'The Relentless Nature of Whiteness': Black Psychologists' Experiences of Racial Microaggressions in Cross-Cultural Supervision.

OBJECTIVES: Research suggests that cross-cultural supervision can be prone to microaggressions with deleterious effects for ethno-racial minorities. There are currently no known studies examining the impact of racial microaggressions in supervision on qualified psychologists. This study aimed to explore Black psychologists' experiences of microaggressions in supervision with a White supervisor and their impact. METHODS: Semi-structured interviews were conducted with 10 individuals who had completed clinical or counselling psychology doctoral training. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS: Three superordinate themes and 12 subthemes were derived from the analysis. The superordinate themes were: 'It's the subtle things', 'It's an ordeal' and 'Surviving Whiteness in psychology'. The findings illustrate the complex nature of racial microaggressions and their profound and lasting impact on individuals. The cumulative impact of these experiences resulted in significant negative psychological outcomes. CONCLUSIONS: The results suggest that there are common microaggressions that recur in supervision. Encountering microaggressions impeded the supervisory relationship, supervision and professional development. Clinical implications include recommendations for including multicultural competency in psychology trainings and ongoing professional development plans.

"It's more than milk, it's mental health": a case of online human milk sharing.

BACKGROUND: Milk sharing is not a new concept and occurs today via regulated human milk banks and unregulated online milk sharing groups. Exploring and understanding how, and why, mothers use these peers to peer milk sharing groups, is a vehicle to understanding how breastfeeding mothers can be tangibly supported online, adding to the literature on peer milk sharing, from a recipient's perspective. This research presents a single case example of an online breastfeeding support group use, through one mother's experiencing of seeking human donor milk. METHOD: This is a qualitative, exploratory study observing the attitudes, thoughts, and feelings of one mother who is seeking human donor milk through online groups. A single key case was identified, and the participant was asked to document thoughts and feelings as she searched for milk online. A telephone interview was conducted after two months, and the online page activity from the Human Milk for Human Babies Facebook group was captured for the week following the interview. The results were presented in a chronological and linear analytical approach adopting pattern matching. RESULTS: 'Abbi' is a mother who has Polycystic Ovary Syndrome and subsequent low milk supply and sought donor breastmilk online. Online support groups introduced her to donor milk sharing, which not only supported her breastfeeding but supported her own mental health. Abbi talks of the need to build a trusting relationship with her donor, due to the lack of regulation, and the positive impact it had for her and 'Lucas', her baby. CONCLUSION: Considering milk sharing groups simply as tangible online support ignores the complexities around Abbi's decision to use human donor milk. Peer milk sharing online is an option for mothers, but it is surrounded by stigma amongst other mothers, professionals, and even within pro breastfeeding support groups.

Online social support group use by breastfeeding mothers: A content analysis.

BACKGROUND: Breastfeeding is a public health priority and lack of breastfeeding support a contributing factor to the low initiation and continuation rates in the UK. Online social support groups are being increasingly utilised by breastfeeding mothers and research into this phenomenon is only now emerging. AIM: To document and describe the posts made within an online breastfeeding support group. METHOD: The posts made to an online breastfeeding social support group between 1st and 7th November 2016 were recorded using an unobtrusive non-participant design, and subject to systematic message content analysis. Themes relating to topics of discussion were deduced from the data and concepts of social support used to analyse the data. RESULTS: The group received 501 posts over the week (m = 72, range 20-93 a day) and was accessed 24 hours a day. Eighty-two percent of posts received comments (m = 12, range 0-415, SD = 24) and 93% received likes (m = 11, range = 0-641, SD 42). The group was used from pregnancy and until the child was over two years old. The majority of infants discussed were aged 6 weeks to 6 months. Informational support was the greatest reason for use (65%), followed by esteem support (18%) and emotional support (10%). Thirteen topics of conversations were identified. CONCLUSION: Mothers are using online social support groups in their thousands to seek information from people in similar situations. Not only do they pose questions but they discuss a range of parenting and breastfeeding topics in an environment that aims to support and facilitate responses. The impact of this support avenue within the wider context of professional, family and offline support warrants further investigation through a qualitative approach.

The use of computer mediated communication in providing patient support: A review of the research literature.

