Preparation of Mental Health Clinicians to Work With Children With Co-Occurring Autism Spectrum Disorders and Mental Health Needs

ABSTRACT

Up to 70% of children with autism spectrum disorders (ASD) have a co-occurring mental health disorder; however, many clinicians feel unprepared to serve children with complex co-occurring conditions. This study surveyed 64 mental health clinicians working in 21 publically-funded mental health agencies in a large urban setting to explore their preparation and supports for providing mental health services to children with ASD and other developmental disabilities. Results indicated that only half of clinicians received training in ASD/DD in their professional education, with social workers least likely to have had such training. Only half of clinicians felt confident to diagnose mental health problems or provide interventions to children with ASD/DD; those with training on ASD/DD during their professional education were more likely to report confidence. Agency supports were lacking, with just 16% of therapists having supervisors with expertise in ASD/DD, and only 23% receiving training in ASD/DD at their agency. Participants from county agencies were less likely to have agency supports for their work in ASD/DD compared to participants from private non-profit agencies. Implications are discussed for enhancing education and training to meet the mental health needs of children with ASD/DD.     

Sexual minority reflections on their psychotherapy experiences

Objective: Sexual minority (lesbian, gay, bisexual, queer) individuals are regular consumers of psychotherapy, and are more likely to utilize psychotherapy than heterosexually identified individuals. However, there is scant research on sexual minority clients examining their perceptions of therapists’ efforts to work successfully with them. Method: We examined the experiences reported by sexual minority individuals in psychotherapy (N?=?77), utilizing an Internet-based survey that asked open-ended questions such as, “How did your therapist address your sexual orientation?” Result: Using directed content analysis, we derived 19 repeating ideas, which we categorized into five major themes and two overarching concepts, including: (a) participants reported appreciating general person-centered psychotherapy competencies (e.g., active listening, validation, Socratic questioning) and (b) participants reported that various aspects of sexual orientation (e.g., therapist sexual identity, therapist knowledge about sexual minority populations) are relevant to their experiences in therapy and should be addressed directly by therapists. Conclusions: Results indicated that clients want generally competent therapists who understand that a sexual minority identity is only one part of a client's overall identity and not a defining characteristic or psychopathological. We explicate themes and representative quotes, and provide preliminary recommendations for therapists working with sexual minority clients.     

Integrating Sex Therapy Strategies and Techniques into Marital Therapy

Abstract

Marital therapy is a growing field, while sex therapy is stagnating, and even shrinking. However, this does not mean sexual problems have lessened in frequency or severity.

Traditionally, sexuality has not been a focus in marital therapy training, research, or practice. The Plissit model provides a format for marital therapies to integrate sexual interventions into their therapeutic repertoire. Sex therapists can provide workshops and consultations emphasizing permission giving, sexual information, and specific cognitive and behavioral suggestions. The supervision format helps the marital therapist assess interest in and ability to integrate sexual interventions into the therapeutic repertoire, as well as explore personal issues or values that might subvert therapeutic effectiveness.     

Comparison of the attitudes of Israeli therapists and lay persons to ethical dilemmas in psychotherapy

The issues of confidentiality and boundaries cause ethical dilemmas for psychotherapists. We investigated whether therapists have ethical attitudes to confidentiality and boundaries that are unique to their professional group compared with lay persons and whether gender or professional characteristics are associated with these attitudes. Clinical vignettes capturing ethical dilemmas regarding confidentiality and boundaries were presented to 93 psychotherapists of different professional backgrounds (professional group) and 55 staff and students from the fields of law and the humanities (lay group). In general, the lay group showed a greater tendency to maintain confidentiality than the professional group. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students, or supervisees; the differences between the groups in this area were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared with only 54.4% of the lay group. Analysis of the psychotherapists by professional background revealed that for the majority of the vignettes, there was no difference in attitude to confidentiality and boundaries between psychiatrists, psychologists, and social workers. The present study shows that therapists have different ethical codes from nontherapists regarding the issues of boundaries and the treatment contract. Therapists are stricter than nontherapists regarding issues of boundaries but less strict regarding issues of confidentiality, and there are some minor differences in the attitudes to these issues among different types of therapists.     

