Families play a key role in psychiatric emergency services (PES). Given the cost of PES in terms of dollars and restrictiveness, clients, families, providers, payers, and policymakers involved in these services need more understanding of how families affect these key PES outcomes. Marriage and family therapy theories offer frameworks for understanding family and provider system dynamics in PES. This study explores how family presence and family quality influence restrictiveness and cost of PES dispositions, and how they moderate the effect of suicide risk, homicide risk, and inability to care for self on those outcomes. The sample of 306 clients and 33 clinicians was drawn from the records of a mobile PES unit serving a rural area. A regression-based, quantitative methodology, Hierarchical Linear Modeling (HLM), was employed to explore associations between restrictiveness and client risk and family factors, as well as differences in dispositions between PES clinicians. In order to extend practical implications, the same questions were also examined in monetary terms by translating restrictiveness into cost of dispositions. Results show inability to care for self and suicide risk to be the strongest predictors of increased restrictiveness and cost. Family quality appeared to reduce restrictiveness but not cost and only when not considering interactions with individual risk factors. When interactions were considered, family quality exhibited a statistically significant disordinal interaction with inability to care for self. That is, when clients were unable to care for self, positive family quality worked toward increasing restrictiveness and cost, perhaps due to families seeking help for the client. However, when clients were able to care for self, positive family quality worked in the opposite direction (i.e., toward reducing restrictiveness and cost). Theoretical and practical implications of this interaction were considered. There was found no significant variability in dispositions and associated costs between clinicians, which may be evidence of standardized clinician training and procedures. Non-standardized instrumentation, lack of comparison with other programs or sites, and limited cell sample size are limitations of the study. This study shows the complexity of family systems in PES and provides basis for recommendations for future research and clinical practice. / Ph. D.

This research project utilized concepts and methods from the field of marriage and family therapy, to help leaders from business organizations develop greater relationship competency. A training workshop was designed and then evaluated to improve the quality of the training process, and to answer the following question: what, if any, effect did the workshop have on the participants1 relationship competencies in their work and/or family roles? The workshop participants were 12 people from small to medium sized business organizations who held leadership positions in their companies. The training model consisted of an initial three-day session, followed by a two-month interim period where the participants were given individual coaching, concluded by a two-day follow-up session. Several qualitative methods were used for obtaining data including the use of focus groups, in-depth interviews, and case notes. Formative evaluation processes provided information critical to the program1s improvement. Summative evaluation results indicate that the training was effective in helping individuals increase their relationship competency in the following four areas: 1) increased awareness, 2) greater relationship orientation, 3) new relationship-oriented behaviors, and 4) perceived outcomes. Participants reported having greater awareness of their own cognitive and emotional processes, as well as greater empathy for the experiences of others. Participants1 attitudes became more relationally oriented and were followed by new behaviors that promoted closer family relationships and collaborative work relationships. Participants credited the training with positive relational outcomes such as greater trust, more intimacy, and better communication in selected relationships. Other outcomes, specific to the experience of particular individuals, were also attributed to the training experience. The results provide preliminary evidence that MFT processes may be effective in helping leaders develop interpersonal or relationship competencies in a workshop setting. This study adds to the collection of research where family therapy models have been successfully utilized in diverse human systems contexts. / Ph. D.

In this study I assessed a causal model between caregivers’ prior relationship to care-receivers, commitment to the relationship, and depression in parental and spousal caregiving, based on social exchange and commitment theory. Data (N=695) from the National Survey of Families and Households (NSFH) were used to test a path model examining the effects of relationship quality and commitment, as well as ace, gender, income, education, health, living arrangement, emotional support, and adult children's marital status on depression. This study began the process of combining the social psychological concept of commitment and the gerontological caregiving literature. The expected effects of commitment on depression were not statistically significant for either spousal caregiving or parental caregiving. As for spousal caregiving, caregivers’ health and relationship quality were negatively associated with caregivers’ depression. In parental caregiving, caregivers’ education and health had negative effects on caregivers' depression. The quality of the relationship with spouse or parent was notable for explaining commitment to the relationship. The predicted positive effect of relationship quality with parent on moral commitment was contradicted by a statistically significant finding of a negative effect. Spousal caregivers’ structural commitment to marital relationship was positively affected by the quality of the relationship with spouse. / Ph. D.

