Rebecca A. Schwartz-Mette

Recognizing, assessing, and intervening with problems of professional competence.

THIS ARTICLE WAS AUTHORED by members of a workgroup on students with competence problems associated with the Council of Chairs of Training Councils, which is affiliated with the Education Directorate of the American Psychological Association. Nadine J. Kaslow and Nancy J. Rubin took primary responsibility for crafting this manuscript. Nadine J. Kaslow is the workgroup chair. To the extent possible, the remaining authors are listed in the order of their contributions: Nadine J. Kaslow, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; Nancy J. Rubin, Department of Psychiatry and Behavioral Medicine, University of Alabama School of Medicine—Tuscaloosa Campus; Linda Forrest, Counseling Psychology and Human Services, University of Oregon; Nancy S. Elman, Psychology in Education, University of Pittsburgh; Barbara A. Van Horne, Department of Psychology, University of Wisconsin-Madison; Sue C. Jacobs, Applied Health and Educational Psychology, Oklahoma State University; Stephen K. Huprich, Department of Psychology, Eastern Michigan University; Sherry A. Benton, Counseling Services, Kansas State University; Victor F. Pantesco, Department of Clinical Psychology, Antioch University New England; Stephen J. Dollinger, Department of Psychology, Southern Illinois University; Catherine L. Grus, Education Directorate, American Psychological Services; Stephen H. Behnke, Ethics Office, American Psychological Association; David S. Shen Miller, Counseling Psychology and Human Services, University of Oregon; Craig N. Shealy, Department of Graduate Psychology, James Madison University; Laurie B. Mintz, Educational, School, and Counseling Psychology, University of Missouri-Columbia; Rebecca Schwartz-Mette, Department of Psychology, University of Missouri-Columbia; Kristi Van Sickle, Department of Psychology, James A. Haley VA Hospital in Tampa; Beverly E. Thorn, Department of Psychology, University of Alabama. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Nadine J. Kaslow, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Grady Hospital, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail: nkaslow@emory.edu Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 5, 479–492 0735-7028/07/

Dimensional models of personality disorder: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and beyond.

12.00 DOI: 10.1037/0735-7028.38.5.479

Predicting Difficulties in Youth's Friendships: Are Anxiety Symptoms as Damaging as Depressive Symptoms?

Purpose of review We describe several dimensional models of personality disorders and highlight future directions for the integration of dimensional approaches in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This review is timely and relevant, given the upcoming revision of DSM (DSM-V). Recent findings Research has identified four common higher order factors that could be used to characterize personality pathology. Evidence supports the inclusion of this dimensional representation of personality disorders in DSM-V, possibly as an adjunct to the traditional categorical classification scheme. A dimensional approach would ameliorate many of the problems associated with the categorical approach. Issues that still need to be addressed are on how to integrate these dimensions into the current classification system in a way that they will be accepted by clinicians and psychopathologists. The clinical utility of the dimensional models must be demonstrated, and the development of a method that combines trait elevations and impairment associated with personality pathology is needed in order to define personality disorder from a dimensional perspective. Summary Although there may be some initial resistance to the incorporation of the dimensional models in the future diagnostic manuals, researchers and clinicians are expected to benefit from the more reliable and valid portrayal of personality pathology.

Depressive symptoms and conversational self-focus in adolescents' friendships

Youths friendships serve important functions in development; however, internalizing symptoms may undermine these relationships. Two studies are presented that examine the association of depressive and anxiety symptoms with friendship adjustment. Study 1 tested concurrent effects and Study 2 tested prospective effects over 6 months. Like past studies, depressive symptoms predicted greater problems in friendships. However, anxiety symptoms generally did not and, in some cases, actually predicted positive friendship adjustment. The results suggest that the friendships of youth with depressive symptoms should be targeted for intervention, but that incorporating the friendship strengths of anxious youth in interventions could be helpful for reducing these youths anxiety. The results also caution researchers studying the interplay between friendships and internalizing symptoms against collapsing across assessments of depressive and anxiety symptoms.

Co-Rumination Exacerbates Stress Generation among Adolescents with Depressive Symptoms

This multi-method, longitudinal study considered the interplay among depressive symptoms, aversive interpersonal behavior, and interpersonal rejection in early and middle adolescents’ friendships. In particular, the study examined a newly identified interpersonal process, conversational self-focus (i.e., the tendency to redirect conversations about problems to focus on the self). Traditional interpersonal theories of depression suggest that individuals with depressive symptoms engage in aversive behaviors (such as conversational self-focus) and are rejected by others. However, in the current study, not all adolescents with depressive symptoms engaged in conversational self-focus and were rejected by friends. Instead, conversational self-focus moderated prospective relations of depressive symptoms and later friendship problems such that only adolescents with depressive symptoms who engaged in conversational self-focus were rejected by friends. These findings are consistent with current conceptualizations of the development of psychopathology that highlight heterogeneity among youth who share similar symptoms and the possibility of multifinality of outcomes.

