Group Dynamics in Sex Offender Treatment Involving Individuals with Personality Disorders

This qualitative investigation primarily employing a phenomenological perspective and psychoanalytic interview approach intends to provide contextual understanding of group dynamics in sex offender treatment involving individuals with strong features of personality disorders or Axis II psychopathology according to the Diagnostic and Statistical Manual of Mental Disorder (4 ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). Of note, this study particularly focuses on the cluster B type (Narcissistic, Borderline, Histrionic, and Antisocial Personality Disorders), based on the assumption that this type is more interpersonally operational in its nature. The present study is based on semi-structured interviews of three clinicians who arecurrently providing group treatment for sex offenders. The interview was designed to elicit the participants' clinical observations of group dynamics involving group members with features of the Axis II, Cluster B type. In this study, 11 therapeutic factors postulated by Yalom (2005) were utilized to qualitatively investigate group dynamics. Analyses of qualitative data highlighted how group members with features of the Axis II, Cluster B type may distinctively affect group dynamics. Based on the results, group members with Axis II diagnoses, as reported bythe therapists who responded to this study, were observed to present with altruistic behaviors in group. In addition, motivation appeared to be one of the most influential factors in promoting and maintaining therapeutic group behaviors. Group members with antisocial features appeared to present with low motivation for treatment, and individualswith a pervasive history of criminal institutionalization seemed more prone to disengagement in group. Individuals with borderline and histrionic traits seemed to be interpersonally oriented and affectively engaged in group process. Persons with a narcissistic tendency also appeared to be interpersonally invested and showed altruistic behaviors, yet the importance of confirming their superiority seemed to outweigh the need for acceptance or approval from other group members. As briefly discussed above, the qualitative analyses of the current data showed that individuals with Axis II disorders, Cluster B type uniquely affect group dynamics, which suggest clinical considerations foreffective treatment planning, maintenance, and outcomes.

An un-mounted horse care group for children and youth with an Autism Spectrum Disorder: Recommendations for program development and treatment intervention

Equine Assisted Activities and Therapies (EAAT) including Therapeutic Horseback Riding (THR) and un-mounted equine assisted activities are interventions aimed at improving the daily functioning and success of individuals with disabilities, including those with an autism spectrum disorder (ASD). While THR is frequently utilized as a treatment intervention for children with ASD, there are many limitations (individual's weight, horse health, weather, physical limitations, health conditions, etc.) that prevent this population from participating in mounted programs. Un-mounted equine assisted activities are often utilized as an alternative, but they are not informed by empirical research or a standardized treatment model. This paper provides a comprehensive review of the literature for EAAT including un-mounted programs, examination of organizational guidelines as they apply to un-mounted programs, and consultation with program directors regarding current practices in the field, and finally it establishes recommendations for the development of a standard curriculum that would strengthen un-mounted horse care group programs serving children with ASD.

Cross-Disciplinary Collaboration Behavior of Practitioners in the Treatment of Anxiety Disorders

Current research on the collaborative behaviors of conventional and alternative health care providers for the treatment of anxiety is lacking. While there are multiple studies looking at alternative health care integration into primary care, none of them look at anxiety specifically. The purpose of this paper is to provide a preliminary exploration of possible barriers to collaboration between conventional and alternative health care providers for the treatment of anxiety. Quantitative data on collaboration behavior patterns were obtained with an anonymous survey. Data from the surveys were analyzed using a chi-square analysis. Along with these numerical data narrative data from the survey and interviews were collected in order to assess beliefs about the barriers to collaboration from different health care providers. The results indicate that conventional providers collaborate the least with alternative providers and alternative providers collaborate the least with conventional providers. The descriptive results regarding the barriers to collaboration from the study illustrated a common theme, specifically, the lack of education of conventional providers on alternative health care practices on anxiety. This is an exploratory study: therefore it would be beneficial for future researchers to look deeper into the beliefs of health care providers on the barriers to collaboration, possibly identifying the specific barriers to collaboration for each type of healthcare provider.

