Eugene W. Farber

An assessment of rates of psychiatric morbidity and functioning in HIV disease

This study examined demography, rates of psychopathology, and functional impairment in HIV-seropositive women and men in a large, urban, public outpatient infectious disease clinic. Fifty-three percent of the women and 70% of the men met Structural Clinical Interview for DSM-III-R criteria for psychiatric disorders. Current mood disorders were the most frequent diagnoses, followed by psychoactive substance abuse/dependence disorders and psychotic disorders. Seventy-six percent of the women and 90% of the men had previous psychiatric histories, including 59% of the women and 55% of the men who had psychiatric histories prior to their knowledge of HIV seroconversion. Depressed subjects reported significant impairment in physical, social, and role functioning. Similarly, impairment in physical functioning was highly correlated with self-reported anxiety symptoms. These data suggest considerable past and current psychiatric comorbidity in HIV-infected individuals seeking medical care, and draw attention to the need for recognition and aggressive psychiatric treatment, particularly for those depressed and anxious patients with impaired functioning.

Intimate Partner Violence and Suicidality in Low-Income African American Women A Multimethod Assessment of Coping Factors

This study used quantitative and qualitative methods to examine psychological factors that influence links between intimate partner violence (IPV) and suicidality in a sample of low-income African American women. Quantitative results demonstrated greater general coping, more efficacious behavioral strategies in response to IPV, more effective use of resources, greater use of social support, and less substance use among women who did not attempt suicide compared with those who did. Qualitative findings showed that suicide attempters showed less adaptive coping strategies aimed at accommodating the abuser, whereas nonattempters were more focused on strategies that supported leaving the relationship and/or avoiding further harm.

Social anxiety and HIV transmission risk among HIV-seropositive male patients.

The role of psychological factors in predicting HIV sexual transmission risk behavior is increasingly of interest in prevention research. Social anxiety, or anxiety about being evaluated in interpersonal situations, is associated with unprotected insertive anal intercourse among young men who have sex with men (MSM) and with other behavioral risk factors for unprotected intercourse, such as depression, smoking, alcohol use, and drug use. Social anxiety may be especially relevant in understanding HIV risk among HIV-seropositive men, given its stronger association with unprotected insertive than with receptive anal intercourse. In the present study, for which participants were recruited between October 2002 and May 2003, HIV-positive men attending regularly scheduled primary care medical appointments at a community HIV clinic were approached by research personnel and informed about the study topic and procedures. Ninety percent of patients approached agreed to participate, resulting in a sample of 206 patients. The sample was primarily African American, unemployed, of low educational level, and 95% of the sample had an AIDS diagnosis. The present study replicated and extended previous research from community samples by demonstrating an association between social anxiety and unprotected insertive anal intercourse with non-HIV-positive partners in a clinical sample of HIV-positive MSM and men who have sex with women (MSW). This association was maintained controlling for depression, smoking, and club drug use. Social anxiety is a relatively robust risk factor for unprotected insertive anal intercourse among MSM. Future work should examine the mechanisms by which social anxiety is associated with sexual risk among MSM.

Childhood abuse and suicidality in obstetrics patients in a hospital-based urban prenatal clinic

This study reports findings from a chart review examining the relationship between self-report of a history of childhood abuse and the emergence of suicidal ideation in pregnancy in a group of patients referred for psychiatric evaluation. The relationship between history of childhood abuse and actual suicide attempts prior to the current pregnancy was also investigated. Results revealed that women reporting a history of childhood sexual abuse, physical abuse, or both were significantly more likely than those not reporting a history of abuse to evidence suicidal ideation during the pregnancy. Additionally, those reporting a history of sexual abuse or both physical and sexual abuse were more likely than those not reporting such a history to have made a suicide attempt in the past at some point prior to the current pregnancy. Interpretations and potential implications of these findings for clinical work with psychiatrically at-risk pregnant women are discussed.

