Although empathy is one of most robust predictors of client outcome, there is little consensus about how best to conceptualize this construct. Objective: The aim of the present research was to investigate clients' perceptions and in-session experiences of empathy. Method: Semi-structured, video-assisted interpersonal process recall interviews were used to collect data from nine clients receiving individual psychotherapy at a university psychology clinic. Results: Grounded theory analysis yielded a model consisting of three clusters: (1) relational context of empathy (i.e., personal relationship and professional relationship), (2) types of empathy (i.e., psychotherapists' cognitive empathy, psychotherapists' emotional empathy, and client attunement to psychotherapist), and (3) utility of empathy (i.e., process-related benefits and client-related benefits). Conclusions: These results suggest that empathy is a multi-dimensional, interactional process that affects-and is affected by-the broader relationship between client and psychotherapist.

This research used qualitative methods and archival data to examine clients' perceptions of the early formation of the working alliance. Following their first and second sessions of individual psychotherapy, 54 clients responded to structured written assignments that were rooted in Bordin's (1979) model of the alliance. Analysis yielded 884 recording units, which were organized into 4 main clusters: (a) clients' initial misgivings about psychotherapy; (b) organization and meaning-making; (c) psychotherapist supportive activities; and (d) client appreciation of techniques. Clients' perceived contributions to alliance development and their experiences of the initial interactions with their psychotherapists are explored in the context of existing theory and research.

As of October 9, 2009, 463,000 children were receiving care in the public foster care system (U.S. Department of Health and Human Services, 2009). Parental rights to 75,000 (16%) had been terminated. Parents with serious mental illness (SMI) are confronted with increased risk of involvement with the child welfare system and of having their children placed in out-of-home care (Park, Solomon, & Mandell, 2006; Sands, Koppelman, & Solomon, 2004). In fact, five states (Alaska, Arizona, California, Kentucky, and North Dakota) and Puerto Rico list mental illness or disability as grounds for not providing reasonable efforts toward reunification (Kaplan, Kottsieper, Scott, Salzer, & Solomon, 2009). The reality of threats to the parenting status of people with mental illness, particularly the influence of stigma on policy and services decisions, makes this an important area for social work research. Because much of the research on custody loss among women with SMI is dependent on self-reports, valid measures are imperative. In the present study, we were interested in discovering whether a Life History Calendar (LHC) would provide a valid measure of custody loss. Using a sample from a longitudinal study of women with SMI who were parents, we compared their responses on an LHC with their responses to a standard structured interview questionnaire. METHOD Sampling The Birth Mothers. The longitudinal study in which participants were involved was a study (RO1-54321) of the parenting history of women with SMI. Serious mental illness was defined as having been diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder (with or without psychosis), or major depression (with or without psychosis). Participants were recruited from 12 community mental health centers and from the inpatient psychiatric units of three hospitals, all in southeast Michigan. Eligibility criteria were as follows: being 18 to 55 years of age, having primary care responsibility for at least one child four to 16 years of age, having a severe mental illness lasting at least one year and producing major dysfunction in one or more life areas, and being in active mental health treatment. Of 379 participating at baseline, 324 were interviewed at wave 2 and 322 at wave 3. Wave 2 and wave 3 participants did not differ significantly demographically from those at wave 1. (Demographic data are provided for wave 3 participants.) All participants provided voluntary informed consent according to the criteria of our university human subjects review board. Wave 3 participants had a mean age of 40 years and 3.24 children on average. Sixty percent were black/African American; the next largest racial group (30%) was white/Caucasian. Among birth mothers still participating at wave 3, 36% had less than a 12thgrade education, 23% had completed high school, and 41% had completed education beyond high school. Diagnosis was measured at wave 1 only, at which time information from 28 interviews was not sufficient to reach a diagnosis. Of the remaining, 10% of the wave 3 participants had had a wave 1 diagnosis of schizophrenia/schizophreniform disorder, 11% of schizoaffective disorder, 40% of major depression, 12% of major depression with psychosis, 12% with bipolar 1 disorder, and 15% with bipolar 1 disorder with psychosis. Seventy-four percent considered themselves still receiving mental health services at wave 3, and 70% said they were being prescribed medication for their psychiatric disorder. The Children. In the study, 575 children were represented. (This excludes children who were not the mothers' birth children, were older than 18, or, in one instance, for which no custody loss information was available.) Of the 575, 56% were boys; the mean age was 10.6 years. At wave 2, birth mothers reported currently having custody of 84% of their children. Procedure Data Collection. Interviews were conducted in participants' homes. …

Clubhouses and consumer-run drop-in centers (CRDIs) are two of the most widely implemented models of consumer-centered services for persons with serious mental illness. Differences in structure and goals suggest that they may be useful to different types of consumers. Information on what types of consumers use which programs would be useful in service planning. This study analyzes data from the authors' NIMH-funded research on 31 geographically matched pairs of clubhouses and CRDIs involving more than 1,800 consumers to address the following question: are there significant differences in the characteristics and outcomes of members of clubhouses versus CRDIs? Results from multilevel analyses indicated that clubhouse members were more likely to be female, to receive SSI/SSDI, to report having a diagnosis of schizophrenia, and to live in dependent care; and they reported both a greater number of lifetime hospitalizations and current receipt of higher intensity traditional MH services. Controlling for differences in demographic characteristics, psychiatric history, and mental health service receipt, clubhouse members also reported higher quality of life and were more likely to report being in recovery. CRDI consumers were more likely to have substance abuse histories. Possible reasons for the differences are discussed. The results suggest that CRDIs are a viable alternative to more traditional mental health services for individuals who might not otherwise receive mental health services.

