Evaluating the vermont system of care: Outcomes associated with community-based wraparound services

Evaluation of innovative community-based interventions is becoming a high priority for child and adolescent mental health service system research. The present study examined outcomes for a sample of Vermont children (N=27) experiencing emotional and behavioral problems and receiving individualized, wraparound services. One year after initiation of wraparound care, incidence of negative behaviors rated as placing a child at risk of removal from the community had decreased significantly, compliance behavior had increased, and a significant decline in Total Problem Behavior scores on the Child Behavior Checklist was observed. In addition, though 70% of the participants had previously required inpatient or residential treatment, 89% were maintained in the community after one year of services, and the total cost of services was less than that of out-of-state residential care. Although further comparative research is needed, this study suggests that for many of these children, wraparound services may be a more efficient intervention than long-term psychiatric hospitalization or residential treatment.     

Delayed matching-to-sample performance: Effects of relative reinforcer frequency and of signaled versus unsignaled reinforcer magnitudes

Six pigeons were trained on a delayed red-green matching-to-sample task that arranged four delays within sessions. Matching responses intermittently produced either 1.5-s access to food or 4.5-s access to food, and nonmatching responses produced either 1.5-s or 4.5-s blackout. Two phases were conducted: a signaled phase in which the reinforcer magnitudes (small and large) were signaled by houselights (positioned either on the left or right of the chamber), and an unsignaled phase in which there was no correlation between reinforcer magnitude and houselight position. In both phases, the relative frequency with which red and green matching responses produced food was varied across five values. Both matching accuracy and the sensitivity of performance to the distribution of reinforcers for matching responses decreased with increasing delays in both phases. In addition, accuracy and reinforcer sensitivity were significantly lower on signaled small-reinforcer trials compared with accuracy and sensitivity values on signaled large-reinforcer trials and on both types of unsignaled trials. These results are discussed in the context of research on both nonhuman animal and human memory.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Clinical and functional correlates of processing speed in pediatric Attention-Deficit/Hyperactivity Disorder: a systematic review and meta-analysis

It is well established that processing speed is negatively impacted in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Unfortunately, exactly how processing speed vulnerabilities manifest in daily functioning has not been well established. To support clinical care of youth with ADHD, it is important to better understand the functional consequences and relevant outcomes associated with processing speed deficits. This systematic review and meta-analysis sought to identify the association between processing speed and clinical or functional correlates among children or adolescents diagnosed with ADHD. A total of 409 abstracts were screened, of which, 60 full-text articles were identified as potentially relevant, and 8 of these studies met inclusion criteria. Domains evaluated across these studies included reading skills, mathematics skills, written expression, anxiety, self-appraisals of competence, and adaptive functioning. Six studies reported an association between processing speed and reading skills, allowing for meta-analysis. Processing speed difficulties among youth with ADHD appear strongly associated with several clinical and functional correlates including weaker academic skills, poorer adaptive skills, increased self-reported anxiety, and overestimates of social competence. Meta-analytic results for studies reporting the association between processing speed and reading skills indicate a medium overall weighted mean effect size (r = 0.33, 95% CI = 0.28 –0.39) with minimal heterogeneity (I² = 0.17). Clinical implications of these findings, limitations in the current knowledge base, and suggestions for future research are discussed.     

“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.     

Child’s Play: The Role of Play in Mitigating the Fear of Death Among Pediatric Palliative Care Team Patients,Families, and Caregivers

Terror Management Theory (TMT), derived from Ernest Becker’s The Denial of Death (1974), maintains that humans are motivated by the desire to overcome our fear of death by constructing meaning and significance in our lives in various ways, including making light of our mortality. In this paper, we examine the role of play as seriously ill children involved with a hospital-based palliative care team live out what may be the remainder of their lives. We question the function that play has, if any, in mitigating the fear of death among dying children and their caregivers. We explore formal and informal manners of therapeutic play among children and adults occurring in moments of terrible stress, pain, and the looming threat of death. We draw on playful representations of death from popular culture and from extended field research conducted with a pediatric palliative care team in a large regional children’s hospital caring for seriously ill children and their families, as patients, families, and caretakers struggle to make sense of their suffering, fear and loss.     

Embodied Self-Care: Enhancing Awareness and Acceptance Through Mindfulness-Oriented Expressive Writing Self-Disclosure

Self-care is fundamental to mental health practitioner training and professional efficacy. Expressive writing about stressful events has been researched and shown to have positive physical and psychological effects. Mindfulness, an embodied approach to clinical practice and education, has also been studied and documented as an effective self-care approach. Embodied education integrates experiential history with current learning, which may influence future practitioner performance and client outcomes. This self-care exercise is designed to promote awareness and acceptance among counselors and counselors-in-training, as well as among clients, through use of a mindfulness-oriented written self-disclosure task that may facilitate meaning-making and may enhance psychological well-being and therapeutic efficacy. It aligns with Council for Accreditation of Counseling and Related Educational Programs and American Counseling Association Code of Ethics standards addressing counselor self-care as a necessary facet of ethical practice.     

Peer victimization and social‐emotional outcomes: The role of teacher and peer support

The relation between peer victimization, risk of social, emotional, and behavioral difficulties, and school‐based sources of social support for students in elementary and middle school were examined. Participants included 656 students in third to eighth grade from one school district. Results indicated that peer support mediated the relation between peer victimization and risk of social, emotional, and behavioral difficulties, but teacher support did not mediate this relation. Conditional indirect effects analyses revealed that the indirect effect of peer support varied as a function of school level (i.e., intermediate and middle school). The implications and limitations of the current study are discussed, as well as directions for future research.

     

Working online due to the COVID-19 pandemic: a research and literature review

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the ‘online disinhibition effect’, the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.