Humanistic-existential psychotherapy competencies and the supervisory process.

There has been an increasing focus in recent years on articulating foundational and functional competencies for practice in professional psychology and how a competency-based approach might inform psychology training. With the aim of contributing to the dialogue in this area, the discussion herein explores psychotherapy competencies through the lens of a humanistic-existential perspective and describes implications for psychotherapy training and supervision. Specifically, competencies pertaining to facilitating the clients experiential awareness and use of the psychotherapy relationship to engender client change are described. Next, the foundational and functional competencies within professional psychology that are particularly salient to a humanistic-existential psychotherapy framework are discussed. Finally, the ways in which a humanistic-existential supervision framework contributes to the development of psychotherapy competencies in trainees is considered. A brief vignette is presented to illustrate the supervision process.

Severe mental illness and HIV-related medical and neuropsychiatric sequelae.

Medical and neuropsychiatric sequelae of HIV infection present a spectrum of diagnostic and treatment challenges to mental health clinicians. Both HIV and the many opportunistic infections that manifest in patients due to their immunocompromised state also can affect the central nervous system (CNS). Thus, mental health clinicians need to be familiar with the diagnosis and management of HIV-related medical and psychiatric complications. This article provides an overview of the CNS-related manifestations resulting from HIV disease, including HIV-related dementia, psychotic disorders, delirium, CNS opportunistic infections and tumors, systemic abnormalities, psychoactive substances, and the adverse effects of certain medical treatments. Treatment strategies for individuals with HIV disease and comorbid severe mental illness are outlined and recommendations for future research are offered.

Core conflictual relationship themes in patients diagnosed with borderline personality disorder who attempted, or who did not attempt, suicide

Extant relational notions of suicidal behavior were examined in a sample of 22 psychiatric inpatients with a diagnosis of Borderline Personality Disorder (BPD), 11 of whom were hospitalized following a suicide attempt and 11 of whom reported no history of suicidal behavior. Relationship narratives were obtained during a psychodynamically oriented clinical interview and assessed using the Core Conflictual Relationship Theme (CCRT) coding scheme. The results did not support the relational differences of heightened dependency needs, perceived rejection by others, and subsequent anger that were hypothesized to exist between BPD persons who were hospitalized for a suicide attempt and BPD individuals who had never made an attempt. Relational patterns for both groups were similar and consistent with conventional conceptualizations of suicidal behavior and previous CCRT studies examining relational narratives among depressed psychotherapy patients. Specifically, the relational pattern most often described by all participants was a wish to be loved and understood, experiencing others as rejecting, and responding with depression and disappointment.

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.

Optimism, well-being, and perceived stigma in individuals living with HIV.

Given the significant psychological challenges posed by HIV-related stigma for individuals living with HIV, investigating psychological resource factors for coping with HIV-related stigma is important. Optimism, which refers to generalized expectations regarding favorable outcomes, has been associated with enhanced psychological adaptation to health conditions, including HIV. Therefore, this cross-sectional study investigated associations among optimism, psychological well-being, and HIV stigma in a sample of 116 adults living with HIV and seeking mental health services. Consistent with study hypotheses, optimism was positively associated with psychological well-being, and psychological well-being was negatively associated with HIV-related stigma. Moreover, results of a full structural equation model suggested a mediation pattern such that as optimism increases, psychological well-being increases, and perceived HIV-related stigma decreases. The implications of these findings for clinical interventions and future research are discussed.

Theories and Techniques of Marital and Family Therapy

Histories of the intertwined fields of marriage and family therapy have appeared during the past 2 decades (e.g., Broderick & Schrader, 1991; Guerin, 1976; F. Kaslow, 1982, 1987; Thomas, 1992). Elaborating upon an earlier version of this material (F. Kaslow, 1987), this chapter concentrates on developments in the past decade, a time during which the convergence of the marital and family therapy fields has been accepted.