Meaning, trust, and belonging: Exploring the factors that foster elite forced migrant athletes' growth

BACKGROUND AND PURPOSE

Researchers have highlighted elite refugee athletes' acculturation and sport-related challenges upon transitioning into host country sports systems. Using a strength-based approach, we aimed to broaden this view through exploring the internal and external factors that have fostered refugee athletes' abilities to find meaning and growth following their transitions into a national sports system.

METHODOLOGY

Data collection began with an arts-based drawing activity which was then discussed in a conversational interview. Fourteen (n = 11 male, 3 female) national and international refugee athletes participated. The interviews were analyzed using a reflexive thematic analysis, a form of qualitative analysis used to derive commonalities that connect athletes' experiences. The data is represented through polyphonic vignettes (narrative featuring multiple perspectives) to safeguard athletes' anonymity whilst showcasing varying perspectives.

RESULTS

Athletes were at various phases of growth at the time of the interviews. The primary internal factor that facilitated growth was responsibility to find and pursue meaning. External factors of trust and belonging, actualized through supporting elite athletes' personal differences, were external factors that fostered their abilities to find meaning.

CONCLUSION

Elite refugee athletes' growth occurred at the nexus of individual responsibility, trusting relationships, and inclusive sport environments. The findings inform individual and environmental growth-based interventions for current and future elite athletes who face varying adversities within their sports contexts.

"Ethical Care in Secret": Qualitative Data from an International Survey of Exploratory Therapists Working with Gender-Questioning Clients

This is a mixed methods international survey of therapists (n = 89) belonging to Therapy First, an organization supporting the use of exploratory therapy, rather than gender affirmative therapy, with gender-questioning clients. The method used was an electronic questionnaire, producing a 33% response rate from members. Responses were analyzed using thematic analysis. This article reports qualitative responses relating to therapists' experiences of anxiety in working in a hostile professional environment, and their adoption of strategies to minimize risk of allegations of conversion therapy. Therapist strategies included refining existing marketing approaches to serve preferred client groups, and reliance on proven therapy models.

"This Is a Disease" and "Disease Has No Sin": Discourse Constructions of Individuals With Obsessive-Compulsive Disorder With Regard to Being Diagnosed

Obsessive-compulsive disorder (OCD) symptoms have different cultural images in society. Deconstructive psychology studies can contribute to understanding the dominant discourse surrounding these patients, given the prevalence of OCD. The objective of this study was to investigate the discourse of participants regarding "having/receiving a diagnosis of OCD" and the function of this discourse. The research approach was qualitative and language-based, specifically employing Lacanian Discourse Analysis (LDA) perspective. The possible questions and prompts were determined along with the research team, and seven semi-structured interviews were conducted with six participants diagnosed with OCD. The interviews explored how participants referred to their diagnosis, the language they used, and the function of this discourse. The findings revealed that participants diagnosed with OCD insistently used the term "disease" to explain their peculiar and distressing situations, referring to "medical discourse" with expressions such as "This is a disease" and "This disorder." Additionally, they often utilized "religious discourse" with the statements like "Disease has no sin" and "The sick and insane are exempt from their responsibilities." The findings of the current research indicated that when individuals with OCD "receive a name" through a recognized diagnosis, they experience a sense of recognition and validation for their OCD-related problems. Consequently, individuals diagnosed with OCD tend to find "legitimacy" for their irrational or unwanted thoughts and behaviors by taking comfort from their diagnosis. This study provides valuable insights into an understanding of patients with OCD. The findings are discussed in the context of their implications for both theoretical and applied research.

Student Health Services at Historically Black Colleges and Universities and Predominantly Black Institutions in the United States

Introduction

Student health services are associated with improved health outcomes and academic success, particularly among under-resourced college populations. This study compared student health services at Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs) and identified factors associated with the availability of comprehensive health services (CHS).

Methods

We conducted a secondary analysis of 2022 data from the Integrated Postsecondary Education Data System (IPEDS), the Minority Serving Institutions (MSIs) Directory, and the websites of HBCUs and PBIs (n=167). Bivariate and multivariate logistic regression analyses were undertaken to identify institutional variables associated with providing CHS. Institutional variables included college type (public vs. private), MSI category (HBCU vs. PBI), undergraduate enrollment, location, and proportion of Pell grant recipients.

Results

Approximately 13% of HBCUs and 26% of PBIs offered no student health services; 65% of HBCUs and 39% of PBIs offered on-campus CHS with prescribing providers. Four-year HBCUs were five times more likely than 4-year PBIs to have CHS (p=0.014). Institutions with more Pell Grant recipients were less likely to offer CHS.

Conclusions

Access to health care is an important social determinant of health, academic persistence, and achievement for college students. HBCUs were significantly more likely than PBIs to offer CHS. HBCUs are more likely than PBIs to have resources from federal funding, donors, and endowments that may support the development of student health centers and services. Increased funding for PBI health centers could improve access and promote health equity among the most vulnerable student populations.

(In)visibilising pregnancy loss in Southern Malawi

Miscarriages, stillbirths and neonatal deaths have received limited attention in global health programmes and research, even though pregnancy loss is common, traumatic and stigmatised. This paper seeks to illuminate lived experiences of pregnancy loss in southern Malawi, drawing on findings from semi-structured interviews and focus groups with women who have experienced loss, health professionals and community members, and observations of maternity care. Combining thematic and discourse analysis, we show how societal and medical discourses frame women as responsible for (failed) reproduction, and restrict possibilities to speak about, and respond to, loss. Some accounts and (care) practices invisibilise loss and associated suffering. However, invisibilisation may also be intended as support, and underscores rather than denies the social significance of parenthood. Other accounts (e.g. women emphasising faith and acceptance) constitute moral survival strategies to avoid the acquisition of a 'spoiled identity'. We conclude that societal and medical discourses of loss enact stigmatised, subaltern subject positions for women experiencing pregnancy loss, create social suffering, and amount to a form of structural violence. Programmes and interventions should change these discourses.

