Is more better? The relationship between outcomes achieved by problem gamblers and the number of counselling sessions attended

Abstract

This paper addresses the question of how much intervention is necessary for the effective treatment of problem gambling by exploring the relationship between the number of counselling sessions attended and the degree of problem resolution achieved for 613 individuals who attended problem gambling counselling services in Victoria. While those who achieved partial or full resolution of presenting problems attended more sessions than those who finished counselling with their problems still unresolved, problems were typically reported as being resolved in fewer than five sessions. It is concluded that for some problem gamblers a relatively brief intervention may be sufficient.     

Negative Consequences

Abstract

This article reports the results of a qualitative study of self-identified HIV-Negative gay/bisexual men living in urban gay communities. The study explored the effects of living through nearly two decades of the AIDS pandemic. Most researchers have focused on those who are HIV-Positive. Those whose serostatus is HIV-Negative are rarely included, but are greatly affected by this disease. An increasing number of these men, especially younger men, are seroconverting. Forty-seven gay men returned a questionnaire asking about feelings on being HIV-Negative, dealing with grief, sexual practices, and relationship and caregiver issues. Many HIV-Negative gay men reported psychological problems such as depression and unresolved grief. Therapists and AIDS prevention educators need to attend to the special needs of this overlooked population.     

Emotion-Focused Couples Therapy and the Facilitation of Forgiveness

The goal of this study was to evaluate the effectiveness of an emotion-focused couple therapy intervention for resolving emotional injuries. Twenty couples acting as their own waitlist controls were offered a 10–12-session treatment to help resolve unresolved anger and hurt from a betrayal, an abandonment, or an identity insult that they had been unable to resolve for at least 2 years. Treated couples fared significantly better on all outcome measures over the treatment period compared to the waitlist period. They showed a significant improvement in dyadic satisfaction, trust, and forgiveness as well as improvement on symptom and target complaint measures. Changes were maintained on all of the measures at 3-month follow-up except trust, on which the injured partners deteriorated. At the end of treatment, 11 couples were identified as having completely forgiven their partners and six had made progress toward forgiveness compared with only three having made progress toward forgiveness over the waitlist period. The results suggest that EFT is effective in alleviating marital distress and promoting forgiveness in a brief period of time but that additional sessions may be needed to enhance enduring change.     

Into the Wilderness—A Case Study: The Psychodynamics of Adolescent Depression and the Need for a Holistic Intervention

Adolescent depression has become epidemic in the United States, with statistics showing that one in five adolescents may suffer from depression (Brent and Birmaher in N Engl J Med 347(9), 2002). This article examines adolescent depression from a psychodynamic perspective, and identifies the psychodynamics of adolescent depression as the affective correlates that stem from unresolved developmental conflicts, issues of separation/individuation, the search for identity and the development of the true self. This article presents wilderness therapy as a holistic intervention which can be used to address the intrapsychic, developmental and relational factors that give rise to adolescent depression. Wilderness therapy is a modality of mental health treatment that takes place outdoors and utilizes challenge and adventure, group work and other structured clinical interventions. A clinical case study presents wilderness therapy as an effective intervention for adolescent depression that can promote positive self-image and enhanced coping skills, and discusses limitations and implications for social work practice.     

Self-transcendence and depression among AIDS Memorial Quilt panel makers

Self-transcendence is a process that can help individuals reestablish well-being after experiencing a significant, life-altering event. In this study, we sought to identify the relationship between self-transcendence and depression in individuals who lost loved ones to HIV/AIDS and to describe and compare self-transcendence, self-transcendence variables of acceptance and spirituality, and depression among bereaved individuals who created AIDS Memorial Quilt panels with those who did not. The findings support Reed's self-transcendence theory, with inverse correlations between self-transcendence and depression obtained from both the total group and the panel makers. Significant differences were also found between certain self-transcendence variables and depression among the study participants related to gender and ethnicity. In addition, thematic analysis of panel maker interviews revealed five themes: Quilt panel making provides validation, Quilt panel making creates a living memory, liberating acceptance of loss, community of survivors, and connection to a higher power. These findings assist in understanding the complexities of the grief process and support the usefulness of Quilt panel making as an intervention for coping with grief related to HIV/AIDS.     

