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.

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

Global Mental Health in Action: Reducing Disparities One Community at a Time.

There are great disparities in mental health care around the world. Traditional approaches to mental health care have not been found to be transferrable to many parts of the world and are inadequate to address these disparities. Unconventional approaches are needed that match the traditions of care-seeking and care-giving within the communities where they are delivered. The authors review the global mental health literature and discuss how marriage and family therapists are in a particularly good position to have worldwide impact on mental health disparities. Five principles of global mental health are presented along with an example of how these principles are applied through the Reducing Mental Health Disparities One Community at a Time (RD1CT) model.

Depressão pós-parto e satisfação conjugal: impacto longitudinal em uma amostra brasileira / Postpartum depression and marital satisfaction: a longitudinal study in a Brazilian sample / Depresión posparto y satisfacción con la relación de pareja: impacto longitudinal en una muestra brasileña

Objetivo: O objetivo deste trabalho foi verificar a relação entre a satisfação conjugal e a depressão pós-parto e o impacto destas variáveis nos níveis de satisfação conjugal e depressão futuros, em uma amostra brasileira. Estudos revelam que o conflito conjugal é um antecedente importante no desenvolvimento da depressão e que a depressão pós-parto influencia significativamente a satisfação conjugal. Métodos: Este estudo longitudinal com 99 mulheres brasileiras utilizou análises de regressão múltipla para verificar a associação entre a satisfação conjugal e a depressão. A sintomatologia depressiva foi avaliada pelo instrumento Self-Reporting Questionnaire (SRQ-20). A satisfação conjugal foi verificada a partir de itens sobre a percepção de satisfação conjugal das participantes. Os dados foram coletados 4 meses e 2 anos após o parto. Os dados longitudinais possibilitaram a análise cronológica da interação entre as duas variáveis. Resultados e Conclusões: Os resultados indicam que o modelo teórico que estabelece a relação entre conflito conjugal e depressão é também apropriado para casais brasileiros, sugerindo a utilização potencial da terapia de casal no tratamento da depressão pós-parto no Brasil.

Objective: This study examined the relationship between marital satisfaction and postpartum depression as well as the impact of postpartum depression and marital satisfaction on later relational characteristics among Brazilian couples. Studies have shown that marital satisfaction is an important antecedent to depression and that postpartum depression has an influence on marital satisfaction. Methods: A longitudinal study using multiple regression to test the association between marital satisfaction and depression was conducted among Brazilian women. Depressive symptomatology was assessed using the Self-Reporting Questionnaire 20 and marital satisfaction using an instrument developed by the researchers to test the individuals' perception of their marital quality. Data were collected at 4 months and 2 years after childbirth. The longitudinal data allowed researchers to chronologically analyze the interaction of key variables. Results and Conclusions: Results showed that the model established between marital satisfaction and depression is appropriate for Brazilian couples as well as for postpartum women. This study highlights the potential impact of marital treatment on postpartum depression in Brazil.

Objetivo: El objetivo de este trabajo fué verificar la relación existente entre la satisfacción con la relación de pareja y la depresión pos-parto y el impacto de esas variables en los niveles de satisfacción con la relación de pareja y depresión futuros, en una muestra brasileña. Estudios revelan que el conflicto de pareja és un antecedente importante en el desarollo de depresión y que la depresión pos-parto provoca influencia significativa en la relación de pareja. Métodos: Este estudio longitudinal con 99 mujeres brasileñas hizo uso de análisis de regresión multiple para estudiar la asociación entre la satisfacción en la relación de pareja y la depresión. Los sintomas depresivos fueron evaluados por el instrumento Self-Reporting Questionnaire (SRQ-20). La satisfacción con la relación de pareja fué verificada utilizando datos sobre la percepción de satisfacción de las participantes. Los datos fueron obtenidos 4 meses y 2 años después del parto. Resultados y Conclusiones: Los resultados indican que el modelo teórico que establece la relación entre conflicto de pareja y depresión és tambien apropriado para parejas brasileña s y sugiere la posibilidad de utilización de la terapia de pareja en el tratamiento de la depresión pos-parto en Brasil.

Rural experiences with mental illness: through the eyes of patients and their families.

