnership with the Transgender Community

The challenge facing the authors was to develop a relationship with members of the Transgender community in a large urban city in order to develop research that would benefit this group. The situation is presented from the differing perspectives of the three women involved (one Transgender woman and two biological women); they provide their accounts of a meeting with key members of the Transgender community where the challenge became apparent. During the meeting, the issue of representation arose resulting in a discussion of whether the research agenda should be focused on a specific subgroup under the Transgender umbrella or be open to all members of this diverse and underserved group. Reflections on what was learned about the diversity of individuals under the Transgender umbrella and the lessons that helped them respond to the challenge are discussed.     

Lessons Learned From a Randomized Controlled Pilot Trial Testing an Inhibitory Learning Approach to Exposure in Anxious Youth

Accumulating evidence from basic and translational research indicates that fear extinction may be best explained by principles of “inhibitory learning,” by which prefrontal cortical structures inhibit activity in the amygdala. New guidelines for the clinical practice of exposure therapy have arisen from research on inhibitory learning, but these guidelines have received little empirical testing in clinical samples of youth receiving treatment for anxiety disorders. We investigated the acceptability, feasibility, and initial efficacy of conducting exposure therapy for anxiety disorders in youth according to clinical guidelines developed from basic research on inhibitory learning principles, using a pilot randomized controlled trial design. Thirteen youths (ages 7 to 16) were recruited from a university hospital-based pediatric outpatient clinic to participate in a 9-week treatment study and were randomized to either an inhibitory learning-based exposure condition or a standard exposure condition. Results supported the feasibility and acceptability of an inhibitory learning-based approach to exposure therapy in youth and, despite the small sample size, effect sizes were in favor of the inhibitory learning approach on several measures. Differences between the standard exposure and inhibitory learning conditions are discussed using two case examples. Discussion of results and lessons learned may contribute to changes in clinical guidelines for optimally effective practice of exposure.     

Surviving a Lawsuit Against a Counseling Program: Lessons Learned From Ward v. Wilbanks

This article features information about a lawsuit brought by a former student against Eastern Michigan University and its counseling program. In addition to describing the major elements of the lawsuit, the authors reflect on lessons learned and offer recommendations for other counseling programs.     

Lessons Learned from the National Arts and Youth Demonstration Project: Longitudinal Study of a Canadian After-School Program

We discuss some of the lessons the investigators learned during the development, implementation, and dissemination phases of the National Arts and Youth Demonstration Project (NAYDP). The lessons learned are relevant to various groups involved in large-scale, multi-site, community-based intervention studies: parents, youth, researchers, project staff, policy makers, and funders. Specific lessons learned include: (1) how to engage the community; (2) methodological lessons, including cross-site training and monitoring adherence to research protocol; (3) recruiting and sustaining involvement of parents and youth; (4) program development; and (5) dissemination strategies.     

Toward a Developmental Understanding of the Counseling Specialty: Lessons From our Students

Trends in professional practice and training have led to a debate concerning the need for an increasing remedial emphasis within the counseling field. Proposals for an integration of the counseling and clinical specialties have been opposed by those arguing that a specialty differentiation captures meaningful differences. This article hypothesizes that the counseling specialty is distinguished by its reliance on a developmental metatheory, which makes unique assumptions regarding distress, change, and the helping process. This metatheory is rooted in a rich theoretical and empirical tradition and has generated innovations in practice that transcend usual remedial forms of helping. It is proposed that the value of developmentalism and the counseling specialty are most evident in the developmental interventions of college counseling.     

Immigrant Youth and Employment: Lessons Learned from the Analysis of LSIC and 82 Lived Stories

Finding a job has become a critical challenge to many youth. Immigrant youth, who have been a key part of the global migrants, are particularly vulnerable when entering the job market of the host country due to various structural barriers. However, in both public policy discourse and research, their labour market experience tends to be overlooked. In this paper, we report the employment experience of recently arrived immigrant youth based on an analysis of the LSIC and findings of in-depth interviews of 82 immigrant youth in four cities in Canada. Our results reveal that recently arrived immigrant youth tend to work in lower-skilled employment, experience significant delays in finding employment, have difficulties with foreign credential recognition, and have fewer means to access to job markets.     