Therapists' Choice of Treatment for Adoptive Families

Abstract

The purpose of this study was to conduct exploratory research to determine the extent to which therapists considered adoption issues when treating adoptive families, and to assess the types of treatment models therapists chose when treating adoptive families. A written vignette describing an adoptive family was given to 32 therapists, and their discussion of the family was recorded during audio-taped interviews. The results of the study and treatment recommendations for working with adoptive families are discussed.     

Évaluation du sentiment d’efficacité des cliniciens lors d’une formation TCC pour la gestion des hallucinations auditives en groupe : étude Accept Voices©

ObjectivesThe objective of this study was to measure clinicians’ self-efficacy (psychologists and psychiatrists) in helping their patients cope with auditory hallucinations, before and after receiving a specific training in this regard. This research work was part of a larger clinical research project to assess the feasibility and effects of a CBT/third wave group approach for the management of auditory hallucinations in patients with schizophrenia. Currently, in France few CBT/third wave approaches to treating patients with schizophrenic disorders who hear voices are being offered. Given our study, we were also interested in determining how efficacious clinicians working with this clientele feel when helping their patients better understand and manage their voices. Our main objective was to train clinicians to become efficacious in working with patients with auditory hallucinations, particularly in using the CBT/third wave group intervention under study.MethodAfter responding to a call for projects launched with nine mental health institutions in the Occitanie region of France, 23 clinicians (psychologists and psychiatrists) accepted to participate and received a three-day training. The purpose of this training was to: 1) develop the basic skills necessary in CBT/third wave to deal with psychotic disorders (non-confrontational approaches, coping development, CBT/third wave principles and basic exercises; 2) acquire competence in managing group sessions for the intervention called Accept Voices; 3) ensure the protocol is respected for the implementation of the study in the region (regulatory and research ethics aspect). A 15-items questionnaire with a response system based on a percentage score was developed specifically for this research. The items addressed different clinical situations, in order to assess clinicians’ sense of self-efficacy in helping their patients manage their auditory hallucinations, both in a group and individually. This measurement was done with clinicians before and after receiving the training.ResultsRegardless of the clinicians’ therapeutic orientation (CBT or psychoanalysis) and the number of years in working with psychotic disorders, the initial level of clinicians’ sense of efficacy in helping their patients manage their auditory hallucinations was relatively low, for both individual and group interventions. Following the training, the 23 clinicians saw their self-efficacy significantly improve, in both conditions (group and individual), regarding their ability to help their patients better manage their voices. Subsequently, after the training, 12 of the 23 clinicians were able to implement the group intervention method for voice management acquired during the training. The three-day training, provided as part of our study, appears to have been sufficient and effective to engage clinicians in implementing and managing the group intervention. It has also helped improve their skills and feelings of efficacy in their daily practice with individuals with schizophrenia.ConclusionThe outcomes from our study, which were part of a larger research project evaluating the effectiveness of a group intervention for auditory hallucinations, allowed us to observe an initial low self-efficacy among clinicians in helping their patients manage their auditory hallucinations. Fortunately, the training appeared successful in improving their self-efficacy. For many, helping patients cope with auditory hallucinations with psychotherapeutic tools, rather than solely with medication, was deemed difficult prior to the training. Despite the small size of our sample, these results encourage further initiatives to train clinicians who accompany patients with psychotic disorders in CBT/Third wave therapeutic approaches.     

