Psychological interventions in the context of poverty: participatory action research as practice

Fostering the Reconstruction of Meaning Among the General Population During the COVID-19 Pandemic

The COVID-19 outbreak has seen people in many countries asked to radically modify their way of life in compliance with sweeping safety measures. During the current crisis, technology is turning out to be key, in that it allows practitioners to deliver psychological services to people who would otherwise be unreachable. However, professionals cannot solely rely on their traditional modes of practice, in that different methods are required to bring to light the needs of those affected by the emergency. People are being overwhelmed by a cascade of unusual and unexpected events that are putting a strain on their everyday routines and usual meaning-making systems; ongoing challenges to their employment and financial status will likely divert personal resources away from psychological well-being. We therefore argue that psychologists should also consider the needs of the general population. Among those who may require help-aside from the main targets of psychological intervention, such as healthcare personnel and COVID-19 patients and their relatives-specific attention should be paid to those who are not at the center of the crisis. We suggest that this large segment of potential users may benefit from a non-medical approach focused on the promotion of meaning-making processes. Indeed, the disruptive nature of the current situation hinders sense-making and threatens to undermine psychological balance and well-being, at an individual as well as at a societal level. The present article proposes a methodological perspective based on the reconstruction of meaning-making processes (sense of coherence, predictability, metaphors, narratives). Specifically, psychological interventions should promote personal and collective resources with a view to: "normalizing" current distressful experiences (i.e., acknowledging that such reactions are normal in light of the present situation); widening the observational field, taking relational contexts into account, and promoting an understanding of distressful experiences as coping strategies; fostering meaning-making/reconstruction processes through the use of appropriate metaphors and narratives; promoting a sense of coherence. We present two clinical vignettes to illustrate how these principles might be applied in practice. In conclusion, the exceptional psychological challenges posed by the COVID-19 pandemic require practitioners to adopt a broad and flexible perspective on clinical intervention.

How Stress Influences Purpose Development: The Importance of Social Support

The present study explored the influence of psychological stress on the development of purpose among youth of color living in urban, low-income communities. A qualitative approach based on grounded theory was used to understand how stress-related experiences influence the development of youth purpose in participants’ own words. Findings revealed that participants faced substantial psychological stress in their lives resulting from financial, family, academic, vocational, peer, neighborhood, relocation, and immigration-related stressors. Moreover, stress appeared to act as a barrier to purpose development in two common ways: (a) through youths’ perceptions of impossibility of realizing their goals for the future and (b) through youths’ experiences of regularly being overwhelmed to the point where purpose engagement was not a priority. However, stress could also serve as a motivator to purpose development for youth through (a) pressure from important others who held high expectations and (b) strong desires to escape from contextual stressors, such as violence or financial strain. Four patterns emerged from the data indicating that social support could serve to mitigate stress, propelling youth to develop a sense of purpose.

A Social Ecological Model of Syndemic Risk affecting Women with and At-Risk for HIV in Impoverished Urban Communities

Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer-reviewed literature; secondary data analyses of a cohort dataset including women living with and at-risk of HIV in Bronx, NY (N = 620); and input from a Bronx-based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi-level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi-level interventions might bolster women's resilience by increasing self-worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder-informed model depicts how self-worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population.

'SMS' for mental health—feasibility and acceptability of using text messages for mental health promotion among young women from urban low income settings in India

OBJECTIVE

The current study assesses the acceptability and feasibility of mobile text messages for promoting positive mental health and as a helpline among young women in urban slums of Bangalore.

METHODOLOGY

Forty girls in the age range of 16-18 years from urban slums received messages every day for a month. They could call or message back or give a 'missed call' to the same number whenever they had emotional problems or felt like talking to a counselor. The received responses in the form of return texts, missed calls and return phone calls were recorded. Feedback about the feasibility and acceptability of the mobile messages was collected after a month.

RESULTS

25 out of 40 (62.5%) participants called back, asking for mental health services and to say they felt good about the messages. 23 of 40 (57.5%) messaged back regarding their feelings. 62% reported that they felt supported with the mental health messages. Male family members of nearly half of the participants called back to check the authenticity of the source. Most women did not face any problems because of the messages.

CONCLUSION

This pilot qualitative study indicates that mobile text messages are a feasible and culturally acceptable method for mental health promotion and prevention among young women from urban slums in India. Issues such as consent from the woman and family, ensuring confidentiality and providing authentic and reliable support services, need to be taken into account before attempting to scale up such a service, particularly in vulnerable groups.

Structural Competency as a Framework for Training in Counseling Psychology

The purpose of this article is to explore structural competency as a framework for training in counseling psychology. Structural competency as a guiding paradigm can be an important component of counseling practice that is informed by an understanding of the effects of oppression and structural-level disparities on the psychological well-being of marginalized groups and individuals. We outline a set of training principles that can inform the development of socially responsive curricula in counseling psychology programs. These principles are derived from the need for an emancipatory, liberatory stance among newly trained practitioners and from the need for counseling psychologists to engage in anti-oppression advocacy. We argue that part of this advocacy must involve partnering with clients to counteract the over-reliance on de-contextualized treatments that ignore the role that individual and collective agency can play in bringing about positive psychological change.

Applying mobile technologies to mental health service delivery in South Asia

Mobile phones have increasingly assumed an important role in the treatment of mental disorders in high-income countries. This paper considers such possibilities in the South Asian context. First, a brief review of mobile phone use in mental disorders is provided. Next, data on the market penetration and dissemination of mobile phones in South Asia is presented. Finally, common barriers to treatment for mental disorders in South Asia are evaluated against solutions that could be derived from mobile technologies. Though not without their risks, mobile phones have the potential to increase engagement, treatment, and retention of South Asian patients with mental disorders in unprecedented ways.

Best Practices in the Reporting of Participatory Action Research: Embracing Both the Forest and the Trees 1Ψ7

Participatory action research (PAR) represents an approach that is deeply consonant with counseling psychology’s commitments to social equity and action. However, counseling psychologists who would like to study this literature, or who would like to write about a project of their own, may discover that the reporting of PAR is not straightforward: PAR is a fluid, multifaceted, co-created, idiosyncratic process that does not necessarily correspond to established report-writing conventions. In this article, the authors present best-practices suggestions for writing about PAR based on an analysis of PAR articles published between 2000 and 2008.