Thursday June 7th 2012 - NYBH Staff
Beyond Medication and Therapy
Important research on dietary sensitivities and symptoms of attention deficit/hyperactivity disorder (ADHD) conducted over the past three decades was recently summarized in an article in the Clinical Pediatrics Journal. While the most common and effective treatments for ADHD are psychostimulant medications (such as Ritalin) and behavior therapy, the available medications are only effective in approximately 70% of children. Therefore, many parents and clinicians are still searching for alternative treatments for the 30% of children who do not respond to the traditional interventions, as well as for those who wish to avoid experiencing the potential side effects often caused by medication. Alternative treatments pertaining to diet focus on addressing one debatable environmental factor: hypersensitivity (or intolerance to certain food additives).
Addressing Dietary Hypersensitivity
The following include some of the most common and researched diets that are proposed by scientists and medical experts as alternative treatments to ADHD symptoms.
The Kaiser-Permanente (K-P) Diet
The theoretical background of this diet is drawn from the controversial work of Dr. Benjamin Feingold, who in the 1970s suggested that many of the hyperactivity and learning problems observed in children were due to the intake of certain foods and food additives. According to this diet, foods and food additives to be avoided include:
· Apples, grapes, luncheon meats, hot dogs, and cold drinks with artificial flavors and coloring agents
· Red and orange synthetic dyes, preservatives, butylated hydroxytoluene (antioxidant food additive) and butylated hydroxyanisole (antioxidant and food preservative)
Weak Response (Improvement in Behavior)
Although Dr. Feingold estimated that 30 to 70% of the treated hyperactive children showed improvement of symptoms, subsequent controlled studies have failed to support the effectiveness of the diet to the extent claimed (Millichap & Yee, 2012). In fact, Stevens et al. (2011), after a meta-analysis of the last 35 years of research, conclude that only a small proportion of hyperactive children (11-30%) respond to the K-P diet as evidenced by their improved functioning at home and in school.
Artificial Food Color (AFC) Diet
Supporters of a diet free of artificial food color (AFC) suggest that ingestion of AFCs may result in significant changes in behavior. The most common AFCs studied for their effects in behavior include sunset yellow, quinoline yellow, tartazine, carmoisine, allura red and ponceau red. Following a literature review of extensive research on the effects of AFC, Stevens et al. (2011) conclude that although AFCs cannot be accounted as the main cause of ADHD, accrued evidence suggests that a subgroup of children with suspected sensitivities to AFC showed significant symptom improvement when following an AFC-free diet. Moreover, of these children suspected to have sensitivity to AFC, 65-89% reacted when administered at least 100mg of AFC.
Previously known as oligoantigenic diets, elimination diets are based upon the negative effects that some natural foods could have in children’s behavior. An elimination diet focuses on eliminating sensitizing food allergens like those often found in foods labeled as allergenic. Some of these foods include cow’s milk, cheese, wheat cereals, egg, chocolate, and nuts. Supporters of this diet encourage consumption of hypoallergenic foods, such as lamb, potatoes, tapioca, carrots, peas, and pears. Supporters often reference data published in scientific research suggesting that elimination diets can result in significant statistical decreases in symptoms of ADHD in up to 62% of children (Millichap & Yee, 2012). However, it is important to note that many of these studies also eliminated AFCs from the children’s diet, given that many children seem to show a food “cosensitivity.” In other words, in addition to being sensitive to AFCs, they are also sensitive to allergenic foods (Stevens et al., 2011). While some data might seem compelling, the role of elimination diets in the treatment for ADHD remains uncertain particularly when evaluating the possibility of maintained long-term improvements.
An upcoming post will continue the discussion of alternative diet therapies to address symptoms of ADHD.
Millichap, J. G., & Yee, M. M. (2012). The diet factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics, 129, 2011-2199.
Stevens, L. J., Kuczek, T., Burgess, J. R., Hurt, E., & Arnold, E. (2011). Dietary sensitivities and ADHD symptoms: Thirty-five years of research. Clinical Pediatrics, 50, 279-293.
