Working with multiracial clients in therapy: Bridging theory, research, and practice.

The growing multiracial population has resulted in a need for professional psychologists to become knowledgeable about unique identity issues that may influence therapy with multiracial clients. The overarching goal of this article is to provide clinicians with current theory and research, as well as particular therapeutic strategies that will be useful in their work with multiracial clients. Specifically, this article (a) provides a brief review of some prevalent models of multiracial identity; (b) discusses several common themes derived from theory and research about multiracial identity, which should be taken into account when working with this population; and (c) offers some specific techniques and strategies that may be used in therapy to develop more accurate conceptualizations of multiracial clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies that psychotherapists use in working with stressful clients.

Historically, research in the area of coping has been based on subjective data-gathering techniques and has dealt with specific life crises or the phenomenon of burnout. Many researchers concluded that client contact is the basis of burnout; however, little or no research has dealt solely with the client–therapist interaction. The purpose of this study was to address this interaction. The coping instrument used in this study consisted of selected coping scales of Folkman and Lazarus and of Prochaska and DiClemente, as well as those that we constructed. We identified six coping strategies that psychotherapists use to deal with the stress that they experience in working with difficult clients. Analyses also revealed that certain coping strategies were related to perceived success. By ascertaining coping strategies used by psychotherapists who perceive themselves as successful, both practitioner and researcher can gain a better understanding of how therapists cope with client-generated stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, coping, and marital satisfaction in couples with a depressed wife.

Evaluated the relationships among psychological distress, perceived stress, marital satisfaction, and coping in 20 couples in which the pregnant wife suffered major depression, 20 couples in which the pregnant wife suffered minor depression, and 40 control couples in which the pregnant wife was nondepressed. Consistent with a systems conceptualization of depression, the depressed Ss and their husbands both reported greater dissatisfaction in their marriages and used more dysfunctional coping strategies than did the nondepressed control couples. Whereas both the minor and major depressed Ss differed from the nondepressed Ss with respect to psychological distress and perceived stress, only husbands of the minor depressed Ss differed significantly on these measures from husbands of the nondepressed Ss, reporting greater distress and a higher level of perceived stress. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informing clients about the limits to confidentiality, risks, and their rights: Is self-disclosure inhibited?

Investigated the effects of providing varying amounts of detail regarding the limits to confidentiality in a psychotherapy analog. 24 mildly depressed undergraduates (as determined on the Beck Depression Inventory) were offered an interview to explore their depression and were told it would be much like single-session therapy. Before the interview, Ss were randomly assigned to read and sign 1 of 3 consent forms. Little evidence emerged of significant inhibition of disclosure when detailed information was provided; straightforward encouragement for disclosure eliminated the small inhibitory effect. A 2nd study, with 40 Ss, demonstrated the concurrent validity and sensitivity to change of the major dependent variable. The results of the 2 studies are encouraging not only to psychologists concerned about the moral rights of their clients but also to psychologists who have avoided informing clients about the limits to confidentiality, risks of therapy, and clients' rights because they feared it would necessarily discourage disclosure. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' experiences treating Asian American women with eating disorders.

How do psychologists treat eating disorders (EDs) and subclinical issues in Asian American women in a culturally competent manner? Disordered eating and body dissatisfaction are so common in women that most therapists work with the issues to some degree, and it is increasingly likely they will see women of color. Asian American women are at significant risk and yet little treatment literature exists. Twelve therapists with experience in ED treatment were interviewed about their work with Asian American women. Grounded theory and consensual qualitative analysis methods were used to analyze the data, resulting in two central domains of conceptualization within the cultural context and treatment approach. Therapists reported that their clients were mostly first- and second-generation Americans who experienced acculturation stress and cultural conflict, particularly with elders. Other results suggested therapists perceived a strong connection between clients' desires to be thin and successful, and clients' efforts to conform to traditional Asian cultural values and fit in with U.S. mainstream culture. Therapists emphasized the cultural contextualization of family dynamics, developmental processes (e.g., individuation), and intergenerational conflicts. They viewed EDs as providing clients with culturally congruent coping strategies to affectively disconnect and to express distress. Treatment themes centered on psychoeducation and the importance of including parents in the treatment of their adult daughters. Helping clients navigate autonomy within the family and cultural context, and challenging clients and parents on the cultural (both Asian and mainstream U.S.) pressures regarding achievement and beauty were particularly important. Implications for therapy are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Improving mental health services for Latino and Asian immigrant elders.

