Doctor of Philosophy / Department of Family Studies and Human Services / Sandra Stith / Recent years have seen a rise in the medicalization of treatments for erectile dysfunction (ED). While there has been a divide between the medical and psychological communities, some have called for a more collaborative relationship. Little research has been done on the collaboration between medical professionals and psychotherapists in treating ED. This study seeks to increase current knowledge about medical professionals’ referral practices and communication post-referral. An online survey was developed and distributed to the members of the Sexual Medicine Society of North America (SMSNA) (N = 541). Survey questions inquired as to the factors that increased participants’ willingness to refer ED patients, the form of communication participants currently desire to have with psychotherapists and the participants’ desired level of communication with psychotherapists to whom they might refer. Less than ten percent of the medical professionals invited to participate in the study completed the survey (n=50). Those who did complete the survey were primarily male, specialized in urology and practiced in the U.S. Almost half the respondents were employed in an academic setting while just over half of respondents worked in hospital-based, group, or solo practices. Just over half of the survey participants practiced in urban areas. Although the number of medical professionals who completed the survey was small, findings indicated that those who completed a sexual medicine fellowship and who had a larger percentage of their patient population being seen for ED were more likely to refer patients to psychotherapists. Participants who have referred ED patients to psychotherapists reported little-to-no communication between them and the psychotherapists to whom they refer. The study participants expressed a desire to refer patients to psychotherapists who are experienced in working with both sexual and couples issues. Questions about the desires and experiences of medical professionals who have not referred to psychotherapists were not able to be answered because of the limited number of these individuals in the data set. Although the number of participants who completed the survey limits the generalizability of the data, this study demonstrates that most medical professionals who responded to the survey are willing to refer ED patients to psychotherapists.

Adlerian family counseling was developed and systematized by Rudolf Dreikurs and carried into the world by his many student/colleagues, including Oscar Christensen and Manford Sonstegard. This is an experiential workshop using Dreikurs’ model in multiple family consultation demonstrations. Interventions include assessments of family constellation, mistaken goals, typical days, goal disclosure, and the use of encouragement and natural and logical consequences.

This paper presents results from cost-analysis research for treating Post-Traumatic Stress Disorder in adults. Data for this research was provided by Cigna, a nation-wide healthcare manager in the United States of America. The sample size was 12,845 adults who were diagnosed with PTSD and received outpatient individual and family psychotherapy from one of the following mental health care providers: Marriage and Family Therapists (MFTs), Master’s Nurses (RNs), Medical Doctors (MDs), Professional Counselors (LPCs), Psychologists (PSYs), and Social Workers (MSWs). Results were compared across treatment modality, across practitioner license type and between practitioner educational levels. The results demonstrated that family therapy was most cost effective and used the fewest sessions, while mixed therapy was least cost effective. Among practitioner licensure types MDs were found to be the most cost effective, while the group of RNs, MSWs and MFTs were least cost effective compared to one another. Also, no significant differences in cost effective treatment outcomes were found between Masters Level and Doctoral Level practitioners.

This study examined the treatment outcomes for Oppositional Defiant Disorder by provider license type and therapy modality. Administrative data from Cigna Insurance Company for 9,904 ODD cases were analyzed to determine the cost, number of sessions, dropout rates, and recidivism rates for treatment of ODD. Descriptive statistics indicate that the mean cost of treatment for ODD across all professions is $389.83. Analyses revealed significant differences in total cost by profession, as well as cost per session for different license types with counselors providing therapy for the lowest average total cost, followed by MFTs, MSWs, Psychologists and then MDs. Chi square analyses revealed that in the treatment of Oppositional Defiant Disorder, MFTs have the lowest drop-out rate, followed by MSWs, then Counselors and Psychologists together, with MDs having the highest proportion of client drop-out. Results on re-admission rates rank MFTs with the lowest proportion of clients returning to care, followed by MDs, Counselors, MSWs, with Psychologists having the highest re-admission rate. When comparing outcomes by therapy modality, results of ANOVA tests indicate that family therapy is most cost-effective followed by individual, then mixed therapy modalities. Family therapy also had significantly fewer sessions than the other modalities.

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Research has linked emotional regulation to the adaptive functioning of adolescents. Further research suggests that family processes, which include implicit rules, impact children's emotional regulation. The current study examined the impact of implicit rules that are facilitative of family connectedness on development of adolescents' emotional regulation. Data came from the Flourishing Families Project (FFP), a seven-year longitudinal study measuring family processes that impact adolescent development. The sample was collected in the northwestern United States and consisted of 500 families with a target child between the ages of 10 and 14 years. Participants filled out self-report measures on implicit family rules and emotional regulation. Data was organized in a cohort sequential design and analyzed using latent variable growth curve modeling. Results indicated that there was no statistically significant growth in emotional regulation across the adolescent years. Results further indicated that initial status of facilitative rules did not have a statistically significant effect on growth in emotional regulation. Finally, growth in facilitative rules was found to have a statistically significant impact on growth in emotional regulation. Clinical implications for work with adolescents and families are discussed.

Extensive literature suggests that Latino youth experience higher levels of depression when compared to youth from other ethnic backgrounds yet relatively little is known regarding why this particular population is especially susceptible to depression. This study focused on family level stressors and the link between interparental conflict and adolescent depressive symptoms in Latino families. The sample consisted of 400 girls and 290 boys, they were distributed into four groups based on gender and family structure. Written surveys were completed in their respective English classes measuring the aforementioned variables. Results indicated a significant relationship across all four groups between family stressors and interparental conflict, along with interparental conflict and depression. Implications and directions for future research are discussed.

The purpose of this research is to explore differences in the therapeutic alliance for High-Conflict Co-Parents (HCC) vs. Regular Couples. Therapeutic alliance refers to the relationship, consisting of a bond, and agreement on the tasks and goals of therapy, between at least two people in the therapeutic relationship. It was hypothesized that HCC clients would have lower therapeutic alliance scores compared to regular couple clients. The results supported this hypothesis. By identifying these differences, more research can be conducted to improve our understanding of how to strengthen the therapeutic alliance with HCC clients, leading to improved treatment of this population.

Dual roles are common in mental health work. The implications and pitfalls of dual roles are regularly addressed in the legal and ethical literature (Corey, Corey, & Callanan, 2007; Kaplan, et al.; 2009; Moleski & Kiselica, 2005). Most ethical codes caution against entering into dual roles and provide guidance when they cannot be avoided (American Counseling Association, 2005). Dual roles and relationships most frequently addressed in ethical codes included bartering, social relations, and sexual relations. Some of these dual relationships are unethical as well as illegal and should be avoided; for example, sexual relationships with clients. Other dual roles are potentially harmful and should be avoided or managed carefully with a keen awareness of the potential consequences. Bartering for services and social relationships outside of therapy would fall into this category.