<p> Despite its importance, little is known about how psychologists are trained to reflect on their conduct of psychotherapy. These abilities are collectively known as reflective practice, which is considered a core competence within the field of psychology. This study examined the use of reflective practice by clinical, counseling, and school psychology interns and looked at how reflective practice is being facilitated by supervisors. The study examined the use of reflective practice in different clinical situations and obtained opinions about which reflective practices are believed to most impact clinical effectiveness. The study also examined barriers that may impede engagement in reflective practice. A mixed-method approach, including quantitative and qualitative analyses, was used to examine study questions in a sample of 69 pre-doctoral psychology interns. Results of this study indicated that for clinical cases in which the therapeutic work was &ldquo;going well,&rdquo; psychology interns engaged in reflective practice slightly more than once per month. However, for challenging cases (whether the &ldquo;work was going well or not&rdquo;) reflective practice was reported to increase, on average, to more than once per month, but less than once a week. There was no significant difference in frequency of reflective practices used between &ldquo;challenging cases going well&rdquo; and &ldquo;challenging cases not going well.&rdquo; This study found that supervisors facilitated an average of slightly over half of the total reflective practices measured. Further, the number of practices facilitated by supervisor was significantly correlated with the frequency of reflective practice use among interns. The reflective practices perceived to have the most impact on clinical effectiveness were (a) reflecting on feelings during session, (b) examining personal beliefs and values, and (c) reflecting on the quality of the therapeutic relationship. The most significant barrier to engagement in reflective practice was reported to be time. In regard to interns&rsquo; beliefs about how helpful reflective practice is to clinical practice, two major themes emerged: (a) whether reflective practice was helpful to the therapist (e.g., increased self-awareness) versus (b) if it was helpful to the client (e.g. helped client process their emotions more). Implications for future research and application to clinical practice are discussed.</p>

Thesis (M.A.)--University of Wisconsin--Madison, 1967. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (PH.D.) -- Syracuse University, 2006 / "Publication number AAT 3251809."

<p> Chronic pain is a significant problem in the U.S. pediatric population, conservatively estimated to affect 15% to 20% of children. Few studies have focused on coping strategies African American children use to manage chronic pain. The purpose of this study was to examine coping strategies used by African American children and adolescents ages 11 to 18 years suffering from chronic pain and to examine gender and age differences in this population. The gate control theory provided the framework for the study. The Pain Coping Questionnaire was used to measure coping strategies in a convenience sample of 44 children and adolescents recruited from pain clinics and online pain support groups. Descriptive statistics indicated that active coping was used most often, and emotion-focused coping was used least often. Analyses of variance indicated that age was positively related with cognitive distraction, that male participants used problem-solving more often than female participants, and that female participants sought out social support and used internalizing/catastrophizing more often that male participants. Findings may be used to improve assessment and management of chronic pain by providing mental health professionals and doctors with a better understanding of African American children and adolescents&rsquo; coping strategies.</p><p>

BACKGROUND: Poor mental health and the varying stressors that provoke psychological disturbance are considerable issues that plague the United States young adult population. Within the collegiate student-athlete cohort, where athletes are subjected to unique pressures placed on them secondary to performance demands, significant injury such as an ACL tear requiring surgical reconstruction and a rigorous rehabilitation course remains a major contributor to psychological and physical disruption. Females in particular may be at higher risk of psychological instability due to hormonal and personality factors, increased injury rates, and gender bias that still exists in the collegiate sports world. LITERATURE REVIEW FINDINGS: Despite recognition of the mental health sequelae of injury in this cohort, sports medicine personnel report discomfort in approaching emotional difficulties and mentoring athletes on the utilization of psychological skills. In conjunction, referral to sports psychologists remains low. The use of a universal self-report survey can help athletes and sports medicine providers acknowledge the psychological impact of injury and take proactive action to provide the athlete with the necessary psychological support needed to fully recover and return to play. PROPOSED PROJECT: The goal of this cross-sectional study is to use a previously validated psychometric tool to assess and compare differences in acute psychological response to ACL tear in male and female collegiate soccer players. If there is a consistent gender disparity observed based on survey scores, sports medicine specialists could develop heightened awareness toward a specific gender that is at high-risk for psychological instability following injury and provide immediate psychological intervention if an event occurs. CONCLUSIONS: The use of a psychometric survey to assess mental health in the collegiate athlete population should be standard practice. If used correctly, the tool has the ability to assess injury response and the need for psychological intervention for all athletes suffering from chronic injuries. The benefits are widespread among all parties of the sports medicine team and the end result is increased stability and mental well-being within the athletic environment. SIGNIFICANCE: The clinical significance of the study extends beyond identifying gender and demographic risk factors and aims to stress the importance of recognizing psychological distress following injury and the necessity of appropriate psychological intervention in a large population of student-athletes across the country.

