Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model,Telehealth, and the Covid-19 Pandemic

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our “incubator” treatment development model and process (Asarnow et al., 2022). As illustrated in the second case illustration, the incubator model approach was particularly useful during the COVID-19 pandemic switch to telehealth. SAFETY specifically targets suicide and self-harm risk reduction using an individually tailored principle-guided approach, grounded in a case conceptualization that identifies cognitive-behavioral processes and reactions that contribute to increased suicide attempt risk and explains the youth’s suicidal/self-harm behavior within the context of his or her broader social systems. The SAFETY treatment has been tested in two treatment development trials, and results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm.     

Psychotherapeutic Interventions and Processes

Cognitive behavioral therapy (CBT) has been one of the most influential developments in psychiatry ever. Since it was developed and introduced, a vast number of treatment protocols focused on specific psychiatric syndromes have been developed. Although this has benefitted many patients and advanced the field, CBT as a treatment with its focus on alleviating psychiatric syndromes seemed to have reached a plateau and a process-focus approach is now emerging within the family of CBT models. This represents a new form of idiographic functional analysis guided by models that integrate a coherent set of change processes. Here, I describe the foundations of this new approach to mental health, called process-based therapy (PBT) and discuss its scientific and clinical implications.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Culturally Attuned Behavior Therapy for Anxiety and Depression in Asian Americans: Addressing Racial Microaggressions and Deconstructing the Model Minority Myth

Extant research has shown that racial discrimination and microaggressions can have negative effects on anxiety and depression among Asian Americans. However, not much has been published regarding how to process and integrate experiences of racism into culturally attuned behavior therapy specifically for Asian Americans. In this article, I describe the process of culturally attuned behavior therapy for two Asian American clients, with an emphasis on integrating racial microaggressions into exposures for social anxiety, and deconstructing the model minority stereotype through value-driven behavioral activation for depression. Cultural attunements common to both case examples are then summarized, alongside practical recommendations for clinicians. Limits to generalizability are also discussed. Finally, the article closes by addressing the importance of cultural humility in effective culturally attuned behavior therapy with Asian Americans.     

Bien-être,satisfaction au travail et conflit travail–famille : une perspective centrée sur l’influence du leadership

This research investigates the relationship between well-being, work satisfaction, work–family conflict and leadership, based on hierarchical status. Regression analysis confirmed that leadership can predict a significant part of work satisfaction and well-being variation. The most significant results suggest that transformational leadership is related with higher satisfaction and laissez-faire leadership with lower satisfaction. Results showed no significant contribution of leadership on work–family conflict score variation. These results provide evidence that management styles should be considered to increase well-being and employees satisfaction.     

青少年家庭功能与心理复原力的关系：一个有调节的中介模型

为探讨家庭功能、自我控制与青少年心理复原力的关系及其作用机制,采用家庭功能评定量表、自我控制量表、心理复原力量表对浙江省、山东省、河北省957名中学生进行调查。结果发现：（1）家庭功能对青少年心理复原力具有显著正向预测作用。（2）自我控制在家庭功能和青少年心理复原力之间起到部分中介作用。（3）家庭功能对青少年心理复原力中介过程的前半段路径受到性别调节,相比于女生,男生群体的家庭功能对自我控制的影响更为显著。     

二孩家庭父母偏爱的特点及其与青少年抑郁的关系

对1655名来自二孩家庭的青少年进行调查,以考察二孩家庭中父母偏爱的特点及其与青少年抑郁的关系。结果发现：（1）父母偏爱水平较低,且父亲偏爱和母亲偏爱不存在显著差异。（2）父母偏爱存在性别和出生次序差异,男孩报告父母更偏爱自己,女孩报告父母更偏爱同胞;头胎子女报告父亲更偏爱自己,母亲更偏爱同胞,二胎子女则相反。（3）父母偏爱对青少年抑郁有显著影响,且为U型曲线关系,即当父母偏爱同胞或中高程度偏爱自己时,青少年抑郁水平均较高;当父母较低程度偏爱自己时,青少年抑郁水平最低。说明二孩家庭中不存在严重的父母偏爱,但父母偏爱会对青少年发展产生消极影响。     

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.     

On family secrets and –K

In this paper I present a novel interpretation of family secrets. Leaning on Bion's concept of ‐K, the constitution of secrecy is interpreted in terms of family dynamics that actively prevent knowledge formation and mental growth. Family secrets are interpreted as a destructive process that attacks the family's truth‐generating‐space – the shared semiotic space within which meanings are constituted through family relationships. The paper explores the microstructure interpersonal process of ‐K through the analysis of Mike Leigh's movie, Secrets and Lies. Two scenes in the movie are used to demonstrate how ‐K is worked out in the form of a specific intersubjective semiotic endeavor that unconsciously blocks the process of meaning‐making.     

Mechanisms of Change in Brief Couple Therapy for Depression

The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women’s depressive symptoms and their husbands’ psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women’s depression and husbands’ depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women’s marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners’ understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.