What is Effective in Massage Therapy? Well, "It Depends…": a Qualitative Study of Experienced Orthopaedic Massage Therapists

Background

Massage has been used as a treatment for musculoskeletal pain throughout history and across cultures, and yet most meta-analyses have only shown weak support for the efficacy of massage. There is a recognised need for more research in foundational questions including: how massage treatments are constructed; what therapists actually do within a treatment, including their clinical reasoning; and what role therapists play in determining the effectiveness of a massage treatment.

Purpose

The aim of this study was to explore what experienced orthopaedic massage therapists consider to be the aspects of their work that contribute to effectiveness.

Setting and Participants

Semi-structured interviews were conducted via Zoom with six experienced orthopaedic massage therapists in Australia.

Research Design

The interviews were analysed using inductive thematic analysis, seeking insights that might be practically applied, rather than theory-driven interpretations.

Results

The participants focused on the underlying differences between clients, between therapists, and between treatments, and clearly indicated that this concept of "difference" was foundational to their view of their work and was the underlying context for the comments they made. Within that frame of "difference", three key themes were interpreted from the data: (1) "Everyone is different so every treatment is different": how they individualised treatment based on these differences; (2) "How therapists cope with difference": how they managed the challenges of working in this context; and (3) "What makes a difference": the problem-solving processes they used to target each treatment to meeting the client's needs.

Conclusions

Participants did not identify specific techniques or modalities as "effective" or not. Rather, a therapist's ability to provide effective treatment was based on an iterative process of treatment and assessment that allowed them to focus on the individual needs of the client. In this case "effectiveness" could be considered a process rather than a specific massage technique.

An exploration of family dynamics in adults who self-harm

OBJECTIVES

The aim of the present study was to explore how adults who self-harm experience family relationships.

METHODS

A phenomenological design was employed to examine the dynamic relationship between self-harm and family systems. Semi-structured interviews were conducted with six female adults who attend a community mental health service and engage in self-harm. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Four superordinate themes emerged from the data and two subordinate themes emerged within each superordinate theme: family interactive patterns (subordinate themes: enmeshed patterns and culture of 'getting on with it'), searching for meaning (subordinate themes: expressing emotional turmoil and engrained worthlessness), relating to others (subordinate themes: guilt and feeling misunderstood) and journey towards life without self-harm (subordinate themes: acceptance and family support).

CONCLUSIONS

Findings emphasise the role of family systems in understanding self-harm in adults. The study highlights the need for family-based interventions for family members who support adults that self-harm.

Men's Access to Outpatient Psychosocial Cancer Counseling

BACKGROUND

Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it.

METHODS

In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically for male patients) over a period of 12 months would be able to increase the percentage of men among patients seeking outpatient cancer counseling (primary endpoint, initial contact; secondary endpoint, all contacts). The intervention effect was quantified by the fitting of generalized linear mixed models to obtain an odds ratio, which was adjusted for cluster structure and for the percentages of first contacts and of all contacts during the 12 months before the start of the intervention.

RESULTS

In 12 regions of Germany (6 each in the intervention arm and the control arm), 11 986 people had first contacts with outpatient cancer counseling, 6004 of them during the intervention phase. The percentage accounted for by men was 30.7% in the intervention arm and 25.7% in the control arm, corresponding to a statistically insignificant model-based adjusted odds ratio (OR) of 1.2 (95% confidence interval [1.0; 1.4], p = 0.08) for the primary endpoint. There were a total of 51 842 counseling sessions (both initial contacts and subsequent contacts), 26 651 of them in the intervention phase. The percentage of these that was accounted for by men was 27.6% in the intervention arm and 22.2% in the control arm; the adjusted OR for this secondary endpoint was 1.3 [1.1; 1.6], p = 0.01).

CONCLUSION

The targeted implementation of malespecific measures on multiple levels can increase, by a small amount, the percentage of men among persons seeking outpatient cancer counseling.

Personal reformulation during the clinical associate psychologist apprenticeship: Exploratory mixed methods evaluation

OBJECTIVES

Clinical associate psychologists (CAPs) train under the auspices of the apprenticeship programme and are a new addition to the psychological workforce. This project sought to evaluate whether a "personal reformulation" (PR) was helpful in terms of personal and professional development during the apprenticeship.

METHODS

A mixed methods evaluation containing a longitudinal quantitative element and a "Big Q" qualitative element with a single cohort of N = 18 CAPs. A PR consists of a 2-hr one-to-one session and a follow-up session with a cognitive analytic psychotherapist. During a PR, a sequential diagrammatic reformulation is produced to aid recognition and revision of potentially problematic relationship patterns at work. Two outcome measures concerning reflective capacity and professional quality of life were completed at the start of the apprenticeship, pre-PR and at 3-month PR follow-up. The semi-structured interviews (n = 11) conducted at the follow-up were analysed using reflexive thematic analysis.

RESULTS

Quantitative changes were limited to significant increases to general confidence and 8/12 apprentices had a reliable increase in confidence in communication. Qualitatively, five overarching themes were found: (1) gaining insight, (2) wellbeing, (3) nature of the space, (4) being an apprentice, and (5) moving forward.

CONCLUSIONS

PRs were generally found to be emotionally challenging, but relatively large amounts of insight are possible from a very brief intervention that can contribute to personal and professional development during clinical training. More controlled research needs to be conducted and wider applications and evaluations of PRs in different professions would be welcome.