<p> This dissertation explored several internal and external factors in relation to psychiatric readmissions. Internal factors are directly related to the individual i.e., demographic information, diagnosis, admission history and status. External factors are factors outside of the individuals control i.e., length of hospital stay and reimbursement processes. The goal of the study was to explore the impact of multiple factors in relation to the phenomenon of psychiatric readmissions. Dynamic Systems Theory (1994) was used as a theoretical foundation to understand the complexities associated with psychiatric readmissions. The study utilized state archival data provided by the Maryland Health Services Cost Review Commission; an agency charged with collecting statewide hospital data on hospital admissions. </p><p> A quasi experimental study was conducted using a logistic regression design to answer the research question: When taken together do age, sex, ethnicity, diagnosis, insurance type, admission status and length of stay predict psychiatric readmission? This researcher predicted that the null hypothesis will be rejected. The sample included a large state-wide data set of over 130,000 individuals who fell under the criteria of being over the age of 18 when readmitted for psychiatric care in Maryland in 2015. The research methodology includes a logistic regression research design, exploring multiple factors, simultaneously, that impact psychiatric readmissions. </p><p> The results of the study indicate that length of stay is the most important factor impacting psychiatric readmissions. The second most important factor associated with psychiatric readmission, is a psychiatric readmission within 30 days. Medicare and Medicaid were also found to be significant factors associated with psychiatric readmission. Additionally, affective disorders were found to be the primary diagnosis associated with psychiatric readmissions. Lastly, individuals at greatest risk for psychiatric readmissions are between the age of 18-39, are non-Hispanic, are enrolled in Medicare, most likely to be disabled, are diagnosed with an affective disorder and have had a previous psychiatric readmission.</p><p>

There are 2 organizations in Vancouver, the Child Guidance Clinic and the Mental Hygiene Division of the Metropolitan Health Committee, which offer services to maladjusted children. No descriptive account of the work of these 2 clinics has been previously written, particularly from the viewpoint of the social worker. Accordingly, this study undertook a review of the clinic records of a particular group of patients, namely, children of elementary school age, to throw light on the problems and needs in this field. The criteria set for the selection of cases was threefold. (1) The examination took place within a 3 year period (1945 to 1947). (2) Patients were those between the ages of 6 and 12 years, with intelligence quotients of at least 80, who had lived with parents or relatives at least until the age of 5 years, or were still living with them. (3) The children were confined to those residing in Greater Vancouver. The number of cases which satisfied these criteria was 257. These cases were classified into 4 groups on the basis of "problems" or symptoms of maladjustment which led to clinical examination. The classifications adopted distinguished (1) socially unacceptable behaviour, (2) personality reactions, (3) habit disorders, (4) disabilities in specific school subjects. The proportion which this group of 257 cases bears to the total number of cases examined by the clinics is examined, and an attempt is made to demonstrate to what extent the clinical population is a cross-section of the general population, but gaps in information in the clinic records make this possible in part only. A further sample was selected (on a one-in-five basis) from each of the four classifications, in proportion to the number of cases examined by each clinic, as well as to the number of boys and girls in the total survey. More detailed information was obtained from the clinic records on the 52 cases which comprised this sample. An analysis of this material, with the use of case illustrations, throws light on the work of the clinics, and on the factors of disorganization existing within the family and the community which contributed to the maladjustment of the children. The clinical recommendations for the treatment of children are outlined, and so far as possible an evaluation of the outcome of treatment is made. There is evidence that emotionally disturbed patients might be better served by the clinics if more adequate community resources for mentally retarded children existed, thus reducing the number of clinical examinations of such children. More awareness on the part of parents of the availability of clinic services would undoubtedly lead to the earlier referral of many children requiring this kind of help. Improvement of the working relationships between the 2 clinics and between the Child Guidance Clinic and the schools would be beneficial. The enlargement of the Mental Hygiene Clinic staff to include social workers would result in a better integrated clinical service. A third psychiatrist on the Child Guidance Clinic staff would overcome some of the present lacks in clinic services. A treatment and observation centre for emotionally disturbed children is greatly needed in this community. In many instances, staff members of social and health agencies responsible for the preparation of social histories would benefit from brief clinical orientation and discussions with the members of the clinic team on the subject of history taking. The addition of a group worker to clinic teams would enhance the services to maladjusted children. / Arts, Faculty of / Social Work, School of / Graduate

