Identifying Training Needs of Health-Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England

SUMMARY

The Transgender Training Project of the New England AIDS Education and Training Center has been providing training on transgender-related issues to health-care providers in the New England region since 1999, having trained nearly 600 providers in that time. The Transgender Training Project embarked on a study during the 2001–2002 grant year to interview providers of HIV-related care and advocacy on their knowledge and experience with working with trans-gendered people and to assess training needs to increase their effectiveness with transgendered clients.

The methodology consisted of face-to-face interviews with 13 providers of HIV treatment and care who are affiliated with the New England AIDS Education and Training Center network to discuss clinical challenges in working with transgendered people.

In this exploratory study, we found that providers had:

1. Desire to treat transgendered patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.

2. Experience with a range of transgendered patients, but lack of information on distinctions among transgendered experiences.

3. Restrictions based on time constraints that create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care.

4. Concern and frustration with lack of information, studies and research.

5. Concern and frustration with lack of treatment guidelines, (or ability to access them), referral contacts and ways to advocate for transgender clients.

6. Belief that training by transgendered people themselves was an essential teaching element.

These results point to the need for the development and dissemination of specific training materials and resources for health-care providers serving transgendered people living with or at risk for HIV.     

Cognitive-behavioural Anger Management Training for Adults with Mild Intellectual Disability

Although people with intellectual disabilities often display anger control problems, little research has been conducted on the development and evaluation of cost-effective anger management training programs for this special population. This study evaluated the efficacy of cognitive-behavioural anger management for 11 adults with mild intellectual disabilities in a group therapy format. Improvements were evident on self-report measures of anger and self-esteem. Additionally, caregiver reports indicated general improvements in emotional and behavioural adjustment. Limitations of the study are acknowledged, including the absence of a control condition.     

Sexual Abuse Litigation

Summary

Practicing psychologist Janet Sonne and attorney Julian Hubbard illuminate how the different aims and languages of psychotherapy and law can be either an asset or a liability in the emotionally-charged environment of sexual abuse litigation. Properly understood, these differences can optimize the ability of each professional to assist their common client, the sexual abuse survivor, in the litigation process and beyond. Dr. Sonne reviews the psychological and behavioral sequelae of childhood sexual abuse and identifies six elements of the client's psychological functioning key to the litigation process, as well as posing questions for the attorney's self-evaluation for the unique demands of sexual abuse litigation. Mr. Hubbard then addresses what survivors and therapists need to know about the litigation process, exploring dynamics of legal strategy that can exacerbate the client's psychological problems. In the final section, both offer tips to enhance professionals' focus on education and communication as a means to better serving the sexually abused client.     

Evaluation of the Delayed Discovery Case

Summary

In this chapter, practicing lawyer Michael S. Morey guides the reader through the complex legal and non-legal issues involved in evaluating whether legal action should be pursued on behalf of an adult survivor of childhood sexual abuse. After analyzing how evaluation of sexual abuse cases differs from that in most other personal injury cases, he presents a model for non-suggestive yet thorough client interviewing and case evaluation to help both survivor and lawyer decide whether to pursue litigation. Viability of a case, determined by three critical legal issues, does not necessarily mean litigation ought to be pursued, and he explores how to make the initial interview a valuable resource to survivors, whether or not legal action is ultimately sought, with practical tips and a reproducible intake form.     

Relational Psychoanalysis Potential Usefulness with Black South African Clients

The aim of this article is to suggest that relational psychoanalysis may be a useful approach for working with clients from indigenous African cultures. In particular, the article considers the utility of relational psychoanalysis to understanding and enacting the therapeutic relationship with clients from an indigenous African cultural background. The notion of “we” self from the perspective of African cultures is a case in point for possible compatibility between relational psychoanalysis and black clients who come from background that place a high value on communal or “we” selves. An integrative therapy that combines African worldviews and relational psychoanalysis is possible.     

Parenting styles and psychological needs influences on adolescent life goals and aspirations in a South African setting

The present study examined the role of parenting styles and basic psychological needs in the adoption of goals and aspirations of learners, as well as for their psychological wellbeing (positive versus negative affect) in a South African sample of learners. A cross-sectional design was used to conduct this study with a sample of 853 learners at public schools in the Western Cape of South Africa (females?=?57%, mean age 16.96 years, SD?=?1.12). Data were collected using the Parenting Style and Dimensions Questionnaire (PSDQ), Psychological Needs Scale, Aspiration Index and the Positive And Negative Affect Schedule (PANAS). The results suggest that authoritative and authoritarian parenting styles influence the adoption of life goals and psychological wellbeing of adolescents with fathers' negative parenting possibly reducing adolescent wellbeing. Extrinsic life goals was a significant predictor of positive affect, while need frustration was a significant predictor of negative affect. These findings suggest parenting styles and basic psychological needs influence life aspirations and psychological wellbeing of learners in a developing country context.     

