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PubMed2003

Informed consent for psychotherapy: a look at therapists' understanding, opinions, and practices.

Forensic experts agree that the doctrine of informed consent now applies to psychotherapy. The optimum level of detail and content in this interaction remains nebulous. This study examines opinions and practices of therapists. The authors administered a survey regarding this subject to 231 psychotherapists. Six scales were constructed from this survey. High scores on these scales suggest more positive opinions regarding the application of the doctrine of informed consent to psychotherapy. Psychiatrists scored significantly lower on the Informed Consent (p = 0.005), Written Consent (p < 0.001), and Self-Disclosure (p = 0.026) scales than other types of therapists (suggesting a more negative opinion of the application of this doctrine to psychotherapy). Interpersonal therapists scored significantly higher than psychodynamic psychotherapists on the Informed Consent (p = 0.003) and Patient (p = 0.003) scales. Psychodynamic psychotherapists scored significantly lower than therapists with different modalities on the Written Consent scale. This paper suggests that opinions and practices of informed consent for psychotherapy vary with the characteristics of the therapist. More research in this area could serve as a guide for therapists embarking on the process of informed consent or for professional organizations who wish to establish guidelines.

Adult↗
PubMed1986

A review of supportive psychotherapy.

Although supportive psychotherapy techniques are more widely used than expressive or insight-oriented techniques, particularly with hospitalized or chronically ill patients, supportive treatment strategies have been underrepresented in the literature and not adequately taught to therapists in training. The authors review the diverse definitions and goals of supportive therapy as related to two major types of objectives. They stress the distinction between the supportive relationship, which is present to some extent in all psychotherapy, and supportive treatment, and they examine the inverse relationship between expressive and supportive therapy. Finally, selected elements and techniques of the conduct of supportive therapy, such as style of communication, respect, praise, advice, self-disclosure, and interpretation, are discussed.

Combined Modality Therapy↗
PubMed1993

The impact of patients' and therapists' religious values on psychotherapy.

OBJECTIVE: The American Psychiatric Association's committee on religion and psychiatry has issued guidelines urging therapists to understand and maintain an empathic respect for patients' religious orientations and beliefs. This paper reviews recent literature on the effects of patients' and therapists' religious values on psychotherapy. METHODS: Relevant psychiatric and psychological publications were searched; both empirical studies and clinical discussions were included. RESULTS AND CONCLUSIONS: Psychotherapists communicate their values to patients in psychotherapy. Many therapists have secular values, which may clash with some patients' religious values. To avoid negative counter-transferences, therapists must be sensitive to patients' values and aware of their own attitudes about religion. Therapists' self-disclosure of their attitudes and beliefs has been encouraged, and referral of patients to clergy or religious counselors is sometimes recommended.

Defense Mechanisms↗
PubMed1999

Heading off boundary problems: clinical supervision as risk management.

The effective management of risk in clinical practice includes steps to limit harm to clients resulting from ethical violations or professional misconduct. Boundary problems constitute some of the most damaging ethical violations. The authors propose an active use of clinical supervision to anticipate and head off possible ethical violations by intervening when signs of boundary problems appear. The authors encourage a facilitative, Socratic method, rather than directive approaches, to help supervisees maximize their learning about ethical complexities. Building on the idea of a slippery slope, in which seemingly insignificant acts can lead to unethical patterns of behavior, the authors discuss ten cues to potential boundary problems, including strong feelings about a client; extended sessions with clients; gift giving between clinician and client; loans, barter, and sale of goods; clinician self-disclosures; and touching and sex. The authors outline supervisory interventions to be made when the cues are detected.

Ethics, Professional↗
PubMed1995

An ecological analysis of pregnancy resolution decisions among African American and Hispanic adolescent females.

Using data from the 1988 National Family Growth Cycle, IV, this study sought to identify specific individual, family, sociocultural, and social structure factors that influence pregnancy resolution decisions of first conception among African American and Hispanic adolescents aged 15 to 21 years. A hierarchical discriminant function analysis was used to determine the extent to which selected variables could distinguish those who terminated their first pregnancy from those who decided to carry their first pregnancies to full term. Three individual factors (age at conception, contraceptive behavior pattern, degree of self-disclosure about the pregnancy), two family-level variables (family sexuality socialization, family income), and each of the selected social structure (access to sexual health care facilities) and sociocultural factors (religious affiliation and church attendance) were found to discriminate between the two groups. However, the discriminating power of these variables differed depending on race/ethnicity.

Adolescent↗
PubMed2005

Grandparent-grandchild contact and attitudes toward older adults: moderator and mediator effects.

Two studies tested the intergroup contact hypothesis in the context of the grandparent-grandchild relationship. The hypothesis suggests that contact with an out-group member has more influence on attitudes toward the out-group when group memberships are salient. In Study 1, the predicted link was found but only for grandparents with whom the grandchild had more frequent contact. The second study examined only the most frequent grandparent relationship and replicated the effect. This study also investigated the role of various mediators of the link between quality of contact and attitudes, as well as quality of contact and perceived out-group variability. Perspective taking, anxiety, and accommodation mediated the effects of contact on attitudes, whereas individuation and self-disclosure mediated the effects of contact on perceived out-group variability. Moderated mediational analysis indicated that the moderating effect of group salience occurs between quality of contact and the mediator, not between the mediator and attitudes.

