<p> This qualitative discovery-oriented case study sought to examine and describe change processes and change mechanisms related to successful treatment with Integrative Behavioral Couple Therapy. The model of psychotherapy change by Brian Doss (2004) was utilized as a framework for this study, which included one couple who experienced marital distress at the outset of therapy and was categorized as &ldquo;recovered&rdquo; at the end of treatment. Cultural considerations were also emphasized in this study. Processes of change included, but were not limited to, vulnerability, unified detachment, and empathic joining. Some notable change mechanisms included increases in acceptance and decreases in negative behaviors. Ideas for future psychotherapy change research are provided. </p>

<p> Although one-third of partners in couple therapy have experienced childhood abuse, our field has developed few specific interventions that address the lingering effects of child abuse on current couple dynamics. A common impact on adult survivors is the struggle to trust their intimate partner. Furthermore, asymmetrical gendered power processes often erode trust. Given the propensity for adult-survivor couples to experience a distrusting emotional culture, this dissertation studied the effect of gendered power dynamics on trust in partner interactions, as well as identified clinical processes of Socio-Emotional Relationship Therapy (SERT) that helped adult-survivor couples change power disparities to a mutually supportive and trusting emotional culture. </p><p> This dissertation includes two publishable papers. The first article articulates relational trust theory, which integrates feminist, social constructionist views with relational ethics. This theoretical conceptualization describes how the intermingling of gendered power interactions and adult-survivor power responses negatively impact emotional connection. The second article presents the results of a longitudinal grounded theory study of video and transcripts of 40 SERT sessions with four heterosexual adult-survivor couples. The findings from the research were applied to an additional four couples to refine the final grounded theory on how to work with the intersection of trust, gender, and power issues of adult-survivor couples. Three key themes on gendered power processes emerged: 1) gendered fear of being vulnerable, 2) unique gendered power approaches, and 3) distrustful reactions. The analysis identifies five key clinical processes to enhance trust: 1) recognize gendered power&rsquo;s effects on relational safety, 2) comprehend the socio-emotional experience of partners, 3) accentuate relational needs, 4) initiate partners sharing power, and 5) identify trustworthiness of partners. The study also delineates components of relational vulnerability that augment trust. </p><p> The final dissertation chapter compares the findings from the grounded theory analysis to current CFT models with adult-survivor couples and discusses clinical implications for addressing the complex interplay of gender, power, and trust in partner interactions. A significant contribution of this dissertation is a better understanding of the link of trust with gender and power dynamics in adult-survivor intimate relationships and how to sensitively address relational processes interfering with trust.</p>

<p>The purpose of this study was to investigate the likelihood of disclosure and comfort in disclosure of personal reactions occurring in the conduct of psychotherapy in the clinical supervision of marriage and family therapy trainees and interns/associates. This study replicated and expanded on Pakdaman, Shafranske and Falender ?s (2014) and Daniel?s (2008) analog studies of the effects of supervisory alliance on self-reported comfort and likelihood of disclosure of personal reactions in therapy with psychology interns and trainees. This study also investigated the relationship between working alliance and experiences of isomorphism and parallel process. There were a total of 161 participants; 56 trainees and 105 interns. The majority of the participants identified as female, Caucasian and heterosexual. Results indicated if trainees have a strong working alliance with their supervisor, they would feel safe and supported when sharing they are having personal reactions in therapy and if they feel isomorphism or parallel process is occurring. The results of this study have implications for supervision of marriage and family therapy therapists and possibly the field of mental health in general, as results were replicated from previous studies. The implications of the results are further explored.