Burnout and attachment in oncology and palliative care healthcare professionals

OBJECTIVES

Examine the prevalence of burn-out in health professionals working in a hospital dedicated to patients with cancer. Explore the relationship between attachment style and burn-out in healthcare professionals working in Oncology and Palliative Care.

METHODS

Cross-sectional descriptive and correlational study with a sample of 337 health professionals working in a tertiary hospital dedicated to oncology care. The evaluation protocol included a sociodemographic questionnaire, two burn-out (Copenhagen Burnout Inventory (CBI) and Maslach Burnout Inventory) and attachment (Adult Attachment Scale) scales. Statistical analysis was performed by IBM SPSS Statistics V.25. The tests were performed at a significance level of 5%.

RESULTS

In the sample, there is a predominance of professionals working in oncology services (76,8%). Comparing professionals who work in oncology services and palliative care, it appears that just over half have high levels of personal burn-out, however the groups do not differ significantly (53.5% vs 56.8%, p=0.619); the same is observed in work-related (p=0.626) and patient-related burn-out (p=0.672). The number of hours per week in which one has the perception that is exposed to suffering is positively correlated with personal, work-related burn-out and exhaustion (p<0.05). Correlating the two burn-out scales in the sample, it is observed that higher levels of personal, work-related and patient-related burn-out are associated with higher levels of emotional exhaustion and depersonalisation, as well as lower levels of personal accomplishment (p<0.001). Considering the correlation between the burn-out dimensions and attachment scale, it appears that high levels of exhaustion, depersonalisation, personal, work-related and patient-related burn-out were associated with higher levels of anxiety (p<0.001). Similar results were found in the palliative care professionals sample.

CONCLUSIONS

The constant exposure to the suffering of others places high emotional demands on oncology and palliative care professionals, making them vulnerable to burn-out. Burn-out is a multifactorial process, that involves individual characteristics with environmental effects. There are no significant differences between Oncology and Palliative Care professionals. Higher levels of personal, work-related and patient-related burn-out are associated with higher levels of anxiety. These results suggest that an anxious attachment style increases the risk of burn-out . In the sample, the most important predictor of burn-out was the number of hours per week exposed to suffering. In order to prevent burn-out, there is a growing evidence that suggests mindfulness, exercise, high-quality sleep and pursuit of happiness can improve burn-out in healthcare professionals. This work brings the advantage of using two burn-out assessment scales (particularly CBI scale), in addition to trying to correlate the level of burn-out and attachment in professionals exposed to suffering.

[The Structural Reform of The Psychotherapy Guidelines in Germany]

OBJECTIVES

Our study investigates how psychotherapists implement and assess the newly introduced elements of the structural reform of the psychotherapy guideline in Germany.

METHODS

We asked psychotherapists about their experiences with the structural reform in semi-structured interviews. The data was analysed using qualitative content analysis.

RESULTS

A total of 37 h of audio material from 41 psychotherapists were available. The interviews showed that acute treatment and relapse prevention are welcomed by psychotherapists. However, due to lack of appointment capacity as well as conceptual barriers, these are rarely used. Concerning psychotherapeutic assessment consultations, the opinions were heterogeneous.

CONCLUSION

Individual aspects of the new care elements are assessed positively. However, these can only be implemented to a limited extent and are not sufficient to significantly improve the strained supply situation.

CBT Meets Process: Assimilative Integration with Reference to Group Psychotherapy

This paper offers a brief overview of the historically predominant form of psychotherapy research both for individual and group psychotherapies, the randomized control trial (RCT), and its surrounding controversies and critiques as the backdrop from which new directions in both clinical theory building and research are being pursued, including efforts at building integrative models of treatment. The paper explores one promising integrative model, namely the incorporation of process and dynamic orientations into the province of group cognitive behavioral therapy (CBT) and identifies challenges in implementing this model.

The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study

PURPOSE

The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study.

MATERIALS AND METHODS

We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis.

RESULTS

We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other.

CONCLUSIONS

The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.

Predictors of Satisfaction and Value of Advanced Training for Mental Health Professionals in Wartime Ukraine

The full-scale escalation of Russia's war against Ukraine in 2022 created a surge of mental health issues, requiring urgent, evidence-based interventions to reduce trauma and mitigate stress. Reflecting recommendations from leading specialists in the field, Ukrainian mental health professionals sought to develop appropriate skills and knowledge for working in wartime through advanced training programs. This study aimed to investigate the experiences of Ukrainian mental health professionals having completed advanced training in mental health topics in wartime. A survey design was adopted, using the purposefully developed, and validated 'Wartime Learning Satisfaction Scale'. Regression analysis assessed the hypothesized contribution of four scales (Education, Educator, Learner, and War) to the perceived value of advanced training and learners' satisfaction. Respondents (n = 271) were trained in up to 30 courses (M = 4.27, SD = 3.03) lasting from two to over 120 h. Regression analysis revealed different predictors for satisfaction and value of the courses. Advanced training resulted in higher satisfaction with learning if it matched professional goals of mental health professionals and perceived higher value when relevant to societal demand, consistently constructed, practically useful, and not solely focusing on war-related issues. Respondents who completed all advanced training courses they were interested demonstrated significantly higher confidence in working in wartime. These findings are essential for effective mental health practice during wartime.

The meaning and feeling of the time and space between psychotherapy sessions and everyday life: Client experiences of transitions

OBJECTIVE

To explore how clients in psychodynamic or psychoanalytic psychotherapy, conducted in the traditional in-person setting, experience the transitions in time and space between psychotherapy sessions and everyday life.

METHOD

Twelve semi-structured interviews were analyzed with inductive experiential thematic analysis, focusing on how the participants experience and make sense of the phenomenon in focus.