Adult↗
PubMed1994

The role of marital therapy in the treatment of depressed married women.

The absence of a close, confiding relationship has been identified as a vulnerability factor to depression for women under adverse circumstances. Marital discord has also been identified as a risk factor in initiating and sustaining depression in women. Recent research has suggested that marriages with a depressed spouse are associated with lack of intimacy and decreased self-disclosure. This paper reviews three controlled outcome studies which demonstrate that marital therapy in combination with antidepressant medication is not indicated for hospitalized women with major affective disorder but either alone or in combination with antidepressants, marital therapy is a viable treatment for outpatient women who are suffering from depression.

Adolescent↗
PubMed1995

Incest/child sexual abuse: historical perspectives.

After identifying that social scientists and historians have long believed (and vigorously defended) that the only universal trait found in every known culture is the prohibition against incest, occurrence of incest and child sexual abuse is traced first through Western culture from antiquity to the present with special emphasis on Sigmund Freud's "reversal." It then is traced through Eastern culture from ancient to modern times. Contemporary trends of self-disclosure of incest and child sexual abuse are examined, and current incidence data are provided. The backlash phenomenon is then explored, and conclusions are drawn.

Child↗
PubMedDate not supplied

Stages of change and condom use among an Internet sample of gay and bisexual men.

The purpose of this descriptive correlational study using the transtheoretical model was to determine the relationship between stages of change and condom use among gay and bisexual men with primary (steady) and casual (occasional) partners. A convenience sample of 241 gay and bisexual men was recruited from the Internet. The majority of men (n = 198, 82%) never used condoms during anal, vaginal, or oral intercourse with primary partners, indicating they were in the first of five stages of change (precontemplation). Thirty percent (n = 71) of men reported using condoms every time during anal intercourse with casual partners and were in the last stage of change (maintenance). Multiple regression analysis revealed that older bisexual men who informed partners of their HIV status and who were confident and perceived more advantages in using condoms were in higher stages of change. By placing participants into various stages of change, stage specific interventions can be designed.

Adolescent↗
PubMed2004

The prediction of health-related behaviour in elementary school children.

This study investigates the importance of psychological concepts with regard to health-related behaviour in elementary school children based on self-report data of 802 second- and fourth-graders. The results show significant relations of self-efficacy and the choice of appropriate coping strategies to positive health-related behaviours. The amount of stress experiences (measured by the Youth Self-Report) is associated to health-risky behaviours for the total sample and for the gender subgroups, while the other predictor variables show inconsistent relations for different subgroups. The significance of the results for health-promotion during early developmental stages is discussed.

Adaptation, Psychological↗
PubMed2004

Relationship building in Clinical Pastoral Education: a Confucian reflection from Asian chaplains.

The authors reflect on the intentional model of relationship building in Clinical Pastoral Education (CPE) and its roots in the Western concept of the self as a rational, autonomous, and bounded agent. They compare the Western idea to the Confucian two-dimensional self orientation as relational as well as autonomous, and discuss possible difficulties that Asian students from Confucian background may encounter entering CPE. The chaplains explore implications and suggestions for how CPE supervisors and students may enter into dialogue in order to create mutual understanding and help Asian students translate CPE learning methods into meaningful cultural contexts.

Asia↗
PubMed1995

The discovery that an offspring is gay: parents', gay men's, and lesbians' perspectives.

This study explores and integrates parents', gay men's, and lesbians' perceptions of the "coming out" process. The research employed a sample of thirty-two gay and lesbian young adults and twenty-seven parents. It investigated how family dynamics prior to the discovery of homosexuality could be related to post-discovery experiences on parts of both children and parents. In-depth interviews were conducted with all participants. Two bodies of literature enriched the theoretical framework for this study: self-disclosure literature and the literature pertaining to homosexual identity formation. Findings of this study call for educating parents about homosexuality prior to the actual act of disclosure. Ensuring that parents do not learn about homosexuality while finding out that their child is gay potentially eases parents' adjustment to the discovery and thus may also improve the emotional dynamics within the family.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The myth and history of some psychoanalytic concepts. Thoughts inspired by a reading of Orange et al., Working intersubjectively.

In this paper the author gives her reactions to a book on the intersubjective approach that deals with major issues such as the analyst's role in the psychoanalytic process, neutrality, technique and self-disclosure. Noting that the book often adopts an antagonistic and innovative stance towards Freud, she draws attention to aspects of his theories that deal with concepts deemed by the intersubjective school to be of fundamental importance. Chief among these is the influence of the analyst on the analytic process, in terms both of his 'defects' and of his individuality in general. In opposition to the 'myth of the isolated mind' attributed by the book to Freud, the author presents some selected passages from his works that emphasise the structuring function of the object and the influence of various groups on the individual. The aim of the paper is not only to counter the oversimplified view of Freud that emerges from the book but also to put forward a theoretical position with respect to a school that is exerting an increasingly powerful attraction on both sides of the Atlantic. The author's argument is based mainly on a discussion of the detailed clinical sequences featuring in the book. She also considers some possible cultural and social determinants of the development of the intersubjective trend.

