CACREP Accreditation: A Solution to License Portability and Counselor Identity Problems

A confluence of forces addressing counselor identity occurred with the 20/20: A Vision for the Future of Counseling initiative, the 2009 Standards of the Council for Accreditation of Counseling and Related Education Programs (CACREP), and the quest by the American Association of State Counseling Boards to establish license portability. This article provides a historical context for the profession's struggles with these issues, 1 state's experience, TRICARE's impact, and the role CACREP standards can play in their resolution.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Psychological consequences of positive results in cervical cancer screening

Abstract

This study was carried out to assess the psychological impact of abnormal cervical smear results. Existing literature contain only uncontrolled studies or controlled studies with non-standardised measures. Subjects were recruited from women attending two general practices for routine cervical smears over a six month period. A comparison was made between women with positive results who were referred for colposcopy, with mild abnormalities who were asked to return for a repeat smear in six months, or negative smear results. Psychometric assessment by postal questionnaire was carried out one week after receiving the result. The measures used were the 28-item General Health Questionnaire (GHQ-28), Spielberger State Anxiety (STAI), and a measure designed specifically for use in the study, the Cervical Screening Questionnaire (CSQ). Results indicated that women with positive smear test results who were referred for colposcopy had significantly higher scores on GHQ (p<.01) STAI-S (p<.05) and CSQ (p<.001) than women with mild abnormalities or negative results. Significant differences between the groups with mild abnormalities and negative results were found on the CSQ (p<.05). These findings suggest that positive results on cervical screening are associated with a significant psychological impact including a range of specific concerns about gynaecological health and cancer, increased anxiety and impaired well-being. Even mildly abnormal results, which involve a recommendation for early repeat screening, cause raised concern about cancer for the recipients. The procedures for providing smear results should be organised to minimise the level of distress.     

Examining the role and functions of self-development in healthcare therapy trainings: A review of the literature with a modest proposal for the use of learning agreements

Many healthcare trainings with a psychodynamic orientation encourage or require students to commit to a process of personal development, such as provided through attending individual psychotherapy and/or an experiential ‘as if therapy’ group. This paper reviews recent literature about training in psychodynamically oriented practices within counselling psychotherapy, psychiatry, the creative arts therapies and clinical psychology. The results indicate that the mandatory personal development dimension of therapy training needs urgent reassessment. Results of studies consistently call for further research about the direct benefits of personal development on students’ development of skills for therapy practice. There is minimal evidence to indicate what self-development through individual psychotherapy can specifically deliver in terms of eventual professional competence. To address some aspects of the current lacuna, this paper summarises the recommendations for training programmes available from the current research, and makes a modest proposal for the use of learning agreements, rather than only mandated hurdle requirements, to ensure that the incremental steps by which the student attains expected requirements is negotiated and agreed within regularised, and widely accepted university course procedures.     

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety

Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.     

‘I don't want to be the mother of a paedophile’: the perspectives of mothers whose adolescent sons with learning disabilities sexually offend

The subject of sexual abuse is a major focus of professional and public concern. Sexual abuse of (and by) people with learning disabilities evokes even greater disquieting emotions, and makes severe demands on the social services, and the criminal justice system. The aims of the project were: 1) to determine whether group psychotherapy produced effective outcomes for adolescent boys with learning disabilities who exhibit sexually abusive behaviour, 2) to explore the perspectives of parents and other care-givers, and 3) to document the nature and extent of service support to families. This paper focuses solely on the mothers' perspectives. This was a three-year project with six boys (under 16) receiving group psychotherapy, using both quantitative and qualitative methods. Clinical measures were used to track changes throughout the course of psychotherapy. Semi-structured interviews (taped and transcribed) were held (separately) with the boys, their parents, paid care-givers and the therapists. The mothers tried hard to make sense of, and come to terms with, what was happening to their sons and to themselves, they struggled to reconcile their own confused and often conflicting emotions, and to maintain their own sense of identity. They felt almost totally unsupported by the services, both in the past and present, and could see little hope for the future. There is an urgent need for development of effective and sympathetic services for the parents of boys with learning disabilities who have been abused, and who are now showing abusive behaviour.     

Some thoughts and responses to The Francis Report

This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.     

Chaotic attractors in the therapeutic system 1

Because little research had been done on the presence and role of latent communication in the context of team‐conducted family therapy, the writers set out to monitor unconscious responses generated under these conditions. Specifically, they investigated an ongoing family treatment situation conducted according to the “reflecting team model.” One team of therapists handles the actual treatment session, while the other observes from behind a one‐way mirror. During the course of a session, the second team makes suggestions to the treatment team either by telephone or by calling the therapists out of the treatment room.

As the project developed, the writers found that the unconscious responses of both family and treatment teams indicated a process at work beyond the conscious intentions of the participants. That is, the therapeutic enterprise was functioning as a dynamical system, whose increasing complexity suggested a self organizing principle at work. This paper traces the development of the system's movement toward greater complexity, identifies the specific interventions that indicate this process, describes how all participants demonstrated a high degree of resonance and synchronization with this overarching‐self organizing pattern. This paper serves to alert therapists to the role of unconscious communication within the therapeutic system and postulates that the generation of form within psychotherapy follows many of the same self organizing processes found in other human and non human systems.     

Reasons for Not Helping

Second-grade, fourth-grade, sixth-grade, high school, and college students (N = 140) were asked to describe situations in which they would not help someone else and their reasons for not helping in those situations. Younger subjects used perceived self-incompetence as a reason for not helping more frequently than did older subjects. In contrast, older subjects more frequently cited a desire not to violate another's personal situation and/or their own internalized values, laws, and rules as reasons not to help than did their younger counterparts. For a majority of the not-helping categories, however, no significant effect of age level was found, and indeed, some individuals in even the youngest age group expressed subtle and insightful reasons for not helping.