Choice: what,when and why? Exploring the importance of choice to disabled people

Extending choice and control over public services is central to current policies in England. Such policies have immense potential for independence and well‐being. However, it is still not clear how disabled people conceptualise choices, what choices are important, for which groups of people, in what areas of life and why. This paper presents findings from the first phase of a longitudinal qualitative study of choice and control over the life‐course. Semi‐structured interviews were carried out with 111 participants including disabled young people with progressive conditions; their parents; adults and older people with fluctuating support needs and those experiencing sudden deterioration in health. The findings suggest that while most people across all study groups wanted to be able to make choices in all areas of their lives, there are significant differences in the importance they attach to specific choices. The findings have implications for service reforms and identify some policy and practice issues that need to be addressed.     

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.     

Toward a Better Understanding of the Use of Psychodynamically-Informed Treatment with Latinos: Findings from Clinician Experience

Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. Therefore, the question of what types of mental health treatment approaches are useful in working with this population is of increasing concern. A strong sentiment against the use of psychodynamic treatment with Latinos persists in the literature in the absence of rigorous data that would support such a stance. Thus, it is important to examine systematically the use of psychodynamically-informed treatment with Latinos in order to address the question of its potential relevance and utility with this population. This article presents the results of a qualitative study of Latino therapists who employ psychodynamic approaches with Latino clients. Findings suggest that the clinicians interviewed have expanded the psychodynamic framework to include a flexible focus on the relationship, consideration of each client as an individual, and an acknowledgment and understanding of external reality and its impact on the client. Modifications these clinicians have made in technique, such as increased self-disclosure, support and maximize this expansion of the frame. Simultaneously, such modifications enhance the cultural sensitivity of these clinicians' work and are congruent with contemporary psychodynamically-informed relational theories.     

The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.