Feasibility and acceptability of an intervention for enhancing reintegration in adults with experience of homelessness.

BACKGROUND: Service centres for homeless adults are potential settings for implementation of reintegration interventions. This study aimed to evaluate (i) the acceptability of a group-based programme among individuals from the broad population of homeless people and (ii) if a future study of its feasibility and acceptability for re-housed homeless people is warranted. METHODS: Recruiting participants and intervention facilitators from partnering service centres was thought to improve recruitment and retention, cost-effectiveness and social interactions compared to professional-led interventions. Seven adults with experience of homelessness (three females, four males, mean age 39 years, range 18-63) were recruited to participate in the intervention. The research protocol comprised completion pre/post of scales [Recovering Quality of Life questionnaire; Working Alliance Inventory-short form revised (WAI-SR)] and focus groups, and WAI-SR and focus groups after sessions 3 and 6. RESULTS: The intervention and research protocols were feasible, with all participants engaging in all sessions, completing all scales and attending all focus groups. The quantitative data demonstrated the feasibility of obtaining practically useful measures of relevant outcomes. In the four focus groups, the intervention received very favourable feedback. CONCLUSIONS: This study demonstrated initial feasibility and acceptability of an intervention that places minimal burden on infrastructure and promotes user autonomy. This is an important advance as there is increasing recognition that the challenge of reintegration is as much a psychological and social problem as a housing problem. If effective, this style of intervention may serve as a template for future interventions with similar populations.

Prevalence of childhood abuse among people who are homeless in Western countries: a systematic review and meta-analysis.

PURPOSE: This article systematically reviews studies of prevalence of childhood experience of physical and sexual abuse in adult people who are homeless in Western countries. METHODS: Medline, PsychInfo, and the Cochrane Library were searched using the keywords: homeless*, child* abuse, child* trauma, and child* adversity and the bibliographies of identified articles were reviewed. Sources of heterogeneity in the prevalence rates were explored by meta-regression analysis. RESULTS: Twenty-four reports published between January 1990 and August 2013 in three countries provided estimates obtained from up to 9,730 adult individuals who were homeless. Prevalence of reported childhood physical abuse ranged from 6 to 94% with average prevalence of 37%, 95% CI [25, 51]. Reported sexual abuse ranged from 4 to 62%, with average prevalence estimated as 32%, 95% CI [23, 44] for female and 10% for male, 95% CI [6, 17]. Substantial heterogeneity was observed among the studies (I2 ≥ 98%). Including moderators greatly reduced but did not eliminate this heterogeneity. Moderator analyses suggested that reported physical abuse tended to be higher for predominately white samples and tended to be lower for younger samples. Sexual abuse was far more prevalent in predominately female samples and slightly higher in non-US samples and convenience samples. CONCLUSIONS: The findings of this study suggest that childhood physical and sexual abuse is more prevalent among the homeless in Western countries than in the global population. Physical abuse appears to be particularly prevalent in younger samples and sexual abuse rates are higher in predominately female samples. Further investigation is needed to advance our understanding of how trauma informed treatment and care for the homeless effectively can take into account the service user's experiences of childhood abuse.

Individual brief art therapy can be helpful for women with breast cancer: a randomized controlled clinical study.

OBJECTIVE: Recent research shows that almost every second woman with breast cancer is depressed or has anxiety; the risk for younger women is even higher. Moreover, research shows that women are at risk for developing depression, also a threat for women with breast cancer. The aim of this randomized controlled clinical trial was to study the outcome of five sessions of art therapy given at a 5-week period of postoperative radiotherapy. METHODS: The participants were between 37 and 69 years old; six participants in each group were below 50 years of age. Half of the participants (n = 20) received art therapy and the other half (n = 21) were assigned to a control group. At the first measurement, at least 17% (n = 7) of the participants medicated with antidepressants. Data were collected before and after art therapy and at a 4-month follow-up using self-rating scales that measure self-image (the Structural Analysis of Social Behaviour) and psychiatric symptoms (the Symptom Check List-90). RESULTS: At follow-up, significant lower ratings of depression, anxiety, and somatic symptoms and less general symptoms were reported for the art therapy group compared to the control group. The regression analysis showed that art therapy relates to lower ratings of depression, anxiety, and general symptoms; chemotherapeutic treatment predicts lower depressive symptoms; in contrast to axillary surgery and hormonal treatment as well as being a parent predicts higher ratings of anxiety and general symptoms. SIGNIFICANCE OF RESULTS: The conclusion suggests that art therapy has a long-term effect on the crisis following the breast cancer and its consequences.

Supervisor trainees' and their supervisors' perceptions of attainment of knowledge and skills: an empirical evaluation of a psychotherapy supervisor training programme.

