Bonnie K. Lee

Congruence Couple Therapy for Pathological Gambling

Couple therapy models for pathological gambling are limited. Congruence Couple Therapy is an integrative, humanistic, systems model that addresses intrapsychic, interpersonal, intergenerational, and universal–spiritual disconnections of pathological gamblers and their spouses to shift towards congruence. Specifically, CCT’s theoretical foundations, main constructs, and treatment interventions are illustrated in a progression of six clinical phases. Promise of CCT’s systemic conceptualization and interventions for pathological gambling and future directions in its continuing evolution are discussed.

Congruence in Satir's Model: Its Spiritual and Religious Significance

This article casts into relief the essentialist-existential philosophy implicit in Satirs model of healing using Paul Tillichs systematic philosophical framework. Parallels between Satirs model of the person are drawn with Tillichs ontological categories of essence and existence, individualization and participation, and destiny and freedom. Congruence as the integration of elements in three vital human dimensions: the interpersonal, intrapsychic, and spiritual-universal, is correlated with Tillichs philosophical understanding of “salvation.” The religious quest is understood as a systemic, multidimensional process that brings the interactive and interdependent personal, interpersonal and spiritual dimensions into a restored unity. Thus Satirs rehumanization project and Tillichs religious quest are shown to coincide.

Development of a congruence scale based on the Satir model

The Congruence Scale derives from the construct of congruence, the goal of therapeutic change in the Satir model. Congruence is conceptualized as a state of awareness, openness, and connection in three human dimensions: the Intrapsychic, Interpersonal, and Universal-Spiritual. Procedures in developing the Congruence Scale are described. Results provide evidence of concurrent validity with the Satisfaction With Life Scale and the Outcome Questionnaire. Four factors of the Congruence Scale are extracted from factor analysis: Intrapsychic-Interpersonal, Spiritual, Creative, and Communal. Further research to confirm the reliability and validity of the congruent construct is recommended.

Not Alone in the Field: Distance Collaboration via the Internet in a Focused Ethnography

Ethnography as method remains orthodox in its application. It is largely replicated through the lone field ethnographer model. In challenging this fieldwork model, the authors describe distance collaboration via the Internet linking two researchers across space and time in the fieldwork process: one in the field, the other home based. Using a reflexive, retrospective analysis of e-mail correspondence generated during the fieldwork experience, they explicate key factors in their successful collaborative effort. In addition, interchanges conducive to “thickening” the ethnographic inquiry are highlighted. The collaborative process, facilitated through the Internet, lent psychological strength to the field researcher and added to research quality, timeliness, and trustworthiness in this focused ethnography. Cybertechnology invites exploration of new approaches and resultant challenges in conducting ethnographic fieldwork.

The Dawn of Awareness: Women’s Claiming of Self In Couple Relationship with Substance Abusers

This phenomenological study aimed at understanding the experiences of women living with intimate partners with substance abuse problems. Findings show that the five participants’ family-of-origin experiences centrally influenced their degree of awareness of their responses to their intimate partners’ addictive behaviors. Experiences leading to dawning of awareness include an escalating toll on self, critical life events, and the catalytic effect of outsiders’ perspective and support. The discovery of self and care for one’s own well-being precipitated changes in spouse and family relationships. Implications of these findings for clinical practice and recovery are suggested.

Training Problem Gambling Counsellors in Congruence Couple Therapy: Evaluation of Training Outcomes

Congruence Couple Therapy (CCT) is an integrative, humanistic, systemic model for problem gambling treatment. This study evaluates the efficacy of CCT training in imparting key concepts, skills and values of CCT to a sample of problem gambling counsellors (N = 21) from 13 Ontario problem gambling treatment programmes. CCT training comprised of a 4-day residential workshop followed by 12 weeks of CCT application to couples supported by teleconference consultation. Two cycles of training were conducted. The evaluations were driven by two controlled designs using quantitative measures complemented by qualitative data. Triangulated mixed methods findings indicate that counsellors increased significantly their knowledge of CCT concepts, values and skills from both training cycles. Trainee satisfaction was highly positive. Further studies on CCT and CCT training are recommended in light of these results.

‘I was Independent since I was Born’: Pre-Immigration Traumatic Experiences and Pathological Gambling in Four Chinese Canadians

Trauma and adverse childhood events are found in the pre‐immigration histories of a cohort of four Chinese Canadian pathological gamblers. The nature of their traumatic experiences, consisting of loss and abandonment, neglect and deprivation, physical and emotional abuse, socioeconomic and political oppression, is elucidated and described. The impact of pre‐immigration trauma and its relationship to the development of pathological gambling post‐immigration are discussed. Upon further corroboration of the existence of pre‐immigration trauma among Chinese and Asian immigrants in future studies, training of counsellors to incorporate an in‐depth pre‐immigration history in the assessment and treatment protocol of immigrants manifesting pathological gambling is recommended.