Memory,Mourning and Meaning in a Psychotherapist’s Life

In this paper the author, a psychotherapist specializing in bereavement, recounts her personal experiences of loss and the ways in which they intersect and inform her professional life. One clinical vignette explores how unresolved grief in a patient and anticipated grief in a therapist emerge in transference-counter-transference issues. Another vignette illustrates a way in which supportive therapy can open the door to intra-psychic work with the ill or dying patient and how psychoanalytically informed psychotherapy with the aged can help them to re-imagine their lives and to form different relationships, in their minds, with significant others in their past.     

Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women

This study examines the impact of social media-based drama therapy and family counselling in reducing symptoms of postpartum depression (PPD) in women aged 18–34. The researchers used a quasi-experimental design and randomly assigned the participants (n = 303) to the control, drama therapy, and family counselling groups. The key findings of the study are as follows. First, at baseline, women not only showed more symptoms of PPD than their male counterparts, but men also reached the PPD threshold of 12/13. Second, the difference between women and men regarding their PPD scores achieved statistical significance (p = 0.004). However, during the post-intervention assessment, men who received drama therapy intervention reported a significant drop in their PPD below the threshold of 12/13. Only women whose spouses received family counselling on spousal support reported a significant drop in their PPD. However, those whose partners did not receive family counselling on spousal support still reported PPD scores within the threshold. In both instances, women in the control group still had high PPD scores. Finally, during the 6-month follow-up assessment, even men in the control group did not have significant symptoms of PPD as their scores dropped below the threshold. On the contrary, women in the control group still had high PPD, indicating that PPD lasted more in women than in men. Also, women whose husbands received family counselling on spousal support reported PPD scores below the threshold. However, women whose husbands did not receive spousal counselling still had PPD scores at the threshold, even though their scores marginally dropped.     

“She was more than a friend”: Clinical intervention strategies for effectively addressing disenfranchised grief issues for same-sex couples

This article focuses on grief experienced by same-sex couples with attention to the distinct factors that influence same-sex grieving partners within all social work system levels. An actual case narrative—the first author's lived experience—guides the reader through a powerful, personal journey to gain a greater perspective and connection on the impact of grief and loss. The concept of disenfranchised grief is applied to same-sex couples focusing on the grieving process. The authors delineate effective strategies for practitioner intervention for those working with individuals experiencing grief due to the loss of their same-sex partner. Particular emphasis is placed on cultural competence and cultural humility for enhanced effectiveness while working with same-sex-partner grief issues.     

Preparing the school-age child for adoption.

The development of an adoptive relationship for children who have been in the limbo of foster care is a continuous process. It is unrealistic to expect these families to live happily ever after. Agencies must begin developing regular services to meet the special needs of the families being created. To a large extent the issues that will have to be worked through relate to the stages of preparation outlined in this paper. Each stage in the child's growth may activate unresolved issues around the grief at the biological parents' rejection, confusion about identity or difficulty in working through problems. Future adoptive home recruitment must take this into account by providing training and other supports to families considering adopting the older child.     

Trait Mindfulness and Relationship Satisfaction: The Role of Forgiveness Among Couples

This study sought to understand the link between trait mindfulness, forgiveness, and relationship satisfaction. Previous research established a significant positive relationship between mindfulness and relationship satisfaction, but forgiveness had not been studied in relation to these variables. Two hundred and nineteen couples in committed romantic relationships were included in the sample and completed self‐report measures on trait mindfulness, forgiveness, and relationship satisfaction. Upon conducting an actor–partner interdependence model mediation (APIMeM; Zeitschrift für Sozialpsychologie, 2006, 37, 27–40) analysis for dyadic data, results indicated significant positive associations for both inter and intrapersonal effects for both men and women. Findings indicated forgiveness is linked to both individual and partner mindfulness and relationship satisfaction, such that a person's ability to be mindful can impact the ability to forgive and therefore increase relationship satisfaction.     

