Book Review: Managing Mental Health in the Community: Chaos and Containment

Abstract

The British Association of Counselling first introduced a Code of Ethics and Practice for Counsellors in 1984. It has subse-quendy been revised three times. The codes have to be sufficiently broad to be accepted by the membership of BAC, who come from a wide range of theoretical backgrounds. Inevitably this means that the codes do not satisfy everyone nor do they resolve all ethical dilemmas. This paper focuses on sections of the codes which are unsatisfactory, or inadequate for psychodynamic counsellors. It also looks at the influence of psychodynamic counsellors in changes to the clauses on sexual exploitation. Finally the absence of any mention of dual and multiple relationships is discussed.     

Understanding Transference and Countertransference

Abstract

Professional misconduct-especially misconduct involving client-worker boundary violationsgenerates serious costs for clinical social workers. It harms the very clients we aim to help; it frequently tarnishes the reputation of not only the individual social worker involved but also the face of the entire profession; and, it adds significantly to the overall costs of malpractice insurance. This paper defines the scope of the problem and provides support for understanding transference and countertransference as important contributors to prevention.     

Parental Bonding and Its Effect on Adolescent Substance Use and Sexual Debut

The purpose of this study was to examine associations among parental bonding factors and the early onset of sexual behaviors and substance use. Significant differences were found in the levels of care among the parental status groups and among the ages of onset for alcohol use.     

The Use of Metaphors with African-American Couples

SUMMARY

There is a dearth of data in the literature on African-American couples. This omission probably reflects the assumption that interventions that are effective with one race are effective with others. This paper explores the use of metaphor as a tool for working with an underserved and neglected population. Since the African-American culture is extensive in its use of metaphor, this medium provides a fertile channel for therapeutic communication.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Bestiarium Judaicum: Unnatural Histories of the Jews,by Jay Geller,New York,Fordham University Press, 2017, ix + 404 pp., US$75.00 (hardback), ISBN 978 0 8232 7559 5

This review article celebrates the massive contributions José Ignacio Cabezón’s Sexuality in Classical South Asian Buddhism has made to the fields of Buddhist studies, South Asian studies, and studies in gender and sexuality. After introducing the vast scope of Cabezón’s masterwork, the article draws attention to Cabezón’s notably minimalist treatment of tantra, which he asserts did no more to challenge the denigration of queer people than exoteric Buddhism did. Even so, this article picks up on the possibility Cabezón puts forward, if only hesitantly, that Mahāyāna antinomianism and tantra have the (as yet unrealized) potential for a queer Buddhist theology, with the aim of inviting further scholarship on this potential.     

Unwanted Sexual Experiences in University Settings: Survivors’ Perspectives on Effective Prevention and Intervention Strategies

Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors’ perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwanted sexual experiences participated in semi-structured in-depth interviews. Data were analyzed using thematic analysis and a constructionist perspective. The findings were contextualized using the ecological model. Barriers to reporting included concerns about one’s story not being believed, personal minimization of the incident, belief that no action will be taken after reporting, confidentiality concerns, and other perceived costs of reporting. Survivors provided valuable insight on potentially effective prevention and intervention strategies to address the problem of unwanted sexual incidents on university campuses. These findings may be useful for prevention and intervention policies and programs in university settings and for providers who assist survivors of unwanted sexual experiences.     

Trauma-Related Negative Cognitions Mediate the Relationship Between Avoidant Personality Beliefs and Impeded Response to Psychotherapy for PTSD

There is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD symptoms. However, the relationship between personality pathology and TRNC in the context of PTSD is mostly unknown. In the present study, we aimed to examine whether avoidant and borderline personality beliefs (PB, indicator of personality pathology) could predict therapy outcome in PTSD, and whether the relationship between PB and therapy outcome could be mediated by TRNC. Sixty patients with PTSD were assessed for PB, TRNC and PTSD symptoms at baseline, and for PTSD symptoms at the termination of Prolonged Exposure Therapy. Baseline avoidant PB predicted significant variance in PTSD symptoms at termination over and above baseline PTSD symptoms (16% reduction in treatment effect per SD on avoidant PB). Moreover, TRNC at baseline fully mediated the relationships between baseline avoidant PB and PTSD symptoms at termination. This is the first study to show that avoidant PB predicts treatment response in PTSD, and that patients with avoidant beliefs are more vulnerable to have TRNC, which are associated with impeded therapy response. Our results highlight the importance of targeting both dysfunctional PB and TRNC in PTSD interventions.     

A Single-Arm Meta-Analysis of Cognitive Processing Therapy in Addressing Trauma-Related Negative Cognitions

Cognitive Processing Therapy (CPT) is a first-line treatment for posttraumatic stress disorder designed to address cognitive “stuck points” connected to a patient’s trauma-related negative cognitions (NCs). Although CPT has well-established efficacy, the ability of CPT to address NCs remains understudied. The purpose of this study was to conduct a single-arm meta-analysis to determine the overall effect of CPT in attenuating NCs pre- to posttreatment across multiple clinical trials. A review of the existing literature was performed with only peer-reviewed clinical trials included in the meta-analysis. Nine studies with data from 583 participants were entered into the meta-analysis. CPT was found to have a large effect size in reducing NCs from pre- to posttreatment. Findings are limited by the single-arm nature of analyses and heterogeneity in included trial methodology (e.g., gender, trauma type, civilian versus veteran).