Austria↗
PubMed2001

Helping processes in a mutual aid organization for persons with emotional disturbance.

To date, the notion of helpfulness of group processes has been equivocal in research on self-help groups. This article argues that findings drawn from the participants' subjective appraisals of helpfulness carry meanings different from those drawn from the correlational approach. In a mutual aid organization serving adults with mental health problems, the study found that, whereas universality, self-disclosure, and instillation of hope were the most valued processes, support and catharsis were the strongest correlates of benefits of participation. The authors propose a two-level hierarchy that distinguishes sustaining and beneficial factors. Different sets of factors should constitute the focus of facilitation at different stages of group development.

Adolescent↗
PubMed1999

Restraining orders: a frequent marker of adverse maternal health.

OBJECTIVE: Women with histories of interpersonal violence are poorly identified because of barriers in self-disclosure. This study identified differences on maternal health and child behavior between women who report filing a restraining order (RO) and those who do not among a nonreferred sample of women living in high-crime neighborhoods. METHODS: During a maternal interview mothers were asked whether they ever filed a RO, the victim/defendant relationship, the number of times, and the year of the filing. Four types of violence were coded independently based on maternal narratives: verbal harassment, verbal threats or intimidation, physical assault, and destruction of property. We controlled for differences between RO and non-RO groups regarding demographic background, partner characteristics, other types of maternal past victimization, and use of alcohol and illicit drugs. Outcomes for mothers include partner aggression (Conflict Tactics Scale-R), perception of health and bodily pain (SF-36 Health Survey), distress symptoms (SCL90-R), posttraumatic stress (PTS)-related symptoms, and partial posttraumatic stress disorder (PTSD) diagnosis (modified Diagnostic Interview Schedule PTSD-Module). Outcomes for the child include partner aggression (Conflict Tactic Scale-R), behavior problems (CBC 2-3 or Child Behavior Checklist), and PTS-related symptoms (PTS-related symptom checklist). PATIENTS: One hundred sixty patients between 3.0 to 6.1 years who resided within five residential ZIP codes with a high rate of local crime in the City of Boston were drawn from a pediatric care clinic practice. Patients were participants of a larger study about the impact of community violence on mother-child relations. RESULTS: Sixty-four (40%) of 160 mothers reported a history of filing a RO against a current boyfriend or husband (39%), ex-boyfriend or husband (44%), someone known (8%), or other (9%), with a mean of 3.9 years (standard deviation = 3.5 years) since RO filing. After controlling for covariates of marital status, immigrant status, public assistance, and lifetime sexual victimization, we found a significant multivariate analysis of covariance group effect on maternal outcomes. Analysis of covariance analyses indicated that mothers in the RO group experienced higher current partner verbal aggression and physical violence to mother, poorer health, and higher PTS-related symptoms, compared with mothers in the non-RO group. More mothers in the RO group met partial lifetime PTSD diagnosis. Unadjusted for maternal covariates, the multivariate analysis of variance analyses on child outcomes (partner aggression to child, behavior problems, and PTS-related symptoms) indicated a nonsignificant group effect. CONCLUSIONS: Among dyads residing in high-risk crime areas, the incidence of RO histories is substantive considering this was a nonshelter, nonreferred sample. The inquiry about the history of a RO may provide a new and efficient marker to quality of current partner relationship, maternal health, and maternal stress-related symptomatology.

Adult↗
PubMed2002

An assessment of outcomes following parents' participation in a child abuse prevention program.

The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.

Child↗
PubMed1986

Telephone conversational skills training with socially isolated, impaired nursing home residents.

We evaluated the effectiveness of a comprehensive training program for enhancing the conversational skills of socially isolated, impaired elderly nursing home residents. A multiple baseline design across behaviors was used to train four subjects (aged 87, 85, 68, and 66), on four content-related conversational components: expressing common courtesies, making positive self-disclosures, asking questions, and making interjections and acknowledgements. Training procedures included instructions, modeling, behavior rehearsal, feedback, and reinforcement. Results showed positive effects with all four subjects; in two cases, changes were significant enough to affect untrained observers' perceptions of the elders' conversational skills.

Aged↗
PubMed1998

Pragmatic language behaviors of adults diagnosed with chronic schizophrenia.

35 adults diagnosed with schizophrenia provided samples of narrative and conversational discourse and completed a criterion-referenced test of pragmatic language ability. There was a significant relationship between performance on pragmatic language tasks and perceived over-all functioning of schizophrenic subjects as measured by psychological assessment. Subjects who were perceived as functioning at low levels on the Global Assessment of Functioning Scale from the Diagnostic and 1994 Statistical Manual of Mental Disorders had low self-disclosure in conversation, produced less information in narratives, and produced more nonscorable items on a criterion-referenced test of pragmatic language. Appropriateness of speech suprasegmentals was also related to patients' perceived effectiveness as communicators as well as to their perceived over-all functioning as measured by the Global Assessment of Functioning Scale.

Adult↗