Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

Synchrony in mother-infant vocal interactions revealed through timed event sequences

This report extends a previous cross-cultural study of synchrony in mother-infant vocal interactions (Bornstein et al., 2015) to immigrant samples. Immigrant dyads from three cultures of origin (Japan, South Korea, South America) living in the same culture of destination (the United States) were compared to nonmigrant dyads in those same cultures of origin and to nonmigrant European American dyads living in the same culture of destination (the United States). This article highlights an underutilized analysis to assess synchrony in mother-infant interaction and extends cross-cultural research on mother-infant vocal interaction. Timing of onsets and offsets of maternal speech to infants and infant nondistress vocalizations were coded separately from 50-min recorded naturalistic observations of mothers and infants. Odds ratios were computed to analyze synchrony in mother-infant vocal interactions. Synchrony was analyzed in three ways -- contingency of timed event sequences, mean differences in contingency by acculturation level and within dyads, and coordination of responsiveness within dyads. Immigrant mothers were contingently responsive to their infants’ vocalizations, but only Korean immigrant infants were contingently responsive to their mothers’ vocalizations. For the Japanese and South American comparisons, immigrant mothers were more contingently responsive than their infants (but not robustly so for South American immigrants). For the Korean comparison, mean differences in contingent responsiveness were found among acculturation groups (culture of origin, immigrant, culture of destination), but not between mothers and infants. Immigrant dyads’ mean levels of responsiveness did not differ. Immigrant mothers’ and infants’ levels of responsiveness were coordinated. Strengths and flexibility of the timed event sequential analytic approach to assessing synchrony in mother-infant interactions are discussed, particularly for culturally diverse samples.     

The Nature of Client Agency Prior to Therapy: A Qualitative Study on Clients’ Narratives

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.     

Predictors of Client Attrition in a University-Based Community Counseling Clinic

The purpose of this study was to investigate how symptom distress, social role, interpersonal relationships, gender, age, number of supports, and education level predict client attrition in a community sample. Using binary logistic regression and cross-sectional data, the authors examined the predictive impact of 8 variables on adult client attrition in a university-based community counseling clinic. Results indicated that education level, interpersonal relationships, and number of supports significantly predicted attrition. In this sample, gender, age, symptom distress, social role, and race did not significantly predict attrition. Implications for clinical assessment and counseling practice are discussed.     

A Validation of a Multicultural Competency Measure Among South Korean Counselors

The authors translated the California Brief Multicultural Competence Scale (CBMCS; Gamst et al., 2004), a measure of multicultural competence, into Korean for cross-cultural validation. An exploratory factor analysis followed by a confirmatory factor analysis on a sample of Korean counselors (N = 365) supported a 3-factor model: Multicultural Ability, Multicultural Knowledge, and Multicultural Awareness. The Korean version was deemed to possess sound psychometric properties, such as high test-retest reliability and criterion-related validity. Los autores tradujeron al idioma coreano la Escala Breve de Competencia Multicultural de California (CBMCS, por sus siglas en inglés; Gamst et al., 2004), un instrumento de medida de competencia multicultural, para su validación intercultural. Un análisis factorial exploratorio seguido de un análisis factorial confirmatorio sobre una muestra de consejeros coreanos (N = 365) respaldó un modelo de 3 factores: Habilidad Multicultural, Conocimiento Multicultural y Conciencia Multicultural. Se concluyó que la versión en coreano tenía propiedades psicométricas sólidas, como una alta fiabilidad de la repetición de las pruebas y una alta validez de criterio.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

In Experiential Sessions, There Is No Therapist or Client: There Is a “Teacher” and a “Practitioner”

In virtually every kind of psychotherapy, therapist and client attend mainly to one another throughout almost the entire session. If each experiential session is to be successful in enabling the person to become the whole new person that the person can become, and to become free of the painful feeling in the painful situation, the radical alternative is for the experiential teacher–therapist and the person to attend mainly to the third thing that is the important center of attention for the person. An even more radical glimpse into the future includes the person having one's own sessions by oneself, complemented by skill-development sessions with the experiential teacher.     

The Relative Influence of Client Characteristics on the Process and Outcomes of Premarital Counseling: A Survey of Providers

To explore the influence of client characteristics in premarital counseling, a five factor model is presented that includes the social context, family-of-origin influences, individual characteristics, couple interactional processes, and motivation for attending premarital counseling. The findings demonstrate that providers believe that many client characteristics influence the degree to which couples benefit from premarital counseling. Providers rated the influence of the client characteristic factors in the following order (from most to least influential): couple interactional processes, family-of-origin influences, individual characteristics, motivation for premarital counseling, and the social context. Recommendations for future theory development, practice, and research are discussed.The findings presented in this article were part of the authors doctoral dissertation at the University of Florida.     

Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment?

Dyregrov, K. (2004). Strategies of professional assistance after traumatic deaths: Empowerment or disempowerment? Scandinavian Journal of Psychology, 45, 181–189. Referring to research and theory in the field, this discussion paper addresses the more overarching question of current strategies for professional assistance to populations bereaved by traumatic death. The issues and controversies that have long surrounded the “medicalization” of mental health arise anew with respect to the medicalization and professionalization of psychosocial help for people who have been traumatically bereaved. Who should provide what help and how? To what extent should the bereaved be expected to help themselves, receive help and support from friends and family, or even the wider community; and to what extent should the bereaved be able to access appropriate professional help when they are in crisis? Recent studies have indicated that bereaved parents want to receive help from mainstream crisis psychology, and this is not always available. Families experiencing traumatic bereavement are not able to access appropriate services along the same lines as those suffering similar levels of somatic complaints. It is argued that the main factors contributing to this situation are the lack of knowledge and inadequate organization of services; the fact that somatic issues take priority over psychosocial difficulties and dysfunction, and curative services over prophylactic intervention; and particularly the de‐medicalization ideology. By not listening to the needs of user groups, the de‐medicalization movement disempowers rather than empowers users – the very opposite of the desired effect.     

Client Advocacy and Collaboration with Insurance and Laboratory Testing Agencies: A Case Study Illustrating Genetic Counselor Roles

Genetic counseling and the many roles a genetic counselor must assume to provide quality genetic health care are becoming increasingly complex, especially when the genetic condition is rare, and DNA testing is costly and not yet routinely used. A case study of a couple with a family history of retinoblastoma and their pursuit of DNA testing for prenatal diagnosis is presented. The case study illustrates the instrumental role of the genetic counselor in advocating for clients for genetic services such as DNA testing and in educating insurance companies in the nature and importance of such services to achieve improved client health care outcomes.