Meaning Coconstruction in Group Counseling: The Development of Innovative Moments

This study discusses a model of group counseling, the narrative mediation path (NMP), which is a unique narrative, multimodal approach that combines four narrative modes (metaphoric, iconographic, writing, and bodily) and the narrative group. The purpose of the NMP is to foster reflexive processes with underachieving university students and to improve their academic performance. The study analyzes a single case of group counseling for seven underachieving economics students at an Italian university and the process of meaning construction among NMP narrative modes and the follow-up session. It applies the innovative moments coding system, a reliable method for studying change by tracking narrative innovations in sessions. More specifically, we focus on how innovative moments (IMs: action, reflection, protest, and reconceptualization) evolve during the four different narrative modes and the follow-up session. The findings suggest that the NMP fosters narrative innovations, mainly of a reflexive nature (reflection and reconceptualization). Moreover, during counseling and the follow-up session, the pattern of change is primarily characterized by reconceptualization IMs, the most complex form of narrative innovation.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Self-construal, mental distress, and family relations: a mediated moderation analysis with Asian American adolescents

The interactive effects between interdependent and independent self-construal on family cohesion and mental distress were examined. Survey responses from 153 Asian American high school students supported the hypothesized moderation of interdependence by independence on family cohesion, which was found to further mediate the relationship between self-construal and mental distress. Specifically, interdependence was positively associated with family cohesion when independence was high and negatively associated with family cohesion when independence was low. Accounting for the mediator effects of family cohesion, mental distress was positively associated with interdependence and more so for those low on independence than those high on independence. The benefits of biculturalism and research implications for the bidimensional conceptualization of self-construal for ethnic minority populations are discussed.     

An evaluation of the effectiveness of Diploma-level training in cognitive behaviour therapy

Background

As part of the UK government’s initiative to Increase Access to Psychological Therapies (see http://www.iapt.nhs.uk/for full details of the IAPT programme) there has been an expansion in the provision of post-graduate Diploma training in cognitive behaviour therapy (CBT). Previous evaluations of such training programmes have yielded mixed results but have been limited by small sample sizes and/or limited assessment measures.

Aims

To evaluate the impact of a long-standing Diploma in CBT training programme on a variety of measures of CBT competence.

Method

Trainees’ levels of CBT skill are compared at the beginning and end of CBT training. The effect of therapist factors such as age, professional background and gender on the development of CBT competence is also examined.

Results

Results show that trainees demonstrate higher levels of CBT skills after completing the training than they did before, with the majority achieving pre-determined criteria for competence. Trainees’ gender was not related to their performance but trainees’ age showed a negative association with CBT skill (older trainees performed worse). Trainees’ professional background also had an impact on their level of CBT competence, with trainees who were clinical psychologists demonstrating the highest levels of competence across a range of measures.

Conclusions

CBT Diploma training leads to increases in the level of trainees’ CBT competence, with the majority achieving the levels demonstrated in research trials by the end of training. Thus, this training is likely to lead to improved outcomes for patients. Further research is needed to determine the most efficient ways of enhancing CBT skills.     

Cognitive-Behavioral Therapy With Chinese Americans: Research, Theory, and Clinical Practice

In this article, we discuss how to conduct cognitive-behavioral therapy with Chinese Americans. We present an integration of theory, research, and clinical practice to help mental health practitioners understand how Chinese culture may potentially influence the CBT treatment process for Chinese immigrants. Several recommendations are provided as to how to adapt and modify CBT to better meet the therapeutic needs of Chinese American clients. A case example demonstrates how cultural modifications of CBT can lead to effective psychotherapy outcomes for Chinese American clients.     

Counseling Jewish Women: A Phenomenological Study

The field of counseling has paid little attention to religion in general and Jewish women's realities in particular. This article presents the findings of a qualitative phenomenological study examining 12 Ashkenazi, non‐Orthodox, Jewish American women's self‐reported understanding of their Jewish identity, revealing the themes of Jewishness and being Jewish in a broader societal context, as well as 7 related subthemes. Recommendations are offered for counselors, educators, and researchers who work with Jewish women.     