Out with Impairment, in with Professional Competence Problems: Response to Commentary by Collins, Falender, and Shafranske

Through stress generation, individuals’ own thoughts and behaviors can actually lead to increases in their experience of stress. Unfortunately, stress generation is especially common among individuals who are already suffering from elevated depressive symptoms. However, despite the acknowledgement that some individuals with depressive symptoms generate greater stress than others, few studies have identified specific factors that could exacerbate stress generation among individuals with depressive symptoms. The present study examines co-rumination as a factor that might exacerbate stress generation among adolescents with depressive symptoms using a short-term longitudinal design. Considering these processes among adolescents was critical given that many youth experience increases in depressive symptoms at this developmental stage and that co-rumination also becomes more common at adolescence. Participants were 628 adolescents (326 girls; 302 boys) who reported on their depressive symptoms, experiences of stress, and co-rumination with a best friend. Interpersonal stressors (peer and family stress) and non-interpersonal stressors (school and sports stress) were assessed. Consistent with past research, adolescents with depressive symptoms experienced greater interpersonal and non-interpersonal stress over time. Importantly, co-rumination interacted with both depressive symptoms and gender in predicting increases in peer stress. Depressive symptoms predicted the generation of peer stress only for girls who reported high levels of co-rumination with friends. Implications for protecting youth with depressive symptoms against stress generation are discussed.

When Does Co-Rumination Facilitate Depression Contagion in Adolescent Friendships? Investigating Intrapersonal and Interpersonal Factors

Given their significant contributions to the field, the time and attention given by Collins, Falender, and Shafranske to review this article (Schwartz-Mette, 2009) and offer comments are much appreciated. In regards to the history of the article, the original paper won the 2006 APA/APAGS Graduate Student Ethics Prize and, as part of the award, was requested for publication in this journal. However, due to publication lag, it did not appear in print until 2009. While the paper lay in wait, the field made a concerted shift away from using impairment as a general term in favor of more precise language (Elman & Forrest, 2007; Falender, Collins, & Shafranske, 2005, 2009). Thus, use of the term impairment in the article is best explained by the state of the literature at the time and, more specifically, by the confluence of publication lag and important advances in the field. It is the case that the term impairment historically has been loosely defined and consequently misapplied. In short, impairment typically is utilized as an umbrella term to describe both performance and behavioral problems with myriad etiological factors including underlying disability, personal problems, and inadequate training. However, use of the term in this general or global way is rife with problems, as it confounds descriptions with causes of problem behavior and fails to distinguish between competence that was lost and that which was never attained (Elman & Forrest, 2007). Further, as Collins and colleagues discuss here and elsewhere (Falender et al., 2005, 2009), imprecise use of impairment contributes to confusion and legal risk in the identification, assessment, and remediation of trainees’ problematic performance, as impairment connotes disability under the Americans with Disabilities Act (ADA; 1990).

Social-Cognitive and Social-Behavioral Correlates of Suicide Risk in College Students: Contributions from Interpersonal Theories of Suicide and Depression

Research supports the notion that adolescents’ mental health is impacted by peers via contagion processes. A growing area of interest has been how co-rumination may influence depressive symptoms within friendships. The current study examined particular conditions under which co-rumination is especially likely to facilitate depression contagion. Participants were adolescents (N = 480, 49% female, M age = 14.6 years, 59.5% European American) paired in friendship dyads and assessed over 9 months. Characteristics of the adolescent (personal distress), of the friend (excessive reassurance seeking), and of the friendship (friendship quality) were considered. Moderated mediation analyses indicated that co-rumination facilitated depression contagion only under conditions of adolescents’ high personal distress, friends’ high excessive reassurance seeking, and high positive friendship quality. This research underscores the importance of attending to how and under what conditions depression contagion occurs within friendships in order to support adolescents’ positive social and emotional development.

Medication for child and adolescent depression: Questions, answers, clarifications, and caveats.

Joiner’s interpersonal-psychological theory of suicide (IPTS) is predated by literature examining maladaptive interpersonal behaviors associated with depression; however, research has not examined the potential relevance of such behaviors for the IPTS. The current study aimed to expand understanding of suicide risk by examining two maladaptive interpersonal behaviors in the context of Joiner’s IPTS model. Structural equation modeling examined associations between depressive symptoms, social-cognitive predictors of suicide, maladaptive interpersonal behaviors, and suicide risk in 228 college students (53.9% female; M = 19.5 years, SD = 1.8). Social-cognitive IPTS variables mediated the relation between depressive symptoms and maladaptive interpersonal behavior. Both social-cognition and maladaptive interpersonal behavior mediated the effect of depressive symptoms on suicide risk. Findings have the potential to add to our understanding of the interplay of social-cognitive factors and interpersonal behaviors associated with suicide risk. Directions for future research are discussed.

Ships in the Rising Sea? Changes Over Time in Psychologists’ Ethical Beliefs and Behaviors

Antidepressant medications have become the treatment of choice for many children and adolescents with depression. As such, practitioners will routinely encounter youth who are currently taking, or whose families are considering the use of, such medication. To help make sense of this large, complex, and continually evolving literature and address some of the related controversies, this review is designed as a primer for practicing clinicians that poses and answers several key questions: (a) Are antidepressant medications effective for treating child and adolescent depression?; (b) How do antidepressants compare in effectiveness to psychotherapy and their combination?; (c) Do antidepressants impact long term outcomes and risk of relapse?; (d) Are antidepressants U.S. Food and Drug Administration (FDA) approved for use with children and adolescents?; and (e) Do antidepressants impact risk for suicidality? The answers to these questions are not necessarily straightforward and important considerations and caveats are highlighted. The review concludes with practical suggestions for how clinicians may use this information in practice.