Adapting Parent–Child Interaction Therapy for Deaf Families That Communicate via American Sign Language: A Formal Adaptation Approach

While our field has made positive strides in adapting psychotherapeutic interventions for diverse groups of people, considerable work is still needed in this area. We present our formal adaptation procedure for parent–child interaction therapy (PCIT) with Deaf persons. This includes a review of the cultural adaptation process for psychological interventions, including PCIT, as well as an introduction to Deaf culture. Details regarding the specific adaptation of PCIT for Deaf persons are outlined. We found that the utilization of a clear framework to guide the cultural adaptation process facilitated careful consideration of the numerous linguistic and cultural variables involved, while maintaining integrity of the treatment model. While the current focus was on adapting PCIT for Deaf families who communicate via American Sign Language, this framework can also be applied to other populations and/or interventions.     

Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Exploring the links between gender,dwelling, and career orientations of African emerging adults

The study explored the socio-ecological (i.e. gender and geographical location) influences on the career orientations of emerging adults. The participants comprised a convenience sample of 159 black African South African university students (57% rural, 43% urban; 63% females, 37% males; mean age = 19.0, SD = 2.24). The emerging adults completed a career orientations inventory and also self-reported their demographics. We applied hierarchical regression analysis to predict the emerging adults’ career orientations from their gender and place of dwelling (geographical location) controlling for age. Results indicate that gender predicts interest in entrepreneurial creativity orientations for males rather than for females, and interest in service-oriented occupations for females compared to males. Geographical location predicted interest in entrepreneurial, general management, and service type of occupations for those from the rural rather than urban areas. Urban location predicted interest in technical and functional careers anchors. Career orientations among South African emerging adults appeared to be gendered and tied to place of geographical origin, suggesting social context socialisation influences.     

Raising the Virtuous Bar: The Underlying Issues of Genetic Moral Enhancement

From the perspective of virtue ethics, is it possible and permissible to enhance moral behavior through gene modification? In preparation to answer this question, we must ask five questions: (1) What may we assume regarding genetic inheritance and human nature? (2) Can specific genes predispose behavior related to the moral virtues? (3) What kind of genetic enhancement would be useful for moral enhancement? (4) Should there be a distinction between somatic and germline gene modification? (5) Is genetic modification best approach to moral enhancement? This article concedes that genetic engineering has the capacity to enhance the human disposition to moral behavior, but gene editing cannot create virtue because virtues are stable, habituated dispositions, acquired over time. That being said, gene editing for purposes of enhancing moral behavior is permissible.     

Shifting the Relationship Education Field to Prioritize Youth Relationship Education

The field of couple and relationship education is dominated by a focus on helping committed couples strengthen their relationship. This article reviews several lines of research to argue that the field should give greater priority to youth relationship education—individually oriented relationship literacy education for adolescents and young adults. Serious problems are common in adolescent and young adult romantic relationships and increasing numbers of youth follow paths from adolescence to marriage that make it harder for them to form and sustain a healthy marriage. Early evidence on the effectiveness of individually oriented youth relationship education provides some reason for optimism. The article concludes by exploring implications of this proposed shift in the field for practice and policy.     

Staff and Administrators’ Perceptions of Music Therapy with Acute Care Mental Health Inpatients: A Qualitative Investigation

The purpose of this qualitative study is to understand staff members’ and administrators’ perceptions of group-based music therapy in an acute care mental health setting. The researcher conducted semi-structured interviews with six experienced administrators and unit staff who were familiar with music therapy. Using an inductive approach to thematic analysis, the author identified six themes: (a) music constitutes an important role in patients’ lives, (b) patient-centricity and competence of the music therapist, (c) music therapy uniquely engages the patient with music, the music therapist, and peers, (d) music therapy shifts patients’ focus from internal to external, (e) music therapy is a normalizing experience that facilitates interaction, and (f) music therapy provides optimal conditions for cognitive, affective, and behavioral change. Implications for clinical practice, suggestions for future research, and limitations of the study are provided.     

Art Making and Identity Formation in Children and Adolescents with Differing Social Behaviors

Not everyone develops social behaviors and interaction skills in an expected manner. This study explored the relationship between art making and identity formation in children and adolescents who were identified as having differing social behaviors. In three small group settings, 17 participants created abstract self-portraits from modeling compound and responded to questions about their self, self-concept, and self-esteem. From this, a model was created to describe identity formation as it relates to the relationships between social environment, desired occupations and activities, and creativity. Practice guidelines are proposed for those who provide children and adolescents with opportunities to make art as part of sessions aimed to promote the development of a healthy self-concept.     

Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.