The Development and Feasibility of a Novel Group Intervention to Support Helping Professionals in Metabolizing Suffering and Engaging Strengths: The CHRYSALIS Program.

This feasibility study reports on the development and initial evaluation of a novel online intervention for helping professionals (HPs; i.e. mental health professionals, chaplains, clergy) designed to (a) address occupational hazards, such as burnout and vicarious traumatization, and (b) promote well-being and flourishing at work. In contrast with competency and self-care focused models, the CHRYSALIS (Catalyzing Helping Professionals' Resilience, VitalitY, Spirituality, Authentic Living, and Inner Strength) intervention centers the self of the provider, explores cultural and spiritual contexts, and attends to systemic challenges. As part of a larger randomized controlled trial evaluating two program formats, the group format entails eight online sessions exploring strengths that can promote well-being, including processing, relational, vitalizing, orienting, and agentic capacities. To pilot test this framework and establish proof of concept, this study analyzed data from 41 HPs who had been randomly assigned to the group condition and completed surveys at four time points. Quantitative results indicated significant reductions in vicarious traumatization and burnout as well as increased well-being and meaning in work. Qualitative results suggest the intervention fostered relational support, cultivated new perspectives, and increased engagement with strengths, positively impacting participants' work and navigation of caregiving systems. Feedback about cohesion and group dynamic challenges in an online format informed further program development. This study provides initial support for the feasibility and efficacy of the group format of the CHRYSALIS intervention as a creative means to address HPs' risk for occupational hazards and promote holistic formation in a relational context.

Longitudinal processes among humility, social justice activism, transcendence, and well-being.

Introduction: Existing research shows positive associations between humility and well-being, and between civic engagement and well-being. Rarely have humility, civic engagement, and well-being been examined together. We build off of previous cross-sectional findings and a prior longitudinal study that used three waves of data and found significant positive bivariate correlations between humility and the presence of life purpose across time points. Methods: Extending these previous findings, we used six waves of data obtained from graduate students at 18 seminaries across North America (N = 574; Mage = 31.54; 46.7% female; 65.3% White) to explore the dynamic associations among humility and life purpose, along with horizontal transcendence (an indicator of the attitudinal dimension of civic engagement) and social justice activism (an indicator for the behavioral dimension). We explored reciprocal short-run processes and dynamic long-run effects using a general cross-lagged panel model. Results and discussion: We found robust evidence for a reciprocal influence between the presence of life purpose and horizontal transcendence, and long-run effects for initial levels of life purpose to influence later levels of horizontal transcendence. We also found long-run effects for the influence of initial levels of life purpose on later levels of humility, and initial levels of social justice activism on later levels of horizontal transcendence. Implications center on the use of the findings for planning future one-time life purpose and social justice interventions to affect changes in humility and horizontal transcendence.

A practice-based study of relational virtues and alliance correspondence in psychodynamic psychotherapy.

OBJECTIVE: Treatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence-based by modeling changes in gratitude and forgiveness. METHOD: We utilized a practice-based research design involving non-manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self-reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White). RESULTS: A 3-class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well-being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well-being, lowest symptoms, and improved well-being. CONCLUSION: Clinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in-session conversation and/or the practice of virtue interventions in and/or outside of session.

Supporting chaplains on the frontlines of the COVID-19 pandemic: A mixed-method practice-based pilot intervention study.

During the coronavirus disease 2019 (COVID-19) pandemic, chaplains have played a pivotal role in patient, family member, and staff care. However, little empirical attention has been given to (a) the potential toll of frontline spiritual care on chaplains' mental health and occupational functioning as well as (b) the development of interventions that can help ameliorate these risks and promote resilience. Using a mixed-method practice-based design, we conducted a pilot study (n = 77) to evaluate a novel spiritually integrated support group intervention for chaplains across multiple industries, which consisted of five Zoom-based sessions cofacilitated by psychotherapists. Participants completed pre- and postintervention measures of traumatic stress, burnout, spiritual/moral struggles, flourishing, resilience, and overall experience in the group. Qualitative findings elucidated the salience of peer support, therapeutic group processes, and key intervention components that warrant further study. Quantitative results indicated significant (a) decreases in burnout and spiritual/moral struggles from pre- to postintervention as well as (b) increases in sense of resilience and flourishing. Findings of this pilot study offer preliminary evidence for the use of a spiritually integrated group model to decrease isolation, address moral and spiritual distress, and promote resilience among chaplains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Distress and Satisfaction in Women Who Perceive that Their Male Partners Use Pornography: The Roles of Attitude, Religious Commitment and Conservative Religiosity.