The Trail of No Tears: Traditional Masculinity Ideologies and The Cycle of Dismissing-Avoidant Attachment

Raising boys in accordance with traditional masculinity ideologies is creating a mental health crisis among men. Socialization in accordance with traditional male gender roles causes boys to develop dismissing-avoidant attachments with their primary caregivers. Approaching subsequent relationships with a dismissing-attachment style creates disconnection between men and male peers, female partners, and their children. Many researchers advocate clinical interventions that perpetuate men's traditional fears of intimacy, however attachment theory provides an alternative lens through which clinicians may approach therapy with men. By engaging men in therapeutic attachment relationships, clinicians can inspire implicit and explicit learning of new attachment patterns. This experience by nature challenges traditional definitions of masculinity, and men may develop more congruent, adaptive, and healthy definitions of masculinity.

Modified Dialectical Behavior Therapy Program Applied Within a Time-Limited Corrections Setting

Dialectical Behavioral Therapy (DBT) is an empirically supported therapy developed to treat individuals with Borderline Personality Disorder that has sustained efficacy following completion of the treatment (Linehan, 1993; Van Den Bosch et al., 2005). The core concepts of DBT include mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance, which seek to foster more functional ways of interacting with others, coping with distress, and managing difficult emotions. Using a standard DBT format in a corrections setting can be difficult due to the population's multifaceted composition. The Denver County Jail is a unique corrections setting because it contains a unit specifically developed for male inmates with mental health issues. A corrections modified, time-limited DBT curriculum was developed to fit the needs of this unique population. During the course of the group, staff appeared to be accepting of the group material and initial feedback from inmates and officers was positive.

Working Therapeutically with Interpreters in Mental Health: A Curriculum for Clinicians.

Given the increasing numbers of people who lack proficiency in spoken English, it would not be uncommon for American healthcare practitioners to encounter clients whose primary language is not English. Additionally, for those clinicians who specifically wish to work with immigrants, refugees or asylees, it is likely that their clientele will be comprised of LEP individuals and families. While many professional interpreters have completed formal training and been certified to provide their unique services, mental health clinicians rarely receive such training to help negotiate the complex dynamics inherent in working with LEP populations where the therapeutic relationship is altered with the addition of an interpreter. This training curriculum proposes the detailed, in-depth training for clinicians as recommended by numerous sources in the literature.

Acceptance and Commitment Therapy with Forensic Inpatients

This paper provides a preliminary exploration of the application of Acceptance and Commitment Therapy (ACT) within the context of a forensic hospital. ACT has a reputation for being a clinically flexible and empirically sound therapeutic intervention, which appears uniquely suited for forensic hospital settings. However, no research has been published to date on the use of ACT as a treatment for forensic inpatients. The ACT approach directly aims to help people let go of the unwinnable struggles to control symptoms of mental illness, and instead focus on constructing a "life worth living." ACT interventions can equip forensic patients with the values and flexible behavioral repertoires necessary to lead lives that are personally meaningful and satisfying and do not involve inflicting harm to others. The ACT model also attempts to minimize the therapist-patient hierarchy through an emphasis on the ubiquitous nature of human suffering. This approach can be particularly useful when working with marginalized, treatment-resistant patients. Continued research on the application of ACT with forensic inpatients is recommended.

Establishing Culturally Sensitive Therapeutic Communities in Ghana for Individuals with Severe and Persistent Mental Illnesses

This paper makes a proposal for the establishment of therapeutic communities for people with severe and persistent mental illnesses in Ghana. It discusses the history and features of therapeutic communities, as well as the elements that make it compatible with the agenda of the new 2012 Ghana mental health bill. This paper also discusses the present state of mental health care in this West African country and how the establishment of therapeutic communities will promote recovery of people with severe and persistent mental illness, and change the perception of chronic mental illness in Ghana. A discussion of potential modifications of the therapeutic community is offered as well as justifications for maintaining other structural aspects should this establishment materialize in Ghana. The costs of setting up therapeutic communities in this third world country are addressed with the offered conclusion that costs far outweigh the benefits. Finally, given the endeavor of the proposed therapeutic communities to assist in deinstitutionalization of care, cautions are made in this paper to ensure that the trends experienced in the United States with deinstitutionalization are not replicated in Ghana. A proposal is made in the conclusion for Ghana to move past therapeutic communities when developmentally able- to community mental health centers which were in part established to account for some of the fallouts of deinstitutionalization by providing a comprehensive and extensive range of services for people with severe and persistent mental illness.