Black client,white therapist: Working with race in psychoanalytic psychotherapy in South Africa

In post‐apartheid South Africa we speak about race extensively. It permeates our workplace, weaves a thread through the fabric of our professional and personal lives, as well as our private conversations and public interactions with others. From within psychoanalytic theory, the thread weaves through the unknown content of our racialized unconscious. When there is a focus on race in the South African psychoanalytic context it largely takes the form of the struggle to articulate the complexities of working with difference, as Swartz notes, or the struggle to map out issues of race. Such struggles are not localized in South Africa, but strongly reflect a much broader struggle within the global psychoanalytic community, as mirrored in the expanding focus on race. Although the consulting rooms seem far removed from the ongoing political tensions that have recently emerged in South Africa, psychoanalytic psychotherapy remains a space of meaningful engagement with the other, and where the therapeutic dyad is one of racial difference it permits an encounter with our racialized unconscious. This article seeks to document the experience of my black client and my white response to her racial pain and struggle; in doing so, I describe the racial ‘contact’ between us and within us that triggers a racialized transference and countertransference dynamic, which contains the space for racial healing for both of us.     

Differential influence of basic psychological needs on burnout and academic achievement in three southeast European countries

Several studies show the importance of basic psychological needs (BPN) for decreasing burnout and increasing grade point average (GPA), but, to our knowledge, no prior study has explored the potential contextual differences in Southeastern European countries. Moreover, even less is known about how this relationship may differ during stressful (exam) and less stressful (beginning of the semester) periods. Measures of the Maslach Burnout Inventory—Student Survey and BPN Satisfaction and Frustration Scale were translated and adapted. The study included a cross-sectional sample of students from Croatia, Serbia and Slovenia during beginning of the semester and exam period. Across all countries and both contexts, students with high autonomy need satisfaction showed the strongest decrease in burnout, followed by those with high competence need satisfaction. Students with high academic achievement showed an increase due to competence need satisfaction. Competence and autonomy need satisfaction were higher beginning of a semester, while burnout was higher during the exam period. BPN play an important role in educational settings—satisfaction of the need for autonomy and competence protects students from burnout, and the need for competence predicts greater academic achievement regardless of culture or time of the semester.     

Everything you always wanted to know about therapy (but were afraid to ask): Social,political, economic and clinical fragments of a critical psychotherapy

Three seemingly consensual propositions concerning psychotherapy and counselling are examined critically. All turn out to be unreliable, tendentious and even damaging: (i) Psychotherapy and counselling can be free and independent professions provided therapists, acting together, fight for them to be that way. (ii) Psychotherapy and counselling are private and personal activities, operating in the realms of feelings and emotions – the psyche, the unconscious, affects rooted in the body. Above all other factors, the single most important thing is the therapy relationship between two people. (iii) Psychotherapy and counselling, and psychotherapy are vocations, not jobs. Therapists are not only motivated by money. In developing his critiques of these propositions, the author utilizes social, political and economic perspectives. The author reviews new clinical thinking on the active role of the client in therapeutic process and suggests that a turn to the legendary figure of the Trickster might be of benefit to the field. The author locates his arguments in his experience of the politics and practices of psychotherapy and counselling, and engages in self-criticism.     

Extending hierarchical achievement motivation models: The role of motivational needs for achievement goals and academic performance

In the current study, we investigated the role of three basic motivational needs (need for power, affiliation, achievement) as antecedents of goals within the 2 × 2 achievement goal framework, and examined their combined predictive validity with regard to academic performance in a sample of 120 university students. Structural equation modeling analysis largely supported our postulated model, linking motivational needs indirectly to course grades through goals. Achievement goals were formed by a combination of different motives: need for achievement was a positive predictor of all four achievement goals, and need for affiliation was negatively related to performance-approach and performance-avoidance goals. Additionally, need for power was a positive predictor of performance-avoidance goals. Performance-approach goals had a direct (positive) effect on performance outcomes. In sum, our results integrate basic motivational needs with the achievement goals literature and extend therefore hierarchical achievement motivation models, by showing how basic human motives of achievement, affiliation, and power are related to goal striving motivation and performance outcomes in an academic setting.