Spirituality has been cited in the literature as having a positive effect on mental health outcomes. This paper explores the relationship of spirituality to demographic, psychiatric illness history and psychological constructs for people with mental illness (N=1835) involved in consumer-centered services (CCS-Clubhouses and Consumer run drop-in centers). Descriptive statistics indicate that spirituality is important for at least two thirds of the members in the study. Members primarily indicated participation in public spiritual activities (i.e., church, bible study groups), followed by private activities (prayer, reading the bible, and meditation) (both of which were centered on belief in the transcendent). A logistic regression analysis was done to explore variables related to spirituality (i.e., demographics, psychiatric illness history, and psychological constructs). Results suggest that age, gender, having psychotic symptoms, having depressive symptoms, and having a higher global quality of life, hope and sense of community were all significant correlates of spirituality.

Abstract Insufficient attention has been devoted to an examination of the factors that predict the level of satisfaction that community residents have with the neighborhoods in which they live. In this paper, we describe a program of research to examine the predictors of neighborhood satisfaction. Data on neighborhoods and individuals in Flint, Michigan were obtained from the 2000 Census and a citywide survey of neighborhood residents. Multilevel models were used to predict the effect of individual and neighborhood-level characteristics. Findings suggested that many factors from the survey predicted residents' satisfaction from their neighborhoods. While neighborhood characteristics derived from the census were statistically related to levels of neighborhood satisfaction, census variables did not add information to a model of neighborhood satisfaction already containing survey variables.

This study used a mixed methods approach to describe and analyze data from groups observed in two types of mental health consumer-centered programs, namely consumer-run drop-in centers and clubhouses. An overview of consumer-centered programs is presented, followed by a report of the study which includes a description of the groups in the sample and data on the effects of group process and group leader characteristics on group functioning. Results indicate that, for the most part, the groups were task oriented (e.g., planning events or discussing issues about the center). Psychoeducation and recovery were also frequent topics in the group meetings. In terms of group participation, consumers took on various assignments, served as facilitators, assumed tasks and roles, shared experiences, and provided support to other group participants. A major finding is that group leaders displayed both good and poor leadership behaviors. The good leadership behaviors were often efforts to respond to problematic responses of members and poor leadership behaviors often elicited such responses. The qualitative analysis provided examples of how these behaviors affected the group sessions. This pilot study, by identifying some of the group conditions present in such groups, should lead to new studies that are based on specific hypotheses concerning the relationships that exist among group conditions, interventions to improve such conditions, and outcomes for participants.

Children of parents with mental illness are at risk of psychiatric and behavioral problems. Few studies have investigated the psychosocial outcomes of these children in adulthood or the parental psychiatric history variables that predict resilience. From a sample of 379 mothers with serious mental illnesses, 157 women who had at least one adult child between the ages of 18 and 30 were interviewed. Mothers reported that about 80 percent of these adult children were working, in school, or in training. However, about one-third had not completed high school, and 54 percent were judged to have a major problem in psychological, drug or alcohol, or legal domains. Although nearly 40 percent were parents of minor children, only about 12 percent were in a committed relationship. Mothers' bipolar diagnosis was a significant predictor for number of adult child problems. The results indicate a need for more attention to the parenting status of adults with mental illnesses and to their parenting concerns and needs.

Fidelity criteria are increasingly used in program monitoring and evaluation, but are difficult to derive for emerging models (i.e., those not based on theory or a research demonstration project). We describe steps used to develop and operationalize fidelity criteria for consumer-run (CR) mental health services: articulating and operationalizing criteria based on published literature, then revising and validating the criteria through expert judgments using a modified Delphi method. Respondents rated highest those structural and process components emphasizing the value of consumerism: consumer control, consumer choices and opportunities for decision-making, voluntary participation (and the absence of coercion), and respect for members by staff.

Despite evidence that gender and race/ethnicity matter in the relation between functioning and diagnosis, studies often fail to separate results for women or to include sufficient non-Whites for analyses. The present study investigated personal characteristics, contextual factors, and current functioning of women (N 379) across major diagnostic groups. Using statistical controls for race, multivariate analyses indicated significant differences across diagnoses. In paired comparison tests, women with major depression had significantly higher education, higher socioeconomic status, less severe clinical histories, and better current status. Women with schizoaffective diagnoses were most impaired in functioning, and women with schizophrenia diagnoses were most positive in their subjective perceptions. Analyses explored alternative explanations for these differences. Implications for treatment and research are presented.

Assisted death and voluntary euthanasia have received significant and sustained media attention in recent years. High-profile cases of people seeking assistance to end their lives have raised, at least in the popular press, debate about whether individuals should be able to seek such assistance at a time when they consider their suffering to be unbearable or their quality of life unsatisfactory. Other recent developments include a number of attempts to legislate on the issue by the minor parties in Australia and the successful enactment of legislation in a few overseas jurisdictions. However, despite all of the recent attention that has focused on assisted death and voluntary euthanasia, a discussion of the adequacy of existing laws has not made it onto the political agenda of any of the Australian State or Territory governments. This is in spite of the fact that the private views of the majority of our elected Members of Parliament may be supportive of reform. This article explores the role of politicians' views and, as a case study, considers the opinions expressed by a number of Queensland Members of Parliament. In light of the views of these politicians and those of members of the public, as well as considerations arising from current medical practice, the article argues that there is a need for open political debate on assisted death and voluntary euthanasia. The article also suggests ways that such a debate may be achieved while minimising any political impact on governments that are prepared at least to consider this issue.