Evaluation of an Online “Internationalization at Home” Course on the Social Contexts of Addiction

Internationalization of higher education to include international, intercultural, or global components into the delivery of postsecondary education has drawn increasing attention in the last two decades. A globally relevant course focusing on the “Social Contexts of Addiction” engaged students’ online interaction at a Canadian university with learners from across various institutions in mainland China, Macau, and Hong Kong. Although “internationalization at home” (IaH) is one of the most prevalent themes in the internationalization literature, empirical evaluation of its merits along with the challenges of its implementation is still limited. In this article, the authors used student and faculty feedback to identify the design factors of this online IaH course that facilitated its success and transformative benefits. Discussion highlighted several follow-up strategic initiatives to broaden the adoption and conversations on internationalization in teaching, and the necessity of multilevel support and alignments among government, university, and faculty leadership to sustain internationalization efforts across the curriculum.

Breaking the silence of racism injuries: a community-driven study

Purpose Injuries resulting from racism are largely hidden by silence. Community services to provide healing from racism are missing in at least one Canadian city. The purpose of this paper is to identify the injuries suffered by immigrants who experienced racism and discuss the development of culturally appropriate programs and tools to address injuries from racism. Design/methodology/approach Participants representing visible minorities service providers from non-profit, public-funded organizations in a major Canadian city took part in two focus groups. Data from focus groups were thematically analyzed. Findings Racism produces traumatic and persistent psychological, social and intergenerational injuries. An ostensible gap exists in services, professional education and skills to address the psycho-social effects of this complex problem. The complicity of silence in both dominant and subordinated groups contributes to its perpetuation. A dearth of screening and assessment instruments is a barrier in identifying individuals whose mental health and addiction problems may have underlying racism-related etiology. Creation of community healing circles is recommended as a preferred method over individual “treatment” to expose and deconstruct racism, strengthen ethnic identity and intergenerational healing. Research limitations/implications These qualitative findings were generated based on the perspectives of a small purposive sample (n=8) of immigrant service providers and immigrants from one Canadian city. Many of these findings are consistent with the existing literature on internalized racism and racism injuries. Generalizability to the wider population of the province and of Canada requires further research. Practical implications Practitioners in health and social care as well as educators need to understand the injuries and internalized effects of racism to provide appropriate services and leadership. Development of anti-racism professional knowledge and skills, healing circles, and assessment instruments will contribute to deconstructing racism and mitigating its injuries. Originality/value Community-driven studies exploring racism and the lack of services to address the issue are scarce. This study pulls together the experience of service providers and their insights on ways to break the detrimental silence surrounding racism.

Shame and Sex Addiction: Through A Cinematic Lens

Sex addiction has been a topic of debate. With the new DSM-V (2013) category of Substance-Related and Addictive Disorders that now includes gambling disorder, other excessive behaviors including sex are poised to capture increasing attention. Depiction and clinical case studies of the progression and features of sex addiction are limited in the research literature due to ethics of confidentiality and the taboo nature of the topic. This article puts a human face to the question of sex addiction through the use of cinema as a ‘cultural text’ with the film Shame (2011). A framework for addiction comprising of the 3C’s: (1) craving; (2) loss of control; and (3) negative consequences, is used to analyze the protagonist’s behavior. Parallels to alcohol and gambling disorders are drawn. Momentous shifts in society’s sexual environment and norms that currently re-shape sexual behaviors are highlighted. The article points to avenues of research and its urgency to society and its individuals. Clear neurobiological and behavioral markers to define sex addiction can reduce shame and alleviate the suffering of those afflicted through appropriate treatment. A fortified understanding of sex addiction has significant individual, family and social implications. to use the movie Shame [11] to delineate the features of compulsive sexual behaviour that fit with the criteria used to determine substance use disorder and gambling disorder according to DSM-V (APA, 2013) [12]. Film engages a large audience in a visceral way and acts as a form of social commentary on contemporary phenomena. It mirrors and constructs a representation of our social worlds with sounds, images and narratives that stimulate intellectual and emotional engagement with what is on the screen [10]. As such, cinema can bring a phenomenon to life the pathos of which is otherwise obscured by abstractions. Interpretations generated by a film could fuel further exploration and raise our private, public and professional consciousness of complex issues such as whether sex addiction exists. The fact that Gambling Disorder is now placed under the section Substance-Related and Addictive Disorders in the DSM-V (APA 2013) [12] is a portent of other excessive behaviors being examined as addictive disorders. Indeed, the interest in behavioral addiction is on the rise [13-16]. The DSM-V cites activation of the brain reward system and behavioral symptoms of Gambling Disorder as comparable to Substance Use Disorder. However, insufficient current peer-reviewed evidence to establish diagnostic criteria and course of development of ‘sex addiction’ precludes its inclusion the latest DSM [12,17].