RESULTS

The participants described therapy as a sheltered space where they could be open, vulnerable, receptive, and present. Approaching and leaving psychotherapy sessions, the participants established different behavioral patterns and routines dealing with their anxieties and resistances. In this in-between area, the participants could handle interconnections and differences between therapy and everyday life. Participants stressed the clinical impact of transitions: transitions affect both therapy and everyday life; disturbed transitions have an adverse impact; transitions are insufficiently addressed in therapy.

CONCLUSION

Transitions between therapy and life appear to be an essential but seldom recognized part of the therapy process beyond the borders of therapy sessions. Implications of these findings for psychotherapy training and practice are discussed, and a tentative transtheoretical framework for further research is proposed.

How therapists respond to "uneven" alliances in couple and family therapy: A conversation-analytic study

This article examines how family and couple therapists respond to uneven alliances with their clients at the micro-level of therapeutic exchanges in the context of Interpersonal Process Recall (IPR) interviews. We operationalize uneven alliance with the interactional concept of asymmetry of affiliation. To this end, first, using conversation analysis (CA), we identify episodes of asymmetry of affiliation in the moment-by-moment conversation between the therapist and the client in therapy consultation. Second, applying CA to the IPR interview data, we examine how therapists orient to the episodes of the session in which the asymmetry of affiliation was identified. The findings demonstrate therapists' two key practices of orienting to the episodes of asymmetry of affiliation: (1) therapists' exclusive identification with one participant by typically invoking gender roles and (2) therapists' investigation of their agency in the emergence of asymmetry.

Moments of change: Clients' immediate experiences when sharing emotions in psychotherapy

OBJECTIVE

In-session processing of emotions is important in facilitating psychotherapeutic change. This study explores how clients in active treatment experience inner changes when sharing emotions in psychotherapy sessions. The aim was to retrieve in-depth knowledge about clients' moment-by-moment experiences of change in a naturalistic psychotherapy context.

METHOD

Two psychotherapy sessions (session 3 or 4 and session 7 or 8) were videotaped and immediately followed by semi-structured interviews with clients (n = 11) in the format of Interpersonal Process Recall (IPR). Interviews were analysed using thematic analysis.

RESULTS

Four themes resulted from analysis: (1) reaching a new clarity about inner struggles; (2) a shift in how I approach and experience my feelings; (3) grieving losses and gaining a more positive understanding of myself; (4) feeling relief and liberation when allowing difficult emotions.

CONCLUSION

The resulting themes took into account the importance of the felt quality of change experiences within sessions, which appears to be important in making micro-processes of change salient. Across themes, we found accounts of shifts in awareness and self-compassion, which we discuss as micro-outcomes that clients can ideally be guided to dwell with.

An auto-ethnographic reflection on the nature of nursing in the UK during the Covid-19 pandemic

In this article I discuss the effects on the patient experience of isolation nursing during the CoronaVirus Disease (COVID)-19 pandemic. An unintended consequence of isolation nursing has been to distance patients from nurses and emphasise the technical side of nursing while at the same time reducing the relational or affective potential of nursing. Such distanced forms of nursing normalise the distal patient in hospital. I consider ways in which this new form of distanced nursing has unwittingly contributed to the continued commodification of nursing care in the British NHS. Autoethnography is used to describe and reflect on the illness experience, the experiences of caregivers and the sociocultural organisation of health care. The findings discuss three areas of the illness experience: intimate nursing care; communication; the 'distanced' patient experience.

Bridge connection between depression and anxiety symptoms and lifestyles in Chinese residents from a network perspective

Background

Lifestyle habits are vital components of the culture of mental health treatment settings. We examined the bridge connection between depressive and anxiety symptoms and lifestyles from a network perspective using a population-based study.

Methods

Face-to-face interviews were conducted with a provincially representative sample of 13,768 inhabitants from the Guangdong Sleep and Psychosomatic Health Survey based on standardized evaluation techniques. We identified the central symptoms by expected influence. The interconnection between depression and anxiety symptoms, as well as the bridge connectivity linking depression-anxiety symptoms and lifestyle factors, were assessed using the bridge centrality index. Network stability and sensibility analyses were performed using a case-dropping bootstrap procedure.

Results

The core symptom that exhibited the highest expected influence was fatigue or little energy, followed by uncontrollable worry, trouble relaxing, and sad mood in the depression-anxiety symptoms network, while guilt was the most interconnected symptom and had the highest bridge strength. Surrounding nodes of each node explained an average variance of 57.63%. Additionally, suicidal thoughts were recognized as collective bridging symptoms connecting lifestyle variables in the network integrating depression-anxiety symptoms with lifestyle factors. Current tobacco and alcohol consumption were positively associated with suicidal thoughts and irritability. Habitual diet rhythm and physical exercise frequency were linked to suicidal thoughts, guilt, and poor appetite or overeating. Suicidal thoughts, irritability, and guilt indicated the greatest connectivity with lifestyle factors. All networks had high stability and accuracy.

Conclusion

These highlighted core and bridge symptoms could serve as latent targets for the prevention and intervention of comorbid depression and anxiety. It might be crucial for clinical practitioners to design effective and targeted treatment and prevention strategies aiming at specific lifestyles and behaviors.