People living in rural areas are often faced with multiple, complex, and seemingly insurmountable barriers to receiving appropriate treatment for mental health problems. Some of the barriers identified in the research literature include inaccessibility to mental health providers, stigma, and limited resources in the community. Despite existing data regarding rural patients and their families, little is known about their lived, personal experiences. For this reason, the purpose of this study was to determine the experience of patients and family members who are dealing with mental illness in rural communities. Based on this qualitative analysis of patient and family members' experiences in rural areas, issues surrounding mental health and treatment are accompanied by significant stigma, often left unresolved, and exacerbated by practical challenges which hinder access to proper mental health resources, frequently leaving rural residents to cope with inadequate solutions or seek their own, alternative solutions.

Training for collaboration: collaborative practice skills for mental health professionals.

The purpose of the study was to identify skills that mental health practitioners need for successful collaborative practice in medical settings. Known experts in the field of collaborative health care completed a survey designed to elicit their suggestions about what is needed for successful collaborative care practice. Through qualitative analysis, a set of 56 skills was developed. These skills are organized into three general categories of competency: (a) skills for working in a medical setting; (b) skills for working with patients; and (c) skills for collaborating with healthcare providers.

Portuguese translation and validation of the Revised Dyadic Adjustment Scale.

The absence of a translated and validated instrument for measuring marital satisfaction in Brazil, the largest country in South America and fifth most populous country in the world, is a significant barrier for research and mental health service delivery. The purpose of this study was to translate and validate a marital satisfaction scale into Portuguese that would have both empirical credibility and cultural relevance in Brazil. A six-step serial approach was used to simultaneously translate and culturally validate the Revised Dyadic Adjustment Scale (RDAS). The translated instrument (RDAS-P) demonstrated good psychometric properties during field testing.

A phenomenological study of family needs following the suicide of a teenager.

The objective of this phenomenological study was to develop an understanding of family needs following the suicide of a teenager. Six parent units living in the Midwest who lost a teenager to suicide were interviewed. Participants indicated several key themes that describe a parent's needs following the suicide of a teenager. These needs were organized into 6 main categories: (a) support by listening and responding, (b) support from another suicide survivor, (c) support in finding direction, (d) support when viewing the deceased teen, (e) support in remembering the teen, and (f) support in parents giving back to the community.

Mind-body therapy: attitudes, beliefs and practices of graduate faculty and students from accredited marriage and family therapy programs in the U.S. and Canada.

CONTEXT: Interest in CAM and mind-body therapies (MBT) among mental health professionals has increased over the last decade. Individuals seeking treatment for mental health concerns often use MBTs and expect clinicians to be aware of such treatments. Yet, current data reveal a critical gap in training, practice, and the needs of those seeking treatment. OBJECTIVE: To determine the attitudes, beliefs, and practices of marriage and family therapists regarding MBTs. DESIGN: Electronic survey method using Likert-type scale questions. PARTICIPANTS: Clinical faculty members and graduate students (N = 140) from accredited Marriage and Family Therapy programs in the United States and Canada. RESULTS: Findings revealed that a majority of respondents believed that graduate programs should introduce MBT topics during course of training and that MBTs are valuable in the treatment of various clinical problems. Respondents were familiar with at least one form of MBT and reported using such in personal and professional settings.

Finding the heart of medical family therapy: a content analysis of medical family therapy casebook articles.

In an effort to identify the essential ingredients of medical family therapy, a content analysis of 15 peer-reviewed case studies in medical family therapy was conducted. The case studies were published from 1996 to 2007 in Families, Systems, & Health. Through a qualitative content analysis, three main themes emerged that describe the essence of the practice of medical family therapy: (1) The patient's multisystemic experience of disease, (2) treatment is about caring, not just caregiving, and (3) elevating the patient as collaborator in the care team.

Attitudes and beliefs of marriage and family therapists regarding psychotropic drugs and therapy.

Clinical members of AAMFT were solicited by means of a randomized multi-staged clustering technique to identify their attitudes and beliefs regarding psychotropic drugs. All participants were blind to the overall purpose of the study (n = 322) and were directed to read a clinical vignette and then identify what course of action they would take with the client. They were then asked to complete a small questionnaire regarding their attitudes and beliefs regarding psychotropic drugs. Results of the study showed that 35.7% of the clinicians identified medication and a medication referral as a viable treatment option they might pursue with a client meeting criteria for major depressive episode. Clinicians who reported having a dedicated university class (17.2%) in psychopharmacology were more likely to identify medication referral as a treatment option. However, 80% of the AAMFT clinicians we surveyed reported that they were not adequately trained about psychotropic medications in their graduate programs. Further implications regarding diagnostic practices are also discussed, as 26% of clinicians failed to explicitly diagnose the client in the case vignette with depression.