Activity-Dependent Activation of TrkB Neurotrophin Receptors in the Adult CNS

In this paper we have investigated the hypothesis that neural activity causes rapid activation of TrkB neurotrophin receptors in the adult mammalian CNS. These studies demonstrate that kainic acid-induced seizures led to a rapid and transient activation of TrkB receptors in the cortex. Subcellular fractionation demonstrated that these activated Trk receptors were preferentially enriched in the synaptosomal membrane fraction that also contained postsynaptic glutamate receptors. The fast activation of synaptic TrkB receptors could be duplicated in isolated cortical synaptosomes with KCl, presumably as a consequence of depolarization-induced BDNF release. Importantly, TrkB activation was also observed following pharmacological activation of brain-stem noradrenergic neurons, which synthesize and anterogradely transport BDNF; treatment with yohimbine led to activation of cortical TrkB receptors within 30 min. Pharmacological blockade of the postsynaptic α1-adrenergic receptors with prazosin only partially inhibited this effect, suggesting that the TrkB activation was partially due to a direct effect on postsynaptic cortical neurons. Together, these data support the hypothesis that activity causes release of BDNF from presynaptic terminals, resulting in a rapid activation of postsynaptic TrkB receptors. This activity-dependent TrkB activation could play a major role in morphological growth and remodelling in both the developing and mature nervous systems.     

Cognitive-Behavior Therapy for Low Self-Esteem: A Case Example

Low self-esteem is a common, disabling, and distressing problem that has been shown to be involved in the etiology and maintenance of a range of Axis I disorders. Hence, it is a priority to develop effective treatments for low self-esteem. A cognitive-behavioral conceptualization of low self-esteem has been proposed and a cognitive-behavioral treatment (CBT) program described (Fennell, 1997, 1999). As yet there has been no systematic evaluation of this treatment with routine clinical populations. The current case report describes the assessment, formulation, and treatment of a patient with low self-esteem, depression, and anxiety symptoms. At the end of treatment (12 sessions over 6 months), and at 1-year follow-up, the treatment showed large effect sizes on measures of depression, anxiety, and self-esteem. The patient no longer met diagnostic criteria for any psychiatric disorder, and showed reliable and clinically significant change on all measures. As far as we are aware, there are no other published case studies of CBT for low self-esteem that report pre- and posttreatment evaluations, or follow-up data. Hence, this case provides an initial contribution to the evidence base for the efficacy of CBT for low self-esteem. However, further research is needed to confirm the efficacy of CBT for low self-esteem and to compare its efficacy and effectiveness to alternative treatments, including diagnosis-specific CBT protocols.     

Understanding Cancer Patients’ Narratives: Meaning-Making Process,Temporality, and Modal Articulation

Temporality is a fundamental dimension of each narrative process of meaning making. In fact, the narration constructs and organizes temporal frames that connect one's own experiences. From this point of view, oncological illness is experienced as a traumatic experience that interrupts the sense of continuity of one's own life, resulting in the configuration of different temporal frames, which are not always able to support the processes of elaboration of this experience. The aim of this article is to explore the way the modal verbal predicates (must, can, will, know) are organized and work in relation to the representation of time in narrations of cancer patients. The modal verbal predicates—introducing the meanings of possibility, knowledge, will, desire, duty, need, or ability—allow us to organize the relationship between the subject, action, and context. Six narrations of cancer experience were analyzed—one for each time frame (linear, circular, fragmentary, static, cyclic, and spiral) proposed by Brockmeier (2000)—by means of quali-quantitative analysis of the use of modal verbs. Narrations show specific modal positioning: dispersion, plasticity, focusing, rigidity, and poverty. It is possible organize them along a continuum from plasticity to rigidity. The modal plasticity is the capacity to reconfigure a new temporal relation between subject and context, whereas modal rigidity shows a repetition of a specific and same modality in connecting subject and context. This preliminary research allows us to reflect about some possible clinical implications to support and foster processes of meaning making of cancer conditions.