Social Work News Headlines

Updated on: Sun, 27 May 2018 06:00:33 GMT

Introduction to special issue: Cultural processes in psychotherapy.
This article introduces the special issue on cultural processes in psychotherapy. The special section was organized to highlight both the clinical and research aspects of the cultural processes in psychotherapy from a variety of different theoretical orientations, perspectives, and methodologies. Additionally, I discuss some ideas for a future culturally focused psychotherapy scholarship. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Extending the context-responsive psychotherapy integration framework to cultural processes in psychotherapy.
Psychotherapist competence in attending to cultural processes has long been considered an ingredient of successful treatment. Although some research findings support a positive association between clinician multicultural competence (MCC) and client improvement, others suggest that MCC may not be a skill that therapists uniformly acquire and then stably maintain. Rather, MCC is likely more fluid and contextualized, potentially rendering within-therapist variability across their patients and within-dyad variability across different moments in a given case. With such variability in perceptions and actual behavioral manifestations of therapist MCC, it may be important for clinicians to heed contextual markers that call for flexibility and evidence-informed responsivity. To this end, we extend Constantino, Boswell, Bernecker, and Castonguay’s (2013) context-responsive psychotherapy integration framework, a pantheoretical, if-then approach to responding to common clinical process markers with modular, evidence-based therapeutic strategies. Specifically, we present a therapy case supporting that clients’ social and cultural identities can serve as both specific-client contexts in themselves and unique factors that may influence other important therapeutic contexts (e.g., lowered client outcome expectation and alliance ruptures, client change ambivalence/resistance to treatment) that require context-relevant therapist responsivity. With this case, we provide examples both of successful responsivity and missed opportunities. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Therapist effects due to client racial/ethnic status when examining linear growth for client- and therapist-rated working alliance and real relationship.
Using data from 3,263 sessions nested within 144 clients, nested within 19 therapists, we examined client- and therapist-rated working alliance (WA) and real relationship (RR) at Session 3 and growth in WA and RR across the course of open-ended psychodynamic psychotherapy for clients who identified as racial/ethnic minority (REM) or as White. To be included in the analyses, therapists had to work with at least 2 REM and 2 White clients. There were no significant therapist effects for the interaction between client- or therapist-rated WA and client REM status at Session 3, or for client- or therapist-rated RR and client REM status at Session 3. There were, however, significant therapist effects due to client REM status on the interaction between client-rated linear growth in WA and RR, showing that some therapists had stronger WA and RR growth with REM than that with White clients, whereas other therapists had stronger alliance growth with White than that with REM clients. There were significant therapist effects on therapist-rated linear growth in both WA and RR, which indicated that some therapists reported stronger WA and RR growth with all of their clients, whereas other therapists reported weaker WA and RR growth for all of their clients, although this differential WA and RR growth was not related to clients’ REM status. Implications for practice and research are discussed in this paper. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.
This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents’ ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent’s loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent’s response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent’s experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent’s feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

The feasibility of a culturally informed group therapy for patients with schizophrenia and their family members.
Research suggests that group-based psychosocial treatments for schizophrenia provide benefits to patients and family members alike. However, few existing treatments consider cultural factors that may enhance their efficacy with diverse populations. The current study examined the feasibility of a culturally informed group therapy for schizophrenia (CIGT-S), which incorporates collectivistic principles and spiritual coping into the treatment protocol. The feasibility of the group protocol was tested by examining differences in patient symptom severity and patient and family member depression, anxiety, and stress after completion of the group program. Within-groups analyses were conducted comparing baseline data to group termination data from 12 patients and 11 family members. Additionally, between-groups analyses were conducted comparing waitlist termination data from 20 patients and 13 family members to group termination data from 12 patients and 11 family members. Finally, we examined participant satisfaction with the group protocol, including qualitative reports on components of the protocol that participants deemed most valuable. Results indicated that patients demonstrated lower levels of symptom severity upon completion of the CIGT-S program; however, no other significant effects were found. Results examining overall patient and family member satisfaction with the treatment protocol indicated that patients and family members both reported being highly satisfied by the treatment program. This was also represented in participant’s open-ended responses to our satisfaction questionnaire. These findings indicate that CIGT-S may represent a feasible, cost-effective approach that can be flexibly used with patients and family members of diverse racial and ethnic backgrounds. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Extending the multicultural orientation (MCO) framework to group psychotherapy: A clinical illustration.
