Outcomes in clients transitioning from in-person counselling to telehealth counselling with trainees

The onset of the 2020 COVID-19 pandemic necessitated a rapid transition of mental health services from in-person to telehealth counselling. Despite the far-reaching impact of this transition, we know little about the impact of this transition on outcomes for clients working with counsellor trainees. The present study utilised longitudinal data collected from a counselling training centre at a major U.S. university to compare client ratings of depression, anxiety and working alliance across 1) in-person services delivered (i.e. pre-pandemic) and 2) telehealth services delivered after the pandemic began (i.e. intra-pandemic) among the same group of clients. Results support our hypothesis that changes in clients' self-reports would be generally equivalent across in-person and telehealth services. Depression and anxiety symptoms decreased, and working alliance tended to increase during both in-person and telehealth care; however, these trends were only statistically significant during telehealth services. Limitations related to sample size (N = 15 clients; up to 17 sessions per client) and low statistical power are discussed. Nonetheless, this study supports the growing body of literature supporting the efficacy of telehealth counselling services. We provide suggestions for future telehealth research and discuss implications for counsellor training.     

Moral Identity Predicts Adherence to COVID-19 Mitigation Procedures Depending on Political Ideology: A Comparison Between the USA and New Zealand

Reducing the spread of infectious viruses (e.g., COVID-19) can depend on societal compliance with effective mitigations. Identifying factors that influence adherence can inform public policy. In many cases, public health messaging has become highly moralized, focusing on the need to act for the greater good. In such contexts, a person's moral identity may influence behavior and serve to increase compliance through different mechanisms: if a person sees compliance as the right thing to do (internalization) and/or if a person perceives compliance as something others will notice as the right thing to do (symbolization). We argue that in societies that are more politically polarized, people's political ideology may interact with their moral identity to predict compliance. We hypothesized that where polarization is high (e.g., USA), moral identity should positively predict compliance for liberals to a greater extent than for conservatives. However, this effect would not occur where polarization is low (e.g., New Zealand). Moral identity, political ideology, and support for three different COVID-19 mitigation measures were assessed in both nations (N = 1,980). Results show that while moral identity can influence compliance, the political context of the nation must also be taken into account.     

ICT – the new frontier? Pushing the boundaries of careers practice

Much progress has been made in integrating information and communications technology (ICT) into careers practice, but there is still room for improvement. An international lens is adopted to examine some key elements that contribute to the successful integration of ICT into careers practice. We start by exploring the role of policy, using the UK as a case study. Next, the perceptions that Finnish career practitioners have of ICT are reviewed using research findings into the different ways they think about social media and its purpose in career services. Finally, lessons learned from the design and integration of online services within career development programming in Canada are discussed that ensure accessibility both to practitioners and their clients.     

Affective Constellations for Countertransference Awareness Following a Client's Suicide Attempt

Effective counseling with suicidal clients requires the development and maintenance of a strong therapeutic alliance. However, unmanaged countertransference (CT) can inhibit the alliance. This article provides strategies for enhancing CT awareness in counselors to support alliance building with clients after a client suicide attempt. The authors define CT in the context of suicide, introduce affective constellations as a method for CT awareness, and apply the method to a case vignette. A figure for self‐reflection and supervision is provided.     

Is It Possible to “Incorporate” a Scar? Revisiting a Basic Concept in Phenomenology

Although scars never disappear completely, in time most people will basically get used to them. In this paper I explore what it means to habituate to scars against the background of the phenomenological concept of incorporation. In phenomenology (Husserl, Merleau-Ponty) the body as Leib or corps vécu (lived body) functions as a transcendental condition for world disclosure. Because of this transcendental reasoning, phenomenology prioritizes a form of embodied subjectivity that is virtually dis-embodied. Endowing meaning to one’s world through getting engaged in actions and projects is most successful indeed when one’s body is “absent,” “transparent,” or, at least, if it is not in the center of one’s attention. This taken-for-granted nature can be disturbed by discomfort, disability, and disfigurement. Incorporation, so I explain, aims at maintaining or restoring the body’s taken-for-grantedness. My analysis of the case of a woman who successfully habituated to her mastectomy scar demonstrates, however, that habituation to a perceptible scar can only be understood partly in terms of incorporation. Next to a decrease of explicit attention for the scar and the discomfort it produces (i.e., incorporation), the scar should also stop being a sign that refers to something else than itself. This is only possible, I argue, by taking the body’s materiality seriously, rather than it being wiped out as a result of transcendental reasoning.     

Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions

Background: Goal-setting is recommended and widely used within diabetes self-management programmes. However, empirical evidence around its effectiveness lacks clarity. This review aims to evaluate the effectiveness of goal-setting interventions on diabetes outcomes and to determine which behaviour change techniques (BCTs) are frequently used within these interventions.

Methods: A systematic search identified 14 studies, describing 12 interventions targeting diabetic-control which incorporated goal-setting as the main intervention strategy. Study characteristics, outcome measures and effect sizes of the included studies were extracted and checked by two authors. The BCT taxonomy v1 was used to identify intervention content. Meta-analyses were conducted to assess intervention effects on the primary outcome of average blood glucose levels (HbA1c) and on body-weight. Psycho-social and behavioural outcomes were summarised in narrative syntheses.

Results: Significant post-intervention improvements in HbA1C were found (?.22, 95% CI, ?.40, ?.04) across studies. No other main effects were identified. The BCT ‘goal-setting (behaviour)’ was most frequently implemented and was identified in 84% of the interventions.

Conclusions: Goal-setting interventions appear to be associated with reduced HbA1C levels. However, the low numbers of studies identified and the risk biases across studies suggest more research is needed to further explore goal-setting BCTs in diabetes self-management.     

Bilingual comparison of Mandarin and English cognitive bias tasks

Most research into cognitive biases has used Western samples, despite potential East-West socio-cultural differences. One reason is the lack of appropriate measures for non-Westerners. This study is about cross-linguistic equivalence which needs to be established before assessing cross-cultural differences in future research. We developed parallel Mandarin and English measures of interpretation bias and attention bias using back-translation and decentering procedures. We assessed task equivalence by administering both sets of measures to 47 bilingual Mandarin-English speakers. Interpretation bias measurement was similar and reliable across language versions, confirming suitability of the Mandarin versions for future cross-cultural research. By contrast, scores on attention bias tasks did not intercorrelate reliably, suggesting that nonverbal stimuli such as pictures or facial expressions of emotion might present better prospects for cross-cultural comparison. The development of the first set of equivalent measures of interpretation bias in an Eastern language paves the way for future research investigating East-West differences in biased cognition.     

Living with Death in Rehabilitation: A Phenomenological Account

This paper uses an ongoing ethnography of childhood rehabilitation to rethink the Heideggerian phenomenology of death. We argue that Heidegger’s threefold perishing/death/dying framework offers a fruitful way to chart how young people, their parents, and practitioners address mortality in the routine management of muscular dystrophies. Heidegger’s almost exclusive focus on being-towards-death as an individualizing existential structure, rather than the social life with and around death, is at odds with the clinical experience we explore in this paper. After looking to the basic structures of Heidegger’s philosophy of death, we point to recent work by Leder, Svenaeus, Aho, and Carel, bringing health and the spaces of healthcare into our purview. Turning to ethnographic data, we argue that a revised phenomenology of death gives a nuanced account of how health care practitioners address death, dying, and perishing, and outline some steps toward a more ontologically sensitive clinical space. These revisions are in line with recent work in disability studies, that see disability as more than a death sentence. We advocate adjusting phenomenological reflections on disability, to be framed as a way of life, rather than as a deficient or especially deadly mode of human existence.