While existing research suggests that caregivers contribute to the onset and maintenance of adolescent substance use, research also posits that caregivers are negatively affected by adolescent substance use. However, caregivers' experiences of adolescent substance use is the subject of little academic research, and it remains poorly understood. This study offers important empirical insights that address this significant gap in the literature. The purpose of this study is to understand how caregivers perceive and describe their experience with their adolescent's substance use. To gain a deeper understanding of the reciprocal relationship between caregivers and adolescent substance use issues, this study uses a phenomenological, qualitative research approach to examine caregivers' experiences of their adolescent's substance use issues. The guiding theoretical framework is family systems theory (FST; Bowen, 1974). Additionally, the study employed a Community-Based Participatory Research (CBPR) approach by actively involving community members, organizational representatives, and researchers in the research process (Israel, Schulz, Parker, & Becker, 1998). Data were collected through in-depth, qualitative interviews with 20 caregivers of adolescents with substance use issues. Data analyses resulted in 6 core themes: 1) Discovering and making meaning of the substance use, 2) A complex issue, 3) A systemic issue, 4) Process of treatment, 5) Parental efficacy, and 6) The silver lining. Results illustrate how parents discovered and made meaning of their adolescent's substance use. Findings explain how adolescent substance use is a complex and systemic issue, often disrupting the entire family system, leaving caregivers questioning their parental efficacy and negotiating the caregiver-child relationship. The results highlight the process of treatment, transformation, and the growth that took place at the individual and family level. Several implications for future research and clinical practice were identified. The study highlights the need to further examine the reciprocal relationship between caregivers and adolescent substance use. Results can also speak to how family-focused treatment of adolescent substance use may be adapted to meet the needs of this unique population. More specific suggestions for future research and for marriage and family therapists working with families experiencing adolescent substance use issues are provided. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2015. / May 20, 2015. / Adolescent, Adolescent substance use, Caregivers, Parenting, Substance use / Includes bibliographical references. / Kendal Holtrop, Professor Co-Directing Dissertation; Lenore McWey, Professor Co-Directing Dissertation; Stephen Tripodi, University Representative; Ming Cui, Committee Member.

abstract: Despite the increasing number of Asian international students in the United States, American society remains discriminatory against the population. Asian international students are exposed to ethnic-racial discrimination against Asians, as well as language discrimination against non-native English speakers. The purpose of this study was to examine whether the two types of discrimination relate to Asian international students’ regard, which refers to their positive or negative evaluations about Asians in American society. It was hypothesized that language discrimination, a particularly relevant form of discrimination for non-native English-speaking immigrants, will be associated with public and private regard, after controlling for ethnic-racial discrimination and English proficiency. The present study tested two hypotheses by conducting hierarchical multiple regression with a sample of 195 self-identified Asian international students. The results supported the first hypothesis, which predicted higher levels of language discrimination would explain a significant amount of additional variance in negative public regard after controlling for ethnic-racial discrimination and English proficiency. The second hypothesis was not supported—language discrimination was not significantly associated with positive private regard after controlling for ethnic-racial discrimination and English proficiency. Limitations, implications, and future directions are discussed. / Dissertation/Thesis / Masters Thesis Counselor Education 2019

