Michelle D. Sherman

Welcoming Them Home: Supporting Service Members and Their Families in Navigating the Tasks of Reintegration

To date, more than 1.3 million service members have served in the Global War on Terrorism. These men and women and their families face a range of stressful situations and must navigate many important tasks after a deployment. This article outlines four of the tasks of reintegration: redefining roles, expectations, and division of labor; managing strong emotions; abandoning emotional constriction and creating intimacy in relationships; and creating shared meaning. For each task, potential challenges are discussed and suggestions for how psychologists can support families are described. In addition, potential red flags and indicators that more intensive services may be warranted are reviewed.

Distress and professional impairment among psychologists in clinical practice

Distress and professional impairment among psychologists in clinical practice can adversely affect the process of psychotherapy. In this study, 522 practicing psychologists (52.2%) completed a mail survey on distress and impairment. Various life events and work factors were associated with different

Psychological distress and burden among female partners of combat veterans with PTSD

Psychological distress among cohabitating female partners of combat veterans with posttraumatic stress disorder (PTSD) was examined in a cross-sectional study using a modified version of the Health Belief Model. A convenience sample of 89 cohabitating female partners of male veterans in outpatient PTSD treatment was interviewed by telephone using a structured interview. Partners endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression, and suicidal ideation were prevalent among partners. Multivariate analyses revealed that perceived threat, recent mental health treatment, and level of involvement with veterans predicted global partner psychological distress. Partner burden was predicted by partner self-efficacy, perceived threat, barriers to mental health treatment, and partner treatment engagement. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. Psychological distress and partner burden were each associated with a unique combination of predictors, suggesting that although these constructs are related, they have distinct correlates and potentially different implications within the family environment. Future research should examine these constructs separately using causal modeling analyses to identify modifiable targets for interventions to reduce psychological distress among partners of individuals with PTSD.

Distress and professional impairment due to mental health problems among psychotherapists

Abstract Distress and professional impairment among psychotherapists are important to address for a number of reasons, including the impact of impairment on therapeutic effectiveness and on the reputation of the field of psychology. The focus of this review is on one type of impairment, namely the mental health difficulties of applied psychologists. Following a brief discussion of the history of impairment, definitional issues are examined. A review and critique of the prevalence data on distress and impairment among psychologists are presented. Relevant research supporting the three causal factors of impairment outlined by Guy (1987) are discussed, followed by an examination of the various factors that allow for the continuation of impairment. Finally, prevention efforts are reviewed, with suggestions for additional preventive endeavors that could be beneficial.

Self-Esteem and Adjustment in Early Adolescence: A Social-Contextual Perspective

Investigated (a) global self-esteem and (b) social-contextual incongruity in factors contributing to the development and maintenance of self-esteem as predictors of the emotional, behavioral, and academic adjustment of 213 young adolescents. Higher reported levels of global self-esteem were associated with more favorable scores on most measures of adjustment. Incremental predictive contributions also were found, however, for indices of social-contextual incongruity in factors contributing to the development and maintenance of self-esteem. Incongruity in the direction of domain-specific self-evaluations being relatively stronger for peer-oriented domains in comparison to the domains of school and family was linked consistently with less positive adjustment. Descriptive views of the self and standards for self-evaluation that were more favorable and lenient than parental views and standards in corresponding areas also were implicated in poorer adjustment. Results indicate the importance of social-contextual factors for understanding the role of self-esteem in adaptation during early adolescence. Implications for esteem enhancement as a prevention and health promotion strategy with this age group are discussed.

Key elements in couples therapy with veterans with combat-related posttraumatic stress disorder

If a client dealing with combat-related posttraumatic stress disorder (PTSD) presents for psychotherapy, should you consider including his or her partner in treatment? How could couples therapy be beneficial? What framework do you have to conceptualize the relational issues and potential treatment? Although clinicians have long been encouraged to include families in the treatment of combat-related PTSD, few specific couple-family therapies exist, and outcome research is scarce. Because of the adverse effects of PTSD on relationships, couples therapy can be a powerful adjunct treatment; however, few receive this service. A new framework for conceptualizing couples therapy organizes treatment around the 3 PTSD symptom clusters (reexperiencing, avoidance, and arousal). Relationship consequences of each symptom cluster are summarized, followed by useful treatment interventions and a case study.

