Clinical and Ethical Considerations for Delivering Couple and Family Therapy via Telehealth

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in‐office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here.     

Implementing a Multidimensional Poverty Measure Using Mixed Methods and a Participatory Framework

Recently, there have been advances in the development of multidimensional poverty measures. Work is needed however on how to implement such measures. This paper deals with the process of selecting dimensions and setting weights in multidimensional poverty measurement using qualitative and quantitative methods in a participatory framework. We estimate the multidimensional poverty measures developed by Alkire and Foster for a particular group: persons with psychiatric diagnoses in the United States. To select relevant dimensions and their relative ordering, two discussion groups are convened: one consisting of persons with lived-experience expertise and the other consisting of people with mental health service provision or research expertise. Several methods are used to convert dimension rankings into weights. The selection and ordering of dimensions differed between the two discussion groups, as did the resulting poverty measures. For instance, the poverty headcount using the dimensions and weights of the ‘lived experience’ group ranged from 20.61 to 26.96% as compared to a range of 18.62–33.19% using those of the ‘provider/researcher’ group. One of the main results of this study is that the Alkire Foster method is sensitive to the selection of dimensions and the methods used to derive rankings and weights. It points toward the limitation of relying exclusively on small scale qualitative methods for the selection and ranking of dimensions. In addition, the participatory framework used in this study was found to be essential in interpreting results, in particular with respect to the limitations of the data set in measuring relevant dimensions.     

Back to work: vocational issues and strategies for Canadians living with HIV/AIDS

Much has been written since the first appearance of HIV/AIDS in 1981 about its effects on the Canadian health care and social services systems. However, researchers have given limited attention to issues of entry or re-entry to the competitive job market for HIV positive individuals. The emergence of highly active antiretroviral therapies (HAART) has allowed a significant number of persons who are HIV positive to experience a major recovery in health and energy. This increase in physical health has in turn led to a re-examination of the possibility of returning to former types and levels of activity, including the prospect of going back to work or entering the competitive workforce for the first time. The purpose of this paper is to outline some of the issues and concerns that impact HIV positive individuals' attempts to return to or enter the competitive workforce, particularly those relating to disability policies and public insurance. Data from in-depth interviews with a sample of people living with HIV/AIDS (PHAs) are used to help illustrate the disconnect between these policies and the lived experiences of PHAs. Also discussed are the opportunities for Canadian policies and practices to employ a functional definition of disability and a philosophy of early intervention in vocational rehabilitation.     

Walking the talk in multiparty bargaining: An experimental investigation

We study the framing effects of communication on payoffs in multiparty bargaining. Communication has been shown to be more truthful and revealing than predicted in equilibrium. Because talk is preference-revealing, it may effectively frame bargaining around a logic of fairness or competition, moving parties on a path toward or away from equal-division agreements. These endogenous framing effects may outweigh any overall social utility effects due to the mere presence of communication. In two studies, we find that non-binding talk about fairness within a three-party, complete-information game leads toward off-equilibrium, equal division payoffs, while non-binding talk focusing on Competitive Reasoning moves parties away from equal divisions. Our two studies allow us to demonstrate that manipulated pre-game talk and spontaneous within-game dialogue lead to the same results.     

History of child abuse and severity of adult depression: the mediating role of cognitive schema

The link between childhood abuse, adult depression, and anxiety has been well studied, but few studies have empirically explored the mechanism of that link. Using a clinical sample of women, this study examined the relationship between retrospectively measured childhood abuse and neglect and current adult symptoms of anxiety and depression, via the mediating effects of cognitive style. This study found that women who reported a positive abuse history were significantly more depressed and exhibited more maladaptive schemas than women who did not report a history of abuse. Specifically, it would appear that cognitive styles marked by interpersonal disconnection and rejection are particularly pathogenic. These findings contribute to the growing literature by providing support for the role of cognitions in mediating the link between childhood abuse and psychopathology.     

Attachment and Separation: Obstacles for Adoptees

Adoptees face challenges unique to their status as individuals who have been relinquished by birth parents and raised by other persons. They may encounter obstacles when passing through normal stages of development. They may face extra challenges in developing healthy attachments and successfully separating and creating a solid sense of self as an individual. This article will highlight some ofthese potential obstacles and challenges for adopted persons.     

Contracts for intimate relationships

This paper analyzes the extent to which intimate relationships established by contract differ from, and are more egalitarian than, those established by traditional legal marriage. Three types of intimate contracts are examined: contracts between legally married spouses, contracts written as a prelude to legal marriage, and contracts written by unmarried cohabitors as an alternative to legal marriage. The paper addresses two major questions: (1) To what extent do the relationships established by contract differ from those established by legal marriage? (2) To what extent do these contracts support more egalitarian family forms? While considerable variation by type of relationship was found, with the cohabitors departing the most from the traditional legal model, even the married couples wrote contracts that were significantly different from the model imposed by law. They were much more likely to structure their relationship as a partnership rather than as a hierarchy, and to hold their income and property as community property. Further, they were more likely to share the responsibilities for both economic support and homemaking tasks (in contrast to the legal assignment of these duties on the basis of sex). Thus, when compared to the relationships established by law, the 50 intimate contracts in this sample seemed to support more egalitarian family forms.     

Attachment and Separation: Obstacles for Adoptees

Adoptees face challenges unique to their status as individuals who have been relinquished by birth parents and raised by other persons. They may encounter obstacles when passing through normal stages of development. They may face extra challenges in developing healthy attachments and successfully separating and creating a solid sense of self as an individual. This article will highlight some of these potential obstacles and challenges for adopted persons.     

Health care trends, Part I. The promise and perils of evidence-based medicine ... panel discussion.

Numerous studies have demonstrated that there are wide variations in the way physicians manage similar patients. This suggests that an evidence-based approach could lead to better outcomes with less cost. But practicing evidence-based medicine requires new skills, such as using computerized databases and applying the rules of evidence to primary and integrative studies in the medical literature. The progress of evidence-based medicine will depend in large measure on how quickly these new skills can be developed and integrated into the practice environment. Here's how six experts see the promise and the perils of evidence-based medicine, now and in the new millennium. Part 2 of the panel discussion will explore the new provider team, which includes nurses and, more recently, pharmacists, who are collaborating with physicians to provide disease management and drugs therapy management services.