Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Eco-restrictive experiences forming extraordinary consumer experiences

This article contributes to different research traditions when proposes to reflect on theoretical fields, such as consumer culture and contemporary marketing. The study in a tourist and ecological conservation project revealed eco-restricted extraordinary experiences. We found a group of volunteers that build meanings and practices connected with new actions and habits that offer, not only ecological and sustainable benefits, but new value consumption relations. In contextualizing our findings, we highlight experiences and curiosities that are glossed over in academic and practical accounts that celebrate the extraordinary experience. It was observed, by analyzing data from various qualitative techniques, that the findings cross borders of mundane ingrained practices and bring an emerging domain, where both, consumption and anti-consumption experiences, offer insights into to a diversity of areas of knowledge.     

Murder in the family: An analysis of two Poe short stories

Learning to be possessed has been described elsewhere by the writer as a form of pathogenic relating begun when children are taught by adults that they will receive a lesser penalty for misbehavior if they can show they were not responsible, such as if it were caused by an evil agent or the Devil. It was suggested that learning to be possessed can be an underlying cause of psychopathology, the delusion of persecution in particular. Two short stories by the distinguished American writer Edgar Allan Poe are examined to develop the formulation of learning to be possessed, especially when it has passed to a delusion of persecution. Two propositions are offered: (1) Where it appears that a family member is murdered by a delusional assailant by accident, it is not an accident; and (2) the delusion of persecution entails a memory loss so that the murderer not only can claim lack of personal responsibility for the act, but also spares himself the guilt of having broken a fundamental taboo. Further comparison is made between learning to be possessed as a cause of delusion, and the psychoanalytic theory in which the defense mechanism of projection is central. In the latter theory, interpretation of the delusion is critical; whereas in the former, interpretation is counterproductive because it merely reinforces the delusion.Probably a note of appreciation is due the writer's daughter Cary, who at age 14 is an expert at badgering her father for help with homework assignments. For several weeks the writer was alternatively pestered and cajoled to help Cary with her Poe Project for high school English which required an essay analyzing the work of a great American writer denigrated by the author as weird by his recollection formed decades earlier. Cary's persistence required the author to consider Poe anew, to recognize his unwarranted earlier prejudice, and to recognize that Poe offered him a gift of understanding regarding a topic about which the author had been thinking for several years, namely that form of pathogenic relating named learning to be possessed.     

Improvisational therapy: Evolving one's own clinical style

This article offers an invitation to develop one's own unique clinical style, relying less on institutionalized schools of therapy and more on the therapist's own natural resources. An emphasis is placed upon understanding therapy as art, trusting one's imagination, and maintaining a healthy irreverence for professional politics.     

Family coping strategies and the rural Appalachian working poor

Naturalistic research methods were used in this study to collect the voices, ideas, and opinions of rural, working poor, Appalachian families from Southeast Ohio about the stress of poverty in family life and family coping in the face of poverty. This data should be of interest to the professional family therapist who practices with the working poor.     

Live supervision in the postmodern era of family therapy: Issues,reflections, and questions

This article asserts that the family therapy field is approaching an epistemological shift from structuralism and positivism to postmodernism and relativism. The confluence of these movements: feminism, constructivism/constructionism, and cultural relativism is cited as a major impetus for the shift. Live supervision is examined within the context of this transformation, with a discussion of implications for the future.     

Supervising the person of the therapist: Issues,challenges and dilemmas

A major critical issue in marriage and family therapy today is the professionalization of the discipline. Thus the focus on training individuals for a career in marriage and family therapy necessitates the revisitation of the debate over personal growth versus skill development. The trend toward training the person of the therapist, however, would suggest that the field is moving toward the integration of self awareness and skill in the therapeutic system. With the popularization of training the person of the therapist comes other issues, challenges, and dilemmas for the field, including the crucial issue of training gender and culturally sensitive therapists. The potential for creating dual relationships when training the person of the therapist is both a dilemma and a challenge.     

Sado-masochism as a defense against merging: Six case studies

This paper reports on several patients who use sado-masochism as a defense against an unconscious wish for and fear of merging. The sado-masochism can be expressed as a sexual perversion or in a difficult ungratifying interpersonal relationship. These relationships have some of the quality of addictions in that the patients have a compulsive need to continue them and find it extremely difficult to leave them. Therapy must focus on helping the patient become more separate, rather than on other problems which may also be present. Initially, the therapist needs to take an educational stance in regard to the process the patient must complete, rather than the more traditional analytic stance.