AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Objective: Strong social relationships are among the best predictors of mental health, physical health, and longevity, regardless of race or culture. Problems with interpersonal relationships are associated with depression, yet few interventions for depression focus on enhancing social capital. Interpersonal psychotherapy (IPT) and its adaptation for adolescents (IPT-A) are effective, evidence-based treatments for depression aimed at mitigating depressive symptoms by strengthening an individual's interpersonal functioning. Although IPT's efficacy has been established with largely White and middle- and high-income samples, this review highlights studies using IPT and IPT-A to treat depression or depressive symptoms among those affected by marginalization or health disparities around the world. Extensive consideration is given to cultural and contextual adaptations, as well as changes in implementation of the intervention, that the studies may have employed.

Methods: A literature search was conducted in three databases. The studies included in the review examined IPT as a treatment for depression and depressive symptoms in communities for whom IPT was not originally validated and who may experience health care disparities (e.g., marginalized communities and low- and middle-income countries).

Results: Forty-nine studies that adapted or adjusted implementation processes of IPT and related therapies across cultures were identified and included. Common adaptations and implementations included culturally appropriate changes to language or vernacular, treatment location, and therapist characteristics. Studies generally supported IPT for individuals facing health care disparities.

Conclusions: Although initially developed and validated with predominantly White, middle- to high-income samples, IPT and IPT-A may be effective and adaptable interventions across cultural settings, requiring culturally and contextually informed adaptations and adjustments to implementation for optimal success.

Objective: Training in evidence-based psychotherapies (EBPs) in clinical programs is crucial for increasing their use in practice. Twenty years ago, the National Psychotherapy Training Survey-I (NPTS-I) examined whether U.S. training programs required didactic training and clinical supervision in EBPs. Almost all psychiatry (96%) programs, but only 56% of clinical psychology Ph.D., 33% of clinical psychology Psy.D., and 38% of social work (i.e., M.S.W.) programs, required EBP training. After years of dissemination efforts, the authors reexamined EBP training levels across those disciplines as well as counseling psychology and psychiatric-mental health nurse practitioner (PMHNP) programs by conducting the NPTS-II.

Methods: Half of accredited training programs in each discipline were randomly selected for an online survey of training requirements and electives, whether all trainees receive EBP training, and associated barriers and facilitators. Of 574 invited programs, 253 (44%) program directors completed responses: 48 psychiatry (37%), 44 clinical psychology Ph.D. (53%), 14 clinical psychology Psy.D. (36%), 34 counseling psychology (58%), 38 PMHNP (35%), and 75 M.S.W. (49%) programs.

Results: At least 75% of programs across disciplines offered didactic and clinical supervision EBP training. Required training rates were higher in psychiatry (90%) and clinical psychology Ph.D. (81%) programs than in clinical psychology Psy.D. (59%), PMHNP (48%), counseling psychology (28%), and M.S.W. (27%) programs. A similar pattern emerged in estimations of all trainees receiving EBP training.

Conclusions: EBP training requirements held steady in psychiatry and increased in clinical psychology programs. Low EBP training rates persist in other disciplines, possibly contributing to the continuing gap between EBP research efficacy evidence and practice.

Objective: Education that promotes the development of cultural humility and culturally responsive clinical work among psychotherapists may help address health care disparities faced by underserved and minority populations. This study aimed to assess the efficacy of community engagement experiences (CEEs) and directed self-reflection in addressing this area of growth with student psychotherapists.

Methods: The authors examined the effect of a CEE and a directed self-reflection teaching strategy on the development of cultural humility among psychotherapy students. Seven master's-level student participants engaged in a CEE in rural Honduras, providing mental health care to an underserved population in 2023.

Results: Participant-reported experiences were synthesized into four categories: self-reflection, acclimation, service work, and personal growth.

Conclusions: CEEs paired with directed self-reflection were a promising teaching modality in the development of cultural humility with psychotherapy students and may be helpful to other health care professionals.

Objective: The use of telemedicine has soared in recent years. In this study, the authors explored perspectives of Israeli mental health professionals on the use of telemedicine for mental health services.

Methods: Semistructured interviews were conducted with 10 mental health professionals recruited from a health maintenance organization (HMO) in Israel's public health system. The interviews were transcribed and analyzed in an iterative method to code and identify themes and categories.

Results: Most of the participants viewed telemedicine positively, as a way to enable care when in-person visits were not possible, and favored its implementation alongside in-person visits. The providers agreed that video appointments were superior to telephone appointments. Difficulties raised included technical and privacy issues; benefits included the ability to see patients in their home environments. The therapists who set minimal guidelines for video appointments found the process to be effective; those who did not set guidelines found that their patients were less focused. The participants felt that they could effectively connect with their patients via video, particularly once a relationship had been established in person. Whereas some of the providers had received training specific to telemedicine, others had learned on the job.

Conclusions: The results highlighted the growing acceptance and effectiveness of telemedicine in facilitating continuity of mental health care, particularly when combined with in-person appointments. HMOs may consider a hybrid model, offering telemedicine to patients who may benefit from it. Continued training and support for providers is crucial to optimize delivery of mental health care via telemedicine.

Objective: The goal of this study was to evaluate the implementation of a school-based, telehealth-delivered depression prevention program (interpersonal psychotherapy-adolescent skills training).

Methods: Adolescents in ninth or 10th grade (N=14), school counselors and other student support staff (N=14), and school and district administrators (N=14) from schools that were included in a larger randomized controlled trial completed hour-long, semistructured qualitative interviews.

Results: A content analysis, involving a combination of a priori codes from implementation science frameworks and codes derived from transcripts of the interviews, demonstrated that the prevention program was generally viewed as helpful and relevant. Moreover, the importance of mental health programming in the school setting was recognized. Nonetheless, key barriers to implementation were noted, including limited time and resources in the schools, technology challenges, and perceptions from some counselors that the program was more structured than was their typical practice.

Conclusions: The results elucidated key factors to consider for optimizing future efforts to implement evidence-based mental health programs in schools and other community settings.