<p> This qualitative phenomenological study explored the experiences of people with relational trauma in NeuroAffective Relational Model (NARM), a somatically based psychotherapy. Utilizing an interdisciplinary approach of depth psychotherapy, neuroscience, attachment, and somatic therapy, the literature review examined the multifaceted impact of relational trauma and the mechanisms of implicit memory and somatic psychotherapy. The literature review also presented verbal and nonverbal therapeutic actions that theoretically support processes of change for the psychotherapy patient. Although much has been written theoretically about the psychotherapy patient&rsquo;s experience, there has been scant qualitative research from the perspective of the psychotherapy patient.</p><p> The researcher conducted interviews with six individuals who had been in NARM therapy to contribute to our understanding of the experience of the somatic, cognitive, emotional, and relational processes in the clinical dyad. The research participants included four females and two males, ranging in age from 30 to 63 years old. Using Giorgi&rsquo;s phenomenological method, interview transcripts were analyzed. Essential constituents were made explicit, and a refined structural description synthesizing the NARM patients&rsquo; common experience was developed.</p><p> The research identified 11 constituents that comprise the essential structure of the lived embodied experience of being in NARM therapy. They include (a) the patient connects to his inner experience of emotions, thoughts, and sensations; (b) the therapist finely attunes to the patient; (c) the therapy experience is present focused; (d) the body and its expressions and sensations are tracked and incorporated; (e) images facilitate the patient&rsquo;s process; (f) the patient&rsquo;s movements are enacted and processed; (g) the patient experiences a new embodied authentic sense of self; (h) the patient&rsquo;s personal resources are highlighted; (i) metaphor supports the patient&rsquo;s process; (j) the therapy experience is titrated; (k) relational patterns are explored.</p><p> The study suggests the value and efficacy of a resource oriented, integrative, psychobiological therapeutic approach which supports affect regulation for patients exploring implicit and explicit processes of self that were shaped by relational trauma. The research indicates that a holistic divergent discourse supports organization, integration and individuation</p><p> <i>Key words</i>: relational trauma, somatic psychotherapy, implicit memory, depth psychology</p>

<p> Military children are often unspoken or underrepresented casualties of modern day wars. The purpose of this study was to develop a method of empirically measuring civilian mental health professionals' perceived knowledge of the culture of the United States Army. The rational-empirical approach was used during instrument development. The study was divided into three phases: item generation, Army expert panel review, and a pilot study with mental health professionals. Ten experts provided quantitative and qualitative data to inform scale item revisions prior to the pilot study. A revised version of the scale was administered to 97 professionals. Three separate versions of the scale were tested throughout the course of the study. </p><p> Principal component analysis with varimax rotation extracted three factors (Army Knowledge, Army Family Processes, and Adaptability of Army Families) explaining 70.96% of the total scale variance. The Cronbach's alpha was 0.98 and the factor loadings ranged from .42 to .84. These findings show the presence of a strong factor structure. Face and content validity was established via the expert panel. The final result was a 30-item, self-report scale that measures the perceived knowledge of Army culture of mental health professionals in a variety of settings. The SACS-Charlie version reflects an initial attempt to measure the most potent knowledge that mental health professionals need to know in order to provide effective and appropriate services for Army children and families. Subsequent studies can further address this goal.</p>

<p> Sharp waves are areas of transient electrophysiological activity on conventional electroencephalogram (EEG) and are controversial as to their role in psychopathology. While some previous research has approached sub-seizure sharp waves as benign phenomena, the position taken in this study is that such activity indicates focal brain abnormalities with demonstrable behavioral correlations. This study explored the hypotheses that prevalence, location, and pattern of distribution of sharp wave activities in psychiatric patients would be associated with significant pathology and would predict specific clinical features. In a sample of 250 outpatient psychiatric patients, seventy-one non-epileptic patients demonstrated focal epileptiform predominantly distributed to frontotemporal regions. Location and distribution patterns of sharp wave activity had significant implications for clinical presentation, including relationship between homologous pairs of electrodes and affective symptom endorsement. Results of this study provide support of the pathological nature of epileptiform activity and suggest location and distribution have significant impact on clinical features. </p>

<p> Few studies have examined differences between online and offline gamblers, with no study to date enlisting the participation of online gamblers in a laboratory-based study. Moreover, research indicates that there is a link between escape and problem gambling, however, no study to date has examined this relationship in online gamblers using an experimental design. The current study is the first to address these gaps in the literature. All 420 participants participated in the non-experimental phase of the study, and 50 participants participated in the experimental phase. All participants completed a demographics form, SOGS, PGSI, GFA-R, BDI-SF, discounting task, and a gambling motivations questionnaire. In the experimental phase, participants' mood state was manipulated using hypothetical scenarios before gambling. The results indicated that online gamblers had a higher rate of problem-gambling severity than offline gamblers, and that online gamblers have used gambling to escape to a greater degree than offline gamblers. In terms of differences in the gambling behavior of online and offline gamblers, online gamblers were found to have played more hands and committed more errors than offline gamblers. No statistically significant results were found across mood conditions, or when the interaction between participants' gambler status and mood condition was examined, although trends in the hypothesized direction were observed. No statistically significant group differences were observed when online gamblers' rate of discounting certain outcomes was compared to offline gamblers' rates. Taken together, these results suggest that some of the differences between online and offline gamblers may help explain the higher prevalence of problem gambling among online gamblers. Although gambling to escape was found to be positively correlated with problem-gambling severity, the experimental results did not support this finding. Future studies should investigate the relationship between escape and problem gambling in online gamblers by using a different manipulation. A more knowledgeable understanding of the differences between online and offline gamblers will lead to better treatment outcomes for individuals who suffer from a gambling addiction.</p>