OBJECTIVES: The aim of this study is to explore how computer mediated communication has been used by a variety of healthcare,professionals to support their patients and discuss the implication that this may have for future practice. DESIGN: A systematized review of the literature. DATA SOURCES: A review of empirical studies within the literature was carried out in April 2016 in CINAHL, MEDLINE, ASSIA, BNI, Psychinfo, and Web of Science databases. REVIEW METHODS: The databases searched produced 2930 titles, of which 190 publications were considered relevant to the objectives. Titles and abstracts were then reviewed and duplicates removed producing 67 publications. Exclusion and inclusion criteria were applied. The inclusion criteria were (1) interventions that facilitate two-way communication between any healthcare professional and their patients via a computer; (2) Interventions aimed at providing any type of support e.g. emotional, tangible, informational, or esteem support; (3) English language; (4) Primary empirical studies. Data quality was assessed and thematic analysis applied. RESULTS: Thirty-one publications were included in this study. Intervention types included Email (n = 8), Videoconferencing (n = 7), Online Social Support Groups (n = 9) and multifaceted interventions (n = 7). Three themes emerged from the data including increasing access to healthcare, adding value to healthcare delivery and improving patient outcomes. Twenty-five (81%) of the studies found that computer mediated communication could produce positive effects. CONCLUSIONS: Computer mediated communication could be both what patients want and a way of delivering support to patients in a resource tight environment. This has implications for a range of health support needs and professionals including nurses, midwives and allied healthcare professionals. Reviewing the lessons learnt will ensure future interventions are tailored to the support needs of the patients, carefully planned and mindful of the risks.

Nursing and the barriers to sustainable health care: a literature review.

OBJECTIVES: global warming poses a serious threat to human health, yet healthcare organisations and staff have been relatively slow to engage with sustainable healthcare practices. This review of the literature seeks to frame what is already known about nurses and their views on global warming and sustainable health care. DESIGN: 11 primary research articles were sourced from a search of five mainstream databases. These articles were subject to a basic thematic analysis. RESULTS: six themes were identified: sustainability, endemic blindness to global issues, environmental numbness, social norms, priority assigned to sustainability, and psychology of responsibility and blame. CONCLUSION: from the literature reviewed, there are a number of social, cultural and psychological barriers that have led to widespread inaction. This article recommends further research to understand the psychological barriers in more depth as this is a poorly understood area.

Communications to children about mental illness and their role in stigma development: an integrative review.

BACKGROUND: Limited literature on the stigma of mental illness has examined the socio-cultural processes involved in the development of stigma around mental health in children, which emerges in mid-childhood (7-11 years). Greater understanding might inform preventative interventions. AIMS: This review aims to integrate disparate theoretical and empirical research to provide an overview of social communications to children aged 7--11 years about mental illness and their role in the development of stigmatised views. Four key socio-cultural contexts (the media, school, peers, parents) of relevance to children's development will be considered. METHOD: Systematic literature searches were conducted within electronic databases and abstracts were scanned to identify relevant studies. Fifteen papers were selected for the review. RESULTS: The review found few studies have directly examined communications about mental illness to children. Available evidence suggests messages across children's socio-cultural contexts are characterised by silence and stigma, which may shape children's developing views. Specific theoretical frameworks are lacking; possible mechanisms of transmission are discussed. CONCLUSIONS: This review suggests overcoming stigma will require efforts targeting young children, explicitly tackling mental illness, and spanning multiple social spheres: further research is warranted.

Understanding reduced activity in psychosis: the roles of stigma and illness appraisals.

PURPOSE: Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions. Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This study investigated the extent to which three components of illness appraisal accounted for variance in activity. METHOD: 50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive functioning, stigma, insight and illness perceptions. RESULTS: Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress and social support. Affect, cognitive functioning and positive symptoms were not associated with activity. CONCLUSION: For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.

Therapists' beliefs about research and the scientist-practitioner model in an evidence-based health care climate: A qualitative study.

The growing emphasis on achieving therapeutic practice that is informed by research evidence or 'evidence-based' has been well documented. However, if therapists are to operate effectively within evidence-based services, it is necessary to develop a better understanding of factors that influence their attitudes towards research in routine clinical work. Within this context, there is a need to re-examine the scientist-practitioner model as potentially complementing or competing with evidence-based practice. This study explores the beliefs about research and the scientist-practitioner model amongst a diverse group of therapists whose work is contextualized by evidence-based practice. In-depth, qualitative interviews were used to elicit significant themes that related to current practices, previous training and contact with other professionals. The findings suggest that the therapists' beliefs were shaped by different levels of influence that range from personal values to organizational and political issues. The results also highlighted how the therapists had constructed more idiosyncratic definitions of the scientist-practitioner model that related to perceptions of its value. Implications for further research, training and practice are discussed.