Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services

Very little couple or family work takes place in primary care despite the advantages offered by the context. This pilot study investigated the experiences of primary care adult therapists regarding the place of families in their clinical work. Semi‐structured interviews with seven therapists were analysed using interpretative phenomenological analysis. The findings tentatively suggest that primary care psychological therapists ‘think family’ primarily from the perspective of their main therapeutic model when offering individual therapy. Some study participants questioned the appropriateness of their family/context focus. Family members were extremely rarely seen together. Facilitating factors included supervision and training. Barriers to family work were both external (the work setting) and internal (beliefs about it). The impact of the current dominance of cognitive behavioural therapy in National Health Service adult psychological therapy services and the development of Improving Access to Psychological Therapies (IAPT) services on the provision of couple and family therapy are discussed. Some challenges and opportunities presented by IAPT for couple and family therapy are explored.     

The Experience of Former Women Officials and the Impact on the Sporting Community

In an effort to explore the shortage of female sport officials, the authors examined the experience of eight former female basketball officials from five geographically diverse states in the U.S. who voluntarily left the role. Specifically, the authors asked former female basketball officials to describe their workplace experiences. Utilizing a phenomenological approach and workplace incivility framework, the results indicated that the felt social inequity for female officials detracted from the participants experiencing a sense of community in the workplace, which ultimately led to their discontinuation in the role. Results indicate four key factors that created this uncivil work environment. An examination of the data revealed four major themes. Specifically the female basketball officials reported experiencing a Lack of Mutual Respect from male counterparts; Perceived Inequity of Policies; a Lack of Role Modeling and Mentoring for and from female officials; and experiencing more Gendered Abuse than did their male counterparts. The combination of these four factors exacerbated the female officials’ inability to connect to the officiating community and led to their withdrawal from the role. The results further indicate that women officials likely threatened the hegemonic characteristics of a sport setting. Although females have made great strides in terms of sport participation, the practical implications of this research suggest that understanding females in workplace roles, such as officiating, is vital if social equity is to be achieved in the sporting community.     

The effects of co-witness discussion on confidence and precision in eyewitness memory reports

We examined the influence of co-witness discussion on the metacognitive regulation of memory reports. Participants (N?=?92) watched a crime video. Later, a confederate confidently agreed with (gave confirming feedback), disagreed with (gave disconfirming feedback), or gave no feedback (control) regarding participants’ answers to questions about the video. Participants who received disconfirming feedback reported fewer fine-grain details than participants in the confirming and control conditions on a subsequent, individual recall test for a different question set. Unexpectedly, this decrease in fine-grain reporting was not accompanied by a decrease in participants’ confidence in the accuracy of their fine-grain responses. These results indicate that receiving social comparative feedback about one’s memory performance can affect rememberers’ metamemorial control decisions, and potentially decrease the level of detail they volunteer in later memory reports. Further research is needed to assess whether these results replicate under different experimental conditions, and to explore the effects of social influences on metamemory.     

Cognitive outcomes of pediatric stroke

A limited number of longitudinal studies have investigated long-term neuropsychological development in the pediatric stroke population. This study retrospectively examines cognitive outcomes in 41 children with a history of stroke, with reference to age at stroke, laterality, region and mechanism of stroke. In the course of recovery, neuropsychological measures of intellectual functioning and memory were administered at two time points, whilst executive functioning, attention and academic skills were administered at one time point. As predicted, children with stroke performed significantly worse compared to normative expectations on all neuropsychological measures. Up to two thirds of children scored in the borderline impaired and impaired ranges on at least one domain of cognition. Performance on intellectual and memory assessment remained relatively stable over time. Younger age at stroke was found to be associated with poorer intellectual functioning. No effects of laterality of stroke on neuropsychological performance over time were found. Children with subcortical stroke demonstrated a greater improvement in immediate memory over time than children with cortical stroke. These findings reveal that children with stroke display long-term cognitive difficulties that typically remain stable over time. Attention and academic skills are particularly vulnerable to impairment. Further evidence that age at stroke is a significant factor in terms of cognitive outcome is provided, in support of the “early vulnerability” position.     

Anxiety,depression, and the suicidal spectrum: a latent class analysis of overlapping and distinctive features

ABSTRACT

Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.     

