Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Locus of illness control: a cross-cultural study

A comparative study of rural Haitian and southern Appalachian health beliefs revealed significant differences both within and between groups regarding perceived control over illness. Data consisted of scores (N = 293) on the Locus of Illness Control Scale, a 15-item forced-choice instrument designed to include two subscales, one focused on illness prevention, the other on cure. Both cultural groups scored more externally on the cure dimension than they did on prevention. Group differences, however, were reversed for the subscales. While Appalachians apparently expect greater success in preventing illness, interestingly, Haitians show greater perceived ability to cure illness. The findings have implications for traditional views of "fatalistic" cultures, for the refinement of concepts related to health locus of control, and for the practical utility of standardized instruments among populations that vary in health problems and therapeutic resources.     

Self-regulation of distance in supportive psychotherapy

The authors present the case of a schizophrenic man treated in the setting of a supportive care clinic. The course of treatment from beginning to termination is illustrated by treatment vignettes and by excerpts from the patient's letters to the therapists. Case discussion centers around the handling of the classic schizophrenic conflict over intimacy versus isolation. The authors stress that the therapists must be acutely sensitive to the patient's need and ability to regulate his or her own emotional and therapeutic distance over the course of treatment. They make a case for utilizing this conceptual framework in the treatment of chronic psychiatric patients in supportive clinic settings.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Training mental health practitioners to work with adoptive families who seek help

The lack of appropriate therapeutic resources for adoptive children and their adoptive families who seek treatment is a national problem. The mental health community has failed to recognize the specific knowledge and expertise that therapists must have if they are to help this population. This article describes the initiative taken by one organization to attack this problem in its state.     

Subjective distress from trauma in older clients with severe mental illness

There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.     

Misgivings of medicine?: African Americans' skepticism of psychiatric medication

Research has consistently documented black-white differences in rates of voluntary psychiatric treatment that cannot be reduced entirely to differences in either need or access. A variety of explanations have been offered for the gap that remains, but the empirical testing of alternative propositions has thus far been minimal. Using the 1998 General Social Survey's Pressing Issues in Health and Medical Care module (n = 1,387), I find consistent and substantial black-white differences in a variety of beliefs about psychiatric medications, one of the most common treatments for mental illness, and the predisposition to use them. Specifically, blacks express less willingness to use psychiatric medications themselves or to administer them to a child for whom they are responsible. Neither socioeconomic status, knowledge, religious involvement, nor trust in medicine appears to explain this reluctance. Rather, it stems almost entirely from blacks' beliefs about psychiatric medications' efficacy and side-effects. The results indicate, first, that researchers should not assume that African Americans will use psychiatric medications at rates similar to whites if offered equal access. Second, the results indicate that blacks' skepticism of psychiatric medications may be rooted in specific beliefs about psychiatric medications, rather than general ideologies about medical practice. Health beliefs about psychiatric treatment, therefore, will continue to play an important role in understanding race differences in the use of psychiatric medications.     

Reducing HIV risk among people with serious mental illness

The rate of HIV infection among U.S. citizens who live with serious mental illness (SMI) is significantly higher than among the general population. Research on the determinants of risk behavior is limited. The purpose of this article is to explore the effects of HIV-related health disparities on people with SMI by analyzing the multiple determinants, or domains of risk, and describing issues related to tailoring HIV primary prevention risk reduction strategies to people with SMI. According to the model proposed by Meade and Sikkema, domains of risk include psychiatric illness, substance use, cognitive-behavioral factors, social relationships, and demographics. The majority of people with SMI are sexually active and engage in behaviors that place them at high risk for HIV/AIDS. Mental illness may affect HIV risk through interacting domains that influence sexual behavior. HIV risk reduction strategies must consider psychiatric illness and comorbidities, social relationships, and trauma history. In addition, these efforts should be integrated into existing services.     

Health beliefs of college students born in the United States,China, and India

The authors surveyed 243 urban public university students who were born in the United States, China, and India to compare the health beliefs of the China-born, India-born, and US-born students. Although the China- and India-born students shared beliefs in many preventive and therapeutic practices of Western medicine with the US-born students, they retained some of their traditional health beliefs. This suggests that student health service clinicians should assess students' cultural beliefs and individualize healthcare for students from different countries.     