Monday June 4th 2012 - NYBH Staff
Personality and Infertility
The Center for Disease Control and Prevention (CDC) in 2012 reports that 11.8% of women ages 15 to 44 present with fertility problems and about 7.3 million of the same population have undergone some type of fertility treatment during their lifetime. These numbers show a rise in the use of assisted reproductive technologies (ARTs) such as in vitro fertilization (IVF). Reproductive medicine has made astonishing advances in the last few years, and we now have a better understanding of infertility and medical interventions by which it can be treated. Nonetheless, the idea of whether psychological status--in this case, personality traits--affects chances of conception remains controversial. If substantial evidence has been found for showing personality traits to relate to diverse areas of physical health and disease, it almost seems natural to question the relationship between personality traits and infertility (Bleil, Pasch, Gregorich, Millstein, Katz & Adler, 2012).
IVF Success/Failure and the Woman’s Optimism/Pessimism
A recent article in The Journal of Psychosomatic Medicine (2012) dealt with fertility treatment response and its relationship to being optimistic or pessimistic. Authors studied the prospective relation between dispositional traits of optimism/pessimism (the degree to which an individual expects to experience positive versus negative outcomes in life) and the outcome of a woman’s first IVF treatment cycle among couples seeking medical intervention for infertility. Precisely, they looked at the rates of IVF success and failure. Success was defined as a live birth or pregnancy being recorded by the end of the 18-month study; failure was indicated by an inability to complete the IVF cycle, to conceive, or to carry a pregnancy by the end of the 18-month study.
Given than optimism and pessimism have been studied as either unipolar independent dimensions that have different impact on health outcomes or as a single bipolar dimension, in the current study researchers measured optimism and pessimism in both ways.
Findings on Optimism and Pessimism
This study’s findings suggest that:
· Unipolar pessimism: Women who endorsed greater pessimism (when it is measured as a separate unipolar dimension) were more likely to experience treatment failure after their first IVF treatment cycle. Therefore, according to this study, pessimism may present risk for IVF treatment failure.
· Bipolar optimism/pessimism: When optimism/pessimism is viewed as a single bipolar dimension, no independent relationship to IVF treatment outcome was found.
· Unipolar optimism: When it is measured as a separate unipolar dimension, optimism is unrelated to IVF treatment outcome.
CBT as Valuable Intervention
Researchers report that although definitive recommendations for interventions based on these findings would be precipitated, it can be suggested that cognitive behavioral therapy (CBT) may be beneficial. CBT-oriented psychological interventions such as meaning-making and coping skills training may help to address the female’s negative or pessimistic thinking patterns. Much research is still warranted on this matter, but these preliminary data further stress the critical connection between mind and body.
What are your thoughts on the issue of infertility? What other personality traits or dispositions, if any, can you think of that might have implications in the case of couples who have found conception difficult?
Bleil, M. E., Pasch, L. A., Gregorich, S. E., Millstein, S. G., Katz, P. P & Adler, N. E. (2012). Fertility treatment response: Is it better to be more optimistic or less pessimistic? Psychosomatic Medicine, 74, 193-199.
Friday June 1st 2012 - NYBH Staff
Definition of Infertility
Infertility can be defined as failure to produce a pregnancy that results in a live birth after one year of unprotected regular intercourse if you are under the age of thirty-five years and after six months if you are over the age of thirty-five years. It affects approximately 7.3 million women and their partners in the U.S. within their lifetime, representing roughly 12% of the population considered to be of reproductive age (American Society of Reproductive Medicine, 2012).
Reproductive vs. Psychological Care
Dr. Alice Domar (2012), of the Domar Center for Mind/Body Health at Harvard Medical School, explains how the medical treatment of infertility through assisted reproductive technology (ART) has made immense advances yet lacks incorporation of appropriate and effective psychological patient care during this difficult time.
Depression, Stress, and Anxiety Associated with Infertility
Dr. Domar (2011) reports that new research on the matter has provided data demonstrating that infertility is commonly associated with higher levels of depression, stress, and anxiety. These findings have sparked interest in researchers and clinicians interested in the inclusion of psychosocial treatments as an important component of ARTs, particularly when dealing with in vitro fertilization (IVF).
Psychosocial Treatments for Infertility Issues
In her attempt to review the literature on the effects of psychosocial treatments on IVF outcomes, Dr. Domar begins by presenting the most common psychosocial treatments offered to patients dealing with infertility.