Prevalence and Impact of Revenge Pornography on a Sample of Portuguese Women

Victims of revenge pornography (RP) suffer long-term psychological, personal, and social consequences, given that the spread of explicit content may continue to disturb them throughout their lives. However, there is a scarcity of studies on this phenomenon in Portugal. The present study aims to identify the prevalence of RP and analyze its impact on self-esteem, humiliation, depression, and anxiety, and compare victims and non-victims of RP on these same variables. The sample comprises 274 Portuguese women aged between 18 and 82. The data was collected through an online protocol consisting of a sociodemographic questionnaire, the Rosenberg Self-Esteem Scale, the Humiliation Inventory, and the Brief Symptoms Inventory. From the total sample, 45 (16.4%) participants reported at least one experience of RP. RP victims reported higher levels of humiliation, anxiety, and depression and lower levels of self-esteem than non-victims. However, only humiliation distinguished RP victims and non-victims. RP is a growing phenomenon enhanced by the intensified use of technology. Along with this phenomenon comes the impact on victims, which has long-term consequences. This study contributes to the scientific community since the scientific study of RP and its impact on victims is still incipient.

Primary and Secondary Psychopathic Traits: Investigating the Role of Attachment and Experiences of Shame

Primary and secondary psychopathic traits have been documented in the general population and previous research has shown their link to adult insecure attachment and shame. However, there has been a gap in the literature examining the specific role of attachment avoidance and anxiety, and experiences of shame in the expression of these psychopathic traits. This study aimed to explore the associations between the attachment dimensions of anxiety and avoidance, in addition to characterological, behavioral and body shame with primary and secondary psychopathic traits. A non-clinical sample of 293 adults (M age= 30.77, SD = 12.64; 34% males) was recruited and completed an online battery of questionnaires. Hierarchical regression analyses indicated that demographic variables (age and gender) explained the largest variance for primary psychopathic traits, while the attachment dimensions (anxiety and avoidance) explaining the largest variance for secondary psychopathic traits. Characterological shame had a direct and indirect effect on both primary and secondary psychopathic traits. The findings highlight the need to examine psychopathic traits in community samples as a multidimensional construct, with a particular focus on also assessing attachment dimensions and shame subtypes.

Professional identity research in the health professions-a scoping review

Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.

A Systematic Review of the Association between Parenting Styles and Narcissism in Young Adults: From Baumrind's Perspective

The concept 'parenting styles' has been widely examined to understand the etiology of narcissism for decades. This study aimed to systematically review the empirical research literature regarding the association between perceived parenting styles and narcissism. In this study, Ebscohost, Wiley Online Library, Taylor&Francis, Springer Link, PubMed, PsycNet, ScienceDirect, and Google Scholar databases were searched using identified keywords. An extensive database search resulted in 75 identified publications. Of these, 60 were scrutinized, and in the end, ten studies were included in the review for data synthesis. To reach a common conceptualization on the parenting styles, the results were evaluated based on Baumrind's typology. As a result of this systematic review, we can conclude that there is a relationship between narcissism and parenting styles. In particular, perceived permissive parenting was positively correlated with narcissism. However, the relationship between narcissism and other parenting styles is more complex. Therefore, more high-quality empirical studies are needed to investigate the relationship between parenting and narcissism.

Humiliation and state anxiety as predictors of attenuated psychosis in a community sample

Existing literature suggests that humiliation experiences, coupled with a negative family context, significantly predicts persecutory ideation in non-clinical participants. Whether this may also be linked to attenuated psychotic experiences is unknown. The current study aimed to assess whether familial adversity and humiliation may be related to hallucination-like experiences (HLEs) and other psychotic symptoms, and if state anxiety significantly contributed to these relationships. This cross-sectional study recruited a community sample of 93 adults (38% male; mean age = 27.3 years, standard deviation = 10.8 years), who completed measures of maladaptive familial environments, past and anticipated humiliation experiences, state anxiety and attenuated psychotic symptoms. Correlations and hierarchical regressions tested for direct and indirect relationships amongst study variables. A maladaptive family context, and humiliation (past and anticipated) were positively correlated with HLEs, and facets of attenuated psychotic symptoms. Anxiety uniquely predicted audio-visual and multisensory HLEs. Past humiliation and anxiety jointly predicted cognitive-perceptual disturbance and disorganisation, whereas fear of humiliation and anxiety jointly predicted interpersonal difficulty. Elevated state anxiety, coupled with humiliation, may increase attenuated psychotic symptoms in adulthood. Future research is needed to ascertain if these relationships hold true in clinical cohorts to examine the clinical significance of these data.

Perceived effectiveness of therapeutic community model as a rehabilitation approach for Sri Lankan individuals with substance use disorder

Purpose

This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use disorder (SUD).

Design/methodology/approach

A descriptive cross-sectional study was carried out in two selected residential treatment centers which follow the TC model as a rehabilitation approach. All the clients of the selected residential treatment centers were invited to take part in the study and data were collected from 75 consented male participants using an interviewer-administered questionnaire. The perceived effectiveness of the residential treatment was assessed using the Treatment Effectiveness Assessment instrument. Data were analyzed using descriptive statistics.

Findings

Most of the participants were Sinhalese (98.7%, n = 74) with a mean age of 27.0 ± 6.0 years. The average duration in which participants stayed at selected centers was 8.0 ± 4.0 months. Most of the participants reported that the encouragement during the program was sufficient (89.3%, n = 67), psychological support was satisfactory (89.3%, n = 67), freedom (69.5%, n = 52) and facilities were adequate (76.0%, n = 57) within the program. A higher proportion of participants said that the counselors and program guides were friendly (80.0%, n = 60), and participants were allowed to communicate with their family with restrictions (92.0%, n = 69). The mean perceived effectiveness score (score range 1–40) was 34.0 ± 7.0 and the four domain scores (score range 1–10) were substance use (9.0 ± 2.0), health (8.0 ± 2.0), lifestyle (9.0 ± 2.0) and community (9.0 ± 2.0). The majority (88.0%, n = 66) of the participants perceived a high level of treatment effectiveness.

