Population Health and Trauma‐Informed Practice: Implications for Programs,Systems, and Policies

Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma‐informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re‐traumatization. Current trauma‐informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma‐informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma‐informed practice. We then discuss implications of these principles by identifying four priorities for trauma‐informed practice from a population health perspective: (a) adopting trauma‐informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma‐informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma‐informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma‐informed principles for population health impact.     

Moving beyond ethical decision-making: a practice-based view to study unethical sales behavior

Changes in the business environment are rapidly transforming sales practice and pressuring the integrity of key actors in sales. Given that unethical sales behavior is a social activity produced and reproduced by various actors in a complex sales task environment, we introduce a novel research perspective to the study of unethical sales behavior, namely a practice-based view. With knowledge from a systematic literature review and a practice-based view from organization research, we suggest that unethical behavior should be studied as a practice formed through socialization and interaction with relevant others. This view provides an important alternative as well as a complementary perspective to the ethical decision-making paradigm that has dominated the field for several decades. The study answers scholars’ recent calls to strengthen the theoretical foundation of sales ethics research and further extend its perspective toward the social context of sales. With a focus on dynamics, social relations, and the enactment of practices, the practice-based view produces new types of knowledge on unethical behavior and potential new means for addressing it. The article makes suggestions for future practice-based research and proposes several theories for use in studying unethical behavior in currently important sales contexts.     

Distributing mathematical practice of third and seventh graders: Applicability of the spacing effect in the classroom

We examined the effect of distributed practice on the mathematical performance of third and seventh graders (N = 213) in school. Students first received an introduction to a mathematical topic, derived from their curriculum. Thereafter, they practiced in one of two conditions. In the massed condition, they worked on three practice sets in 1 day. In the distributed condition, they worked on one practice set per day for 3 consecutive days. Bayesian analyses of the performance in two follow‐up tests 1 and 6 weeks after the last practice set revealed a positive effect of distributed practice as compared with massed practice in Grade 7. In Grade 3, a positive effect of distributed practice was supported by the data only in the test 1 week after the last practice set. The results suggest that distributed practice is a powerful learning tool for both elementary and secondary school students in the classroom.     

Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training

Training behavioral technicians mainly focuses on teaching accurate implementation of structured behavioral intervention programs. Often behavioral technicians are unable to adequately promote their clients' learning in less structured environments, which can limit opportunities for generalization of the clients' skills to the natural environment. The aim of the present study was to evaluate the effectiveness of using behavioral skills training to coach behavioral technicians on the implementation of naturalistic behavioral interventions. Naturalistic behavioral interventions take advantage of naturally occurring situations to teach new skills and practice mastered skills in natural settings, thus promoting generalization across environments and in the presence of natural contingencies. Five behavioral technicians were trained to implement a novel protocol based on play therapy. Specifically, they were coached to engage in well‐defined positive behaviors during their interactions with clients (e.g., labeled praise). All participants reached mastery criteria, maintained skills at follow‐up, and demonstrated generalization of skills with novel clients.     

Teaching pronouns to individuals with autism

It is well documented that individuals with autism often have significant difficulty with learning to use pronouns appropriately. It does not appear, however, that published studies have systematically investigated teaching procedures for these skills. This study evaluated the effectiveness of a teaching procedure to increase correct pronoun usage as a listener and speaker across four different pronoun pairs (i.e., mine/yours, I/you, me/you, and my/your) using a multiple‐probe design (across pronoun pairs). One participant with autism was taught to discriminate between mine/yours, I/you, me/you, and my/your as both a listener and a speaker. Generalization of the participant's behavior was obtained across novel instructors, places, and stimuli.     

Gendered contours of contemporary South Asian religious practices in the context of migration: second-generation Jain women and men in Britain and the US

Viewing religion through the social constructionist lens and adopting the methodological approach of ‘lived religion’, this article draws attention to the gendered contours of contemporary Jain practice. Although Jain dharma is a non-theistic, non-institutionalised religion, gender differences are embedded within lay practice in India. In contrast, analysis of qualitative data (interviews conducted with 50 second-generation, middle- and upper middle-class Jain women and men in Britain and the US) reveals a gender convergence in patterns of everyday religious practice and performance. I argue that the social turn in late modern societies, together with the dominance of a neo-orthodox approach among diasporic Jains, facilitates this convergence. Further, shifting patterns of religious practices suggest that religion is an important site for the negotiation of gender identities in the context of migration. The construction of Jain religious selves enables young Jains—both women and men—to navigate multiple and contradictory femininities and masculinities and to display more affective, relational, and compassionate selves in late modern societies.     

Early reflections on becoming a therapist: Development of reflective practice in clinical training programmes in an Australian context

The development of competent counsellors, psychotherapists and psychologists depends upon not only the clinical competencies, but also the development of the person as the psychotherapist. This qualitative study investigated the experiences of twenty provisional psychologists enrolled in a university‐based clinical psychology training programme. Participants were requested to write reflective essays describing their experiences in relation to their first year of training. Utilising an interpretative phenomenological approach methodology, three superordinate themes were identified: beginning awareness and internalisation of the role of the therapist, therapy as an inter‐subjective experience, and personal transformation. Themes encompassed a range of key areas identified by trainee therapists as central to their development as reflective practitioners. Findings from this study may contribute to the small but growing literature base explicating the early lived experience of being a therapist working from an integrative framework. The findings contribute to our knowledge of the critical elements involved in fostering the theoretical, practical and reflective processes involved in becoming a competent therapist.     

Class in psychodynamic theory,research and practice

Class is a generally neglected topic within the psychotherapeutic and counselling worlds, and has not benefitted from the psychoanalytic and psychodynamic thought arising from contemporary critiques concerning gender, sexuality, and race. The article presents an overview of my researches over many years in an attempt to formulate the different ways in which considerations of class may impinge on practices and theories in the therapeutic professions. I use a clinical vignette to identify class related issues that may arise within the consulting room, and relate these to wider aspects of the intersections of class with therapy and counselling.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.