Given the changing demographics of the aging population in the United States, it is likely that professional psychologists will encounter elderly clients from diverse backgrounds in their practice. Asians and Latinos represent the 2 fastest growing groups of elderly immigrants. This article offers information and practical suggestions to assist clinicians working with elderly Asian and Latino immigrant clients. Specific recommendations for enhancing assessment and treatment efficacy with these populations are also provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician's reactions to depressive behavior and ill health.

Psychotherapists are susceptible to prevailing negative stereotypes that exist in society at large. Inappropriate negative attitudes toward depressed and ill patients can adversely affect interactions with such clients. The authors examined the reactions of 410 psychologists to vignettes that described a client who emitted either depressed or nondepressed behavior and who varied in terms of cancer prognosis. Clinicians had negative mood reactions after reading the vignette of the depressed client; they also believed the depressed client possessed many undesirable personal attributes. Practicing psychologists are urged to reflect on their attitudes and beliefs so they do not negatively affect assessment and therapy services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of working with older adults in an Australian psychologist sample: Revisiting the influence of contact.

Despite increasing numbers of older people in most global populations and increasing evidence of the efficacy of psychological therapy in older clinical populations, few psychologists work with older clients as compared with other clinical groups. In the present research, the authors examine potential influences on psychologists choosing to specialize in working in the field of aging. The authors surveyed 1,498 psychologists Australia-wide to examine which factors exerted the most influence on choosing to specialize in clinical work with older clients. Clinical exposure to older clients and age-related course content within training programs, together with further education external to formal training, were significantly correlated with specializing in aged care. Holding a more negative attitude toward one's own aging was another predictor of specialist category membership, with interest in working with older clients also being a significant factor based on direct logistic regression analysis. In contrast to previous work, amount or quality of contact with older persons did not appear to relate to working with older adults. These findings highlight the importance of quality training experiences in influencing attitudes toward working with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding stress and burnout in shelter workers.

Crisis intervention workers and other front-line mental health workers often face excessive stress and seek psychotherapy or supervision and support from professional psychologists. The authors sought information on job-related stressors, coping mechanisms, and burnout levels and found that shelter workers who reported high job-related stress and low social support may be most vulnerable to experiencing burnout symptoms. Psychologists providing clinical or consultation services to domestic violence shelter staff should emphasize the importance of creating a supportive work environment, developing a sense of personal accomplishment related to one's work, and teaching and modeling helpful coping strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiver models of self and others, coping, and depression: Predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed, and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive affect and the other side of coping.

Although research on coping over the past 30 years has produced convergent evidence about the functions of coping and the factors that influence it, psychologists still have a great deal to learn about how coping mechanisms affect diverse outcomes. One of the reasons more progress has not been made is the almost exclusive focus on negative outcomes in the stress process. Coping theory and research need to consider positive outcomes as well. The authors focus on one such outcome, positive affect, and review findings about the co-occurrence of positive affect with negative affect during chronic stress, the adaptive functions of positive affect during chronic stress, and a special class of meaning-based coping processes that support positive affect during chronic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical Psychologists as Psychotherapists: History, Future, and Alternatives.

As managed care and other cost-containment strategies become centralfeatures of the American health care system, doctoral-level clinical psychologists will be increasingly supplanted in the role of psychotherapist by lower cost providers such as social workers, marriage and family counselors, and masters-level psychologists. To provide one basis for clinical psychologists to make judgments about their role in psychotherapy, this article describes what the field was like before psychotherapy became a core activity and then compares the present transition with its historical counterpart: the opening up of the psychotherapy profession to doctoral-level clinical psychologists after World War II. History suggests that efforts to resist the current changes will be unsuccessful and that the most adaptive coping strategy for clinical psychologists is to take advantage of the transition by re-envisioning training and practice of clinical psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping effectiveness and coping diversity under traumatic stress.