Most Successful Intervention Strategies for Abused Older Adults

ABSTRACT

In this Project CARE study, intervention plans for 83 cases, with a total of 473 strategies, are analyzed in a qualitative content analysis method. The 473 strategies are designed and implemented by an abuse-trained, multidisciplinary, health and social service agency, home care team. Each strategy is rated by the team for its acceptance/refusal by clients and levels of success. The most accepted and successful strategies for abused older adults are concrete: nursing and other medical care and homemaking assistance, followed by empowerment strategies, such as support groups for abused older adults, information about rights and resources and volunteer buddy/advocates. Less successful strategies for abused persons are referrals to general community activities and programs. For caregiver abusers, the most successful and accepted interventions involve individual supportive counselling to reduce anxiety, stress and depression and education and training. Abuser-oriented strategies are most accepted and successful in the study. Thus, it would seem pertinent for intervenors to focus services and strategies on abusers and not only on abused older adults, in particular offering them supportive individual counselling to reduce anxiety, stress, and depression. For abused care receivers, home-based services can offer the necessary support to move out of their abuse situation with the help of volunteers and support group activities.     

An Educational Forgiveness Intervention for Young Adult Children of Divorce

This study tested the effectiveness of a forgiveness intervention for young adult children of divorce. Adults between the ages of 20 and 40 were recruited from counties in a state along the West Coast and from a state in the Midwest. Participants were randomly assigned to either a forgiveness intervention or an alternative treatment control group. Measures of psychological well-being and the quality of social relationships were administered at pretest, posttest, and 8-week follow-up. Results were mixed; between-group analysis revealed little difference between the two interventions, whereas within-group difference indicated the forgiveness group made significant and positive changes on measures of forgiveness, parent–child relationships, and anxiety. Implications for research and practice with young adults are discussed.     

"Languaging" factors affecting clients' acceptance of forgiveness intervention in marital therapy

Forgiveness is a significant intervention for healing interpersonal injury. Yet therapists do not often use forgiveness intervention. Employing a semantic perspective and a survey design (n = 307), this study investigated whether the language used to rationalize forgiveness intervention (set at five levels: personal growth, relationship reconciliation, spiritual issue, others' growth, and pardoning/condoning) may affect its acceptability. Gender, problem type, and choice were also included in the analyses. Overall, forgiveness was found to be an acceptable intervention. A pardoning/condoning rationale led to significantly lower acceptability ratings. Other results are discussed. We conclude that therapists should be less apprehensive about using forgiveness, but need to inform themselves better concerning its purpose, process, and articulation.     

Grief Resolution of Birthmothers in Confidential,Time-Limited Mediated,Ongoing Mediated,and Fully Disclosed Adoptions

Abstract

This study examines grief resolution issues for 75 birthmothers who placed infants for adoption four to twelve years ago in confidential, time-limited mediated, ongoing mediated, or fully disclosed adoptions. Interview data from sets of birthmothers and adoptive families were analyzed. Birthmothers in each of the four adoption arrangements exhibited the continuum of grief resolution, from “very poor” to nearly “very good” resolution. However, birthmothers in fully disclosed adoptions had significantly better grief resolution than those with confidential and time-limited mediated adoptions, and those in ongoing mediated had better grief resolution than those with time-limited mediated adoptions. Implications of these findings for pre-placement planning as well as pre- and post-adoption services are discussed.     

The Role of Forgiveness in Divorce Adjustment and the Impact of Affect

The role of forgiveness and affect was investigated in relation to divorce adjustment. Ninety-one participants separated from their ex-spouse less than 30 months completed a background questionnaire, the Enright Forgiveness Inventory (EFI), the Self Forgiveness Scale (SFS), the Center for Epidemiological Studies–Depression Inventory (CES–D), the Spielberger State–Trait Anger Inventory (STAXI–2), and the Fisher Divorce Adjustment Scale (FDAS). There were significant relationships between depression and the capacity to forgive and between being in an angry feeling state and harboring a lack of forgiveness toward the ex-spouse. The relationship that emerged as the most powerful was that between trait anger and lack of self-forgiveness. Forgiveness intervention that occurs early in the divorce adjustment process is implicated, particularly in relation to the self.     