· Counseling/Support: Conducted either individually or in a group setting, it focuses on emotional expression and open discussion of feelings and thoughts.
· Cognitive-behavioral, educational, and skills-based therapy: Focuses on reshaping negative thought patterns that tend to maintain feelings of depression and anxiety. Programs oriented towards mind/body integration commonly include relaxation training, cognitive restructuring, and psychoeducation on infertility-related topics. Dr. Domar et al. (2000) found that women participating in these types of mind/body programs had significantly better scores on psychological outcome measures when compared to women in counseling/support programs.
· Other interventions: Several other psychosocial interventions, with less evidence supporting them, include hypnosis and medical clowning (being visited by a clown after treatment). However, conclusive data on such interventions have yet to be found.
Results of Psychosocial Treatments
The research to date suggests that psychosocial treatments can help ameliorate psychological distress associated with infertility. However, how can psychosocial treatments increase pregnancy rates in ART and IVF patients?
Increasing Rates of Pregnancy
In and of themselves, psychosocial treatments do not raise pregnancy rates in ART and IVF patients. Nonetheless, data show that by means of several possible mechanisms, they may help rates of pregnancy.
· Increased sexual behavior: Dr. Domar explains how after a six-month Cognitive-Behavioral Therapy (CBT) program, results indicated a decrease in marital distress and an increase in the practice of timed intercourse without a decrease in sexual pleasure during the non-fertile days of the menstrual cycle.
· Decreased dropout rates: ARTs and IVF treatment cause stress to the marriage and produce depression and anxiety in patients. Commonly, these effects drive patients to discontinue treatment. Domar et al. (2010) found that psychosocial interventions that focused on providing information, training stress-reduction skills, and providing support could increase the chances of patients continuing treatment and eventually achieving pregnancy.
· Neuroendocrine system: Reproductive hormones pivotal for conception can be altered by prolonged stress and its effects on the functioning of the neuroendocrine system. Psychosocial interventions geared towards skills training that teach patients to reduce and cope with their stress may help restore the brain centers implicated in reproductive functions.
Efficacy of Infertility Treatments
Dr. Domar concludes by stating that while the available literature on the impact of psychosocial interventions on ART and IVF treatments remains limited, it can be concluded that potential exists to decrease stress and affect reproductive hormones, which in turn can help in the efficacy of medical infertility treatments. There is still much to investigate, but preliminary findings for potential positive impacts of these interventions seem promising. What do you think?
Domar, A. D. & Prince, L. B. (2011). What the evidence shows: Impact of psychological interventions on IVF outcome. SRM-ejournal, 9, 26-32
Wednesday May 30th 2012 - NYBH Staff
Assessing Hopelessness and Bullying/Victimization
Siyahhan et al. conducted a study among Turkish youth, ranging in age from 12-14, in an attempt to understand the relationship between hopelessness and bullying/victimization. Hopelessness, the cognitive component of depression, is characterized by an individual’s perception of a lack of control concerning future event outcomes, most often resulting in negative feelings surrounding an event, the future, and oneself. Hopelessness is an essential component of depression as it has been identified as a cognitive vulnerability that most often precludes suicide and suicidal ideation. Siyahhan’s et al. study reports significant findings relating an individual’s role in the bully/victim relationship and his/her reported hopelessness and suggests important implications for future interventions and preventative programs. Study participants were asked to fill out two questionnaires, the Beck Hopelessness Scale and the Olweus Bully/Victim Questionnaire. The results of the aforementioned questionnaires were then tallied, assessed for variations in SES (Socioeconomic Status) outcomes and reported.
Types of Bullying
Two types of bullying were classified: direct and indirect (relational). Direct bullying refers to overt displays of aggressive behavior including physical or verbal attacks. Conversely, indirect bullying refers to covert aggression that can take the form of gossiping, rumor spreading, and excluding.
Circuitous Relationship between Bullying and Victimization
Siyahhan et al. were careful to highlight that both victims of bullying and bullies themselves report significant levels of depression and anxiety. Their study suggested that neither bullying nor victimization alone has a significant effect of hopelessness, but that the two combined have a significant impact on hopelessness. The most at-risk population for hopelessness and potential suicide, therefore, is the bully-victim. A bully-victim is an individual who is bullied and, in turn, bullies. Siyahhan et al. proposed the circuitous relationship between the two experiences and an inability to see an alternative to the repetition as potential contributors to said hopelessness. Interventions and prevention programs should, therefore, be aimed at influencing bully-victims’, victims’, and bullies’ perception of personal agency and the options available to halt and reverse the vicious cycle of abuse.
