Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation

The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.     

抑郁症的计算机化认知行为治疗

计算机化认知行为治疗(computerized cognitive-behavioral therapy, CCBT), 即指通过电脑交互界面, 以清晰的操作步骤, 高度结构化的多种媒介互动方式(如网页、漫画、动画、视频、声音等)来表现认知行为治疗基本原则和方法的治疗方式。抑郁症的CCBT近年来在西方崭露头角, 目前Beating The Blues、MoodGYM、E-Couch和Good Days Ahead等抑郁症CCBT程序在西方使用较为广泛。从可行性分析上发现, 该疗法较受病人接纳、具有较高的成本效用和易用性; 现有实验研究证明了抑郁症采用CCBT是有效的, 但其有效性仍取决于诸多因素。以往研究存在着较少关注治疗有效性的内在机制、治疗效果差异较大、风险评估简化和被试选择偏向等问题, 建议未来研究应加强：(1)中介效应及机制研究; (2)以人为本的个性化服务研究; (3)风险评估与隐私保护研究; (4)在“弱势群体”中的研究与运用。最后, 对其在中国发展的必要性与可行性进行了展望。     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

African American Couples in the 21st Century: Using Integrative Systemic Therapy (IST) to Translate Science into Practice

The complexity of the African American community in the United States continues to evolve. The growing number of professional African Americans who grew up in the postcivil rights era combined with the persistent reminders of inequity paints a complex backdrop for understanding African American relationships. The majority of our knowledge about African American couples disproportionately comes from nonclinical social science fields such as sociology and demography. Unfortunately, the scholarly literature on how to work with African American couples is relatively scant. This paper seeks to add to this limited literature by providing clinicians and scholars with a proposed set of issues to consider when conceptualizing and treating African American couples. In particular, the complexity and nuance needed to work with African American couples are best done by using an integrative model. Thus, this paper will discuss how the Integrative Systemic Therapy (IST) model is particularly well suited for working with African American couples. This paper will summarize the science on African American marriages with a focus on salient factors such as gender, SES, and trust, which will then be translated into clinical practice by utilizing a case example. The case example will be of a middle‐class couple in order to delineate the challenges and the growing heterogeneity of African Americans. The article will conclude with a commentary on the evolving heterogeneity of African Americans, which sheds light on how an integrative perspective is important for disentangling and embracing the growing complexity of African American couples.     

Discrimination,Internalized Homonegativity,and Attitudes Toward Children of Same‐Sex Parents: Can Secure Attachment Buffer Against Stigma Internalization?

With increasing numbers of same‐sex couples raising children in the United States, discriminatory attitudes toward children of same‐sex parents (ACSSP) are of increasing concern. As with other forms of stigma and discrimination, lesbian, gay, and bisexual (LGB) individuals are at risk for internalizing these societal attitudes, which can negatively affect parenting‐related decisions and behaviors and the mental and physical health of their children. Secure attachment is characterized by positive views of the self as loveable and worthy of care that are understood to develop in early relationships with caregivers. Secure attachment has been associated with positive mental and physical health, including among LGB individuals and couples. This study aimed to test the potential buffering role of secure attachment against stigma internalization by examining associations among secure attachment, discrimination, internalized homonegativity (IH), and ACSSP in an online survey study of 209 U.S. adults in same‐sex relationships. Bootstrap analyses supported our hypothesized moderated mediation model, with secure attachment being a buffer. Greater discrimination was indirectly associated with more negative ACSSP through greater IH for individuals with mean or lower levels, but not for individuals with higher than average levels of secure attachment, specifically because among those with higher levels of secure attachment, discrimination was not associated with IH. These findings build on and extend past research, with important implications for future research and clinical work with LGB individuals, same‐sex couples, and their families, including potential implementation of interventions targeting attachment security.     

Bidirectional Associations Between Newlyweds' Marital Satisfaction and Marital Problems over Time

Prevailing views of marital functioning generally adopt the view that marital problems predict decreases in marital satisfaction, but alternative theoretical perspectives raise the possibility that lowered satisfaction can also predict increases in problems. The current study sought to integrate and compare these perspectives by examining the bidirectional cross‐lagged associations between newlyweds' reports of their marital satisfaction and marital problems over the first 4 years of marriage. Using annual assessments from 483 heterosexual newlywed couples, we find evidence for problem‐to‐satisfaction linkages as well as satisfaction‐to‐problem linkages. Satisfaction was a stronger predictor of marital problems early in marriage but not as time passed; by Year 4 only problem‐to‐satisfaction linkages remained significant. These findings are consistent with the idea that couples with more problems go on to report lower levels of satisfaction and couples with lower levels of satisfaction go on to report more marital problems. This dynamic interplay between global judgments about relationship satisfaction and ongoing specific relationship difficulties highlights the value of examining bidirectional effects to better understand marital functioning over time.     

Feminism,Therapy, and Changing the World

ABSTRACT

In this essay, Miriam Greenspan reviews her life’s work as an early pioneer of Feminist Therapy, the influence of her birth in a displaced person’s camp to parents who were Holocaust survivors, and her development as a feminist, social activist, and psychotherapist. She discusses her most influential works, including A New Approach to Women & Therapy (1983 Greenspan, M. (1983). A new approach to women & therapy. New York: McGraw Hill. [Google Scholar], 1993 Greenspan, M. (1993). A new approach to women & therapy (10th anniversary ed.). New York: McGraw Hill. [Google Scholar]) and Healing Through the Dark Emotions: The Wisdom of Grief, Fear, and Despair (2003 Greenspan, M. (2003). Healing through the dark emotions: The wisdom of grief, fear, and despair. Boston: Shambhala. [Google Scholar]). She concludes with a look back at her own spiritual evolution, her assessment of the ultimate contribution of Feminist Therapy to society, the need for a wide model of therapy that incorporates the political and spiritual dimensions of experience, and the challenges that psychology and psychotherapy face in an age of global threat.     

Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial

Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptom-related measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs.     

Enhancing Interpersonal Psychotherapy for Mothers and Expectant Mothers on Low Incomes: Adaptations and Additions

Intervening with depressed women during their childbearing years, especially with those on low incomes, is critically important. Not only do mothers and expectant mothers suffer unnecessarily, but their untreated depression has critical negative consequences for their families. Despite this, these women have proven especially difficult to engage in psychotherapy. In this paper we describe several adaptations and additions we have made to a brief form of Interpersonal Psychotherapy (IPT) to meet the needs of mothers and expectant mothers living on low incomes in the community who suffer from depression, but face significant practical, psychological, and cultural barriers to engaging in and staying in treatment. In addition, we present some preliminary data on the extent to which our enhanced, brief IPT approach promotes improvements in treatment engagement and retention relative to usual care for expectant mothers on low incomes.