Experiential family therapy interventions delivered via telemental health: A qualitative implementation study.

Telemental health is a ubiquitous form of treatment that has been around for over a half-century, but there remains minimal research on videoconferencing and relational therapy. The purpose of this qualitative study is to identify how telemental health therapists would implement experiential interventions for children, couples, and families. Twelve trainees (n = 12) that participated in a yearlong telemental health practicum were prompted on three experiential interventions to understand how students adapt relational interventions for telemental health delivery. Intervention prompts included couple de-escalation, family sculpt, and sand tray. Using thematic analysis, five themes emerged to describe the implementation of the interventions: (a) adapting verbal communication skills, (b) grand expressions: adapting nonverbal communication, (c) additional preparations to facilitate interventions, (d) flexibility, and (e) self-of-the-therapist. Study findings, limitations, and clinical implications are discussed in further detail.

Competency-based training in the supervision of relational telemental supervision.

Supervision has long been considered essential to developing effective mental health practice, especially among COAMFTE accredited training programs. But with telemental health rapidly being accepted as a standard treatment medium for couple and family therapy, there is little guidance about how to supervise clinicians who are engaged in telemental health practice. This paper presents an important step toward increasing the effectiveness of the supervision of therapists who are delivering relational therapies online through the identification of relational competencies unique to this delivery medium. These competencies have been adopted and integrated into a COAMFTE accredited master's degree program that has been providing training in telemental health since 2008. The competencies are described, and supervision strategies that can be utilized and developmentally assessed throughout the program will be detailed.

A pilot study of a family systems oriented telemental health model in rural Brazil.

There are large disparities in access to mental health care, especially in low- and middle-income countries. Telemental health is a viable solution to reducing these disparities, but quality research demonstrating its effectiveness is needed. The purpose of this pilot study was to examine the feasibility of a telemental health approach in a rural region of Brazil. Primary care providers referred patients diagnosed with depression and anxiety to a 12-session family systems-oriented telemental health program developed by the researchers. Participants (n = 10) received therapy by family systems trained therapists. While sessions were delivered via telemental health, each received one face-to-face session as part of the treatment regimen. Results from the one-tailed t-tests indicate reductions in psychosocial symptoms and improvements in family functioning with medium and large effect sizes. Findings reveal that a family systems-oriented telemental health approach is a promising intervention for improving mental health outcomes in a middle-income country.

Collaborative Care at a Distance: Student Therapists' Experiences of Learning and Delivering Relationally Focused Telemental Health.

There is mounting evidence that telemental health is an effective delivery method for treating a variety of mental, emotional, behavioral, and relational health problems. While many of the therapeutic skills leading to the effectiveness of face-to-face treatments are transferable, the effectiveness of telemental health requires unique skills. The purpose of this phenomenological study was to determine the experience of learning how to use videoconferencing to deliver relationally focused mental health care. Participants included 10 graduates of a COAMFTE-accredited master's degree program emphasizing training in telemental health. Each student had practicum placements that required videoconferencing to deliver relationally based psychotherapy. Analysis of interview data revealed (a) personal reservations about distance delivery; (b) the importance of scaffolding student learning through curriculum, supervision, and mental health-care delivery protocols; (c) the technological barriers associated with this delivery method; and (d) overcoming technological barriers through intentionality.

Global proofing a collaborative care telemental health intervention in Brazil.

Rural proofing ensures that policies, practice guidelines, strategies, and techniques can be applied to rural populations with approximately equal benefit as what would be obtained in urban areas. Extending this concept internationally, the authors argue the importance of global proofing mental health strategies developed in well-resourced, high-income areas in order to determine their appropriateness in areas that have resource poverty such as middle- and low-income countries. An example is used to illustrate both rural and global proofing. Through this example, the authors demonstrate how they proofed urban-inspired models of mental health care in rural areas of the United States. The result is a model of rural mental health care that emphasizes collaborative care and telemental health. This model is now being global proofed in Brazil. The authors describe the application of this model in a remote rural town in Brazil. Consistent with World Health Organization recommendations, the integration of mental health care into primary care medical settings is being discovered as essential to addressing mental health disparities worldwide. (PsycINFO Database Record

The Systemic Interaction of Attachment on Psychophysiological Arousal in Couple Conflict.

Attachment in adult romantic relationships has long been linked to conflict styles. Psychophysiological measures have provided additional insight into this association by accessing less conscious and controlled responses to conflict. The aim of this study was to explore the relationship between attachment anxiety, attachment avoidance, and the interaction between attachment styles on skin conductance responses during conflict and recovery from conflict. Using dyadic analysis of 50 heterosexual couples, we found evidence of a systemic effect of attachment, where psychophysiological arousal increased when one partner had higher levels of attachment anxiety and the other partner had higher levels of attachment avoidance. Attachment avoidance was also negatively associated with increased levels of arousal. Relationship and clinical implications of these findings are discussed.