<p> Previous empirical research demonstrated that major depressive disorder (MDD) had a profound impact on adults. What remained unaddressed in the research was the ability of those with MDD to form positive responses during challenging life events. The purpose of this exploratory quantitative study was to examine the cognitive ability of MDD patients to form positive responses on a standardized psychological assessment. This study, guided by Beck's cognitive theory of depression, was designed to determine whether depressed individuals were prone to negativity and had decreased ability to form positive responses to challenging situations. A 2x2 ANOVA was used to analyze 116 participants who voluntarily completed the Changes in Outlook Questionnaire (CiOQ). Results indicated that the group diagnosed with MDD scored significantly lower than a control group on the positive response scale of the CiOQ and that men diagnosed with MDD scored significantly lower than women diagnosed with MDD on the positive response scale of the CiOQ. This research has positive social change implications in that practitioners may use the findings in developing more effective treatments to help those with MDD to learn to form positive responses in the midst of challenging life events. Practitioners may also develop their ability to recognize when men with MDD are depressed by using the CiOQ to obtain written responses from individuals who do not verbalize depression. This research may also be useful for future research and application within the field.</p>

<p> The paucity of effective alternative or augmentative treatments available for OCD coupled with the emerging potential of mindfulness-based treatments indicate that exploring the potential utility of such interventions for the OCD population is a useful area of inquiry. In addition, although more general examinations of the mechanisms by which mindfulness contributes to positive change have been conducted, those mechanisms of action have never been theoretically linked with the mechanisms of action believed to underlie the mental processes in OCD. The current study will include a critical analysis of the existing literature covering the cognitive and biological bases for understanding the etiology and maintenance of OCD symptomatology, empirical findings on the efficacy and effectiveness of various biological and psychosocial treatments for OCD, research on the effectiveness of augmenting traditional treatments with mindfulness for various psychiatric disorders, and an exploration of the mechanisms of action posited in dismantling studies of mindfulness treatments for various clinical and non-clinical populations. Through an integration of the findings, hypotheses regarding the mechanisms for change are offered along with clinical recommendations for how this understanding might be applied to treating client suffering from OCD. This study's methodology is informed by Pawson's realist synthesis method, whose goal is explanatory rather than summative, making it well suited to carrying out syntheses to develop working explanatory models in areas where data are insufficient to identify and test relationships (Pawson, 2006). The final process of this research involves making logical connections between the proposed components of mindfulness and OCD, developing an explanatory model, and applying such theoretical concepts to clinical practice.</p>

<p> Recent theories of attitudes and cognition have made a distinction between explicit attitudes that are conscious, deliberate judgments people make when asked to do so, and implicit attitudes, or those that are made automatically and without conscious effort (Greenwald and Banaji, 1995). This study integrated research and theory of implicit attitudes about smoking with the Transtheoretical Model's understanding of the process individuals go through as they quit smoking, to test the moderating effect of motivation to change on implicit smoking attitudes and to evaluate the indirect (mediated) effects of implicit smoking attitudes on cigarette demand through explicit smoking attitudes. Participants were <i>N</i>=283 daily smokers who completed an online survey that measured characteristics of their smoking, motivational Readiness to change, decisional balance considerations (Pros and Cons of smoking), and demand for cigarettes (Cigarette Purchase Task), before completing the Smoking Implicit Association Test. Results of multiple regression analyses indicated that as implicit attitudes about smoking became more positive, smokers reported on average more explicit positive attitudes (Pros of smoking) about smoking and less negative explicit attitudes (Cons of smoking) about smoking, beyond the effect Readiness for change had on those explicit smoking attitudes. Readiness to change did not moderate the effect of implicit smoking attitudes on decisional balance considerations. Decisional balance considerations were important predictors of smoker's responses on the smoking purchase task and accounted for the relationship between implicit smoking attitudes and choices on a hypothetical smoking purchase task. More positive implicit smoking attitudes indirectly predicted that smokers would purchase cigarettes at higher average prices before consumption dropped to zero, greater average maximum financial expenditure on cigarettes, and higher average price at which expenditure was maximized. These results may be useful for understanding how cigarette prices affect attitudes about smoking and increase the likelihood that people will quit.</p>