Originality/value

There is a paucity of empirical evidence on effectiveness of TC model for individuals with SUD in South Asian countries including Sri Lanka. The findings of this study highlight that the participants perceived higher effectiveness of the residential treatment which follows the TC approach for Sri Lankan individuals with SUD.

[Sooner or Later you are no Longer Needed - Even as a Psychotherapist?+A Systematic Literature Review on how Psychotherapists Deal with their Own Aging Process]

Up to now, there is little bundled knowledge about how psychotherapists deal with their own aging. The aim of the present study was a systematic review of the existing literature on the topic of psychotherapists' aging. In a systematic literature search, which was primarily conducted via electronic databases, 55 relevant hits (empirical studies, literature-based texts, books and book contributions, and free text forms) were identified, whose relevant contents were systematically compiled. The literature search revealed a lack of empirical research on the question of how psychotherapists deal with their own aging. Within the systematic review, key findings were presented in areas of 1. age-related issues and challenges among older psychotherapists, 2. resources and sources of experience among older psychotherapists, and 3. engagement with aging and exit from psychotherapy practice. The systematic review illustrates the comprehensiveness of the topics that are relevant in the context of psychotherapists' aging. Dealing with aging also includes the discussion of one's own retirement, whereby the literature suggests a high propensity to work among older psychotherapists, who highly value their status and their individual professional freedoms in old age. It was shown that one's own aging is associated with diverse effects on professional identity and psychotherapeutic work. Future empirical research should address age-related changes in the context of psychotherapeutic work and inquire about attitudes of psychotherapists towards age-related issues. Interests and plans of (older) psychotherapists should be heard and their resources should be used.

Communication as the Origin of Consciousness

Since the middle of the 20th century, more and more data have appeared on the limited role of consciousness in determining human behavior. In this opinion paper, we hypothesize that the basis of consciousness is precisely the communicative function, and discuss relations of consciousness to other cognitive processes such sensory detection, decision-making and emotions. Within the framework of the hypothesis, consciousness is considered as a highly specialized function of the brain, which ensures encoding of personal information as communication messages. On a subjective level, mental representation just means the state of information to be shared in a human group. Accordingly, consciousness affects only those components of human behavior that are associated with the transmission of messages. Sensory detection, decision-making, emotions and other processes are only projected into consciousness during the encoding of information of them. The communication hypothesis assumes that consciousness is an adaptation that increases the efficiency of a collective way of life, and the emergence of consciousness is inextricably linked with the development of language in human culture. In the future, our view of consciousness provides an opportunity for an objective analysis of subjective phenomena by means of a directed study of the formation of messages both at the level of brain processes and at the level of interactions between individuals.

Understanding the Experiences of Elderly Bereaved Men and the Bond With Their Pets

The purpose of this transcendental phenomenological study was to understand the bereaved Older males' experiences with the interaction and ownership of a companion animal after the death of their partner. The primary researcher recruited 13 participants via a criterion-based purposeful sampling method to assure the quality of the information collected. Results revealed six themes: (a) bonds with their pets grew stronger and closer after the loss of their wife; (b) men were able to express their grief to their pets; (c) companion animals helped the men psychologically during grief; (d) pets were influential during times when the wife's presence would have been valuable; (e) companion animals helped men with loneliness and social connection; and (f) companion animals helped men find a new normal by providing a purpose and routine during bereavement. The pets proved to be a source of support for these widowed men.

Perceptions and responses of staff to the sexuality of adults with intellectual disabilities at facilities in the Western Cape Province of South Africa

This study explored perceptions and responses of staff members working at facilities for adults with intellectual disabilities in the Western Cape of South Africa toward the adults' sexuality. Semi-structured interviews were conducted with 12 staff members from four facilities. The data was analyzed using reflexive thematic analysis. Perceptions of service providers were mostly determined by their facility's ethos and policy on sexuality issues. Some staff members regarded sexuality as a human right and supported all aspects of it while others acknowledged sexuality as a right but perceived the adults as incapable and suppressed their sexuality. Attitudes of the adults with intellectual disabilities' families were the biggest hurdle faced by the staff who supported the adults' sexuality. Staff members from different facilities need to learn from each other and direct engagement between the facilities and families is needed to ensure support of the adults with intellectual disabilities to experience sexual autonomy.

Persevering professionals: dilemmas of relationships and self-determination in work with people with intellectual disability - a multi-method study based on interpersonal process recall

The article focuses on social educators' reflections on their own professional practice in encounters with people with intellectual disability receiving services. Drawing on Interpersonal Process Recall, a video-assisted method, together with a focus group interview, the study explores the experiences from in-situ encounters of five social educators employed in a Norwegian municipality. The key findings are that they view relationship-building as integral to their work, they grant primacy to the ideal of autonomy and they strive towards realizing this in their daily work. The study however displays how these emphases might lead to dilemmas, especially between the wish to support the service users' self-determination and the urge to protect them from harm. Of special note was how the service users' increasing use of social media was perceived as a particular challenge for social educators, who were left with an experience of being unable to protect.

Depression and quality of life among Macau residents in the 2022 COVID-19 pandemic wave from the perspective of network analysis

Background

In the summer of 2022, Macau experienced a surge of COVID-19 infections (the 618 COVID-19 wave), which had serious effects on mental health and quality of life (QoL). However, there is scant research on mental health problems and QoL among Macau residents during the 618 COVID-19 wave. This study examined the network structure of depressive symptoms (hereafter depression), and the interconnection between different depressive symptoms and QoL among Macau residents during this period.