Further results show that males were more likely to engage in direct bullying, whereas female students were more likely to engage in relational bullying. A positive relationship was reported between direct bullying and depression; males were also shown to engage in all types of bullying more frequently than females. There was no direct relationship between indirect bullying and hopelessness. The indications followed that Turkish boys were more likely to be depressed than their female counterparts as a result of both bullying and victimization.
Social Support and Type of Bullying
Verbal bullying was reported by 47% of the Turkish students as most prevalent in bullying behavior and when being bullied. Instances of physical bullying were most infrequent. Social support, identified as an important coping mechanism for victims, was most often only proactively offered by teachers during instances of physical abuse and thus targeted only the most infrequent and obvious displays. This identified gap must be addressed within Turkish schools for more effective interventions and preventative measures. Gender differences, as well as culturally specific practices surrounding the perception of teasing/bullying must also be considered when designing an intervention.
Siyahhan, S., Aricak, O. T., & Cayirdag-Acar, N. (2012). The relation between bullying, victimization, and adolescents’ level of hopelessness. Journal of Adolescence. Retrieved from http://dx.doi.org/10.1016/j.adolescence.2012.02.011
Friday May 25th 2012 - NYBH Staff
Variations in Reactions of Victims to Bullying
TB Hansen, et al. highlighted the complexity of the effects and potential precursors to a painful phenomenon affecting an estimated 5.3-50% of school age children: bullying. TB Hansen, et al. aimed to better understand the variations in reactions and mental health outcomes among children and adolescents who have been victims of bullying and have, therefore, identified five variables to better evaluate potential risk and protective factors: “Coping, social support, attachment, negative affectivity/neuroticism, and somatization.” To analyze the aforementioned variables, TB Hansen et al. reviewed recent articles and data published about school bullying and complied an analysis demonstrating a direct relationship between the aforementioned variables and victims of bullying.
The Link Between Relationships and Bullying
TB Hansen et al. reported a relationship between attachment patterns and bullying, citing studies that show secure childhood attachments can often lead to positive peer attachments; this indicates that children with insecure parental attachments can be at a higher risk for peer bullying. Additionally, studies are also cited that childhood teasing can cause a lasting disruption in future attachment patterns, most often resulting in insecure intimate relationships in adulthood.
State of Negative Affectivity as Both Risk Factor and Reaction
The second variable considered is “negative affectivity,” which refers to an individual’s tendency for negative emotional reactions, both towards others and toward oneself. TB Hansen is careful to define negative affectivity as a state and not a character trait, though it can be characterized by certain traits such as low-self esteem and introspection. Children in a state of negative affectivity are typically more nervous, angry, worried and agitated and can, therefore, experience more difficulty socially due to their heightened emotional state. Negative affectivity was identified as both a potential risk factor for and a reaction to bullying.
Additionally, TB Hansen et al. report that children who are bullied are more likely to report somatic symptoms with no known physical etiology than children who are not bullied. Somatization is the experience of physical symptoms, such as stomachache, headache, etc, that could be manifestations of a state of duress induced largely by mental health obstacles. Children who are victims of bullying could experience somatization as a form of avoidant coping, wherein the manifestation of physical symptoms excuses them from school or other identified events of concern.
Importance of Social Support
TB Hansen et al. cite that children who are bullied often lack adaptive coping strategies. One such identified coping strategy, the seeking of social support, also appears as a variable to predict outcomes for victims. Studies are cited that indicate low levels of social support often result in higher incidents of reported suicidal ideation. It is also reported that victims, themselves, place significant expressed value on social support; interestingly, corresponding studies indicate that victims are often reluctant to seek out this support.
Hansen, T.B., Steenberg, L. M., Palic, S., & Elklit, A. (2012). A review of psychological factors related to bullying victimization in schools. Aggression and violent behavior, 3, 39-43.