The National Guard is a unique, part-time subset of the U.S. military that has been increasingly deployed during recent conflicts, often has a different set of life circumstances compared to full-time Active Duty servicemembers, and is studied much less frequently than are Active Duty populations. Depression, one of the most common mental disorders among both civilian and military populations in the United States (US), is associated with a range of comorbid mental and physical health conditions. The associations between stressful life events throughout the civilian lifecourse—including during childhood—and adult-onset and persistent depression have been documented in some demographic groups, but have not yet been studied in a National Guard population. Stressful civilian life events may be particularly important in this population, due to frequent transitions between military and civilian employment and engagement among Guard members. We used data from the Ohio Army National Guard Mental Health Initiative to investigate the relationship between two domains of civilian life experiences from across the lifecourse and adult depression: (1) early-life adverse experiences, such as being mistreated during childhood, and (2) more recent stressful experiences outside of deployment, such as financial problems or divorce. First, we estimated the relationships between each of these two domains of exposure and the rates of incident depression across four years using Cox proportional hazards models. We found that male servicemembers who reported at least one out of four traumatic childhood events assessed had a 77% higher rate of incident depression during follow-up compared to those who reported no traumatic childhood events, after adjusting for race and age group (95% CI (confidence interval): 1.33, 2.49). When further adjusting for posttraumatic stress disorder (PTSD) in the time between childhood events and depression, this relationship only slightly attenuated (aHR (adjusted hazard ratio) = 1.71, 95% CI: 1.24, 2.35), suggesting that the relationship between traumatic childhood events and adult depression is not driven by PTSD. Furthermore, when stratified by income level, the association between traumatic childhood events and depression was stronger among men making $40,000 per year or less, with an adjusted hazard ratio of 2.06 (95% CI: 1.22, 3.49), compared to men making more than $40,000 per year (aHR = 1.63, 95% CI: 1.09, 2.45). We also found that men who reported at least one out of nine stressful events assessed in the prior year (a time-varying exposure updated over time) had twice the rate of incident of depression overall compared to men who reported no past-year stressful events (95% CI: 1.52, 2.72), adjusting for race, age group, and past-year PTSD. We observed imprecise associations between these exposures and incident depression among women that should be interpreted with caution due to the small sample size (aHR for one or more childhood events: 0.74, 95% CI: 0.35, 1.61 and aHR for past-year stressors: 1.07, 95% CI: 0.57, 2.01). Our second study departed from traditional epidemiologic null hypothesis testing methods, taking instead a prediction approach to studying incident depression. Supervised machine learning—including methods such as tree classification and random forests—have the flexibility to identify predictors that are not pre-specified, and can be used for hypothesis generation. Among both male and female soldiers, we found that reporting verbal abuse by a parent or guardian during childhood, being of mid-level rank status in the military, recently deploying to a non-conflict area, having been robbed, and having been mistreated were all important predictors of incident depression across five years of follow-up. PTSD and traumatic events in adulthood (including combat-related experiences) as well as having children appeared more important for prediction among men compared to women, while military characteristics (e.g., years of service) as well as hearing about traumatic events happening to others (e.g., learning that a family member was in a serious car accident) appeared more predictive of depression for women compared to men. We also identified subgroups of individuals with certain combinations of predictors who were at high risk of depression onset, such as men with both past-year PTSD and a casualty in their unit during their most recent deployment. Overall, prediction accuracies of our algorithms were moderate to good when cross-validated. Our third study returned the specific focus to our two main exposure domains of interest, childhood traumas and adult civilian stressors, but took a different approach for understanding depression as an outcome. While our first two studies assessed depression as a binary construct, our third study identified latent sub-groups of depression symptom patterns—or trajectories—across follow-up using latent class growth analysis, and estimated the associations between life stressors and membership into these different trajectory groups. For both men and women, a four-group depression model was identified, including a stable, symptom free group (showing essentially no depression symptoms at any point during follow-up) that included about 62% of the overall sample, an increasing depression symptom group including 13% of the sample, a decreasing depression symptom group with 16% of the sample, and a “chronic” depression symptom group representing 9% of the sample (staying essentially steady around 4-5 symptoms throughout follow-up). After controlling for sex, race, and age group, soldiers who reported one or more traumatic childhood events had 3.57 times the odds (95% CI: 2.53, 5.05) of belonging to the chronic depression symptom group compared to the symptom free group. Reporting childhood events was also associated with being in the decreasing and increasing depression symptom trajectory groups compared to the symptom free group (aOR (adjusted odds ratio): 2.33, 95% CI: 1.75, 3.11 for the decreasing symptom group and OR: 1.78, 95% CI: 1.29, 2.45 for the increasing symptom group). When controlling for sex, race, age group, and past-year PTSD, time-varying adult stressors had the largest effect on depression symptoms for the increasing depression symptom group compared to other groups, particularly in the last two years of follow-up (where there was an adjusted difference of 1.02 symptoms at each year, for stressors compared to no stressors). The decreasing depression symptom and symptom free groups saw a negligible difference in symptoms when comparing one or more stressors to no stressors, while about a half of a symptom difference was seen for the chronic depression symptom group, unchanging across the follow-up time. All three studies in this dissertation indicated the importance of considering stressful life events that occur outside of deployment when studying the mental health of National Guard servicemembers. These findings may be particularly relevant given the frequent switch between military and civilian engagement in the National Guard, and the relative neglect of this group within military research. Furthermore, our novel machine learning findings helped to bridge the gap between population-level and individual-level prediction of depression among National Guard members. Although replication studies are needed, the results of this dissertation may help inform potential intervention strategies for depression in order to reduce the overall disease burden of the U.S. Army National Guard.