Method

A cross-sectional study was conducted between 26th July and 9th September 2022. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), while the global QoL was measured with the two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Correlates of depression were explored using univariate and multivariate analyses. The association between depression and QoL was investigated using analysis of covariance (ANCOVA). Network analysis was used to evaluate the structure of depression. The centrality index "Expected Influence" (EI) was used to identify the most central symptoms and the flow function was used to identify depressive symptoms that had a direct bearing on QoL.

Results

A total 1,008 participants were included in this study. The overall prevalence of depression was 62.5% (n = 630; 95% CI = 60.00-65.00%). Having depression was significantly associated with younger age (OR = 0.970; p < 0.001), anxiety (OR = 1.515; p < 0.001), fatigue (OR = 1.338; p < 0.001), and economic loss (OR = 1.933; p = 0.026). Participants with depression had lower QoL F (1, 1,008) =5.538, p = 0.019). The most central symptoms included PHQ2 ("Sad Mood") (EI: 1.044), PHQ4 ("Fatigue") (EI: 1.016), and PHQ6 ("Guilt") (EI: 0.975) in the depression network model, while PHQ4 ("Fatigue"), PHQ9 ("Suicide"), and PHQ6 ("Guilt") had strong negative associations with QoL.

Conclusion

Depression was common among Macao residents during the 618 COVID-19 wave. Given the negative impact of depression on QoL, interventions targeting central symptoms identified in the network model (e.g., cognitive behavioral therapy) should be developed and implemented for Macau residents with depression.

Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective

OBJECTIVES

This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them.

BACKGROUND

The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience.

METHOD

A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach.

RESULTS

The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness.

CONCLUSIONS

The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.

A Systematic Literature Review of the Career Choice of Helping Professionals Who Have Experienced Cumulative Harm as a Result of Adverse Childhood Experiences

The pervasive effects of cumulative harm resulting from adverse childhood experiences influence all aspects of an individual's life course. Research highlights a relationship between early trauma and career choice; however, there is a dearth of research pertaining specifically to cumulative harm and the influence on career choice in the helping professions. A systematic literature review was conducted to explore the associations of cumulative harm and childhood trauma on career decision making in people in the helping professions. A search was conducted across databases between February 1990 and February 2019 relevant to searches combining three areas of interest: (a) "childhood trauma," (b) "career choice," and (c) "helping professionals." Database searches and further manual searches yielded a total of 208 articles, and 28 studies satisfied all inclusion criteria. Only studies that were peer-reviewed and published between February 1990 and February 2019 were included. The evidence from the review indicated that family of origin dysfunction, parentification, individual characteristics, and traits developed through adversity, and experiential motivations were associated with the career choice in the helping professions. Further research is required to explore different professional cohorts and the utility of life themes as both a source of data for research and reflexive practice in helping professionals.

Understanding Formal Responses to Intimate Partner Violence and Women's Resistance Processes: A Scoping Review

Intimate partner violence (IPV) literature addresses the ways in which women oppose violent male partners through acts of "everyday resistance." There is a limited understanding, however, of the relationship between women's resistance and their formal help-seeking in the context of IPV. Our scoping review, which includes 74 articles published in English-language journals between 1994 and 2017, attempts to help fill this gap by developing systematic knowledge regarding the following research questions: (1) How are formal institutional responses discussed within the literature on resistance to IPV? (2) How does institutional help-seeking facilitate or obstruct IPV survivors' personal efforts to resist violence? We find that institutions and organizations succeed in facilitating resistance processes when they counter victim-blaming ideas and provide IPV survivors with shared community and a sense of control over their futures. However, they fall short in terms of helping survivors by expecting survivors to adhere to a rigid narrative about appropriate responses to violence, devoting insufficient attention to individual-level factors impacting survivors' vulnerability and ability to access help, and replicating abuse dynamics when interacting with survivors. Policy and practice implications are discussed.

Understanding the Body and Embodiment in the Context of Women's Resistance to Intimate Partner Violence: A Scoping Review

Scholars acknowledge that women oppose male intimate partner violence (IPV). Yet there is limited comprehensive knowledge regarding how women's bodies and embodiment, that is, their physical and emotional practices and the cultural and social systems that influence them, figure in this process. Our scoping review helps fill this gap by analyzing and synthesizing 74 research articles published in English-language scholarly journals between 1994 and 2017 to address three research questions: (1) How does existing IPV research conceptualize resistance? (2) To what extent do the body and embodiment appear in this research? and (3) What common themes emerge from investigation of the role of embodiment and the body in the context of IPV? The articles identify several subtypes of resistance strategies including avoidance, help-seeking, violent action, and leaving a violent relationship. The reviewed research also regularly describes women's physical and emotional states in the context of IPV. Only a small number of these texts, however, define or conceptualize embodiment. Our analysis of the manner in which the body figures in women's resistance to IPV yielded four themes: (1) the active body, (2) the injured/constrained body, (3) the interactive body, and (4) the transformative body. We conclude with a discussion of policy and practice implications, such as the need to increase awareness about how institutions enforce embodied norms among victims and use the body to assign blame and/or proffer assistance in the context of IPV.

Engaging with difficult topics and emotional experiences in psychotherapy: A study of helpful therapist acts

OBJECTIVE

The purpose of this study was to explore moments during psychotherapy sessions in which clients experience that they have an opportunity to approach and engage with difficult topics and emotional experiences, with the aim of describing therapists' acts that support clients' in-session engagement.

METHODS

Two treatment sessions of 11 participants were videotaped and immediately followed by an in-depth semi-structured interview, using the interpersonal process recall (IPR) interview method. A follow-up interview was conducted 3 months after the final IPR interview. Participants' accounts were analyzed using thematic analyses.