Competence feedback improves CBT competence in trainee therapists: A randomized controlled pilot study

Objective: The development and improvement of therapeutic competencies are central aims in psychotherapy training; however, little is known about which training interventions are suitable for the improvement of competencies. Method: In the current pilot study, the efficacy of feedback regarding therapeutic competencies was investigated in cognitive behavioural therapy (CBT). Totally 19 trainee therapists and 19 patients were allocated randomly to a competence feedback group (CFG) or control group (CG). Two experienced clinicians and feedback providers who were blind to the treatment conditions independently evaluated therapeutic competencies on the Cognitive Therapy Scale at five treatment times (i.e., at Sessions 1, 5, 9, 13, and 17). Whereas CFG and CG included regular supervision, only therapists in the CFG additionally received written qualitative and quantitative feedback regarding their demonstrated competencies in conducting CBT during treatment. Results: We found a significant Time × Group interaction effect (η²?=?.09), which indicates a larger competence increase in the CFG in comparison to the CG. Conclusions: Competence feedback was demonstrated to be suitable for the improvement of therapeutic competencies in CBT. These findings may have important implications for psychotherapy training, clinical practice, and psychotherapy research. However, further research is necessary to ensure the replicability and generalizability of the findings.     

Attitudes and Perceived Barriers to Working with Families of Persons with Severe Mental Illness: Mental Health Professionals’ Perspectives

A state-wide survey of 453 clinicians serving people with severe mental illness in community mental health centers evaluated the degree to which they provide services to families and their perceptions of barriers to developing such services. Most clinicians did not provide many services to families and reported barriers related to the family or client (e.g., family’s lack of interest) and their own work environment (e.g., heavy workload). Clinicians who had received prior training on working with families provided more services, had more positive attitudes toward family, and felt more competent about their knowledge, confirming the importance of staff training.     

Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

BackgroundFND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management.AimThe aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder.MethodsThe survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations.Results568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%).DiscussionBetter training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis.ConclusionThis survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.     

Gay and bisexual men who disclose their sexual orientations in the workplace have higher workday levels of salivary cortisol and negative affect

Background: Previous research has shown that gay and bisexual men who conceal their sexual orientation suffer more adverse physical health problems relative to men who are more “out.” However, little is known about the physiological mechanisms underlying this association.Purpose: This study examined whether concealing sexual orientation in the workplace was associated with increased workday levels of salivary cortisol.Methods: Seventy-three gay and bisexual men responded to questionnaires assessing the extent to which they are open about their sexual orientations at work and other aspects of their work environment. Men then provided saliva samples and reports of negative affect throughout 2 consecutive days-1 at home and 1 at work.Results: Contrary to expectations, being more out at work was associated with higher workday levels of salivary cortisol (B = 0.21, SE B = 0.09, p < .05) and higher workday reports of negative affect (B = 0.14, SE B = 0.07, p < .05), controlling for home day values.Conclusions: These findings suggest that it is disclosure rather than nondisclosure of sexual orientation by gay men in the workplace that is associated with emotional and physiological activation; a pattern that may have implications for their long-term adaptation. This research was supported by a training grant awarded to the first author from the Preventive Intervention Research Center (P30 MH39246), and by Faculty Grant-In-Aid from Arizona State University awarded to Mary C. Davis. David M. Huebner is now at the Center for AIDS Prevention Studies, Department of Medicine, University of Califorina.     

The Journal-Reading Habits of Practicing MFTs

Although authors in the field of family therapy are calling for bridging the gap between clinicians and researchers, it is not clear how well this integration is occurring in our journals. The purpose of this study was to gain a better understanding of the strengths of journal articles for clinicians; identify what weaknesses might exist; and share the implication of this information for authors, editors, or reviewers. In Phase 1, 42 practicing family therapists responded to an open-ended survey to determine the ways in which journal articles are helpful in their practice. Surveys were analyzed through analytic induction and constant comparative methods. In Phase 2, we surveyed family therapy journal editors and asked them about strategies to increase readership among clinicians in journals. In both phases, we identified both themes and categories. Findings indicated that family therapists believe journal articles are helpful when they provide new insights, discuss research relevant to practice, and are easy to read. Some limitations of journals include limited access and the formal language often used. We present recommendations developed by clinicians, editors of family therapy journals, and a former editor of the Journal of Marital and Family Therapy. These recommendations guide authors and editors of family therapy journals on writing and/or supporting clinician-friendly articles.     

