Dsm-iii-R and the family therapist: ethical considerations

DSM-III-R has gained popularity in many segments of the mental health field. Family therapists have generally not found its approach to assessing problems to be helpful in the planning of therapy, yet, are often forced to use it due to the requirements of third-party payers. This raises several ethical and practical concerns, e.g., the incompatibility of orientations between DSM-III-R and family therapy, the stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and the competency of some family therapists to make DSM-III-R diagnoses. Short- and long-term strategies to deal with these ethical dilemmas are also presented.     

Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Training for collaboration: collaborative practice skills for mental health professionals

The purpose of the study was to identify skills that mental health practitioners need for successful collaborative practice in medical settings. Known experts in the field of collaborative health care completed a survey designed to elicit their suggestions about what is needed for successful collaborative care practice. Through qualitative analysis, a set of 56 skills was developed. These skills are organized into three general categories of competency: (a) skills for working in a medical setting; (b) skills for working with patients; and (c) skills for collaborating with healthcare providers.     

Preparing marriage and family therapy students to become employee assistance professionals*

While the number of Employee Assistance Programs (EAPs) has grown tremendously, opportunities for marriage and family therapists in EAP settings have not been adequately described. This paper addresses issues pertinent to training Marriage and Family Therapy (MFT) students to develop the skills needed to become EAP professionals. Qualifications for becoming an EAP professional are described and suggestions are made as to how these skills may be taught within the framework of an academically based MFT training program.     

Social psychopathy,social distress,family breakdown,and custody disputes in the 1990s: Implications for mental health professionals

The decade of the 1990s will probably contain more challenges to the role of the mental health practitioner in child custody cases than ever before in history. Because of increasing social stress and family disintegration, custody disputes are destined to become more frequent, bitter, and traumatic for all parties. Mental health professionals, in particular, need to develop a coherent structure regarding their own participation in this process. Issues of moral changes among our leadership and our citizenry are examined and guidelines for the behavior of the mental health practitioner in the courtroom are formulated and illustrated as they pertain to custody decisions. Particular attention is paid to custody decisions as an art rather than a science, the role of empirical research, the need to anticipate certain unintended circumstances, the need for the application of mental health principles on an individual case-by-case basis, the nature of the mental health professional's expertise, and the problems with the concepts of parental unfitness and the use of psychiatric diagnosis as a way of defining such alleged unfitness.     

Hidden trauma victims: Understanding and preventing traumatic stress in mental health professionals

Mental health professionals, including social workers, are often exposed to the traumatic experiences of clients in their work with victims of violence, crime, and disaster. Given their empathetic engagement with traumatized victims, they may experience severe emotional reactions such as terror, grief, and rage. Empirical evidence identifies these emotional reactions as “traumatic stress” including burnout, Traumatic Countertransference (TC), Vicarious Trauma (VT), and Secondary Traumatic Stress (STS)/Compassion Fatigue (CF). In this study, the history and definition of each traumatic stress are examined, and differences among them are explored. Preventive strategies for reducing traumatic stress in mental health professionals are discussed.     

Mental health disparities in the older Afro-Caribbean population living in the United States: cultural and practice perspectives for mental health professionals

Cultural characteristics play an important role in the lives of many older Afro-Caribbean as they continue to migrate, acculturate, and assimilate in the United States. Many among this unique cultural subgroup will develop mental illness; however, despite the availability of effective treatment, seeking appropriate care within the formal mental health system continues to be a challenge for this group as a consequence of their cultural heritage. This review describes how these cultural determinants often lead to mental health disparities among older Afro-Caribbean living in the United States. Suggestions are also included for how mental health nurses and other professionals can incorporate research and practice into the caring model of cultural humility as they continue to come in contact with this population in various clinical settings.     

The influence of family environment on mental health need and service use among vulnerable children

Children in child welfare are especially likely to have unmet mental health needs. The role of family factors in children's use of mental health services was examined in a longitudinal sample of 1075 maltreated or at-risk children. Vulnerable family environment (poor family functioning, low social support, and caregiver psychological distress) is an important predictor of children's mental health needs. It also predicts them not having these needs met.     

Women and mental health: the interaction of job and family conditions.

Current research on the effects of wives' employment on their well-being focuses on the determinants of those effects. Most studies have used a gender model that concentrates on family conditions as mediators. In contrast, studies of the effects of employment on men typically use a job model and focus on work rather than family conditions as determinants. To understand fully the impact of employment on women, these models should be combined. We predict that certain work and family conditions interact, specifically, that the degree of control at work moderates the effects of demands in the family. Using two data sets on community mental health, we have found some support for this hypothesis.     

Gay and lesbian couples in therapy: perspectives for the contemporary family therapist

This paper outlines the major concerns of gay and lesbian couples who seek therapy. Presenting problems are classified as either internal to the relationship or as external (contextual) ones that reflect the influence of oppressive cultural and gender biases. Throughout the article, distinctive therapy methods are described that address the unique concerns of lesbian and gay couples, with special sensitivity to heterosexist and homophobic bias.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.     

The work–family challenge and mental health

The work–family literature is dominated by studies of white middle-class workers. In this study, we sought to expand this focus by examining work–family issues from the perspective of Mexicans who have immigrated to the USA within the past five years. Using data from qualitative in-depth interviews (N?=?22) and quantitative structured interviews (N?=?150), we documented the work–family experiences associated with immigration, and we examined the extent to which these experiences differed by gender as well as their mental health effects. The in-depth interviews clearly indicated that separation from family and community was a common and poignant strain experienced by Mexican immigrants who came to the USA to find work, and that these experiences did not differ between women and men. Quantitative analyses corroborated the qualitative findings by indicating women and men had similar levels of work–family strain. Analyses also indicated that higher levels of work–family strain were associated with more perceived stress, anxiety and depression, and that these associations did not differ between women and men. Finally, modest evidence suggested that the effects of work–family strain on mental health may be lower when the realities experienced by immigrants in finding employment and sending money home matched their expectations. This study adds a new voice to the work–family literature and the context and results make clear the tension between work and family: families frequently benefit from adults’ paid work, but this paid work is not without costs.     

Alternate intimacy,marriage, and family lifestyles among low-income Black Americans

This article describes nontraditional intimacy, marriage and family structures, and patterns of interaction among low-income Black Americans. Census data are reported to document trends in the development of alternative and alternate family structures for American Blacks. An explanation of why these lifestyles have heretofore been neglected in alternative lifestyle research is suggested. The relation between social structure and ethnic preferences in determining familial lifetyle choices and options is explored. An attempt is made to delineate the social, cultural, and economic forces associated with their emergence. Finally, a theoretical approach to analyzing the genesis of diverse ethnic family structures is explored. Author's Note: The author expresses his gratitude to Teresa Donati Marciano of Fairleigh Dickinson University, Roger W. Libby of the University of Massachusetts, and the Philadelphia Regional office of the U.S. Census Bureau for their comments and assistance.     

The mental health recovery movement and family therapy, part II: a collaborative, appreciative approach for supporting mental health recovery

A continuation of Part I, which introduced mental health recovery concepts to family therapists, Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts. This approach draws primarily upon postmodern therapies, which have numerous social justice and strength-based practices that are easily adapted in recovery-oriented contexts. The model outlined in this article includes an overview of the recovery partnership (i.e., therapeutic relationship), mapping recovery (i.e., assessment and case conceptualization), recovery planning (i.e., treatment planning), facilitating recovery (i.e., intervention), accessing resources (i.e., case management), recovery maintenance, and service contexts as well as a case study.