GENDER AND SERIOUS MENTAL ILLNESS: A Feminist Perspective

Perhaps in reaction to criticisms of "woman as problem" formulations, psychological literature has nearly ignored women with serious mental illnesses (SMI), although epidemiological research indicates that women are overrepresented in these diagnoses. Data are presented on characteristics, functioning, and services received for a sample of nearly 2,500 SMI clients. Statistical clustering of clients with similar profiles produced four out of six clusters with significant differences in proportions of female versus male clients represented. The results indicate that the extent to which SMI clients display gender-related symptoms and behaviors is a significant factor in clinician perceptions and in service utilization. However, results also show substantial overlap in gender composition of the clusters. Discussion centers on the quality of care and appropriateness of services for female clients. Future research is suggested, utilizing a feminist understanding of women's diversity and of sociopolitical factors related to mental health.     

Training Public Sector Clinicians in Competency-Based Clinical Supervision: Methods,Curriculum, and Lessons Learned

This article describes an initiative to train public sector clinicians in competency-based clinical supervision. It was delivered as an 18-session course taught online to clinicians employed in departments of behavioral health in nine Southern California counties. The curriculum was co-constructed by a team of clinical supervision scholars and leaders who then served as instructors. Each two-hour meeting addressed a specific topic for which a training video had been prepared, usually featuring a member of the training team who had expertise in that topic. The second part of each meeting focused on a class member’s supervision case presentation. Those presentations revealed 35 themes; the four most frequently occurring were: developing supervisees’ clinical competencies, addressing countertransference and parallel process, balancing clinical and administrative supervisory roles, and addressing record keeping/paperwork. Participants’ pre-to-post supervisory self-efficacy changes demonstrated a moderate effect size (Cohen’s d?=?.46) for the training, with the greatest pre- to post-training changes being in the use of technology, multicultural competencies (awareness of oppression, bias, and stereotyping in clinical work and in clinical supervision), and contracting. They reported that the strengths of the course included an inclusive learning environment and opportunities to reflect on and apply new knowledge and skills, though they also reported struggling with the assignments and the course platform software. Lessons learned reflected the use of technology in this online program, the importance of obtaining buy-in from agency decision makers and being prepared to address challenges related to the use of direct observation in supervision, gatekeeping, and enacting the simultaneous roles of administrative and clinical supervisor.

     

Correction to: Training Public Sector Clinicians in Competency-Based Clinical Supervision: Methods,Curriculum, and Lessons Learned

Journal of Contemporary Psychotherapy - A correction to this paper has been published: https://doi.org/10.1007/s10879-021-09504-9     

Alliance rupture and repair processes in borderline personality disorder: A case study using dialogical sequence analysis

Objective: This study examined alliance rupture and repair processes in borderline personality disorder (BPD) and how the content of sessions interacts with the quality of the alliance.

Design: A mixed methods single case study design was employed incorporating quantitative and qualitative measures of process and outcome.

Methods: This case study examined a 22-year-old female with BPD who received 16 sessions of Cognitive Analytic Therapy. Measures of alliance, symptoms and global functioning were taken across multiple time-points. Selected sessions were analysed using dialogical sequence analysis (DSA), a theory-driven method of psychotherapy research that analyses utterances according to their author, addressee and referential object.

Results: Quantitative data indicated symptom reduction without functional improvement. DSA demonstrated that the first exchanges in therapy were reflective of key relational themes. The case suggests that, rather than simply negotiating tasks and goals, repairing ruptures involves systematically linking the manifest topic to the client’s core problems.

Conclusions: This case study points to the mediating role that the content of sessions has on alliance quality. Results underline the importance of the therapist stance, the need for a shared formulation to make sense of relational processes and the use of responsively timed interventions to decrease desperation and improve self-reflection.     

Parent-Offspring Transmission of Internalizing and Sensory over-Responsivity Symptoms in Adolescence

Reactions to sensory experiences are an overlooked correlate of affective regulation, despite the importance of bodily states on psychological processes. Children who display sensory over-responsivity (i.e., adverse reactions to typical sensations) are at greater risk for developing affective disorders. We extended this literature to adolescents and their middle-aged parents. Participants in a birth record-based study of families of adolescent twins (N = 506 families; 1012 adolescents; 53% female) completed a subset of items from the Adult Sensory Profile. We derived adolescent self-reported internalizing disorder symptoms and parent affective diagnoses from structured diagnostic interviews. Structural equation models tested the relationship between parent sensory over-responsivity symptoms and affective diagnoses and their adolescent offspring’s sensory over-responsivity and internalizing symptoms. Adolescent sensory over-responsivity symptoms were correlated with internalizing disorder symptoms. Parents with a diagnosis of anxiety or depression (mothers only) reported more frequent SOR symptoms than parents without a diagnosis. Parent depression was significantly related to adolescent sensory over-responsivity symptoms, over and above parent sensory over-responsivity symptoms (β = 0.26, p < 0.001 for mothers; β = 0.13, p = 0.004 for fathers). Father alcohol abuse/dependency also predicted offspring sensory over-responsivity symptoms. Offspring of parents with affective disorders were at additional risk for sensory dysregulation via parents’ influence on offspring internalizing problems.     

Reflections and Confessions of a Pedagogue

In light of increasing levels of polarization between liberals and conservatives both in the classroom and in the wider culture, this article uses an introductory seminary course as a springboard for reflection upon pedagogical practices and assumptions to help address this divide. Special attention is given to the work of moral psychologist, Jonathan Haidt, as presented in his book, The Righteous Mind: Why Good People are Divided by Politics and Religion (2012). Haidt’s work seeks to enhance mutual understanding between persons on both sides of political and religious debates by showing that there are multiple legitimate foundations for making moral judgments. Although he does not frame his argument explicitly in terms of the mind-body problem, he consistently challenges the way western philosophy and psychology have privileged individual reason over the passions, social intuition, and other automatic processes associated with the body. He further challenges this age-old dualism by drawing upon body-related metaphors to make his case against moral monism and a narrow understanding of cognition restricted to conscious reasoning, exclusive of intuition and emotion as additional forms of information processing. Thus, the research of Haidt and other psychologists can contribute some “new directions” to the way we conceive of and teach in relationship to the “old connections” of body/mind and self/other (the theme of the 2012 Conference of the Group for New Directions in Pastoral Theology).     

Film Reviews

Blue, White, Red. Directed Written by Krzysztof Kieslowski & Krzysztof Piesiewicz. by Krzysztof Kieslowski.     

The roles of dispositional optimism and pessimism in hiv disease progression

Relationships between dispositional optimism and pessimism and the course of HIV infection, determined by changes in viral load and CD4 counts, were studied in a longitudinal cohort of 412 patients on antiretroviral therapy (ART). Multiple regression analyses controlling for baseline levels of disease status, ethnicity, and depressive symptoms demonstrated that higher pessimism at baseline was associated with higher viral load at follow-up (average of 18 months later). Optimism at baseline had a curvilinear relationship with CD4 counts at follow-up. Moderate levels of optimism at baseline predicted the highest CD4 counts at follow-up. Although optimism and pessimism were associated with specific health behaviors (e.g., ART adherence, cigarette use, drug use, dietary practices), none of these behaviors mediated the optimism/pessimism effects. The biologic and behavioral mediators of associations of personality variables with the course of treated HIV infection deserve continued investigation.