The effectiveness of different strategies of coping and the impact of coping diversity were tested under traumatic stress conditions. Participants were 632 U.S. soldiers stationed in Iraq (mean age = 27.7, 98 male). Results indicate that four of nine functional coping strategies (including some emotion-focused coping) as defined by the COPE scale were inversely related to psychological symptom, whereas five of six dysfunctional strategies were positively related. Overall, in comparison to the norm group, soldiers showed a depressed level of functional coping strategies. Hierarchical regression, used to control for demographics and coping strategy intercorrelations, indicated that positive reinterpretation, emotional social support, and humor were most strongly related to lower psychological symptoms, whereas venting emotions, denial, mental disengagement, behavioral disengagement, and alcohol and drug use were related to higher levels of psychological symptoms. Two indices of coping diversity were tested. The index more strongly related to higher psychological adjustment was the sum of deviations from the mean of specific coping strategies combined with the alignment of functional and dysfunctional strategy clusters. Implications for research and application were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination stress, coping, and depressive symptoms among Asian Americans: A moderation analysis.

The purpose of our study was to explore: (a) the association between racial discrimination stress and depressive symptoms, and (b) how coping (e.g., individualistic/collectivistic and dispositional/situation-specific coping) attenuated or strengthened this association specifically among Asian Americans. Data were collected from 201 Asian Americans in a large Midwestern state university through an online survey. Results from a hierarchical regression indicated that racial discrimination stress significantly predicted depressive symptoms over and beyond perceived general stress and perceived racial discrimination. For the moderation effect, the simple effect analyses indicated that low utilization of reactive coping strategies and a high helpfulness rating of family support reduced the strength of association between racial discrimination stress and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and linguistic bias in mental health evaluations of deaf people.

Examines assessment issues related to deaf clients, focusing on cultural and linguistic bias. Reliability and validity problems encountered when administering intellectual and personality assessments to hearing-impaired Ss are discussed. Factors influencing psychological assessment are addressed, including inaccurate beliefs and problems with rapport, miscommunication, and using interpreters. It is recommended that research be conducted to refine the psychometric properties of assessment instruments used, that psychologists become more sophisticated about deaf culture, and that psychologists interested in working with deaf clients need to become more skilled in the use of sign language. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping With Employment Uncertainty: A Comparison of Employed and Unemployed Workers.

This study examined coping with stress associated with employment uncertainty for comparable samples of laid-off and employed high-technology workers. It was expected that different coping strategies would be associated with perceived stress for employed vs. unemployed people. Although unemployed participants reported higher levels of stress compared with employed participants, employment uncertainty mediated the association between employment status and perceived stress. Emotion-focused coping strategies were related to higher perceived stress, whereas problem-focused coping strategies were related to lower perceived stress. The use of emotional avoidance as a strategy moderated the effect of employment uncertainty on perceived stress, such that a greater propensity to endorse avoidance coping strategies was associated with higher levels of stress particularly under low uncertainty conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway.

[Correction Notice: An erratum for this article was reported in Vol 42(3) of Professional Psychology: Research and Practice (see record 2011-11548-002). The author's affiliations were listed incorrectly. The correct affiliations are in the correction.] How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Job satisfaction of correctional psychologists: Implications for recruitment and retention.

Do correctional psychologists report levels of job satisfaction consistent with that of psychologists working in other professional areas? Although the number of professionals choosing to work in correctional environments is increasing, relatively little has been written about their job-related experiences. This article explored issues pertaining to career satisfaction among 800 correctional psychologists. Overall, these professionals described a moderate level of job satisfaction. Job dimensions such as safety. job security, and relationships with clients were ranked as most satisfying, whereas opportunities for advancement and professional atmosphere were ranked as least satisfying. Psychologists working in federal prisons or less crowded facilities were comparatively more satisfied. Implications for recruiting and retaining psychologists are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-relationship dilemmas of rural and small-community psychologists.

Sixteen licensed psychologists who lived and practiced in rural areas and small communities participated in interviews about ethical dilemmas they faced in daily practice. Dilemmas involving professional boundaries were identified as significant concerns for all of the psychologists. Major themes were the reality of overlapping business relationships, the effects of overlapping relationships on members of the psychologist's own family, and the dilemmas of working with more than 1 family member as clients or with others who have friendships with individual clients. The psychologists knew the content of ethical codes but often struggled in choosing how to apply those codes in the best interest of clients. Ongoing discussions regarding these choices can contribute to the evolution of practice codes applicable to rural areas and other small communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)