Empowerment theory,research, and application

This introduction to the special issue briefly reviews the meaning and significance of the empowerment concept and problems associated with the proliferation of interest in empowerment. We identify some of the topics not included in this issue and relate those to the many broad and diverse areas of psychological empowerment theory and community-based research and intervention that are covered. We present synopses of each article along with some of the themes and lessons cutting across the frameworks, studies, and applications. These include a wide diversity of settings, fairly representative of empowerment interventions, and, at the same time, improved clarity (if not unanimity) of definitions and measurement, which has been a problem in much empowerment research and intervention.     

Shame, Women, and Group Psychotherapy

This paper addresses gender-related experiences of shame, focusing on the shame-prone woman. Specifically the varied manifest behaviors, dynamics, and defenses commonly observed in shame-prone women are described. It is recommended that the addition of group therapy to individual treatment, once the client is ready, can expedite progress for these patients, as they are more able to integrate previously disowned and shamed aspects of themselves. A number of potential problems when working with these patients in group are identified and explored.     

Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.     

Tales from the Crypt: On the Role of Death in Life

An existential psychodynamic theory is presented based on Ernest Becker's claim that self-esteem and cultural worldviews function to ameliorate the anxiety associated with the uniquely human awareness of vulnerability and mortality. Psychological equanimity is hypothesized to require (1) a shared set of beliefs about reality that imbues the universe with stability, meaning, and permanence; (2) standards by which individuals can judge themselves to be of value; and (3) promises of safety and the transcendence of death to those who meet the standards of value. An empirical research program in support of this theory is then described, and the personal and interpersonal implications of these ideas are briefly considered.     

Timing of HIV Interventions on Reductions in Sexual Risk Among Adolescents

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner: For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

Family-Based Intervention with High-Risk Infants and Their Families

A model of family-based intervention for high-risk infants hospitalized in the neonatal intensive care unit and their families is presented. The theoretical underpinnings, principles, and nature of the intervention are described. The adaptation of the model from a clinical–research demonstration project to a clinical consultation service is highlighted, with particular emphasis on the practical application of the model. Domains of the intervention include infant behavior, family organization and functioning, caregiving environment, and home discharge/community resources. Three case illustrations are provided to demonstrate the breadth of the intervention and how it can be individualized based upon the presentation of the infant and family.     

The Influence of Perceived Versus Aerobic Fitness on Psychological Health and Physiological Stress Responsivity

This study sought to evaluate the association between perceived and aerobic physical fitness and both psychological functioning and physiological stress responsivity. Sixty nonsymptomatic participants (30 males, 30 females) participated in the experiment. Participants completed a series of personality and mood questionnaires as well as a laboratory procedure measuring cardiovascular responses (i.e., heart rate and blood pressure) while performing stressful laboratory tasks (i.e., the Stroop Color Naming Test and a sham IQ test). Aerobic fitness (i.e., VO ₂ max using the Bruce protocol) as well as perceived fitness were also determined. Results suggest that perceived fitness was generally associated with positive personality and mood variables while aerobic fitness was not. Overall results support the view that perception of fitness may be as important or perhaps even more important than aerobic fitness in its association with psychological but perhaps not physical functioning.     

Parental Monitoring and the Prevention of Child and Adolescent Problem Behavior: A Conceptual and Empirical Formulation

The present report accomplishes three goals. First, to provide an empirical rationale for placing parental monitoring of children's adaptations as a key construct in development and prevention research. Second, to stimulate more research on parental monitoring and provide an integrative framework for various research traditions as well as developmental periods of interest. Third, to discuss current methodological issues that are developmentally and culturally sensitive and based on sound measurement. Possible intervention and prevention strategies that specifically target parental monitoring are discussed.     

MULTICOMPONENT INTERVENTION FOR AGITATED BEHAVIOR IN A PERSON WITH ALZHEIMER'S DISEASE

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.