Racial/ethnic disparities in client unilateral termination: The role of therapists’ cultural comfort

The Strong Black Woman Archetype and Therapeutic Outcomes: Examining Relationships Among Women with Childhood Sexual Abuse Histories

The Strong Black Woman archetype (SBWA) describes a cultural pattern where Black women are expected to and present as physically and mentally strong, regardless of past and ongoing stressors. The SBWA has served the historical purpose of aiding survival for Black women throughout years of racial and gender oppression. However, the practice has also been associated with adverse mental health and with behaviors, such as self-silencing, that could impede therapeutic process. The purpose of this empirical study was to investigate the relationships between adherence to the SBWA and therapeutic outcomes (i.e., satisfaction with therapy, satisfaction with therapist, perceptions of one's global improvement in therapy) among Black women with childhood sexual abuse histories-a subpopulation at increased need for mental health treatment and who may be susceptible to high levels of adherence to the SBWA. Black adult female participants (N = 103) completed an online survey including a demographic questionnaire, an assessment of SBWA endorsement, and treatment outcomes from their current or most recent therapy experience. Three hierarchical linear regressions were conducted with SBWA as the independent variable and (i) satisfaction with therapist, (ii) satisfaction with therapy, and (iii) global improvement as the dependent variables. Consistent with our hypotheses, we found that SBWA inversely predicted satisfaction with therapy and the therapist. While the relationship between SBWA and global improvement was statistically significant, the finding was not practically significant. Still, our study findings suggest that higher levels of SBWA predict less favorable therapy outcomes. Future research directions and clinical implications are discussed.

Implementation of implicit bias awareness and action training in a pharmacy residency program

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PURPOSE

To implement an implicit bias awareness and action seminar program for the University of Utah Health pharmacy residency program and measure knowledge, awareness, and comfort around race-related topics.

SUMMARY

An implicit bias awareness training program was implemented with a pre- and post-training survey to measure knowledge, comfort, and confidence around understanding and addressing biases. Fifty-one residents and preceptors participated in the implicit bias training, and 47 (92.2%) consented to take the survey. Twenty pharmacy residents and 27 preceptors attended at least 1 of the 4 training modules and completed the pre- and/or post-training survey. Eighteen of 20 residents (90.0%) and 19 of 27 (70.4%) preceptors completed the pretraining survey (37 total), while 11 of 20 residents (55.0%) and 10 of 27 (37.0%) preceptors completed the post-training survey (21 total). On the post-training survey, more correct answers were obtained for knowledge-based questions and a higher number of responses of strongly agree or agree was observed when assessing participants' comfort and confidence in addressing personal biases, bringing marginalized people into a conversation, addressing biased situations, and intervening when bias is observed.

CONCLUSION

After training, higher scores were attained on the survey for overall comfort and confidence in addressing personal biases and identifying and acting on witnessed biases.

Perceptions of Sexual Risk and HIV/STI Prevention Among Black Adolescent Girls in a Detention Center: an Investigation of the Role of Parents and Peers

Black American adolescent girls constitute approximately one third of the US youth legal system population. Their overrepresentation in the youth punishment system is an indicator of significant physical, sexual, and/or behavioral health needs. Since less is known about perceptions of HIV/STI risk among Black girls with juvenile justice histories, we used intersectionality theory to explore the following: (1) how a sample of Black girls in detention endorse their perceptions of sexual safety given the multiple intersections of their race, gender, and SES and (2) how their endorsements align with interlocking systems of social inequality for system-involved Black at the social structural level. We examined relational and behavioral factors associated perceived HIV/STI risk. Among a sample of 188 Black girls (ages 13-17 years), we examined parent and partner sexual communication, fear of condom negotiation, a positive STI test, and partner risk profile as significant correlates. Major findings indicated that greater partner communication was associated with higher perceived HIV/STI risk, whereas having had a risky sexual partner, fear of condom negotiation, and having had a positive STI test were correlated with lower perceived risk. The significant factors identified in this study can be the focus of STI prevention and intervention programs for Black girls with youth punishment histories.

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers’ Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting

Background

The present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting (IMH-HV) infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental “co-regulation” of infant emotion as a pathway to young children’s capacity for self-regulation. The synchrony of parent–infant interaction begins to shape the infant’s own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and who struggle with symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant–parent relationship may help buffer the effect of parental risk on child outcomes.

Methods

Participants were 58 mother–infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age (<24 months at enrollment) and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences (ACEs) parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder (PTSD) symptoms, as well as their toddler’s socioemotional development (e.g., empathy, prosocial skills, aggression, anxiety, prolonged tantrums).

Results

Maternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment.

Conclusion

Results indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties.

Therapists' Experiences of Working with Ethnic Minority Females with Eating Disorders: A Qualitative Study

Ethnic minority females are less likely to receive a diagnosis or treatment for an eating disorder (ED). This study captured the experiences of therapists who have worked with ethnic minority females to improve outcomes for this group. Twelve therapists in the United Kingdom, London were recruited for semi-structured interviews and thematic analysis was used to analyse the data. Shame was cited as a barrier to accessing help. This influenced therapeutic work such as not challenging shame or linking this to a negative interpretation of parents. Emotional and interpersonal factors were thought to be more common risk factors for the ED. The minimising of weight and shape concern and non-fat-phobic anorexia was thought to lead to a complex and delayed route to accessing ED services. Therapists felt restricted by service management who they felt required them to deliver a narrow range of therapies that had not necessarily demonstrated therapeutic outcomes in ethnic minority females. Nevertheless, therapists reported using curiosity to guide their cultural adaptations when feeling uncertain. When working with ethnic minority females, therapists face challenges from the therapeutic and diagnostic framework that services are aligned to. Creative solutions to address this include adapting the patient care pathway, referral guides, cultural reflective practice, and the use of cultural genograms and scripts in therapeutic work to address unmet needs.

Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy

A cultural opportunity is 1 of 3 pillars within multicultural orientation framework; it is defined as a moment in therapy when aspects of a client's background emerge, which can be deeply explored to better understand the salient aspects of a client's cultural identities. Research on cultural opportunities provides evidence that clients desire cultural conversations. However, no study to date has examined what cultural opportunities sound like in therapy and how therapists and clients utilize these opportunities. Accordingly, the purpose of this study was to examine the ways in which cultural conversations emerge during the first psychotherapy session and how clients and therapists engage in these cultural conversations. Psychotherapy sessions from diverse therapist-client pairings at a university counseling center (n = 22) were analyzed using (reflexive) thematic analysis. Qualitative findings revealed 4 themes around how cultural opportunities emerge (e.g., windowpane of feeling) and 3 themes in how they are responded to (e.g., look out the same window: using client's language to explore culture). Implications for therapist training and supervision are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".