Assessment guidelines and clinical implications for therapists working with couples in sexually open marriages

Over time, there has been a significant population that adheres to non-traditional relationship constructions. Whether this is seen as polyamory, swinging, or open marriage, these couples have been marginalized by their monogamous peers and risk being ostracized if they reach out for help from professionals. As therapists, there is a lack of information about non-monogamous couple dynamics and assessment. Additionally, there is a disparity in the training that clinicians receive to be competent in working with couples in non-monogamous relationships. The authors begin by reviewing current literature about the population of interest and define sexually open marriage, as it will be understood throughout the writing. The authors then go on to suggest assessment guidelines, clinical implications for working with couples in sexually open marriages and finally explore limitations and issues that therapists could face when working with this population.     

Therapists’ characteristics associated with the (non-)use of exposure in the treatment of anxiety disorders in youth: A survey among Dutch-speaking mental health practitioners

IntroductionAlthough there is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Previous research pointed to therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety as important factors in the underusage of exposure in the treatment of adult anxiety disorders. This study examined what therapist characteristics may be involved in the (non-)use of exposure in treating childhood anxiety disorders.MethodsAn internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety, depression and stress.ResultsThe current survey showed that therapists used exposure in about half of their cases of childhood anxiety and that the non-use was independently associated with the relatively strong negative beliefs about exposure, therapists’ age, and non-CBT orientation.DiscussionFindings point to the importance of addressing negative beliefs about exposure in therapists’ training and supervision to resolve therapy drift away from exposure, and consequently improve utilization and delivery of exposure-based therapy for childhood anxiety disorders.     

Relationships between work conditions,job satisfaction and burnout in Israeli Ministry of Education art therapists

ABSTRACT

Background: Art therapists in the education system work within a framework that is not therapeutic in orientation, a fact which has implications for their work environment.

Aims: This study examined the relationships between working conditions and between job satisfaction and burnout of art therapists employed by the education system in Israel.

Method: Forty-nine therapists completed a set of self-report questionnaires at the beginning, middle and end of the academic year.

Results: Several significant correlations between the therapists' perceptions of their working conditions and between burnout and job satisfaction were found. The better the therapists' perception of inter-professional team collaboration, the greater their sense of professional efficacy. More satisfactory perceptions of the working conditions in the therapy room were associated with a lesser sense of exhaustion. Most of the correlations between the variables emerged at Time 2, midyear.

Conclusions: Midyear is characterized by more consecutive workdays, which allows for more staff meetings than in the first and last trimesters of the school year and is considered the main period for therapeutic work to take place. The findings, which partially support the hypotheses, also illustrate the moderating role of inter-professional team collaboration on the relationship between the number of clients and the exhaustion dimension of burnout.

Plain-language summary

Art therapists in the education system work within a framework that is not therapeutic in orientation and has highly specific working conditions. This study examined whether there is a relationship between working conditions; the suitability of the therapy room, the quality of the interprofessional team collaboration, and the number of clients, and between job satisfaction and burnout in 49 art therapists employed by the education system in Israel. The therapists were sent an online link from the researchers to complete self-report questionnaires at the beginning, middle and end of the academic year. We found several significant correlations between the therapists’ perceptions of their working conditions and between burnout and job satisfaction. The better the perception of inter-professional team collaboration, the more job satisfaction was reported at Time 2. The better the therapists’ perception of inter-professional team collaboration in the school system, the greater their sense of professional efficacy at Times 1 and 2 and the less their sense of exhaustion at Time 2. More satisfactory perceptions of the working conditions in the therapy room were associated with a lesser sense of exhaustion at Times 1 and 2. Most of the correlations between the variables emerged at Time 2, midyear. This period is characterised by more consecutive work days, which allows for more staff meetings than in the first and last trimesters of the school year, and is considered the main period for therapeutic work to take place. The findings also show that inter-professional team collaboration affects the relationship between the number of clients and burnout from exhaustion.     