Strategies to Engage Underrepresented Parents in Child Intervention Services: A Review of Effectiveness and Co-occurring Use

The purpose of this review was to estimate the impact of parent engagement strategies tested with underrepresented families of young children with social, emotional, or behavioral disorders, and describe the combinations in which these strategies are commonly used together. We conducted a systematic review using the PracticeWise Engagement Coding System to identify which strategies had the strongest empirical support for engaging underrepresented (i.e., minority race or ethnicity, or low income) families receiving psychosocial services for their children. Social network analyses were used to identify the frequency of strategy use and how strategies were combined to engage underrepresented families. Linear regression was used to estimate the impact of each strategy on parent engagement, using attrition as a proxy for non-engagement. Thirty-five studies met inclusion criteria. Parent attrition was predicted by larger sample sizes, lower maternal education, interventions that were more community or home-based, less therapist monitoring, positive reinforcement from therapists, and more pairing families with peers. Social network analyses suggested that more effective strategies were more frequently implemented alone and less effective strategies were commonly combined with each other. Our findings suggest that researchers and practitioners require guidance in selecting engagement strategies to reduce attrition of underrepresented families in treatment. Although we identified promising strategies for improving parent engagement in treatment for underrepresented children with social, emotional, or behavioral disorders, the frequent combining of engagement strategies in research means that there is little data on the independent effects of interventions to increase parent engagement for this population.     

Infant communication and the mother–infant relationship: The importance of level of risk and construct measurement

Infants' emerging communication skills are understood to be associated with the maternal relationship, particularly for children experiencing high levels of social risk. This study attempts to determine the extent to which this association is influenced by (a) the mental health risk of the dyad and (b) different operational definitions and measurement of both the dyadic relationship and the construct of “communication.” Ninety‐six infants (10–30 months) and their mothers were recruited: A total of 46 were at‐risk dyads referred to a mental health clinic for relationship‐based emotional and/or behavioral difficulties, and 50 were nonrisk dyads not seeking mental health services and served as a normative reference or comparison group. Several factors were assessed: (a) developmental competence, (b) maternal psychopathology, (c) quality of mother–infant interaction during play, (d) attachment security classification, (e) prelinguistic and social‐affective communication, and (f) linguistic communication. In all infants studied, the quality of mother–infant interaction during play, rather than the attachment security classification, was associated with infants' prelinguistic and social‐affective communication abilities, but not with linguistic communication. Different aspects of mother–infant interaction predicted prelinguistic communication for clinic and comparison infants whereas only infant age predicted linguistic communication. All infants displayed communication abilities in the normal range, but the statistically poorer performance demonstrated by clinic‐referred infants could become clinically meaningful in later childhood. Best practices should include communication screening of infants presenting with attachment problems and screening for relational difficulties in infants presenting with communication delays. ©2004 Michigan Association for Infant Mental Health.     

Objectification Theory as It Relates to Disordered Eating Among College Women

Objectification theory (B. L. Fredrickson & T. A. Roberts, 1997) demonstrates how sociocultural variables work together with psychological variables to predict disordered eating. Researchers have tested models that illustrate how certain constructsof objectification theory predict disordered eating, but a more comprehensive model that integrates a combination of constructs central to the theory (i.e., sexual objectification; self-objectification; body shame; poor interoceptive awareness of hunger, satiety, and emotions) has not yet been examined. In this study, we incorporated these variables within an inclusive model based on the assertions of B. L. Fredrickson and T. A. Roberts (1997) and examined it with 460 college women. Structural equation modeling analyses suggested that the model provided a good fit to the data and supported most propositions set forth by objectification theory and the eating disorders literature.     

When is peer rejection justifiable? Children's understanding across two cultures

This study investigated how Korean (N = 397) and U.S. (N = 333) children and adolescents (10 and 13 years of age) evaluated personality (aggression, shyness) and group (gender, nationality) characteristics as a basis for peer rejection in three contexts (friendship rejection, group exclusion, victimization). Overall, peer rejection based on group membership was viewed as more unfair than peer rejection based on personality traits. Children viewed friendship rejection as more legitimate than group exclusion or victimization and used more personal choice reasoning for friendship rejection than for rejection in any other context. Although there were a few cultural differences, overall, the findings provided support for the cultural generalizability of social reasoning about peer rejection.     

Linking cognitive avoidance and GAD symptoms: The mediating role of fear of emotion

Although cognitive avoidance has been linked to generalized anxiety disorder (GAD), the mechanism that may account for this association has not been fully elucidated. The current study uses structural equation models to evaluate the relationship between cognitive avoidance and symptoms of GAD in a large unselected sample (n = 1220), and to examine whether subjective fear of emotion partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relations among fear of emotion, cognitive avoidance, and GAD symptoms is invariant for men and women. However, subsequent analysis revealed equivalence of meditational models where cognitive avoidance leads to GAD symptoms and vice versa. The implications of these findings for better understanding the etiology, maintenance, and treatment of GAD are discussed.