Therapeutic Utility of Discussing Therapist/Client Intersectionality in Treatment: When and How?

The impact of the therapeutic alliance on positive clinical outcomes has been established in the literature; however, literature is lacking on how the intersection of therapist and client identities influences this process. We propose that the relational intersectionality resulting from similarities or differences in therapist and client identities has the potential to impact the bonds, tasks, and goals of treatment (key components of the therapeutic alliance; Bordin, 1979) depending on how it is addressed or avoided in therapy. In this paper, we present a model containing pragmatic steps therapists can follow to navigate these conversations with clients in a way that is therapeutically beneficial and culturally sensitive and attuned. Additionally, we provide suggestions for using the proposed model to train new student therapists (or expose experienced therapists) to ideas of intersectionality and social justice by reflecting on the intersection of their own identities, acknowledging dynamics of power and oppression, and understanding how this could shape their relationship with clients.     

A systematic review of interventions for adults who stutter

PurposeTo examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.MethodsFive electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.ResultsFive RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.ConclusionSpeech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.     

Exploring emotions in dialog between health provider,parent and child. An observational study in pediatric primary care

IntroductionThis paper is part of the theoretical thread of health psychology and it presents a study aimed to recognize information useful to implement psychological interventions finalized to personalize medical treatments and engage users in pediatrics.ObjectiveIn this paper is presented an observational study aimed to explore doctor-patient dialog about worries in pediatric primary care; it has been carried out identifying dialogical interaction patterns, or typical dialog between health providers, parent and child.MethodWe documented conversations in 265 visits; we audio-recordered, transcribed and analyzed them with Verona Coding Definitions of Emotional Sequences. Dialogs between participants were analyzed one by one. Frequencies of emotions’ signals (cues/concerns) and responses were analyzed through Redundancy Analysis, aimed to establish a quantitative relationship between these pair of groups of variables considering the asymmetrical relationship between them.ResultsSix “Dialogical Interaction Patterns” were obtained by interpreting these relationships; they show dialogs mainly aimed at obtaining information useful for diagnosis and treatment, with a limited exploration of worries or issues related to the condition of the child. Pediatric conversations seem to be characterized by a very high attention to cognitive aspects of medical questions with a poor consideration of emotions as useful information to medical practice.ConclusionsThese dialogs seem to ensure the rapidity and the efficiency of medical visits. Nevertheless, it could be useful to implement psychological interventions to achieve an enrichment of the dialog between participants, helping them to recognize users’ emotions as useful to define shared medical strategies.     

La méthode d’intervention en psychodynamique du travail face au « tournant gestionnaire » : l’exemple d’une intervention dans une unité mixte de recherche

This text aims to show the continuing interest in using the “canonical” method of investigation in work psychodynamics in the context of what is commonly called the managerial turning point. In order to demonstrate this methodology, the authors will rely on a survey conducted in a U.M.R of science called “hard science” following a recommendation of the Agency for evaluation of research and higher education. We will raise the impact of this intervention, allowing participants to think about their work relationship and the necessary modalities in order to do it continuously well, within the managerial logic context.     

Prevention of delinquency: Current status and issues

In the present review, we summarize the extant literature in the field of delinquency prevention. We do not provide a recounting of whether specific programs have or have not been effective but, rather, attempt to judge the overall utility of programs to prevent delinquency in its various forms and among various definable groups. Specifically, we organize our review of programs according to the characteristics of the targeted population, differentiating programs for universal, selected, or indicated populations. Within each population type, we further distinguish programs according to designated intervention context, relying on a biopsychosocial model that specifies four levels of influence on risk for delinquency: individual, close interpersonal relationships, proximal social settings, and societal macrosystems. At each level, we identify a number of effective intervention strategies and highlight those that are based on relevant risk factor research. As we note, the effectiveness of some approaches depends on the specific population, although, in general, multicomponent, multilevel programs appear to have the most substantial effects.     

Description of a Behavioral Intervention to Reduce Substance Use and Related Risk and Increase Positive Parenting among Urban Mothers with Alcohol and Other Drug Problems

The abuse of alcohol and other substances by mothers raising adolescent children has serious adverse effects on family functioning and youth outcomes, and on mothers’ own health and adaptation. Mothers who are also HIV-infected face additional challenges. In the present report, we describe a multi-session intervention conducted in individual sessions for mothers with alcohol and other substance use problems who are raising adolescent children. We outline the primary components of the intervention and include case studies and examples of exercises and tools. We found that engagement with the intervention and high rates of attendance were facilitated by tapping into mothers’ desires to improve their relationships with their adolescent children, the use of a harm reduction approach toward substance use, and intensive outreach. We also discuss lessons learned in the course of implementing and evaluating the intervention.     

An approach to preventing coparenting conflict and divorce in low-income families: strengthening couple relationships and fostering fathers' involvement

In the context of current concern about levels of marital distress, family violence, and divorce, the SFI study is evaluating the effectiveness of an intervention to facilitate the positive involvement of low-income Mexican American and European American fathers with their children, in part by strengthening the men's relationships with their children's mothers. The study design involves a randomized clinical trial that includes assignment to a 16-week couples group, a 16-week fathers group, or a single-session control group. Couples in both group interventions and the control condition include partners who are married, cohabiting, and living separately but raising a young child together. This article presents the rationale, design, and intervention approach to father involvement for families whose relationships are at risk because of the hardships of their lives, many of whom are manifesting some degree of individual or relationship distress. We present preliminary impressions and qualitative findings based on our experience with 257 families who completed the pretest, and the first 160 who completed one postintervention assessment 9 months after entering the study. Discussion centers on what we have learned and questions that remain to be answered in mounting a multisite preventive intervention to strengthen relationships in low-income families.     

Is There Life After DEBI? Examining Health Behavior Maintenance in the Diffusion of Effective Behavioral Interventions Initiative

The evidence-based interventions that are identified, packaged, and disseminated by the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention as part of the Diffusion of Effective Behavioral Interventions (DEBI) initiative—commonly referred to the "DEBIs"—currently represent a primary source of HIV prevention interventions for community-based providers. To date, little attention has focused on whether the intended outcomes of the DEBIs, i.e., reductions in HIV-related risk behaviors, are maintained over time. This review summarized evidence for the sustainability of the effects of the DEBIs on HIV sexual risk behavior and intravenous drug use from studies of original and adapted DEBIs. Evidence of intervention decay or a lack of any intervention effect was identified in several original and adapted versions of the DEBIs included in this review. Recommendations include modifications to current criteria for inclusion in the DEBI portfolio, in addition to the development of remediation strategies to address intervention decay. Further, theoretical models that specify the processes that underlie the maintenance of health behaviors over time should be used in developing HIV prevention interventions.     

With a Sword Pointing to the East,West, South,and North

In his In Defense of War, Nigel Biggar argues for an account of war based in Christian love. In the process, he opposes Christian pacifists, the British Left, liberal accounts of just‐war, and accounts of just‐war based on self‐defense. Although framed in terms of love, his account pivots around punishment, which is further explicated by a thorough review of the recent war in Iraq, the invasion of which he deems justified. This review compares Biggar's monograph to prior iterations of a love‐based approach to just war by Paul Ramsey and Oliver O'Donovan. Biggar's contributions regarding love, punishment, and policy analysis are recognized, as well as his attempt to carry on the tradition of the ‘mournful warrior’. As a model for the kind of scrutiny that Christian ethicists should bring to bear on serious social issues, Biggar's monograph is excellent. However, the political stance and – largely implicit and unstated – political theology operating behind this book are, in the end, disconcerting.