Background: The purpose of this study was to examine the impact of a culturally sensitive, cognitive-behavioral family treatment (CBFT) for pediatric patients with Sickle Cell Disease (SCD) to improve pain symptoms, health-related quality of life, functionality, depression, and coping strategies. Individual cognitive-behavioral treatment has been shown previously to be effective at improving pain symptoms, functionality, adaptive coping, and health care utilization, but such benefits have not yet been shown for SCD patients. The present study aimed to address this limitation by modifying the intervention to both include the family and to utilize culturally sensitive practices, which may be particularly relevant for this population. Methods: A non-concurrent multiple baseline design was used to assess the effectiveness of the intervention. A sample of 4 children (ages 8 to 12) and 4 adolescents (ages 13 to 15) participated in the intervention. Manualized treatment consisted of five sessions (including child and parent) that targeted problem-solving skills, cognitive processes, coping strategies, goal setting, and family processes. Outcomes of interest including health-related quality of life, functionality, psychological adjustment, and coping strategies, were assessed by child and parent report at pre-treatment (baseline), post-treatment, and 2-, 4-, and 6-month follow-up. Participants completed daily diaries to quantify pain, anxiety, and functionality. Results: Repeated-measures general linear model analyses were run separately for all outcome variables. A significant main effect of time was found for youth-reported HRQoL, F(4, 20) = 4.6, p=.01, depressive symptomatology, F(4, 20) = 4.5, p=.01, and parent-reported Internalizing, F(4, 16) = 3.4, p=.03, Externalizing, F(4, 16) = 7.2, p=.00, and Total Behavior Problems, F(4, 16) = 7.7, p=.00 from baseline to 6-month post-treatment. The mean frequency of pain symptoms also decreased for five of the eight participants (i.e., visual inspection of the daily diaries from baseline to treatment). Conclusions: These results suggest the potential for clinical gains through the incorporation of culturally sensitive and family-based practices into existing cognitive-behavioral interventions for SCD. The symptomatic improvements observed in the present study indicate gains in both specific domains (i.e., pain), as well as general psychological outcomes (i.e., improvements in depression, health-related quality of life, internalizing and externalizing behaviors). / Ph. D.

The purpose of this sequential exploratory mixed methods study was to develop and test a theory of planned behavior questionnaire that includes both direct and belief-based measures for seeking professional help from a MFT for participants and their spouses during times of relationship distress. To complete this goal, three focus groups (N = 24) were conducted to elicit the salient behavioral, normative, and control beliefs associated with seeking professional help from a MFT for participants and their spouses during times of relationship distress. The data was member checked and then analyzed using thematic analysis. Next, two quantitative measures were constructed, one using the salient beliefs elicited during the focus groups and the second using general questions that assessed participants' overall attitude, perceived norm, and perceived behavioral control. Both measures were placed online pilot tested (N = 102) using Qualtrics panels. The results suggest that the measures were accurate predictors of behavioral intention. The main stage then used both measures to assess the predictive ability of the elicited beliefs. The results also suggest that the beliefs accurately predicted participants' behavioral intentions for seeking professional help from a MFT for them and their spouses during times of relationship distress. The results also indicate that an intervention could be used to encourage troubled individuals, couples, and families to seek professional help from a MFT when experiencing relational issues. / Ph. D.

Book Summary: A model for successful integration of multiple points of view, James R. Bitter's THEORY AND PRACTICE OF FAMILY THERAPY AND COUNSELING, 2nd Edition supports the development of personal, professional, and ethical family practice. The book's concrete, empirically based approaches, as well as diagnostics and visual tools, allow readers to observe others in groups. Updated to reflect recent research and current practice, the Second Edition also includes a new chapter on Object Relations Family Therapy. Case studies, sample dialogues, and exercises help readers apply the concepts they have learned. Available with InfoTrac Student Collections http://gocengage.com/infotrac.