Miscarriage in the Workplace: an Authoethnography

This paper is an extension of the literature on pregnancy and work, and it introduces miscarriage as an important topic of study in management. Miscarriage starts with a pregnancy, so a woman who has miscarried deals with many of the same workplace issues as women who carry to term. The experience of miscarriage, however, often leads to physical and emotional trauma and/or grief that many women hide from their co‐workers. In this paper we also explore how secrecy is an integral part of the miscarriage experience. The combination of secrecy and grief that is layered on top of a difficult physical experience makes miscarriage a unique experience that, to date, has mostly been ignored in management literature and practice. It is well documented that contemporary corporate structures have little room for addressing procreation, health and grief, it is perhaps unsurprising then that despite miscarriage being seen as a relatively common event it remains silenced.     

Groupwork for Parents whose Children are in Care: Challenges and Opportunities

Until recently, the focus for child protection in NSW has been on risk assessment, supportive measures for parents, and ‘the best interests of the child’. The needs of the birth families, once their children have been removed have not received the same attention. An emerging body of research indicates a growing awareness of the importance of the link between good outcomes for children in care and positive ongoing links with their birth parents. Biological parents of children who have been removed invariably continue to have parenting relationships, if not with the removed child, then with subsequent birth children, step children and children in their extended family. Service provision for this group of parents is critical given the complexity and scale of their emotional needs, and the implications for the children they will care for. In this paper, we describe one such intervention: Kids in Care, a group program offered at Relationships Australia NSW, and consider the arising issues and dilemmas for both parents and group workers. Developed to address the particular needs of parents whose children have been taken into care, the group creates an environment of acceptance and support. This opens up possibilities for parents to consider issues of grief, stigma and trauma, as well as to develop skills in communication, assertiveness and emotional regulation.     

Looking at engagement and outcome from the perspectives of child protection workers and parents

This paper reports a study that sought to understand what facilitates engagement between parents and child protection workers and to ascertain the relationship between such engagement and intervention outcome. Quantitative and qualitative data were gathered through personal interviews with 131 worker-parent dyads (workers and corresponding parents receiving service) from 11 child protection agencies in Ontario, Canada. Measures included scales for engagement, parental well-being (depression and stress), and worker well-being (burnout, job satisfaction, stress). Outcome measures included perception of child safety, changed parenting practices and satisfaction. A relationship was found between workers' perception of parent engagement and parents' perception of their own engagement, as well as between the perceptions that workers and parents had around their own respective engagement. Workers who were satisfied with service outcomes were significantly more engaged than those who were unsatisfied. Parents thinking that their children were safer as a result of intervention were significantly more engaged than parents who thought that their children were less safe. The strongest reason given by parents for positive change was being able to trust their worker (p < .001) and believing that their worker was knowledgeable about parenting (p < .01). Qualitative data suggested that parents valued experienced workers because they thought such workers could better understand their problems and how to deal with them. Correspondingly, workers felt that experience enabled them to better understand clients' problems and provide more effective support. No relationship was found between parent engagement and parental depression or stress, but the mean depression score for parents placed them at risk of clinical depression. There was a negative correlation between worker stress and engagement. The study demonstrates that engagement between clients and workers is related to positive outcomes (as reported by workers and parents) and supports the contention that promoting engagement is integral to a successful child protection intervention.     

The Conjoint Session as a Tool for the Resolution of Separation-Individuation in the Adult Mother-Daughter Relationship

In the present article, two case reports are used to examine the adult mother-daughter relationship from the point of view of the mother. The two mothers, in midlife, looked to their adult daughters to perform selfobject functions. The daughters of these patients felt threatened by their mother's desire for emotional dependence and had emotionally distanced themselves from their mothers. Emotional estrangement from their daughters had caused these patients to experience feelings of depression severe enough to seek treatment. The article describes the use of a conjoint mother-daughter session within the context of the mother's individual treatment to help these mothers to recognize the unresolved separation-individuation in their relationships with their daughters and to promote a healthier connection in the mother-daughter relationship.