Mentoring Nurses in Familial Cancer Risk Assessment and Counseling: Lessons Learned From a Formative Evaluation

Background. As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Methods. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. Results. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.     

Consequences of Power in a Simulated Job: Understanding the Turnover Decision1

A great deal of research examines sources of power in organizations, but relatively little research examines its consequences. This paper investigates the effects of employees’ perceived power on the likelihood that they will leave the organization. A competitive test between a power based approach to modeling turnover and a more traditional job satisfaction based model supports the utility of the power based model. In each of two studies, high power subjects were significantly less likely to leave a simulated job than were low power subjects, and high opportunity subjects were significantly more likely to leave than were low opportunity subjects. Each of these effects was significant even after controlling for the effect of job satisfaction. Implications and possible extensions of these results are discussed.     

Barriers and Facilitators to the Implementation of Intensive Treatments for PTSD: Early Lessons Learned From the Field

This article addresses the barriers and facilitators associated with the implementation of PTSD Intensive Outpatient Programs (IOP) across three VHA Medical Centers. Each site developed programs that delivered EBPs in a massed or condensed format and relied on implementation science and the i-PARIHS model to help direct the innovation. Face-to-face, virtual, and combined platforms were used, demonstrating flexibility in design. While each site experienced unique challenges associated with local contextual factors, multiple themes emerged across sites that may help guide future IOP and massed EBP implementations. Common facilitators of the implementation process included: the availability or presence of a credible lead (i.e., champion) to guide the innovation, opportunities to consult with national or outside experts, strong team engagement, processes in place that allowed for ongoing review, clinic operations that are aligned with principles of PTSD specialty care (e.g., time-limited, evidence-based, utilization of measurement based care, willingness to treat complex cases), and leadership support. Alternately, shared barriers included limitations on available resources, options for provider coverage, early staff buy-in, and organizational factors. Solutions to address these barriers and recommendations for future direction are shared.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

Disruption and Working Through in the Supervisory Process: A Vignette From Supervision of a Psychoanalytic Candidate

This paper describes the author’s supervision of a psychoanalytic candidate, including the development and resolution of impasse in both the supervised analysis and the supervisory relationship. When the author became aware of the degree to which her own anxieties and defenses were implicated, she sought consultation, after which both supervision and analysis moved forward. As supervision continued, work on supervisee’s and supervisor’s interlocking anxieties and defenses, and understanding of their impact on the supervised analysis, deepened. The author concludes that exploring supervisory disruptions allows both members of the supervisory dyad to come to grips with conflicts that subtly distort their work and facilitates a deepening of the supervised analysis.     

Preventing Smoking Behavior in School Children: An Initial Test of a Cognitive-Development Program1

A three-session smoking prevention program based on a cognitive-developmental stage model was developed and pilot-tested with 315 sixth through eighth grade students in an urban public school. A media component focusing on experiences associated with different stages of smoking was followed by a structural discussion that linked cognition about symptoms with skills to resist influences to smoke. The control group viewed three commonly used smoking prevention films, made written comments on the films, and participated in an unstructured discussion. Students exposed to the experimental program showed superior gains in accurate interpretations of symptoms, adaptation to symptoms, and addiction. Significantly fewer students exposed to the experimental program made the transition from a first try to occasional or regular smoking at an 18 month follow-up. Change in understanding of symptoms mediated treatment effects. Obtaining these results with only a three-session program, using an active treatment control, a within school design, and an urban, racially balanced population, supports the inclusion of a cognitive-developmental component in smoking prevention.     

Liberating Behavior from Time-Bound Control: Expanding the Present Through Hypnosis1

Temporal perspective was experimentally manipulated by verbal instructions to expand the present while minimizing the significance of past and future. The reactions of trained hypnotic subjects to this induction were compared with hynotic simulators and nonsimulating controls. In a fourth group, time sense was made salient but no suggestion given to alter it. Across a variety of tasks, self-report measures, and behavioral observations, this modification of the boundaries between past, present, and future resulted in profound consequences among the hypnotic subjects. Changes in affect, language, thought processes, sensory awareness, and susceptibility to social-emotional contagion, accompanied an expanded present orientation. Nonreactive measures distinguished simulators from hypnotic subjects who apparently were better able than control subjects to incorporate the induced time distortion and perceive it as a viable alternative to their traditional time perspective. Some implications of time as a pervasive, non-obvious, independent variable in the social control of cognition and behavior are outlined.     