OBJECTIVES: This study aimed to evaluate the success of a 2-year, part-time training programme for psychotherapy supervisors. A second aim was to examine factors that might contribute to perceived knowledge and skills attainment during the training course. DESIGN: This is a naturalistic, longitudinal study where several measures are used to examine group process and outcome. METHODS: Supervisor trainees' (N=21) and their facilitators' (N=6) ratings of learning (knowledge and skills), relations to the supervisor and supervision group, usage of the group, and supervisor style were completed at three time points. RESULTS: The findings suggested that both trainees and their supervisors perceived that the trainees attained a substantial amount of knowledge and skills during the course. In accordance with the literature and expectations, the regression analysis suggested a strong negative association between a strong focus on group processes in the initial and middle phases of the training and perceived knowledge and skills attainment in the final phase of the training. The expected, positive role of relations among trainees in the supervision group in the first half of the training and perceived knowledge and skills attainment in the final part of the training was obtained, whilst the hypothesized significance of the relationship between trainee and supervisor did not receive support. CONCLUSIONS: The supervisory course seemed to provide a training that allowed trainees to attain knowledge and skills that are necessary for psychotherapy supervisors. The results of this pilot study also emphasize the need of more research on learning in the context of group supervision in psychotherapy.

Group supervision in psychotherapy: the relationship between focus, group climate, and perceived attained skill.

This study examined supervisees and supervisors' view on focus and group climate in group supervision and their relationship with supervisees' attained skill. After supervision, supervisees completed a revised version of Buckley's measure of psychotherapeutic skill. Supervisees and supervisors' experience of focus and climate in the supervision was measured with a questionnaire, Topics and Climate (TAC). The results showed that supervisors' ratings of the extent to which different foci were used in the supervision were significantly higher compared to supervisees' ratings. Hierarchical regression analysis showed that differences in supervisor style were related to supervisees' experience of attained skill. Supervisees' experience of the degree to which focus in supervision was on psychodynamic processes was positively related to perceived attained skill, whereas focus on Theoretical aspects was negatively related. These findings underline the importance of research work with topics and group processes in group supervision.

The latent structure of Wallerstein's Scales of Psychological Capacities.

BACKGROUND: Wallerstein's Scales of Psychological Capacities (SPC) is a fairly new measure of psychological change, developed to meet the need for an instrument which can be used by clinicians and researchers from different psychotherapy directions and schools. This study examined whether Blatt's theory of 2 different types of psychopathology can be used to interpret the latent structure of the SPC. SAMPLING AND METHODS: Data from 224 individuals with mild to severe psychopathology were factor analyzed. RESULTS: A 2-factor solution was meaningfully interpreted from Blatt's theory, and the factors were used for computing summary scales. The scales had adequate reliabilities and discriminated well between different classifications according to DSM-III-R. Patients with depressive or anxiety disorder had more problems with issues concerning self-definition compared to patients with cluster B personality disorder. CONCLUSION: The findings supported the assumption that the concept of psychological capacity is based on an integrative model of the mind, and that the SPC can be a useful tool for clinicians and researchers in understanding psychological problems and resources in patients with various psychiatric disorders. A weakness of the study was that reliability data for DSM diagnoses were not gathered. Moreover, the group of patients with depressive or anxiety disorder was small.

Horowitz's Impact of Event Scale evaluation of 20 years of use.

OBJECTIVE: The main objective of this meta-analysis was to model the relations between a set of independent variables (age and gender of the trauma group, country where the study was performed, year of publication, type of event, time elapsed between event and measurement) and stress symptoms. METHODS: Data from 66 studies that used Horowitz's IES to examine the psychological impact of a major life event were subjected to meta-analysis. RESULTS: Results from hierarchical regression analysis indicated that type of event (episodes of illness and injury, natural and technological disaster, bereavement and loss, violence, sexual abuse, and war exposure) is a strong predictor of levels of intrusive and avoidant symptoms after a traumatic event. Intrusive and avoidant reactions reported by trauma victims tended to decrease linearly over time after the trauma. This finding was supported by the results reported by 20 different studies of stress reactions at two different time points after various events. Gender and cultural difference were relatively insignificant, whereas type of event induced different levels of stress reactions as measured with the IES. CONCLUSION: These data provide evidence for the value of the IES as a measure of stress reactions in a number of different populations. Data summarized here will be useful as a comparison resource in future studies of stress response syndromes.

Impact of Event Scale: psychometric properties.

BACKGROUND: For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events. AIMS: To review studies that evaluated the IES's psychometric properties. METHOD: Literature review. RESULTS: The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance. CONCLUSIONS: The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.