Enhancing the drug addiction treatment service by introducing a new residential treatment model in the Philippines: A qualitative study

BACKGROUND

There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government's Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model.

METHODS

Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process.

RESULTS

The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient's recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks.

CONCLUSIONS

The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET's alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

Can you tell me more about that? An examination of self-disclosure in videoconference and face-to-face psychological interviewing

OBJECTIVES

Videoconference psychotherapy (VCP) is a crucial component of many health care systems, allowing for remote delivery of services. However, little is known about the mechanisms of change within VCP. Previous research has suggested that self-disclosure may be greater in VCP than face-to-face modalities and was investigated in the current study.

DESIGN

Young adults aged 18-25 years (N = 57) were randomly allocated to face-to-face or VCP interview conditions, with measures completed pre- and post-interview.

METHODS

Participants completed an autobiographical memory task, requiring them to describe specific memories in response to positive and negative valence cue words. Measures included self-reported self-disclosure, blind observer-rated self-disclosure, memory specificity, and mean number of words per response.

RESULTS

No significant differences were found between conditions with regard to self-reported self-disclosure, capacity to recall specific memories, or words uttered per response. However, observer-rated depth of self-disclosure was significantly higher for participants in the face-to-face than VCP condition. Self-disclosure and memory specificity were also significantly greater for negative than positive valence cue words, regardless of condition.

CONCLUSIONS

The findings indicate that whilst participants may be able to draw on memories with equal ease regardless of interview modality, in VCP, emotional processing of these memories may require increased support and guidance from the therapist.

Detection and disclosure of workplace mental health challenges: an exploratory study from India

Workplace mental health challenges have emerged as a significant concern post-pandemic. Despite this, the pervasive stigma surrounding mental illness leads to the concealment of symptoms and reluctance to seek professional help among employees. This study aims to explore the perception of different stakeholders towards the 'Detection and disclosure' of workplace mental health challenges in the Indian context. Fifteen semi-structured interviews were conducted with human resource professionals, counselors, and employees who had previously experienced mental health challenge(s). Thematic analysis was done to identify recurring themes and sub-themes. Three critical pathways were identified: minimizing the inhibitory factors, including lack of awareness, denial, low self-efficacy, stigma, and underestimating organizational capability; maximizing the encouraging factors, including psychological safety, perceived social support, and communicating success stories; and implementing supportive organizational practices, including generating awareness and literacy, build the organizational capability, strengthen the role of managers, leadership advocacy, policies, and processes. By fostering a culture of support and prioritizing employee well-being, organizations in India can create healthier and more resilient work environments, benefiting both individuals and the larger society.

A systematic review and meta-analysis of clinician behaviors and characteristics related to alliance building with youth clients

The literature on developing alliance with youth clients has severely lagged behind that of adults. To date, there has been no meta-analytic review and limited qualitative synthesis of clinician variables which may contribute to the alliance with youth clients. Systematic literature search found a total of 49 relevant citations. Of the identified articles, 13 (27.08%) reported quantitative methods. Results of the qualitative review suggested that the majority of this research has focused on developing an emotional bond and a sense of collaboration. Meta-analysis found significant relations between alliance building and reducing variables and alliance (r_{alliance building} = 0.17; r_{alliance reducing} = -0.24). This analysis revealed specific behaviors particularly facilitative to youth alliance development, including collaborating with the client, finding common ground, exploring subjective experiences, orienting to treatment, providing praise, and enhancing facilitative conditions. In contrast, clinician lapse and pushing the client to talk were most predictive of a worse alliance. These results indicate certain behaviors which may be particularly important for clinicians to facilitate and not impair youth alliance formation. There is a need for greater youth alliance formation research to better determine how alliance formation may differ across stages of development and treatment modalities.

The nature, motives, and perceived consequences of therapist dishonesty

Honest communication between therapists and clients is an essential part of the process and values of psychotherapy, but the topic of therapist dishonesty has remained virtually unexplored. This study examined the prevalence, motivations, and perceived consequences of therapist dishonesty. Data were compiled from a Qualtrics survey, including several open-ended questions, of 401 practicing psychotherapists. Findings revealed that virtually all respondents acknowledged having been dishonest with their clients at least once, most often about their own emotional health and their attentiveness in session, and that they were significantly more likely to engage in covert than overt dishonesty. Most felt their dishonesty was in the service of their clients' therapy or wellbeing and perceived no negative consequences of such actions. Novice therapists reported being dishonest with their clients more frequently than therapists with more experience. Directions for future research, as well as the need for training programs to introduce students to this issue, are noted.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Inpatient and Day-Clinic Experience Scale (IDES) - a Psychometric Evaluation

OBJECTIVES

The Inpatient and Day-Clinic Experience Scale (IDES) was developed to assess common factors in a multimodal psychotherapy setting from the patients' perspective. The questionnaire measures different aspects of therapeutic relationships, a positive self-view and a critical attitude towards therapy.