Gender Socialization,Countertransference and the Treatment of Men with Eating Disorders

Knowledge about the treatment of eating disorders is largely based on the experience of women with these disorders. The motivations, beliefs, vulnerabilities and developmental factors that cause and perpetuate eating disorders in men are often gendered. Engaging men in therapy and helping them build and sustain motivation requires therapeutic sensitivity to the impact of these gendered factors. Therapists’ sensitivity to these factors inevitably activates personal experiences with gender and provides an important source of information about patients’ experiences. This article focuses on how gender socialization and internalized views of masculinity affect client, therapist and the co-created therapeutic relationship. Male and female therapists can use awareness of gender influences to improve their ability to detect and communicate their gendered countertransference reactions. The article concludes with a discussion of how gendered assumptions and emotional reactions can affect treatment team interactions and treatment program protocols.     

Partners in the Spiritual Dance: Learning Clients’ Steps While Minding All Our Toes

We present four case illustrations highlighting the complex interplay of therapists’ and clients’ spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients’ and therapists’ spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist’s and the client’s spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.     

Health Beliefs of College Students Born in the United States,China, and India

Abstract

The authors surveyed 243 urban public university students who were born in the United States, China, and India to compare the health beliefs of the China-born, India-born, and US-born students. Although the China- and India-born students shared beliefs in many preventive and therapeutic practices of Western medicine with the US-born students, they retained some of their traditional health beliefs. This suggests that student health service clinicians should assess students' cultural beliefs and individualize healthcare for students from different countries     

How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.     

Predictors of White Adoptive Parents’ Cultural and Racial Socialization Behaviors With Their Asian Adopted Children

This study investigated the role of White racial identity statuses, cultural and racial socialization beliefs, cultural socialization self-efficacy, and racial socialization self-efficacy in predicting White adoptive parents’ (N = 200) cultural and racial socialization behaviors with their Asian adopted children. Only cultural and racial socialization beliefs contributed to the prediction of socialization practices. In addition, we examined whether cultural and racial socialization self-efficacy would moderate the relationship between parents’ cultural socialization and racial socialization beliefs and behaviors; there was no support for cultural or racial socialization self-efficacy as moderators in the beliefs–behaviors relationships. Finally, findings revealed that parents were more involved in cultural socialization than racial socialization behaviors, although they did not engage frequently in either type of socialization behavior, particularly racial socialization.     

Diagnosis and therapy of male gamblers in a university psychiatric hospital

From 1980 to mid-1990 fifty-one gamblers were evaluated and treated at the psychiatric university hospital of Homburg/Saar in Germany. All were men with a mean age of 33.7 years. Gambling had lasted 5.2 years on average. Most patients were motivated to undergo therapy by members of their family. The majority of them had been in psychotherapeutic treatment before. Thirty-six of the 51 patients had committed punishable acts including fraud and embezzlement and, in 7 cases, robbery. The sample could be divided into three clinical subgroups. The first group consisted of patients with severe psychiatric diseases such as schizophrenia, manic-depressive illness or organic brain disorder. Patients of the second group suffered from serious personality disorders. Those of the third group showed deep-rooted problems in their current relationships.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.     

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.     

Countertransference risks when women treat women

Certain female patients deal with issues of sexuality, reproduction, aggression, and dependence in ways which may generate intense reactions in their female therapists. We will describe the range of responses we experienced while treating various women in an acute psychiatric inpatient setting. A surprising finding was that not only our problematic responses, but also our effective solutions, have often occurred unconsciously.A shorter version of this paper was presented at the California Chapter NASW Conference on April 7, 1989.     

“My heart is very painful”: Physical, mental and social wellbeing of older women at the times of HIV/AIDS in rural South Africa

The meanings of health and illness as well as people's beliefs about the required response to illness vary widely according to time and place and represents the culture and society in which people live. A double burden of disease in rural South Africa - an emerging epidemic of non-communicable diseases alongside high HIV-prevalence - defines illness as a ‘normal’ part of older persons' everyday lives. Against this background we analyze qualitative interviews with 30 women over the age of 60 in a rural community to provide an in-depth portrait of older women's physical, mental and social wellbeing and how these women make sense of it all in a changing and challenging social and economic context. These women, while making the connections between the various dimensions, view their own physical, mental and social wellbeing as impaired, and make use of a variety of health and help-seeking behaviors in order to feel better. However, poverty and the unavailability of health resources shape older women's constructions of the meaning of their health and their control, or lack thereof, over how healthy or ill they are. This study demonstrates the usefulness of the broader psycho-socio-environmental model in explaining old-age and wellbeing by providing a context specific and nuanced understanding.