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness

It is well documented that family psychoeducation decreases relapse rates of individuals with schizophrenia. Despite the evidence, surveys indicate that families have minimal contact with their relatives treatment team, let alone participate in the evidence-based practice of family psychoeducation. The Department of Veterans Affairs (VA) sponsored a conference, the Family Forum, to assess the state of the art regarding family psychoeducation and to form a consensus regarding the next steps to increase family involvement. The forum reached consensus on these issues: family psychoeducation treatment models should be optimized by efforts to identify the factors mediating their success in order to maximize dissemination; leadership support, training in family psychoeducation models for managers and clinicians, and adequate resources are necessary to successfully implement family psychoeducation; because family psychoeducation may not be appropriate, indicated, or acceptable for all families, additional complementary strategies are needed that involve families in the mental health care of the patient; and work is required to develop and validate instruments that appropriately assess the intervention process and consumer and family outcomes. A treatment heuristic for working with families of persons with severe mental illness is also offered and provides a match of interventions at varying levels of intensity, tailored to family and consumer needs and circumstances. The article describes opportunities for the research and clinical communities to expand the proportion of families served.

Socioenvironmental experiences, self-esteem, and emotional/behavioral problems in early adolescence

Tested the role of self-esteem as a mediator of relationships between socioenvironmental experiences and emotional/behavioral problems using a sample of 215 young adolescents (Grades 7–9). Socioenvironmental experiences were assessed using self-report questionnaire measures of social support and major and minor stressful events. Self-esteem was assessed using a self-report questionnaire, an interview, and a parent-report questionnaire. Emotional/behavioral problems were assessed using self-report, parent-report and teacherreport questionnaires. Utilizing structural equation modeling, the data were used to test a model in which self-esteem mediated the relationship between socioenvironmental experiences and emotional/behavioral problems. The hypothesized model provided a reasonably good fit to the data (normed fit index=.90). However, an alternative model which also allowed for direct effects of socioenvironmental experiences on emotional/behavioral problems produced a significant improvement in model fit. In this model, socio-environmental experiences had significant effects on emotional problems via both direct effects and indirect effects that indicated a mediating role for self-esteem. Only direct effects of socioenvironmental experiences were evident for behavioral problems.

Children of deployed National Guard troops: Perceptions of parental deployment to Operation Iraqi Freedom.

FULL DISCLOSURE POLICY In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

Communication between VA providers and sexual and gender minority veterans: a pilot study.

Approximately one million gay and lesbian Americans are veterans, and rates of engagement in the Veterans Affairs (VA) health care system may be increasing for both sexual and gender minority veterans. Very little research has examined the experience of these veterans when receiving care at VA health care facilities. The purpose of this study was to explore the experiences, beliefs, and preferences of lesbian, gay, bisexual, or transgender (LGBT) veterans in their communication with VA health care providers. LGBT veterans (n = 58) participated in focus groups or individual interviews and completed self-report measures at two southern VA hospitals. Approximately 2/3 of veterans report that none of their VA providers have specifically asked about their sexual orientation, and 24% of the veterans indicate that they have not disclosed their orientation to any VA provider. Although some veterans want providers to initiate these discussions, veterans also expressed fears about disclosure and its possible negative consequences. Similarly, LGBT veterans report varied opinions about the appropriateness of routine assessment of minority status. Only 28% of these veterans experience VA as welcoming to them as LGBT veterans. Systematic training is needed for all VA providers about the rationale for assessing sexual and gender orientation. Staff education should include specific skills for initiating these assessments, and ways of responding to veteran concerns about discussing this topic in the VA health care system.