Using Emotion to Foster Acceptance: A Treatment Approach for Family Therapists Working with Transgender Adolescents and their Families

Currently, there is limited research and clinical focus on family therapy with transgender adolescents. When an adolescent discloses his/her transgender identity to his/her family, the family can experience an array of emotions, such as fear, distrust, anger, and sadness, along with confusion and invalidating behavior that can threaten secure attachment among family members. The purpose of this paper is to present a family therapy treatment approach for therapists working with transgender adolescents that is both culturally sensitive to the needs of these families as well as based on a systemic family therapy model. Emotionally Focused Family Therapy (EFFT) is a systemic model that is grounded in attachment theory and focuses on using emotion as a key tool in restructuring problematic relational patterns and fostering more secure family bonds. Through the use of a hypothetical case study, this paper aims at illustrating how EFFT can help family members process feelings related to the transgender identity of an adolescent family member and restore their attachment in a manner that strengthens family relationships and bonds.

Competencies Needed By Mental Health Professionals Working With Parents of Children With Asthma

This paper describes clinical competencies necessary for mental health professionals working with parents of children with Asthma. Seven highly accomplished mental health clinicians from the Pediatric Behavioral Health Department at the nationally ranked hospital, National Jewish Health in Denver, Colorado were interviewed about the competencies they feel are needed to work with this specific population. The results of these interviews are organized into knowledge, skills and attitudes. Recommendations for other mental health providers are provided.

Phototherapy as an Intervention in Identity Development with Adolescents.

Identity development in adolescence is a period of exploration and experimentation. During this stage of development, adolescents are defining their identity in terms of ethnicity, sexual orientation, and gender. It can be a confusing time and the lack of resources and support influence the ability of the adolescent to form a cohesive identity. This struggle to define an identity may lead to symptoms of depression and difficulties with interpersonal relationships. Identity interventions are limited and primarily involve the adolescent talking to a therapist and attempting to verbalize and define subjective distress. The use of a phototherapy intervention focuses on using an adolescent's subjective experiences. Phototherapy provides a way for the therapist and client to explore the photographs the client takes and opens different avenues in the areas of non-verbal and visual communication. Photographs can also promote increased communication about an adolescent's ethnic, sexual or gender identity. Interpretations made by the adolescent about images in the photographs will get in touch with emotional experiences that may be missed in traditional "talk therapy." This paper reviews literature on identity development, specifically in the areas of ethnicity, sexual orientation, and gender identity. Phototherapy, the use of photography to enhance traditional psychotherapy, is described and a rationale is provided for the utilization of phototherapy in adolescent identity development. Vignettes are provided illustrating how phototherapy can be used when working with adolescents who are questioning and exploring ethnic identity, sexual orientation, and gender identity.

The Impact of Prefrontal Cortex "Warm Up" on Immediate Cognitive Reappraisal Ability in Older Adolescents with Elevated Symptoms of Depression

Cognitive Reappraisal (CR) is a central component of Cognitive Behavioral Therapy for adolescent depression. Yet, previous research indicates that a brain region highly associated with successful CR in adults, the Prefrontal Cortex (PFC), is not fully developed until early adulthood. Thus, there is growing concern that CBT interventions directed at building CR abilities in depressed teens might be constrained by PFC immaturity. However, CR is an effective strategy for regulating affect. The current study evaluated an intervention aimed at enhancing CR performance through PFC “warm up” with a working memory task. Additionally, the study examined moderators of intervention response, as well as cognitive correlates of self-reported CR use. Participants included 48 older adolescents (mean age=19.1, 89% female) with elevated symptoms of depression who were randomly assigned to a lab-based WM or control activity followed by a CR task. Overall, results failed to support the effectiveness of “warm up” to augment CR performance. However, current level of depression predicted negative bias and sadness ratings after CR instructions, and this effect was qualified by an interaction with condition. The moderator analysis showed that depressive symptoms interacted with condition such that in the control condition, participants with higher depressive symptoms had significantly lower negative bias scores than individuals with lower depressive symptoms, but this pattern was not found in the experimental condition. Contrary to hypotheses, history of depression did not moderate treatment response. Additional analyses explored alternative explanations for the lack of intervention effects. There was some evidence to suggest that the WM task was frustrating and cognitively taxing. However, irritation scores and overall WM task accuracy did not predict subsequent CR performance. Lastly, multiple cognitive variables emerged as correlates of self-reported CR use, with cognitive flexibility contributing unique variance to self-reported CR use. Results pointed to new directions for improving CR performance among youth with elevated symptoms of depression.