The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS’ origins in everyday clinical practice. The authors contend that PCOMS represents “both/and,” providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time‐honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.     

Attachment Versus Differentiation: The Contemporary Couple Therapy Debate

This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories—as well as the two “pure form” example models—and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration—particularly between the broader theories of attachment and differentiation—are offered for therapists to consider.     

Attachment Style Differences and Depression in African American and European American College Women: Normative Adaptations?

This study examined ethnic differences in attachment styles and depression among African American and European American college women. African American women reported less favorable views of others, which suggests that attachment styles emphasizing caution in relationships may be normative and adaptive for these women. There were no differences between groups in views of self or reports of depressive symptoms. Implications for long‐term relationships and counseling are discussed. Este estudio examinó las diferencias étnicas en estilos de apego y depresión entre estudiantes universitarias Afroamericanas y Euroamericanas. Las mujeres Afroamericanas expresaron una visión menos favorable sobre los demás, lo que sugiere que los estilos de apego que enfatizan la precaución en las relaciones pueden ser normativos para estas mujeres, y el resultado de su adaptación. No hubo diferencias entre los grupos en cuanto a la visión de sí mismas o expresión de síntomas depresivos. Se discuten las implicaciones para las relaciones a largo plazo y la consejería.     

Somali Women's Reflections on the Adjustment of Their Children in the United States

Somali women were interviewed regarding their children's adjustment. Qualitative analysis revealed 5 themes: cultural comparisons, concerns about children, parents' loss of disciplinary authority, available support, and the future. The women discussed changes in their children, such as loss of respect and threats to use law enforcement against parents. They also discussed their loss of parental authority and the lack of support from U.S. institutions. Implications for schools and mental health professionals are presented. Se entrevistó a mujeres Somalíes con respecto a la adaptación de sus hijos. Los análisis cualitativos revelaron 5 temas: comparaciones culturales, preocupaciones sobre los niños, la pérdida de autoridad disciplinaria de los padres, apoyo disponible y el futuro. Las mujeres hablaron sobre los cambios en sus hijos, como la pérdida de respeto y las amenazas de usar las fuerzas del orden contra sus padres. También hablaron de la pérdida de su autoridad paterna y la falta de apoyo por parte de las instituciones de los Estados Unidos. Se presentan las implicaciones para escuelas y profesionales de la salud mental.     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.     

Those Easily Forgotten: The Impact of Emigration on Those Left Behind

Much has been written about the experiences and stresses of those who emigrate. By contrast, little attention has been paid to the experiences of those who stay behind—family members and friends who for various reasons do not to join their loved ones in the destination country. In this article, I describe the experiences of some South Africans whose families and friends have emigrated. This study forms part of a larger research project focusing on the impact of emigration on South African family life. Twenty‐one participants were interviewed by means of a semistructured interview at least 6 months after one or more family member(s) and/or friend(s) left South Africa, to explore participants’ experiences around their loved ones’ emigration. A thematic analysis of the data reveals that those left behind experience various emotions, ranging from emotional ambivalence to anger and distress. Emigration is mostly experienced as a vast loss, almost akin to a “death,” bringing about significant changes in social networks and relationships. The therapeutic significance of the findings for those working with emigrant families is also explored.     

Are Multicultural Courses Addressing Disparities? Exploring Multicultural and Affirmative Lesbian,Gay, and Bisexual Competencies of Counseling and Psychology Students

Clinical training and counselor competency are essential for ethical practice when working with multiethnic, lesbian, gay, bisexual (LGB), and transgender clients. In this study, the author examined how multicultural courses related to students' (N = 286) LGB and multicultural competencies. Self‐reported multicultural and LGB competencies varied significantly depending on the number and types of diversity education reported. Multicultural courses significantly predicted students' multicultural, but not LGB counselor competency. Political conservatism was the strongest predictor for both multicultural and sexual orientation competencies. La formación y competencias multiculturales afirmativas hacia individuos gays, lesbianas y bisexuales (LGB, por sus siglas en inglés) de consejeros son esenciales para una práctica clínica ética. En este estudio, el autor examinó cómo los cursos multiculturales se relacionaron con las competencias multiculturales de un grupo de estudiantes (N = 286). Las competencias multiculturales y sobre LGB autorreportadas variaron significativamente dependiendo del número y tipos de educación sobre diversidad reportados. Los cursos multiculturales predijeron de forma significativa la competencia multicultural de los estudiantes, pero no la competencia sobre LGB en consejería. La ideología política conservadora fue el predictor más fuerte de las competencias multiculturales y sobre orientación sexual.     

Problematic,absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists’ and psychiatrists’ opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed.