Concrete Tornadoes

I present the case of a Hispanic woman whose physical illness parallels the massive destruction that she witnessed at the World Trade Center. I talk about my own feelings of terror and how I try to deal with my private ghosts as I sit afraid and wanting to help. I mention the longings we all have for powerful parents who can protect us and keep us safe.     

How others respond to non‐suicidal self‐injury disclosure: A systematic review

Non‐suicidal self‐injury (NSSI) is an increasing health concern. Despite the potential benefits of disclosing the behaviour, many decide not to do so because of the fear of negative social reactions. In this review, we examined the existing research on reported and perceived reactions to NSSI disclosure with the aim of identifying how an individual who discloses their NSSI perceives others' responses to this disclosure, with the ultimate goal of understanding how these reactions may impact those who disclose their NSSI. Among the initial 275 studies, 10 fit the inclusion criteria. Three studies reported perceived responses by individuals who had disclosed their NSSI; six studies examined self‐reported responses by others; one study focused on disclosures online. Individuals who disclosed their NSSI often received negative responses, which caused them to withdraw from seeking further help. On the other hand, recipients' reactions to NSSI disclosure varied based on NSSI characteristics such as its perceived cause and/or underlying motivation. Results highlight the importance of providing support rather than searching for the underlying drives of NSSI.     

Predictors and impact of psychotherapy side effects in young adults

What should we tell our younger clients—who may or may not have chosen to come to therapy—about possible risks of engaging in psychotherapy? To explore this question, we examined psychotherapy side effects in 366 young adults with a history of psychotherapy or counselling. Psychotherapy side effects were common, with 41% of participants reporting at least one. Perceived lack of control over the decision of when and how to engage in therapy was the strongest predictor of experiencing therapy side effects. Of the different kinds of side effects, feeling that therapy had gone on too long and experiencing worsening of existing symptoms were the most strongly predictive of poor therapy outcomes such as dissatisfaction with care and lower perceived improvements. Finally, there was a significant association between reporting side effects of psychiatric medications and side effects of psychotherapy, suggesting common factors that contribute to side effect experience across treatment modalities. These findings highlight the need to monitor possible side effects during psychotherapy and counselling, and to have an open dialogue with our youngest clients and their families about the likelihood for negative outcomes when they are compelled to engage in therapy.     

Client attendance measures in counselling psychology trainees

Counselling supervisors and educators have yet to reach a consensus about standard measures for evaluating the performance of graduate student therapists. Compared to self‐reports and rater judgements, client attendance records provide low‐inference behavioural data partially reflective of clients’ engagement with therapists. This naturalistic study evaluates client attendance data using archival records of 92 doctoral students in beginning and advanced counselling practica who produced data for 771 clients, 3,949 scheduled sessions and 3,186 attended sessions. Providing evidence of the sample representativeness for clinicians, results indicated that the mean number of sessions attended per client for student therapists (5.65) was very similar to that reported in the literature for outpatient therapists (<6). As expected because of structural differences in client assignment, beginning and advanced students evidenced statistically significant differences on attendance variables such as number of clients and scheduled sessions. In contrast, attendance ratios were equivalent across counsellor experience, suggesting that these individual difference variables could be useful for evaluation of therapist competencies related to client engagement.     

How Did You Like This Course? The Advantages and Limitations of Reaction Criteria in Ethics Education

Ethics courses are most commonly evaluated using reaction measures. However, little is known about the specific types of reaction data being collected (e.g., content relevance, course satisfaction) and how these reaction data relate to improvements in trainee performance (e.g., knowledge, moral reasoning). Using a sample of 381 ethics training sessions, major reaction data categories were identified. Content and course satisfaction were the most frequently collected types of reaction criteria. Furthermore, content relevance (r = .84) and course satisfaction (r = .79) showed strong, positive relationships with performance criteria, whereas content satisfaction demonstrated a moderate, negative relationship (r = –.28). These results and future directions for ethics training evaluation are discussed.     

Loss Through Betrayal: An Analysis of Social Provision Changes and Psychological Reactions

Results of two retrospective studies suggested that romantic betrayal led to the loss of key aspects of social support from partners, most notably attachment, guidance, and reliable alliance with the partner. Furthermore, specific social provision losses were found to reliably predict recalled and current negative psychological states associated with romantic betrayal. Perceived attachment losses predicted postbetrayal anger and disgust, as well as trauma reactions following betrayal. In addition, a decline in reassurance of one’s worth following betrayal predicted embarrassment about the event, and the degree to which reliable alliance with the partner was lost predicted anxiety and shame.     

National attitudes towards mental health treatment: the importance of research evidence

Most conceptualizations of evidence-based practice view it as a “three legged stool” consisting of: the use of best available research evidence, clinical expertise, and client preferences. Although empirical evidence and clinical expertise have received greater empirical attention, relatively little research has systematically explored client preferences. The present study analyzed self-reported treatment preferences for various clinical and non-clinical presentations. Adult participants (n = 1262) residing in the United States were presented with diagnostic vignettes and rated their relative preferences among 5 treatment variables, including: use of an empirically supported treatment (EST), quality of the client–therapist relationship, therapist empathy, therapist experience, and client speaking for the majority of therapy sessions. Results indicated that participants endorsed significant preference for receiving an EST over other treatment variables for all clinical disorders, with effect sizes ranging from small to large depending on the diagnosis. There was slightly greater variability in treatment preferences for non-clinical issues, though participants generally reported greater preference for receiving an EST. Follow-up questions provided further evidence for EST preferences. The implications of these results are discussed.     

The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.