Qualitative studies suggest that women's attitudes and religiosity have an important role in their experience of their male partners' pornography use, but these factors have not been adequately studied. The present study examined the contributions of perceived frequency of male partners' solitary pornography use (PFREQ), women's attitudes toward their partners' pornography use, conservative religiosity, and religious commitment to women's pornography-related distress, relationship satisfaction, and sexual satisfaction in women who reported they were married to or cohabitating with men who had used pornography in the prior 3 months (median frequency = 1-2 times/week). Participants were online research panel participants (n = 625), age mean = 44[SD = 13], diverse SES, 86% White. Partial correlations and multiple regressions, controlling for demographic variables and COVID-19-related stress, indicated that higher PFREQ and negative attitudes toward pornography were significantly associated with women's higher pornography-related distress, lower relationship satisfaction, and lower sexual satisfaction. Moderation analyses found that negative attitude amplified the negative association between PFREQ and relationship satisfaction, and conservative religiosity amplified the positive association between PFREQ and pornography-related distress. Neither attitude nor religious factors moderated the negative association between PFREQ and sexual satisfaction. Findings suggest that attitude, religious factors, and PFREQ are each important to consider in research and clinical contexts.

Spiritually integrated psychotherapies in real-world clinical practice: Synthesizing the literature to identify best practices and future research directions.

A comprehensive review of the practice-based evidence for spiritually integrated psychotherapy (SIP) is necessary in order to catalyze research and training in this important diversity area. In this article, we identify and synthesize key findings from 35 studies in six key areas: (a) SIPs in trauma treatment, (b) SIPs in treating eating disorders, (c) SIPs in general psychotherapy, (d) existential concerns as part of SIPs, (e) patients and therapist attitudes about SIPs, and (f) SIP supervision and training models. Building on this, we propose a culturally contextual understanding of this diversity area, drawing from the Relational Spirituality Model (RSM). Finally, we discuss best practices for spiritually responsive clinical care and offer a research prospectus to strengthen the evidence base for real-world effectiveness. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Research in counselling and psychotherapy Post-COVID-19.

The COVID-19 pandemic brings to light many areas the field of counselling and psychotherapy may need to address in future research. We outline several issues stemming from or exacerbated by the pandemic and offer suggestions for future research to address the mental health needs of those impacted. Our suggestions focus on five domains: (a) the health and well-being of helping professionals, (b) the infodemic, (c) discrimination and minority stress, (d) spiritual and existential dynamics in mental health and (e) couple and family stress and resilience. We aim to provide a multi-systemic perspective of mental health and well-being in the time of COVID-19, as well as encourage current and future studies to incorporate these suggestions to advance the health and well-being of our communities through evidence-based treatment approaches.

Virtue, flourishing, and positive psychology in psychotherapy: An overview and research prospectus.

Researchers have increasingly called for the examination of both mental health symptoms and well-being when providing and evaluating psychotherapy, and although symptoms and well-being are typically inversely related, these appear to be distinct constructs that may require distinct intervention strategies. Positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on promoting well-being have emerged in response to, or perhaps in concert with, the calls for attention to symptoms and well-being. Our review of the relevant and vast research pockets revealed that these treatments demonstrated relative efficacy in promoting well-being, whereas evidence for relative efficacy when reducing symptoms was largely inconclusive, particularly in psychotherapy contexts. We organized our review around the virtue-ethics notion that growth in virtuousness fosters flourishing, with flourishing consisting of more than the absence of symptoms, and specifically, that flourishing also involves increased well-being. The lack of evidence for relative efficacy among active alternative treatment conditions in promoting flourishing may suggest equal effectiveness, and yet, this also suggests that there are yet-to-be-identified moderators and mechanisms of change and/or insufficient use of research designs and/or statistical procedures that could more clearly test this major tenet of the virtue-ethics tradition. Nevertheless, we know that evidence-based problem-focused psychotherapies are effective at reducing symptoms, and our review showed that positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on well-being promote well-being and/or virtue development. We encourage researchers and psychotherapists to continue to integrate symptom reduction and well-being promotion into psychotherapy approaches aimed at fostering client flourishing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Latent trajectories of change for clients at a psychodynamic training clinic.

OBJECTIVE: Employing practice-based research methods, we addressed the need to examine the effectiveness of psychodynamic treatment as a supplement to the efficacy evidence offered by randomized clinical trials. METHOD: We used person-centered analyses to generate latent subgroups of clients (N = 118; M age = 40.92; 53.4% female; 81.4% Caucasian; 80.5% heterosexual) receiving contemporary relational psychotherapy (CRP) at a psychodynamic community mental health training clinic. RESULTS: Subgroups of clients reported a change in depression, social conflict, and anxiety symptomatology, and overall life satisfaction, depicted by significant quadratic growth curves. Findings also offered exploratory support for a theoretical proposition from CRP that improved relational functioning would correspond to improved affect dysregulation and overall life satisfaction. CONCLUSION: Clinical and training implications highlight the need to distinguish subgroups of "responders" and "nonresponders" to inform treatment.