METHODS

Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire.

RESULTS

Confirmatory analyses show a good model fit and support the proposed structure with 25 items and seven scales. In addition, reliability indices were stable throughout multiple assessments over time. Concerning validity, early IDES process measures were moderately associated with symptomatic improvement.

CONCLUSIONS

The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.

Critical Secret Disclosure in Psychotherapy With Korean Clients

Korean clients who had completed counseling in Korea and viewed the therapy as successful were interviewed about critical secret disclosure during their therapy. In-depth interviews along with grounded theory-informed analyses in a methodological hermeneutic framework revealed that many Korean clients reported that despite initial fears and needing to test their counselors, sharing their secrets was a powerful experience that deepened their connection to their counselor, facilitated positive life changes, and enhanced their relationships with others. We present a hierarchy of categories that explains the meaning and process of critical secret disclosure in therapy. The results are discussed in the context of Korean culture and how these findings can inform therapy with Korean clients.

The role of psychological flexibility in the relationship between self-concealment and disordered eating symptoms

The present cross-sectional study investigated whether psychological flexibility mediates the association between self-concealment and disordered eating (DE) symptoms among non-clinical college students. Data of 209 male and female participants (nfemale =165), aged 18-22 years old, were used for analyses. Self-concealment was found to be positively associated with DE symptoms (i.e., general eating disorder symptoms and eating disorder-related cognitions) and negatively associated with psychological flexibility. Psychological flexibility was inversely associated with DE symptoms. Finally, psychological flexibility was found to mediate the association between self-concealment and DE symptoms after accounting for gender, ethnic background, and body mass index (BMI).

Authenticity: a concept analysis

PURPOSE

This paper aims to analyze the concept of authenticity and propose a definition of authenticity that can be used to enhance the nurse-client relationship.

SOURCES

Published research.

CONCLUSIONS

Authenticity is a life-long process of self-discovery that includes realizing personal potential and acting on that potential. A part of this process is accepting the responsibility for and the consequences of life choices that are consciously or unconsciously made. This is sometimes achieved through suffering. This process culminates in a demonstration of congruency in ideals, values, and actions in relation to self and others.

Is self-disclosure part of the genetic counselor's clinical role?

The role of genetic counselor self-disclosure in clinical practice is unclear as there are few published investigations of this issue. In the present study, 11 genetic counselors who previously received genetic services were interviewed about their opinions and use of disclosure. Several themes were extracted from their responses. All participants reportedly disclosed to patients; however, not all disclosed their receipt of genetic services. Patient requests for self-disclosure influenced many participants' disclosure decisions. Opinions regarding potential benefits of disclosure varied. Nearly all participants stressed the importance of self-disclosing judiciously, stating that it may be counterproductive to client goal attainment. Four individuals with expertise in genetic counseling and psychotherapy were invited to react to these themes and to provide their opinions of self-disclosure. Their views are compared to those of the present sample, and practice and research recommendations are given.

Is Keeping a Secret or Being a Secretive Person Linked to Psychological Symptoms?

This prospective study explored whether keeping a major secret, self-concealment (i.e., the predisposition to keep secrets), and social support at Time 1 predicted symptomatology levels 9 weeks later (Time 2) among a sample of 86 undergraduates. The results showed that the process of keeping a secret actually predicted fewer symptoms, whereas the personality variable of self-concealment predicted more symptoms at Time 2, even when the analyses controlled for social support. However, the predictive effects of both secret keeping and self-concealment were wiped out when the analyses statistically controlled for initial symptomatology, which was positively linked to self-concealment from the outset. These findings challenge conventional wisdom about the dangers of keeping a major secret and suggest that, instead, the kind of person who is secretive simply might be more vulnerable to symptoms.

Effects of naltrexone on repressive coping and disclosure of emotional material: a test of the opioid-peptide hypothesis of repression and hypertension

OBJECTIVE

The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping.

METHODS

Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol.

RESULTS

Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group.

CONCLUSION

The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena.