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International, sociocultural, and cross-cultural matters in clinical and counseling psychology
... Despite this increased global outreach of psychologists, there continues to be barriers to providing adequate care to pediatric populations, particularly in regard to the training of future international pediatric psychologists. Often, the training requirements, such as the length of education, needed coursework, practicum experience, supervised practice, and licensure exams vary internationally (Consoli, Khoury, Whaling, Oromendia, & Daouk, 2017). International agreement on the required training to become a psychologist is far behind compared to other areas of health professionals (e.g., medical, nursing), and international standardization and acceptance of training and practice is important as the field of psychology grows worldwide (Helmes & Pachana, 2005). ...
Culturally appropriate, evidence-based assessments and interventions are necessary to reduce mental health and pediatric psychology disparities worldwide. Currently, there are limited opportunities for psychologists from other countries to learn clinical skills in the United States and adapt evidence-based practices to their home countries. The purpose of this paper is to share the personal perspectives of pediatric psychology international trainees and highlight opportunities for future training. We will also review how training programs may be adapted to ensure the successful dissemination of culturally applicable, evidence-based approaches in the trainees’ home countries. Considerations for training international trainees and future research potential are also discussed. A current Japanese trainee who intends to return to his home country (Japan) and a former Emirati trainee who recently returned to his home country (United Arab Emirates) reviewed the current state of pediatric psychology in their countries and shared their personal training experiences in the field of pediatric psychology in the United States. By highlighting different international trainee perspectives, we have recognized that there is a need for ongoing research that addresses how our current training guidelines support international students in pediatric psychology. International trainees in pediatric psychology are well positioned to have a positive impact in their home countries and support the global outreach of evidenced-based psychological assessment and intervention. It is crucial that the field of pediatric psychology commits to training international trainees appropriately so that they can contribute to reducing mental health disparities worldwide.
Facebook may represent a new avenue through which emerging adults can demonstrate risky sexual behaviour and explore sexual identities with online peers. Emerging adults are in the prime of their sexual lives and the importance of sexuality increases as sexual curiosity peaks (Herbenick, Reece, Schick, Sanders, Dodge & Fortenberry, 2010; Levine, 2013). Hence, there is concern about the effects of social networking sites (SNS) such as Facebook on the development and sexual behaviours of emerging adults in Barbados and England, primarily because emerging adults in both countries are at a heightened risk for contracting sexually transmitted infections (Natsal, 2014; Yearwood, 2007). The purpose of the current research is to statistically investigate the relationship between susceptibility to online peer influence as it relates to sexual risk-taking on Facebook, engagement in casual sex and sex with multiple partners among samples of emerging adults. A cross-national comparative study was conducted using an explanatory sequential mixed methods research design. Surveys and focus groups were conducted in both countries. Weak significant positive relationships were found between emerging adults’ susceptibility to online peer influence and risky sexual behaviour. Seven themes emerged from the qualitative data to explain the quantitative findings in both cultural contexts. The developmental needs of Barbadian and British emerging adults in the study are similar and the findings indicate that though potentially dangerous, sexually risqué online behaviours are in accord with the psychosocial challenges confronting this demographic.
Across 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth meta-analysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiproblem treatment (0.15). ESs differed across control conditions, with “usual care” emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science.
Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014 ), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.
This investigation evaluated the effects of cuento therapy (an intervention using Spanish-language tales) on children's self-esteem, affect, and reading test performance. The sample was composed of 58 third-grade Mexican-American students who were randomly assigned to the treatment and control groups. The results showed a mean self-esteem gain score difference between groups in favor of the treatment group for Global, Academic, and General self-esteem scores. Following intervention, the treatment group reported less physiological anxiety than did the control group. The results also showed mean increases in the pre- and post-standardized high-stakes reading test scores for both groups. Other significant findings regarding self-esteem and anxiety are reported.
Background and objectives:
Adolescents with depression identified in primary care settings often have limited treatment options beyond antidepressant (AD) therapy. We assessed the cost-effectiveness of a brief cognitive behavioral therapy (CBT) program among depressed adolescents who declined or quickly stopped using ADs.
Methods:
A total of 212 youth with depression were randomly assigned to treatment as usual (TAU) or TAU plus brief individual CBT. Clinical outcomes included depression-free days (DFDs) and estimated quality-adjusted life-years (QALYs). Costs were adjusted to 2008 US dollars. Incremental cost-effectiveness ratios (ICERs) comparing CBT to TAU were calculated over 12- and 24-month follow-up periods.
Results:
Youth randomly assigned to CBT had 26.8 more DFDs (P = .044) and 0.067 more QALYs (P = .044) on average compared with TAU over 12 months. Total costs were $4976 less (P = .025) by the end of the 24-month follow-up among youth randomly assigned to CBT. Total costs per DFD were -$51 (ICER = -$51; 95% confidence interval [CI]: -$394 to $9) at 12 months and -$115 (ICER = -$115; 95% CI: -$1090 to -$6) at 24 months. Total costs per QALY were -$20 282 (ICER = -$20 282; 95% CI: -$156 741 to $3617) at 12 months and -$45 792 (ICER = -$45 792; 95% CI: -$440 991 to -$2731) at 24 months.
Conclusions:
Brief primary care CBT among youth declining AD therapy is cost-effective by widely accepted standards in depression treatment. CBT becomes dominant over TAU over time, as revealed by a statistically significant cost offset at the end of the 2-year follow-up.
Objective:
This study examined whether therapists' honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier.
Method:
In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires.
Results:
Therapists' Aggressive Humor Style (AHS) was a significant negative predictor of clients' symptom change over time. The therapists' honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective.
Conclusions:
Therapists' inferred traits of Honesty-Humility and AHS may influence the effectiveness of their treatments.
This article describes how the combination of reframing and joining creates an inherent auto-double-bind within the psychotherapeutic process. Reframing is one of the most frequently used tools in family therapy, and it cannot be used without joining. "Joining" is an essential way of creating therapeutic alliance, which has been acknowledged to be the most important common factor for the outcome of psychotherapy. The article demonstrates how the use of humor allows the therapist to resolve this particular double-bind, using both verbal and contradictory nonverbal communication to join and simultaneously reframe the clients' views of the world.