Humility, Relational Spirituality, and Well-being among Religious Leaders: A Moderated Mediation Model.

Prior research has demonstrated positive associations between general humility and well-being, and posited a protective effect for intellectual humility against maladjustment among religious leaders. We tested a model that extended findings on general humility to include intellectual humility among religious leaders (N = 258; M age = 42.31; 43% female; 63.7% White; 91.9% Christian affiliation). We observed a positive general humility-well-being association. Contrary to expectations, we observed risk effects for religion-specific intellectual humility. Our findings also point to the possibility that these risk effects might be attenuated by the integration of high levels of general and intellectual humility.

Promoting forgiveness: Characteristics of the treatment, the clients, and their interaction.

Forgiveness-based group treatments to address interpersonal hurts have been shown to be efficacious across a range of therapy models (Wade, Hoyt, Kidwell, & Worthington, 2014). However, little is known about how treatment and individual characteristics may interact in predicting outcomes. The present study examined a sample of 162 community adults randomly assigned to three treatment conditions; an 8-week REACH Forgiveness intervention (Worthington, 2006), an 8-week process group, and a waitlist control. Hierarchical linear modeling (HLM) indicated that the forgiveness-based treatment was more effective than the waitlist control across a range of forgiveness-related constructs but no more effective than the process condition. Furthermore, attachment avoidance and anxiety interacted with treatment type to predict certain outcomes, indicating that the REACH Forgiveness model may be more helpful for promoting forgiveness with insecurely attached individuals. (PsycINFO Database Record

Religious and Spiritual Salience, Well-Being, and Psychosocial Functioning Among Psychotherapy Clients: Moderator Effects for Humility.

A number of studies have examined the mediating factors in the relationship between religion and spirituality (R/S) and psychological health. Humility is a virtue that has been positively correlated with R/S variables, measures of well-being, and indicators of psychosocial functioning. In this study, we investigate dispositional humility as a potential moderator in the relationship between religious and spiritual salience and (1) well-being and (2) psychosocial functioning outcomes in a clinical sample. Results indicated that dispositional humility significantly moderated the relationships tested. Implications for future research and clinical practice are discussed.

Religious Involvement and Depression: The Mediating Effect of Relational Spirituality.

Multiple studies have examined the relationship between religious involvement and depression. Many of these investigations reveal a negative correlation between these constructs. Several others yield either no association or a positive correlation. In this article, we discuss possible explanations for these discrepant findings. We investigate the degree to which relational spirituality factors mediate the relationship between religious involvement and depression in a sample of graduate students. Results indicated that spiritual instability and disappointment in God were distinct predictors of depression over and above the predictive strength of religious involvement. Implications for training and conceptualization are discussed.

Group Therapy for Loss: Attachment, Intersubjectivity, and Healing.

Loss is a fundamental human experience that can impact a person's mental health in diverse ways. While this experience is potentially formative, harmful manifestations can fracture one's sense of self and undermine relational health. In this article, we present a rationale for process-oriented group therapy focused on healing relational injuries associated with loss. We draw on attachment, self-psychology, intersubjectivity, and Yalom & Leszcz's (2005) model of group psychotherapy to explore how group processes allow clients to work through losses and relational frustrations in the here-and-now. A case vignette and discussion offer practical insight on the ways in which loss manifests in the room and demonstrate the uniqueness of the group setting for reparative processing.

Forgiveness in the Treatment of Borderline Personality Disorder: A Quasi-Experimental Study.

OBJECTIVE: This pilot study evaluated a manualized group forgiveness module within dialectical behavior therapy (DBT). METHOD: The study utilized a quasi-experimental double pretest design with adults (N = 40; 88.1% female, 11.9% male) diagnosed with borderline personality disorder in outpatient DBT. Measures of forgiveness, attachment, and psychiatric symptoms were completed at 4 time points. RESULTS: Participants showed increases in all measures of forgiveness and decreases in attachment insecurity and psychiatric symptoms during the forgiveness module and maintained to the 6-week follow-up. These effects were not observed during the prior distress tolerance module. Latent change score modeling showed reductions in anxious attachment mediated the effect of changes in benevolent motivations to forgive and trait forgiveness scores on reductions in psychiatric symptoms. CONCLUSIONS: Effect sizes were similar to meta-analytic findings on (a) forgiveness interventions and (b) reductions in psychiatric symptoms in DBT. Participant feedback suggested elements for further development. A randomized controlled trial is needed.