Tuesday May 22nd 2012 - NYBH Staff
Obsessions and Compulsions
As mentioned in a previous blog entry, Obsessive-Compulsive Disorder (OCD) is a psychiatric disorder characterized by obsessions and/or compulsions that interfere with a person’s life. Obsessions are not simple worries, and they are not just our thoughts that produce distress and anxiety and that change daily. Instead, obsessions are recurring and relentless worries. They involve persistent impulses, ideas, images or thoughts that disrupt and interfere with a person’s thinking, leading to excessive worry and anxiety. Compulsions, on the other hand, are mental acts or repetitive behaviors performed to relieve or prevent the worry and anxiety caused by the obsessions.
Given that OCD has a cognitive component (obsessions) and a behavioral component (actions), Cognitive-Behavior Therapy (CBT) is logically the preferred approach to treat this disorder. Additionally, CBT’s efficacy in treating OCD is supported by scientific research (Mancebo, Eisen, Sibrava, Dyck, & Rasmuseen, 2011). In fact, The American Journal of Psychiatry published a study in 2005 that stated that CBT by Exposure and Response Prevention (EX/RP) is the best available psychotherapy for OCD.
Phase One of EX/RP: Exposure
Concisely, (EX/RP) is a behavioral intervention with two parts: First, the exposure component involves exposing the individual to the feared stimulus. This systematically helps individuals overcome their feelings of fear and dread that occur in their triggering situations. During the exposure phase, their nervous system becomes accustomed to the novel stimulus. The exposure component relies on habituation and extinction, which are both learning processes. Habituation is the natural tendency of our nervous system to “numb out” from repeated, prolonged contact with a particular stimulus. Such habituation will systematically help individuals overcome feelings of fear and dread occurring in triggering situations. Extinction, on the other hand, is what happens when a reinforcer no longer brings about feelings of pleasure or no longer reduces tension or discomfort. By blocking behaviors that reinforce worries and perpetuate them, obsessional worries eventually diminish. Exposure can be done either in vivo (become habituated to feared situations) or through imaginal means (become habituated to one’s own fear-provoking thoughts.)
Phase Two of EX/RP: Response Prevention
The second phase of EX/RP involves response prevention. This component prevents the individual from ritualizing after being exposed to a triggering stimulus. In other words, the compulsions will no longer be available to reduce the anxiety and act as a reinforcer. Commonly, EX/RP is accompanied by cognitive interventions, such as cognitive restructuring through which individuals work on exploring and challenging their irrational or maladaptive thoughts that have been associated with their OCD (Hyman & Pedrick, 2005).
Research on OCD Treatment Modalities
Although most data supporting the use of the aforementioned treatment modality for OCD come from randomized controlled trials, the scientific community has researched its effectiveness in diverse settings:
· CBT in Private Practice: An effectiveness study published in The Journal of Anxiety Disorders (2001) reports that CBT can effectively be delivered in routine clinical private practice, yielding similar results to those found when it is implemented in randomized controlled trials.
· Group CBT: Jonsson, Hougaard, and Bennedsen (2011) indicate that, while individual CBT may be slightly more effective than group CBT, data from their randomized comparative study suggest that group CBT is an effective treatment for OCD, yielding large and durable outcomes similar to those of individual CBT.
· Internet-based CBT: In December, 2011, The Journal of Anxiety Disorders published a study that presented preliminary data regarding the efficacy and acceptability of a clinician-guided CBT treatment protocol via the Internet. The data suggest that CBT delivered via the Internet is effective and that acceptability rates by participants are high (81%).
Conclusions and Questions
These are just a few of the many scientific studies that have addressed the treatment of OCD with CBT using EX/RP therapy. The scientific community seems to agree on the effectiveness of EX/RP effectiveness. Have you found otherwise?
Hyman, B. M., & Pedrick, C. (2005). The OCD Workbook: Your Guide to Breaking Free From Obsessive-Compulsive Disorder (2nd Ed.). Oakland, CA.: New Harbinger Publications.
Jonsson, H., Hougaard, E., & Bennedsen, B. E. (2011). Randomized comparative study of group versus individual cognitive behavioral therapy for obsessive compulsive disorder. Acta Psychiatrica Scandinavica, 123, 387-397.
