Family accommodation (FA), efforts to help a loved one avoid anxiety-provoking situations, may reduce distress in the moment, but it has been demonstrated that FA exacerbates anxiety and obsessive-compulsive symptoms over time in both child and adult samples. However, explicit focus on the role of FA across the lifespan is limited, especially for individuals receiving intensive treatment. The current sample included youth (N = 67) and adults (N = 131) ranging in age from 8-76 years, who received intensive and / or residential treatment (IRT) for OC-related or another anxiety disorder at the same hospital. Patients and their family members completed measures of FA and current symptoms at admission and discharge. FA was consistently high across the lifespan: 100% of children and / or their parents and 95% of adults and / or loved ones reporting some form of FA. FA was more frequent among children: 60% of parents reported daily reassurance compared to 24% of family members of adults. Finally, FA at admission was associated with more severe symptoms at admission but did not predict improvement by discharge among both child and adult populations. Our results suggest that FA is pervasive and may persist throughout the lifespan but also can be addressed effectively in intensive treatment so that it does not impede treatment outcomes.
Objective:Concerned allies often call crisis lines and other call centers about their loved ones' mental health. Callers to Coaching Into Care, a non-crisis call center, often report concerns about suicide risk in Veterans yet little is known about how best to support those callers. We conducted a documentation review to understand standard operating procedures, barriers, and opportunities for risk reduction. Method:Across 1,581 unique callers with an initial call over a 6 month period, 225 callers (14.2%) were identified for contact note review and coding. Results:Calls were frequently characterized by current suicidal ideation (62.7%), suicide attempts (24.0%), and access to lethal means (35.6%), although use of lethal means safety interventions was infrequently documented (12.9%). The majority of callers were coded as open to intervention (83.4%). After coaching, 16% of Veterans who were previously not connected to mental health care had connected to care in the community or VA. Conclusions:There was substantial heterogeneity in assessments and interventions used, particularly related to documentation of access to lethal means; however, there is an opportunity to provide risk reduction education and communication skill building for family and friends of Veterans. Those closest to Veterans report being open to learning new ways to engage with Veterans around safety and mental wellness.
Despite the prominence of psychological testing in the early history of clinical psychology in the US, harms perpetuated by and within the field on disabled communities are seldom considered in clinical psychology's teaching, education, and practice. We review clinical psychology's historical and current relationship to ableism-the systematic discrimination, exclusion, and oppression of people with physical or mental disabilities and chronic illnesses. This paper also discusses the medical model of disability, perspectives on current treatments from members of the disability community, the impacts of disability stigma on professional and academic settings for clinical psychology, and future directions for disability-affirming practices.
Sexual orientation and gender identity and expression change efforts (SOGIECE) — commonly known as conversion "therapies” — are harmful practices that seek to change an individual’s sexual orientation (lesbian, gay, bisexual, queer, asexual, etc.) and/or gender identity or expression (transgender, nonbinary, intersex individuals; collectively known as LGBTQIA+) to heterosexual, cisgender behaviors and identities. SOGIECE lack scientific evidence, misreport efficacy, and have significant methodological failings that inflict serious harms (increased depression, anxiety, and suicidality) and stigmatize the already vulnerable LGBTQIA+ community. Given cognitive-behavioral professionals’ (CBPs) commitment to developing and implementing only evidence-based treatments, they have an ethical duty to stand against SOGIECE, especially in a sociopolitical climate that is increasingly hostile toward LGBTQIA+ people globally. De-implementation is a systematic process focused on stopping routine use of an adverse – as in SOGIECE – or otherwise low-value practice. We analyzed and applied four key de-implementation phases that can aid in eliminating SOGIECE. These include: selecting scope of SOGIECE de-implementation efforts, assessing multilevel contextual barriers and facilitators to tailor de-implementation strategies, deploying active strategies, and evaluating selected strategies. Various examples of tailored strategies that address key barriers and facilitators to achieve maximum de-implementation success rates at the individual, organizational, policy, and social levels are outlined and discussed. While strategies needed to eliminate SOGIECE are complex, long-term, and multilevel, CBPs can help de-implement this practice. Through concentrated and coordinated efforts, we can address ethical injustice, repair historical harms, and enable healing by ensuring that affirmative care is available for every LGBTQIA+ person who seeks it.