This study utilized Moustakas’ heuristic methodology as the vehicle in which art creation was explored as a coping mechanism to fend off vicarious trauma when working with incarcerated juveniles with extensive trauma histories. During Moustakas’s initial engagement phase, the following questions were considered: What healthy coping mechanisms help a student deal with the harsh realities encountered in practicum? Can the art creation process fend off vicarious trauma? Can the art making process help the counter-­‐transference and help as a container for residual emotions after contact with a client? The data gathered for the study included twenty pieces of art and twenty journal entries, along with a culminating art piece for the Creative Synthesis. Six major themes were found in the researcher’s art work: Figure drawing, Stream of Consciousness Narrative, Duality, Powerlessness/Trapped, Schema Shifts, and Color. The findings of this study suggest that art making acts as a container for negative emotions that result from working with more challenging clinical populations and assists in fending off vicarious trauma.

The purpose of this research was to explore the integration of restorative justice approaches within the structure of group art therapy. The research approach was based on a mixed methods design that incorporated both a survey and a case study of a group. The open group structure posed some challenges; however, four of the adolescents agreed to participate in the research study. Each of the eight group art therapy sessions was structured to include an art directive, psychoeducation, and group discussion. Based on the analysis of the data, restorative justice approaches can be successfully integrated into group art therapy. Findings suggest that the participants experience an ambiguity between the roles of victim and offender and had difficulty distinguishing the short-­‐term and long-­‐ term effects of behavior. The developed curriculum can be beneficial for incarcerated and anger management populations, as well as in school-­‐based programs. Future research may include explorations into the efficacy of the curriculum in a school setting with a closed group format. This research has opened the door for several future studies and has provided valuable information to the art therapy field.

This qualitative case study examined the influencing factors of runaway behavior, trauma, and the survival response of “flight.” The participant, an 18-year-old male residing at a transitional living program, ran away at age 17 and experienced a significant trauma history. Throughout the course of treatment, artwork and clinical notes were used as data. Many themes surfaced in the analysis process, including controlled chaos, body fragmentation, sun symbols, female imagery, and lack of color. The act of running away emerged subtly, whereas, traumatic experiences, chronic in nature and beginning early in life, were acutely evident. While the study was specifically concerned with the “flight” response, due to the age of the client when the traumatic events began, the “freeze” response was more prevalent in his artwork. This suggested that further research with this population may reveal the thread that connects these two survival responses and specifically when the “freeze” response shifts to a “flight” response related to running away behavior.

This research explores the experience of participation in a pilot program that integrated poetry and photography for a group of seven adults living with severe and persistent mental illness. Data was gathered in the form of written, visual and verbal responses generated through a semistructured, qualitative focus group that took the week after the end of the pilot program. The data was categorized and coded using a analytical procedure based on Photovoice, a participatory action research model that seeks to empower research participants by providing them with cameras to document and share issues of importance to their lives. Analysis of the data resulted in the emergence of six overarching themes: 1) The group experience 2) Self vs. other 3) Accomplishment and challenge 4) Confinement vs. freedom 5) Observing vs. Being observed/new perspectives and 6) Memories recalled. These themes were examined against existing literature about the use of photography and poetry in therapy, arts-based and group therapy treatments of severe and persistent mental illness, and the use of participatory and artsbased research in mental health. The findings of this research emphasize the rich possibilities for incorporating linked language/written and visual interventions in the treatment of severe and persistent mental illness, as the two offer complementary but distinct opportunities for healing, growth and self-expression. Moreover, this study demonstrates the importance of including mental health clients as participants in qualitative research regarding their perceptions of treatment, and the fundamentally empowering experience of being viewed and treated as experts on their own lives.