Rahman, O., Reid, J. M., Parks, A. M., McKay, D., & Storch, E. A. (2011). Obsessive-compulsive disorder. Handbook of Child and Adolescent Anxiety Disorders, 323-338.
Warren, R., & Thomas, J. C. (2001). Cognitive–behavior therapy of obsessive–compulsive disorder in private practice: An effectiveness study. Journal of Anxiety Disorders, 15, 277–285.
Wootton, M., Titova, N., Deara, B. F., Spencea, J., Andrews, G., Johnston, L., & Solley, K. (2011). An Internet administered treatment program for obsessive–compulsive disorder: A feasibility study. Journal of Anxiety Disorders, 25, 1102–1107.
Friday May 18th 2012 - NYBH Staff
Amount of Alcohol Consumption Across the Lifespan
In recent years, much research has been conducted on the trajectory of alcohol use. We know that, as with other developmental phenomena, alcohol use follows a normative course across the lifespan. Of course, there is individual variability, but alcohol consumption commonly increases in the late teens, peaks during the early 20s, and then decreases during the mid to late 20s when individuals transition into adulthood. However, not much attention has been paid to the factors underlying the alcohol consumption trajectories, i.e., looking at the reasons why people decide to use alcohol and not just at how much they use.
Developmental Changes in People’s Lives
Researchers from the University of Michigan and Pennsylvania State University investigated developmental changes associated with alcohol consumption behaviors. They found that factors that motivate people to use alcohol also follow a developmental trajectory, such as that seen with the amount of alcohol they consume. What this tells us is that some of the motivating factors for alcohol consumption become more prevalent or rarer as individuals mature. In particular, as individuals transition into adulthood, they experience residential and social changes.
Motivating Factors for Alcohol Use
The researchers conceptually grouped 14 factors involved in the consumption of alcohol into 5 categories:
· Social/recreational: to get high, to have a good time with my friends, to fit in with a group I like, and/or because of boredom
· Coping with negative situations: to relax, to get away from my problems, and/or because of anger or frustration
· Compulsive use: to get through the day and/or because I’m hooked
· Drugs: to increase or decrease the effect of other drugs
· Miscellaneous: to seek deeper insights and understandings, to get to sleep, and/or because it tastes good
Factors Causing Change in Alcohol Consumption
According to this study, there are a number of factors that cause a change in alcohol consumption as young people transition into adulthood:
· The majority of reasons decreased in prevalence with increasing age. As people grow older they drink less because they have fewer reasons for drinking.
· The chief reasons for using alcohol, other than to fit in, were social/recreational.
· The prevalence of compulsive reasons to drink and use drugs decreased with age. The use of alcohol to relax, to sleep, and because it tasted good increased significantly with age.
· Men were more likely than women to endorse using alcohol to get high, to fit in, because of boredom, because they were hooked, to increase the effects of other drugs, to seek insight, and to sleep.
· Women were more likely than men to report using alcohol to get away from problems and because of anger/frustration.
Addiction and Other Problems Associated with Alcohol Use
Obviously, not everyone who consumes alcohol needs to stop or cut back on its use. There are even some very good reasons to drink wine or other alcoholic beverages. In recent years, research has demonstrated that alcoholic drinks, especially red wine, have health benefits associated with their consumption. On the other hand, alcohol is the number one drug problem in the U.S., nearly a third of the population has abused alcohol at some time, and it is estimated that there are around 12 million alcoholics in the United States alone. The seemingly limitless consequences include family, social, employment, financial, legal, spiritual, physical and mental health, and other problems. Some researchers believe that having the information presented here can potentially help create developmentally appropriate intervention programs for people with alcohol abuse problems. What do you think?
Patrick, M. E., Schulenberg, J. E., O’Malley, P. M., Maggs, J. L., Kloska, D. D., Jhonston, L. D., Bachman, J. G. (2011). Age-related changes in reasons for using alcohol and marijuana from ages 18 to 30 in a national sample. Psychology of Addictive Behaviors. Vol25 (2), 330-339.