Multicultural group work has received growing attention over the past two decades; however, there is a lack of conceptual frameworks to guide therapists’ cultural processes within group therapy at present. As such, we extend the multicultural orientation (MCO) to group therapy in an effort to provide a conceptual framework for group therapists to effectively engage multicultural group work. The MCO framework was developed in an effort to operationalize therapists’ cultural processes of cultural humility, cultural comfort, and cultural opportunity. Although the MCO framework has been empirically tested within an individual psychotherapy context, application to alternative therapeutic modalities is needed. Given the inherent multicultural nature of group therapy and calls for group therapist to be culturally competent in the delivery of group-based services, we extend the MCO framework to the practice of group therapy. In this article, we provide a rationale for the application of the MCO framework to the practice of group therapy, and illustrate how group therapists’ cultural humility, comfort, and opportunities can assist in establishing a multicultural group orientation throughout the development of the group. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Psychotherapy with American Indians: An exploration of therapist-rated techniques in three urban clinics.
The aim of the project was to conduct psychotherapy research in American Indian mental health clinics. To date, very little psychotherapy research has been conducted in this area. We report the findings from a multisite investigation of psychotherapy techniques used with American Indians. Psychotherapists, working in three American Indian clinics, were asked to self-report the therapeutic interventions that they used in sessions with 93 separate adult American Indian outpatients. Each therapist rated each client exactly once, and thus data on 93 sessions were collected. Therapists’ self-reported technique use with the Multitheoretical List of Therapist Interventions (McCarthy & Barber, 2009). Ratings were made immediately following the delivery of a session. The common factors approach was the most reported approach, followed by person-centered and interpersonal approaches. However, the therapists reported using techniques from all of the main therapeutic approaches. Technique use was affected by client- (demographic and diagnostic), therapist-, and therapy-related variables. This project represents a promising start to systematic psychotherapy research in busy, urban American Indian clinics. Many psychotherapeutic techniques are utilized, and there are many avenues for future research. A replication with client and observer ratings will be an important next step. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol.
Lesbian, gay, bisexual, and transgender (LGBT) people seek psychotherapy at high rates, and the importance of providing culturally appropriate and LGBT-affirmative psychotherapy has been widely acknowledged. Despite this, remarkably little research has investigated the effects of therapist training in LGBT-affirmative psychotherapy. Here we examined the effectiveness of a training protocol for LGBT-affirmative psychotherapy with 96 mental health professionals, ranging in therapeutic experience from <1 year to 37 years (M = 6.54 years). Across all outcomes, therapists reported increased knowledge and skills related to working with LGBT clients following the training. Therapists also displayed reductions in homo-negativity and trans-negativity. Therapists’ characteristics did not influence the extent to which they benefited from training. Specifically, years of clinical experience, therapist religiosity, and therapist psychological flexibility were unrelated to changes in attitudes, knowledge, and skills. The results of this study clearly suggest that providing training in LGBT-affirmative psychotherapy can enhance therapists’ attitudes, knowledge, and skills. Of particular importance is that the benefits associated with such training appear to hold regardless of therapists’ characteristics. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Responding to gender and sexual minority stress with functional analytic psychotherapy.