RESULTS

Five themes of engagement-supportive acts resulted from our analyses: 1. inviting the client by showing acceptance; 2. recognizing the clients' hints and try-out signs; 3. providing information on the process and evaluating clients' expectations; 4. actively helping the clients to notice and stay with difficult experience and 5. showing sensitivity to the client's needs for micropauses. We discuss these themes as acts of recognition.

CONCLUSION

Clients found it was engagement-supportive when therapists implicitly and explicitly recognized the challenges of being in psychotherapy. This recognition could be achieved through the engagement-supportive acts described in the five themes. Therapists should continually make space for and seek a balance between different engagement-supportive acts.

Challenges in the delivery of sex education for people with intellectual disabilities: A Chinese cultural-contextual analysis

BACKGROUND

Staff members' views can have a significant impact on sexuality issues of people with intellectual disabilities. Research on the impact of sociocultural factors in this area in the Chinese context is sparse.

METHODS

Semi-structured interviews were conducted with seven professionals (social worker, nurse, life skills trainer and manager) to explore their experiences of and attitudes towards the sexual needs of people with intellectual disabilities by applying interpretative phenomenological analysis.

RESULTS

The study identified two major themes, each with two sub-themes: 1. Professional handling of the sexual needs of people with intellectual disabilities (sex education and intervention); 2. Barriers (incompatible approaches and parental resistance). Participants also experienced feelings of resignation facing the barriers they encountered. Collectivism and cultural view about sex are potentially the influencing factors.

CONCLUSION

This study highlights the need to adopt an evidence-based sex education programme whose content and delivery should take account of cultural factors.

College students mandated to substance use courses: Age-of-onset as a predictor of contemporary polysubstance use

Objective: College campuses report alcohol and other drug policy violations as the most frequent reason students receive disciplinary referrals and, thus, are mandated to programming. This study sought to determine predictors of mandated students' alcohol use frequency, and the likelihood of early-onset alcohol using college students enrolled in mandated programming engaging in current polysubstance use. Methods and participants: Employing a purposive sampling method, n = 822 participants were recruited from a pool of students who violated their university's alcohol policy between October 2019 and July 2021. Results: Data analysis revealed early-onset alcohol use (p < .001), gender ID (p < .01), Greek Affiliation (p < .001), ethnicity (p < .05), and perceived norms (p < .001) significantly predicted alcohol frequency. Analysis also revealed engaging in early-onset alcohol use significantly predicted current participation in polysubstance use (p < 0.01), outside of controls. Conclusions: University programs should consider exploring polysubstance use targeted interventions to mitigate these harmful behaviors and associated negative consequences.

Outside Looking in: Gay Male Psychotherapists Making Meaning at the Intersection of Identity

A gay identity offers a perspective outside heteronormative narratives characterized by exclusion as well as a radical position of difference. Being a psychotherapist, too, holds complex implications for identity. This paper explores the lived experience of gay male psychotherapists, a group whose voice is seldom heard. Based on interviews with six White South African gay male psychotherapists, a narrative analysis explores their experience of identity and voice. This paper highlights the ways in which the journey to occupying oneself as gay and the journey of becoming a therapist are intertwined. The complex power relations evoked in this experience are explored, and the position of the gay male therapist as "outside looking in" is interrogated as a position of marginality that both excludes and provides a unique vantage point from which to challenge exclusion.

Experiential Group Psychotherapy Training with Undergraduate Students in Spain

This paper describes a single case study design examining the experiences of 14 undergraduate psychology students in Spain who participated in a group psychology course with an analytic, experiential group training component. Our goal was to better understand trainees' experiences as participants in the groups and gather their perceptions on the main mechanisms of learning that occur. Qualitative data came from participants' personal reflective journals, and thematic analysis was used to code these data. Quantitative data came from participants' pre-post scores on a therapeutic factors inventory (Yalom's therapeutic factors). Test scores suggest that altruism, universality, cohesion, increased among participants, from pre- to posttest. In addition, qualitative analysis revealed that the group process followed an expected progression (e.g., hesitant and superficial, to deep and emotionally charged interventions, to themes surrounding closure and integration). We review learning mechanisms identified by participants, such as practice in the observer role and the use of silences in the group. Finally, we review the usefulness of an experiential approach in helping undergraduate students learn about group process, develop interpersonal skills, experience personal growth, and acquire group facilitation skills. Study limitations are also discussed.

Exploring Local Values and Beliefs to Develop School-based Mental Health Anti-Stigma: A Phenomenology Study

BACKGROUND: Students in middle-income countries frequently experience stigma related to mental disorders (MDs). Those with MDs are stereotyped as incompetent, uncontrollable, uncooperative, and dangerous. Stereotypes are predominantly formed and disseminated due to culture and beliefs. Therefore, it is essential to investigate, comprehend, and apply the local values and beliefs to increase the effectiveness of school-based anti-stigma programs. AIM: This study aims to investigate the local values and beliefs related to mental health anti-stigma as early initiation of school-based anti-stigma development. METHODS: This is an exploratory phenomenological study. A total of 30 informants were interviewed personally or participated in focus group discussions. Content analysis was performed to identify related sub-themes and themes. RESULTS: This study identified seven themes and 15 sub-themes. The seventh theme included the importance of school-based anti-stigma, school-based anti-stigma approach, school-based anti-stigma method, media dissemination of school-based anti-stigma information, design of school-based anti-stigma information, the target group of school-based anti-stigma, and collaboration partners of school-based anti-stigma. CONCLUSION: Adolescents in middle school frequently experience stigma regarding their mental health from their peers. Using both Islamic and mental health approaches, integrating internal and external stakeholders, dispelling unfavorable misconceptions and stereotypes, encouraging students to understand and empathize with others, and reducing the harmful effects of mental health stigma were found to help reduce the stigma of mental illness.