Monday May 14th 2012 - NYBH Staff
Licensure for Mental Health Counseling
In a previous blog entry, the history of Mental Health Counseling and its journey towards becoming a distinct and accredited profession were described. Currently, licensure is recognized in all 50 states, as well as in the District of Columbia, Guam, and Puerto Rico. California became the 50th state to approve licensure and its first counselors will be licensed in 2011-2012. Although the exact title varies from state to state, with the two most common being Licensed Professional Counselor and Licensed Clinical Mental Health Counselor, all professionals that are awarded this title have the following characteristics in common.
Mental Health Counselors work with individuals, groups, and families in many different settings. They are able to provide a wide range of services that include, but are not limited to, assessment and diagnosis, psychotherapy, treatment planning, program development and evaluation, psycho-education and prevention programs, and crisis management.
Mental Health Counselors are able to work either individually or as part of a team of professionals that provide mental health services. Settings vary greatly, but common ones include private practice, community agencies, hospitals and other institutions, mental health clinics, family care homes, and rehabilitation clinics and agencies.
Mental Health Counseling master’s programs are required to include 60 semester hours of graduate studies and a curriculum that must contain, but not be limited to, the following: human growth and development, social and cultural foundations of counseling, counseling theory and practice, psychopathology, group dynamics, career development, assessment and appraisal, research and program evaluation, professional orientation and ethics, foundations for Mental Health Counseling, clinical instruction, and a minimum of one year (600 clock hours) of supervised clinical work.
1. One of the distinct characteristics of Mental Health Counseling, when compared to psychology, is the fact that the entry-level degree is a Master’s instead of a Doctorate.
2. Mental Health Counselors need a minimum of two years (3,000 hours) of post-master’s clinical work under the supervision of a licensed or certified mental health professional.
3. Finally, Mental Health Counselors are required to pass the state-developed licensure or certification exam.
American Counseling Association (2012). Retrieved from http://www.counseling.org/counselors/licensureAndCert/TP/StateRequirements/CT2.aspx
American Mental Health Counseling Association (2012). Retrieved from http://www.amhca.org/
New York State Office of The Profession (2012). Retrieved from http://www.op.nysed.gov/prof/mhp/mhclic.htm
Thursday May 10th 2012 - NYBH Staff
Description of the Mental Health Counselor
Most of us are familiar with the terms psychologist, psychiatrist, and social worker. Fewer of us have heard the term mental health counselor and consequently may not be aware of the service provided by this professional. The American Mental Health Counseling Association defines the profession as “A distinct profession with national standards for education, training, and clinical practice. Clinical mental health counselors are highly skilled professionals who provide flexible, consumer-oriented therapy. They combine traditional psychotherapy with a practical, problem-solving approach that creates a dynamic and efficient path for change and problem resolution.” Although currently a well-defined and accepted profession, this has not always been the case.
A Professional Identity
Many label it as the youngest profession in the field of mental health services; it has a short but bold history. Counselors have been around for many years, however, only recently have they created and solidified their professional identity and the purpose of this discussion is to review the journey towards this goal by looking at significant historical events that made it possible.
· Late 1800s
o The Counseling profession emerges as vocational guidance in response to the Industrial Revolution and social reform movements.
· Early 1900s
o Frank Parsons, considered by many as the father of vocational guidance, opens the Bureau of Vocational Guidance in Boston. The Bureau’s mission was to help match individuals with suitable careers based on their skills and personal traits.
o Clifford Beers, the leader of the mental health movement, establishes the first mental health clinic in America. He advocated for the more humane treatment of institutionalized patients with psychological disorders.
o During this decade, owing in part to World War II, there is a need for counselors and psychologists to help the government select and train specialists for military and industrial work placements. In addition, the United States Veterans Administration (VA) funds the training of counselors and psychologists to accomplish these goals.
o In 1942, Carl Rogers publishes Counseling and Psychotherapy, advocating a client-centered approach to psychotherapy. His work later becomes a pillar of the profession’s identity. It emphasized a client-centered theory, which had at its core the belief that the client is a partner in the healing process rather than a patient on which the professional imposes a cure.
o In 1952, The American Personnel and Guidance Association was created to provide counselors, who were already in the field providing mental health services, with a professional association. This association will later become the American Counseling Association, as it remains to this day.
o In 1958, The National Defense Education Act passes, providing funds to establish counseling and guidance institutes to train counselors.
o In the early 1960s, humanistic theories continue to emerge and provide a theoretical framework to view the human existence from a holistic approach; this will also greatly contribute to the profession’s identity and help in distinguishing it from other mental health professions.