Despite an overwhelming literature detailing the impact of societal bias on the well-being and relationships of gender and sexual minority clients, as well as greater rates of help-seeking from mental health professionals, recent advances in minority stress research have not been fully incorporated into clinical practice. Minority stress factors such as internalized stigma, rejection sensitivity, and concealment interfere with vulnerable and intimate relationships, and likely contribute to the transdiagnostic challenges that GSM clients report, such as loneliness and social isolation (Mereish & Poteat, 2015). Further, behavioral patterns emphasizing inauthentic self-presentation are common interpersonal styles of stigma management (Pachankis & Hatzenbuehler, 2013). Functional analytic psychotherapy is interpersonal therapy grounded in a behavior analytic approach to the therapeutic relationship, which was developed to promote generalizable change in intimate and vulnerable behaviors with meaningful others (Kohlenberg & Tsai, 1991). Functional analytic psychotherapy emphasizes the role of contingent responding by the therapist to clinically relevant behaviors, to increase vulnerable, interpersonal risks that can be responded to in a warm and compassionate way. FAP is ideal for adaptation to target the interpersonal aspects of minority stress on gender and sexual minority clients that often include histories of punishment in response to vulnerable authenticity, possibly even by past therapists (e.g., Flentje, Heck, & Cochran, 2014; Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991). (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Intersectionality in psychotherapy: The experiences of an AfroLatinx queer immigrant.
Culturally responsive and racially conscious psychotherapeutic work requires that therapists recognize the ways clients are impacted by their multiple marginalized identities and by systems of oppression (e.g., racism, ethnocentrism, sexism, heterosexism, and nativism). Attending exclusively to clients’ marginalized identities (i.e., weak intersectionality) may drive therapists to only focus on internal, subjective, and emotional experiences, hence, missing the opportunity to consider and address how multiple sociostructural dimensions (i.e., strong intersectionality) may be impacting the client’s presenting problems. Alternatively, focusing solely on the impact of sociostructural dimensions on the lives of clients may miss the more nuanced and variable individual personal experiences. In this article, we highlight the challenge of maintaining a culturally responsive and racially conscious stance when considering multiple marginalized identities, overlapping systemic inequities, and how both affect clients’ lives and experiences. The case of an AfroLatinx queer immigrant is presented to illustrate some of the challenges and opportunities while simultaneously considering (a) the client’s multiple marginalized identities, (b) the way clients are impacted by systemic oppression, and (c) integrating the client’s personal experiences and narratives in psychotherapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Contextual consideration of the emergence of alexithymia: A case study highlighting cross-cultural client factors and limited English proficiency.
Alexithymia, characterized by deficits in recognition or expression of emotional experiences, has been demonstrated to be associated with depressive symptoms. In psychotherapy, alexithymia can partly manifest as stunted, disfluent speech when an individual attempts to describe his or her subjective experiences. However, similarly stunted, disfluent speech can be observed in individuals with limited English proficiency who are not diagnosed with a depressive disorder. For individuals who present with both symptoms of depression and limited English proficiency, it can be difficult to determine if disfluent speech is a clinical symptom secondary to depression or simply a byproduct of a language barrier. Determining the underlying cause of speech disfluency is necessary to inform case conceptualization and treatment planning. The following case study describes a Spanish-speaking woman who presented for outpatient psychotherapy to treat major depressive disorder and generalized anxiety disorder. Challenges to the therapy are described; recommendations for English-speaking psychotherapists in similar clinical situations are also provided. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

The multicultural orientation framework: A narrative review.
After several decades of slow progress, researchers are beginning to make advances in linking constructs based on the multicultural competencies tradition—especially those focused on qualities of the therapist—to therapy outcomes. The multicultural orientation framework was developed in response to several trends within the multicultural competencies tradition, with a particular emphasis on integrating the multicultural competencies tradition into research on psychotherapy process. We provide a narrative review of studies that include one of the three constructs (i.e., cultural humility, cultural opportunities, and cultural comfort) articulated by the multicultural orientation framework. Results indicate initial evidence linking multicultural orientation constructs to therapy outcomes (e.g., perceived improvement, racial/ethnic disparities in termination, and therapy alliance). Results also supported the social bond and social oil hypotheses from theorizing on humility. Implications for future research and therapy practice are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)