Catastrophic Conditions in Couple Systems

SUMMARY

A presentation of case studies forms the focus for an exploration of the discovery of an abortion or adoption used as the management of an unwelcome pregnancy which occurred in the context of the marital system. Managing an impasse in the middle phase of therapy in each case led to the emergence of information which then allowed the therapist to work with the couple system to alleviate the core situation out of which presenting problems emanated. In these cases the unwelcome pregnancy had the potential to be cataclysmic to the couple system. Therefore, the possibility that a couple is concealing an abortion or an adoption should be considered by couples' therapists when there is little or no response to usual strategies for change. The reason for concealment is immaterial. What is paramount is that the therapist bring the event to the fore of treatment and work with a couple to put closure on what is generally an unresolved issue.     

Surviving and Thriving After Trauma and Loss

Abstract

Individuals and their communities experience trauma and loss during times of natural disaster. Using Hurricane Katrina as a context, the authors provide an overview of the phases of disaster coping and discuss the ambiguous losses that can occur during these traumatic and life-changing times. The use of rituals as a creative intervention is introduced to help individuals and families facilitate their grief processes.     

Bereavement Groups and Their Benefits

Abstract

This article provides a brief discussion of the various types of grief and posits that the many types, particularly disenfranchised, lend themselves to recovery through reconnection. Bereavement groups offer a particularly useful means of connection with a larger grieving community and allow validation from others along with personalization of loss. Additionally, the use of creativity creates deeper and more meaningful connections with self and others. Finally, the article ends with counseling considerations and two case examples.     

Post‐Traumatic Growth and Optimism as Outcomes of an Internet‐Based Intervention for Complicated Grief

This explorative study examines the effects of an internet‐based cognitive‐behavioural therapy for complicated grief on post‐traumatic growth and optimism. The study is part of a larger randomized controlled trial described in Wagner, Knaevelsrud, and Maercker (2006) Wagner, B., Knaevelsrud, C. and Maercker, A. 2006. Internet‐based cognitive‐behavioral therapy for complicated grief: a randomized controlled trial.. Death Studies, 30: 429–453. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]. The patients were randomly assigned to either a treatment group (n = 26) or a waiting list control condition (n = 25). The internet‐based intervention consisted of exposure to bereavement cues, cognitive reappraisal exercises, and a module on integration and restoration. A short form of the Post‐traumatic Growth Inventory (PTGI), the Life Orientation Test‐Revised (LOT‐R), and measures of complicated grief and psychopathological outcomes were administered. Results indicate that post‐traumatic growth increased in the treatment group. No treatment effect was found for optimism. These findings contribute to the growing literature on personal growth in psychotherapy.     

Perceived lack of training moderates relationship between healthcare providers’ personality and sense of efficacy in trauma-informed care

ABSTRACT

Background and Objectives: Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers’ personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life.

Study Design: The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables.

Methods: Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life.

Results: TIC-efficacy was positively correlated with “intellectence/openness” and inversely correlated with “neuroticism” and perceived lack of training as a barrier. “Intellectence/openness” interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower “intellectence/openness” report greater TIC-efficacy when lack of training is not perceived as a barrier.

Conclusions: Provider personality traits and perceived barriers to TIC appear related to providers’ TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.     

POST-TRAUMATIC STRESS REACTIONS AMONGST RESCUE WORKERS AFTER A MAJOR RAIL ACCIDENT

Abstract

Rescue tasks under heavy strain may act as traumatic events creating stress reactions among the rescue workers. After a major rail accident the rescue workers were examined by questionnaire at 3 and 7 months postaccident using the General Health Questionnaire-28 (GHQ), Impact of Event Scale (IES) and a structured questionnaire made for the purpose. Eighteen percent of the 77 rescue workers who participated in the study had GHQ-case-score and 10% had IES-case-score at 7 months using the usual GHQ-cut-off (4/5) and a low IES-cut-off (19/20). For the case-scorers there was a tendency towards increased GHQ- and IES-scores from 3 to 7 months. Five (6%) had post-traumatic stress disorders (PTSD) of low to moderate severity at 7 months.     

Compassion satisfaction,compassion fatigue,and burnout in a national sample of trauma treatment therapists

Abstract

For behavioral health professionals working with traumatized clients, continuous and prolonged exposure to the stress of working with the myriad of trauma-related stressors experienced by their clients can lead to various responses including burnout, compassion fatigue, and compassion satisfaction. The present study investigates the impact of using evidence-based practices on compassion fatigue, burnout, and compassion satisfaction in a random, national sample of self-identified trauma specialists (N=532). The 30-item Professional Quality of Life Scale (Stamm, 2005) and the 19-item Trauma Practices Questionnaire (Craig & Sprang, 2009) were included in a survey to licensed social workers and psychologists from professional membership rosters. Age and years of experience proved to be powerful predictors of only two of the three criterion variables, with younger professionals reporting higher levels of burnout and more experienced providers endorsing higher levels of compassion satisfaction. The utilization of evidence-based practices predicted statistically significant decreases in compassion fatigue and burnout, and increases in compassion satisfaction. The utility of these findings in understanding the process of trauma transmission between therapist and client as well as directions for future research are discussed.     

An Examination of Posttraumatic Stress Symptoms among Maltreated Multiracial Youth

Symptoms of posttraumatic stress disorder (PTSD) are common among maltreated youth removed from their homes. These symptoms might be particularly evident in multiracial youth, although little research exists on this vulnerable population. A model whereby depression, dissociation, and posttraumatic cognition symptoms contributed to symptoms of PTSD met goodness-of-fit criteria in 160 maltreated multiracial adolescents. Enhanced model fit was found for females and for adolescents 11 to 13 years old. Analyses further revealed that the best predictors of PTSD symptoms were negative cognitions about the world and anhedonia. The findings are discussed within the context of existing theoretical models of PTSD. The results further highlight the importance of ethnically and racially sensitive approaches to assessment and treatment of youth with PTSD symptoms.     

Trauma Affect Regulation Psychoeducation Group and Milieu Intervention Outcomes in Juvenile Detention Facilities

This article reports outcomes of Trauma Affect Regulation: Guide for Education and Therapy (TARGET), a group and milieu intervention, in three juvenile detention facilities, controlling for site, length of stay, ethnicity, number of arrests, mental health and traumatic stress problems, and cohort effects. Linear multiple regression results showed that every session of TARGET received in the first seven days of detention was associated with 54% fewer disciplinary incidents and 72 fewer minutes of disciplinary seclusion ( p < .001) for each youth during the modal stay (14 days) in detention. TARGET group participation was unrelated to recidivism, but recidivism declined significantly following implementation of TARGET. Implementing TARGET in juvenile detention facility milieus might improve safety, reduce punitive sanctions, and potentially reduce recidivism.