o In 1963, The Community Mental Health Centers Act passes and provides federal funding for the creation of community mental health centers across the United States.
o In 1965, The Secondary Education Act establishes that public funding for human services be redirected into supporting the Vietnam War efforts. Graduates of counselor programs, who at the time were primarily trained to work in elementary and secondary education settings, are not able to find employment in those markets. They began to seek employment in University counseling centers or in the Veterans Administration. However, the psychology profession, also facing a scarcity of jobs, began to block the entrance of these counselors into their professional terrain.
o In the early 1970s, counselors, particularly mental health counselors, find themselves a loosely defined profession without a clear identity or a professional organization.
o By the mid-1970s, it is evident that a number of professionally trained individuals were delivering a wide variety of services very similar to the more established mental health care providers (psychiatry, psychology, and social work). However, without a professional association they were not being recognized as a professional group.
o In response to the aforementioned situation, in 1976, The American Mental Health Counselor Association (AMHCA) is created. This is the first step towards solidifying and differentiating mental health counselors as a unique and valid profession. Soon after, they approached the American Counseling Association in order to be part of a larger professional family. This year Virginia becomes the first state to offer counselors the option to seek licensure.
o In 1983, ACA establishes its own credential, The National Board for Certified Counselors (NBCC).
o By the mid 1980s, it has become obvious that, if mental health counselors were to work in the health care system, new and more rigorous standards were going to have to be established.
o The 1986-1987 AMHCA Board of Directors adopts a set of comprehensive training standards for mental health counselors: 60 semester credit hours and a minimum of 1,000 clock hours of clinical supervision.
o In 1992, Counseling is included as a primary mental health profession in the health care human resource statistics of the Center for Mental Health Services and the National Institute of Mental Health.
o In 2002, California adopts a counselor registry, which represents the first step towards licensure.
o Minnesota state legislature passes a counselor licensure bill.
The Profession Today
These are some of the highlights in the history of Mental Health Counseling. The second blog entry of this series will discuss the current state of the profession.
Tuesday May 8th 2012 - NYBH Staff
Does Power Always Corrupt?
Do you remember the famous Stanford Prison experiment? What about those images of low-ranking U.S soldiers abusing prisoners in Iraq? What thoughts spring to mind when you learn about people abusing power? Most of us tend to think that power corrupts. Several studies have examined how people, when given power, will act in atypical ways. However, a recent study by researchers from Stanford University, the University of Southern California, and Northwestern University suggested that power in itself is not a sufficient explanation for these behaviors. There is something else involved. The researchers believe that power needs to be examined as it relates to status.
Power and Aggressive Behavior
According to this research, lacking status usually makes people feel disrespected and unrewarded, conditions that can trigger compensatory behaviors intended to boost self-worth. These behaviors are usually more aggressive in nature. Likewise, power has been associated with aggressive behaviors. Individuals that hold power may have a greater tendency to denigrate others because it produces a sense of entitlement to pursue rewards and goals by more aggressive means.
Focus of Experiment on Power and Status
With these premises in mind, the researchers designed an experiment wherein they randomly assigned 213 undergraduates to high-power or low-power roles that afforded high status or low status. Four possible combinations of power and status produced four distinct types of roles:
· High power/high status
· High power/low status
· Low power/high status
· Low power/low status
Role Played by Feelings about Status
Their results showed that the combination of holding a high-power role affording low status leads to more demeaning tendencies than any other combination. The findings suggest that behaviors like those of the U.S military guards at Abu Graib prison or the participants in the Stanford Prison experiment might be better explained when we look at the role that the status variable plays. Perhaps, when individuals mistreat and humiliate others, it is not because of their status per se, but because they feel a lack of respect and admiration for their own roles (low status). Thus, power is the vehicle that gives people the freedom to act according to their motivations, while their own perception of their status influences the type of behavior they exhibit toward others.
Although the researchers found supporting data for this idea, they acknowledge that it is possible to find people in these positions that do treat others respectfully. Therefore, future research should focus on understanding the particular mechanisms that give rise to the demeaning behavior exhibited by those with power but no status.
What do you think? Have you ever experienced or witnessed any of the behaviors described?