Once Upon a Time in Therapy: Crafting Therapeutic Narratives to Help Familiarize Children with the Therapeutic Process.

Young children often harbor misconceptions about psychotherapy and the role of psychologists. These misconceptions are ignited by rumors and misinformation that are provided to the child by a variety of sources and can compromise both the effectiveness of therapy and the therapeutic dyad. In this paper we explore how recent trends in patient engagement in child psychotherapy, cultural dynamics between patients and practitioners, and children's lack of knowledge surrounding mental health services can negatively impact therapy. Wednesday Afternoons with Dr. J. (WADJ) is a whimsical fictional therapeutic narrative created to inform children about aspects of the therapeutic process while providing adults with tangible structure surrounding how to talk to children about mental healthcare. The advantages of utilizing this narrative to prime children for therapy are discussed, as are methods for promoting the narrative to the greater community.

Providing Bereavement Counseling to Chinese Americans: A Cultural Adaptation of a Western Grief Counseling Model.

The aim of this paper is to extend the existing literature and propose an alternative perspective on bereavement counseling with Chinese Americans. This aim is achieved by integrating William Worden's (2009) grief counseling model with several cultural components that are relevant to counseling with Chinese Americans, including: (a) the barriers to seeking counseling, (b) the clinical presentations of Asian Americans, (c) the common coping styles among Asian Americans, (d) the major Chinese religions and philosophies, and (e) the bereavement-related cultural practices. The corresponding treatment recommendations will be explored following the discussion of each cultural element. Finally, a culturally responsive grief counseling model for Chinese Americans will be proposed in the last section, along with a discussion of important caveats.

Back in Blue: The Successful Reintegration of Combat Veteran Law Enforcement Officers.

In the past ten plus years, several million national guard and reserve component military personnel have been deployed in support of the global war on terrorism. Tens of thousands of those personnel also serve as full-time law enforcement officers in police and sheriff's offices around the country. Life as a law enforcement officer is tough enough, but when combined with the psychological baggage brought on by months of war, reintegrating into civilian life and the role of a law enforcement officer can be extremely difficult. This article discusses a reintegration program specifically for law enforcement agencies that is designed to promote long-term psychological and social health in combat veteran officers. The program's costs are offset by the many assets (leadership, tactical training, etc.) these men and women bring to the department. By committing to the long-term successful reintegration of these individuals, departments enhance their own forces and improve community safety.

The Lighter Side of Anorexia.

Anorexia nervosa is a disorder characterized by ego-syntonic self-starvation and is associated with impairment in functioning, emotional distress, psychiatric comorbidity, and an elevated mortality risk. Evidence-based data on treatment interventions for anorexia nervosa are scarce despite the need for more targeted and effective treatments. This paper offers an integrative model using humor as a therapeutic intervention for the treatment of anorexia nervosa. It proposes that the integration and application of humor in psychotherapy can be a powerful adjunct in treatment because it has the potential to activate change in the physiological, cognitive, emotional, and interpersonal realms negatively affected by this disorder.

Making and Keeping Friends: A social skills game that promotes parental involvement to more effectively address social deficits in children with ADHD

The social deficits of children with attention-deficit/hyperactivity disorder (ADHD) have great impact on overall functioning and life satisfaction; however, ways of addressing these deficits to promote positive interpersonal functioning have been limited. The following paper explores the literature that highlights these social deficits, identifies skills that are proposed to target these impairments, discusses child and parent factors that are relevant to positive therapeutic change, and describes the development of a therapeutic game that incorporates variables important to treatment success of these interpersonal difficulties.

Asperger's Disorder in College Students: Application of Acceptance and Commitment Therapy

College students with Asperger's Disorder (AD) are likely to face significant challenges as they encounter the unpredictable and socially demanding environment of their university setting. Acceptance and Commitment Therapy (ACT) can be a valuable approach to addressing many of these struggles. This paper will explore the application of ACT to problems that are commonly associated with individuals diagnosed with AD. Utilizing ACT and the Hexaflex Model as a guide for working with AD students can assist in establishing a greater understanding and acceptance of their unique internal experience, as well as their interaction with the external world. ACT can offer these students the ability to be more present in the moment, to recognize efforts to avoid negative experiences, and to move in directions in life that are personally meaningful.