Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Facial Affect Recognition and Psychopathy: A Signal Detection Theory Perspective

Though emotional processing deficits are often conceptualized as a core feature of psychopathy, the common assessment of these deficits using the percentage correct (or hit rate) on affect recognition tasks may not provide a full or accurate picture of facial affect recognition in psychopathic individuals. Signal detection theory (SDT) provides a more informative statistical approach by providing independent measures of perceptual sensitivity (d’) and willingness to report perceiving a signal or response criterion (c). The current study employed signal detection methods to test the predictions of the integrated emotion systems and hostile attribution bias perspectives, two theoretical perspectives that make specific predictions regarding facial affect recognition. These perspectives were tested in a sample of 280 adult male incarcerated offenders who were assessed for psychopathy using the Psychopathy Checklist-Revised and who completed a novel test of facial affect recognition presenting 324 digital morphs of faces reflecting systematic combinations of pixels from neutral and affective face images (displaying six different types of emotion) as expressed by four different actors. The findings were generally not consistent with either of these perspectives. Psychopathy was negatively associated with d` for anger. Results also indicated an effect of psychopathy on response criterion for fear and effects of psychopathy on response criterion for anger and surprise that were evident only for some actors. The implications of these findings are considered through the lenses of several theoretical perspectives, and theoretical and methodological limitations of the current study are considered.

     

Family Functioning and Social Support in Men and Women Diagnosed with Depression in China

Previous research has demonstrated the association between family functioning and depression. This study evaluated family functioning and perceived social support in men and women in Shanghai who had received a diagnosis of a major depressive disorder (N = 100), including sixty-six women and thirty-four men. The relationship between family functioning and social support of outpatients with major depressive disorders was explored using the Chinese Family Assessment Device and the Multidimensional Scale of Perceived Social Support. The scores from all dimensions of family functioning for both men and women indicated that depressed men and women all reported experiencing unhealthy family functioning. The clinical implications of these findings for the developing practice of family therapy in China are discussed.     

One size does not fit all: face emotion processing impairments in semantic dementia, behavioural-variant frontotemporal dementia and Alzheimer's disease are mediated by distinct cognitive deficits

Patients with frontotemporal dementia (both behavioural variant [bvFTD] and semantic dementia [SD]) as well as those with Alzheimer's disease (AD) show deficits on tests of face emotion processing, yet the mechanisms underlying these deficits have rarely been explored. We compared groups of patients with bvFTD (n = 17), SD (n = 12) or AD (n = 20) to an age- and education-matched group of healthy control subjects (n = 36) on three face emotion processing tasks (Ekman 60, Emotion Matching and Emotion Selection) and found that all three patient groups were similarly impaired. Analyses of covariance employed to partial out the influences of language and perceptual impairments, which frequently co-occur in these patients, provided evidence of different underlying cognitive mechanisms. These analyses revealed that language impairments explained the original poor scores obtained by the SD patients on the Ekman 60 and Emotion Selection tasks, which involve verbal labels. Perceptual deficits contributed to Emotion Matching performance in the bvFTD and AD patients. Importantly, all groups remained impaired on one task or more following these analyses, denoting a primary emotion processing disturbance in these dementia syndromes. These findings highlight the multifactorial nature of emotion processing deficits in patients with dementia.     

Advancing Organizational Support Theory into the Twenty-First Century World of Work

Purpose

This review focuses and aids the development of organizational support theory, which explains relationships between employers and employees based on social exchange. Many studies have explored the theory??s central construct, perceived organizational support (POS), or the degree to which employees believe their work organization values their contributions and cares about their well-being. Since the last review of POS literature in 2000, the occupational landscape has shifted, increasing nontraditional work relationships and the importance of managing an international workforce while considering influences on employee well-being. This review discusses how the recent POS research reflects these trends.

Design/Methodology/Approach

This review focused on how themes in the POS research since 2000 have enhanced organizational support theory as relevant to the twenty-first century world of work.

Findings

Four important theoretical themes have developed since 2000 that enhance organizational support theory: considerations of employee well-being, nontraditional workers, international and cross-cultural issues, and developments tied to the use of multilevel modeling.

Implications

Giving both researchers and practitioners a synthesized view of the current status of POS research, this review serves as a springboard for new developments. It also integrates the multitude of recent studies into organizational support theory, focusing theoretical progress.

Originality/Value

This is the first review and theoretical integration of the POS literature since 2002. It is a valuable resource for all interested in the field, with theoretical insights, useful tables, explanatory figures, and references.     

Prenatal Treatment of Congenital Adrenal Hyperplasia—Not Standard of Care

Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency is a common autosomal recessive disorder due to mutations in the CYP21A2 gene. Since genetic counselors play a crucial role in educating families about inherited disorders, they need to have thorough knowledge regarding the pathophysiology of CAH especially the effects on the fetus, the complex genetics of this disorder, and the controversies surrounding experimental prenatal dexamethasone treatment. Affected female fetuses may have varying degree of virilization of the external genitalia. Starting in the 1980's, supraphysiologic glucocorticoid treatment was used to decrease the virilization of the external genitalia of affected female fetuses. However, recent clinical observations, animal studies and greater awareness of the details of human fetal adrenal physiology raise concerns regarding the safety of this prenatal treatment. We review the pathophysiology of CAH, the safety and ethical considerations of prenatal dexamethasone treatment and the views of multiple medical societies that conclude that this experimental therapy should only be done in prospective trials approved by ethical review boards.