Therapeutic boundary issues in working with childhood sexual-abuse survivors

The article describes a study of therapists involved in treating survivors of childhood sexual abuse. The authors focus on what induces participants to change their usual therapeutic boundaries. Through qualitative research utilizing extensive interviews, written questionnaires, and a focus-group discussion, the authors gathered information from therapists related to situations that influence them to change their own boundaries. Emergent themes are discussed and the information is integrated with the authors' experience of supervision and psychotherapy. Concern for client safety is the commonly recurrent issue that pushes therapists to change their boundaries. Other intense feelings, such as resentment of the client, worry about the client's feelings, a wish to connect and imbue hope are also strong influences. Self-disclosure boundaries of the therapist are challenged by the wish to balance power within the relationship. Supervision provides an opportunity to examine what influences therapists to make subtle boundary shifts before they become harmful boundary crossings.     

New mother/old therapist: transference and countertransference challenges in the return to work

Psychodynamic psychotherapists are not generally accustomed to discussing with patients the impact of their own personal experiences on their clinical work. Psychotherapists who return to work postmaternity leave, however, have both a rich opportunity and a clinical mandate to explore the effects of their new parenting on the treatment field. Pregnant therapists have addressed their pregnancy with their patients; however, the experiences of both therapists and patients postmaternity leave are often not discussed to the same extent. Using the author's own experience following her return to clinical work following the birth of her child, this paper explores the ways that the psychodynamic work is affected when the therapist has become a parent, including: changes in transference work; problems of separation and abandonment; and expanding boundaries.     

Self-criticism in therapist training: A grounded theory analysis

Objective: The primary objective of this study is to engender an understanding of how therapists-in-training experience and cope with self-criticism in the context of their clinical training and therapy experiences. Method: In this study, trainees were interviewed about their experience of self-criticism related to psychotherapy practice and these interviews were subjected to a grounded theory analysis generating a core self-critical process. Results: The analysis highlighted the vulnerability of self-criticism in therapists‘ training experiences, especially when they related to balancing the ”expert“ role while maintaining authentic interactions with their clients. The results also described ways in which self-criticism is mitigated by a sense of interpersonal safety and the provision of clinical freedom and flexibility in therapists‘ training. Conclusions: The implications for future psychotherapy research and clinical training within clinical training environments are discussed.     

Creating Through Loss: An Examination of how Art Therapists Sustain their Practice in Palliative Care

Abstract

In this article it is argued that therapists working in the field of palliative care should be more open to acknowledging their own needs and feelings of loss when clients die. A review of the art therapy literature demonstrates that there has been a reticence about looking at this feature of our work and the reasons for this are examined. The second part of the article considers the arguments for and against working with the transference and countertransference relationship with this client group. By drawing upon personal experience as an art therapist working in palliative care, the author discusses the positive advantages that can be accrued by working in this way. He suggests that a more active engagement with transference and counter-transference issues would enhance practitioners efforts in this field, by enabling art therapists to retain their own creativity and versatility. The article concludes that an awareness of transference issues is necessary not only for sustained good practice, but for long-term survival of the therapist as well.     

Therapist effectiveness: Implications for accountability and patient care

Abstract

Significant therapist variability has been demonstrated in both psychotherapy outcomes and process (e.g., the working alliance). In an attempt to provide prevalence estimates of “effective” and “harmful” therapists, the outcomes of 6960 patients seen by 696 therapists in the context of naturalistic treatment were analyzed across multiple symptom and functioning domains. Therapists were defined based on whether their average client reliably improved, worsened, or neither improved nor worsened. Results varied by domain with the widespread pervasiveness of unclassifiable/ineffective and harmful therapists ranging from 33 to 65%. Harmful therapists demonstrated large, negative treatment effect sizes (d=?0.91 to ?1.49) while effective therapists demonstrated large, positive treatment effect sizes (d=1.00 to 1.52). Therapist domain-specific effectiveness correlated poorly across domains, suggesting that therapist competencies may be domain or disorder specific, rather than reflecting a core attribute or underlying therapeutic skill construct. Public policy and clinical implications of these findings are discussed, including the importance of integrating benchmarked outcome measurement into both routine care and training.