Sikh Youth Coming of Age: Reflections on the Decision to Tie a Turban

In Sikhism, the turban is a sign of adherence to faith and fighting for justice; for Sikh men, it can also be considered essential to manhood (Chanda & Ford, 2010 ). The authors provide an introduction to Sikhism and discuss the turban's importance to Sikhs. Next, they present a self‐reflective case of one individual's experience of the decision to tie a turban and discussion of that case. Finally, the authors discuss implications for counselors.     

Cultural Differences in Attitudes Toward Smoking: Developing Messages Using the Theory of Reasoned Action1

The theory of reasoned action was used to identify the culturally appropriate beliefs of Hispanic smokers that might be targeted in an anti-smoking campaign. In-depth interviews were conducted with 263 Hispanics and 150 non-Hispanic whites. Intentions to quit smoking were predicted most strongly by the attitudinal rather than the normative component of the model. A pattern of cultural differences between the two ethnic groups was identified. Family-related consequences and concerns about bad smell contributed more to Hispanic attitudes toward quitting than to those of non-Hispanic whites, while the effects of withdrawal from cigarettes contributed more to non-Hispanic whites'attitudes than to Hispanics'. The bad smell of cigarettes, improving relationships with the family, weight gain, breathing more easily, and having a better taste in the mouth were the consequences of smoking and quitting that most strongly discriminated between those Hispanics intending and not intending to quit. These results should be used in the creation of culturally appropriate anti-smoking messages for this group.     

Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss “Recovering Together,” a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad’s experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.     

Understanding the Effects of Cognition in Creative Decision Making: A Creativity Model for Enhancing the Design Studio Process

ABSTRACT

The essential components of creativity—persons, processes and products—were investigated inside a creative environment by deeply focusing on the cognitive stages of the creative decision making process. Mental imagery and external representation were considered as the implicit parts of creativity for enhancing design studio process. An experiment was conducted with 15 subjects who designed the public area of a train as the task in design studio. Observation, protocol analysis, and rating scales were used as assessment tools. Considering the components of creativity, it was found that the highest correlation was between process and overall creativity. Person and product followed process, respectively. However, no significant relationship was observed between imagery and creativity in design process. Three-dimensional representations were found to lead to more creativity compared to 2-dimensional depictions.     

Reconsidering the Role of Attitudes in Exercise Behavior: A Decision Theoretic Approach1

Two studies demonstrated that subjective expected utility (SEU) theory predicted interest in, but not adherence to, a weightlifting exercise program. The studies also showed that attitudes were related to adherence for certain individuals. Specifically, attitudes toward not weightlifting were related to the number of days experienced subjects weightlifted. In addition, in Study 1, experienced subjects had more positive attitudes toward weightlifting and more negative attitudes toward not weightlifting than did inexperienced subjects, and the two groups differed on a number of underlying beliefs. Similarly, in Study 2, experienced subjects had more positive attitudes toward weightlifting and differed from inexperienced subjects on a number of underlying beliefs. These results are discussed in terms of their implications for several issues: the usefulness of SEU theory in the exercise domain; the importance of considering attitudes toward alternative courses of action (including inaction) when attempting to predict exercis–or any other–behavior; the need to distinguish between exercise adoption (initiation) and maintenance (adherence); and the importance of Beach's (1982, 1985) distinction between deasion making and decision implementation.     

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

From Termination to the Evolution of a Relationship: A New Understanding

Much of the psychoanalytic literature on termination is steeped in ideals of autonomy, independence, and permanent cessation of contact. Although more recently some modified perspectives on termination have been offered, literature from various fields including contemporary psychoanalytic models, infancy research, and neuroscience supports a more extensive reconceptualization. After reviewing the literature, this article proposes replacing the concept of termination with the more flexible idea of multiple possible evolutions of the analytic relationship depending on the particular pair and their context. A clinical illustration is offered to support this perspective.