Dissertations / Theses on the topic '170106 Health, Clinical and Counselling Psychology'

As psychologists continue to engage the growing diversity within the United States and around the world, there is an imperative need for psychological services that are specific to cultural needs and integrate relevant sociohistorical and community factors. Currently, ethnocentrism in psychological interventions, research, and graduate training limit psychologists’ international engagement and perpetuate a focus on U.S. psychology. For graduate programs in health service psychology (i.e., clinical, school, and counseling psychology), there is a dearth of literature on their methods of preparation of health service professionals engaging in psychological work outside of the U.S. However, graduate training programs have opportunities to intervene on the field’s colonialism by preparing professionals to effectively engage internationally. Addressing ethnocentrism in training is a critical next step for the field of health service psychology.

This dissertation is comprised of two distinct chapters that are conceptually related. In the first chapter, I review health service psychology’s current international engagement. As psychologists engage outside of the United States, the field of psychology and the training community must critically examine the applicability of psychological interventions, research, and graduate education to international contexts. I propose six recommendations for training programs to deconstruct colonialism and enhance preparation of graduates for competent work outside of the U.S.

In the second chapter, I report an original, empirical study, using qualitative descriptive methodology, which critically examines how U.S. training prepares graduates to work internationally. Through semi-structured interviews, I explored internationally based psychologists’ reflections on their training experiences and preparation for their current roles in teaching, practice, research, consultation and policy, and psychological infrastructure. Data analysis utilized consensual qualitative research methodology (CQR). Results provided valuable information regarding psychologists’ professional roles outside of the U.S., factors contributing to their vocational experiences, country-specific mental health attitudes, values, and practices, the impact of U.S.-centric psychology in the country of location, lessons taken from their graduate training, and recommendations for international work. Findings provided recommendations to the training community to incorporate more of an international focus and enhance preparation of students for work outside of the U.S.

Despite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future.

Mental health concerns of college students are important due to their developmental and life stages and adjustment challenges they must navigate in a new and difficult environment. Compared to students of other ethnicities, Black college students in the United States have historically reported poorer mental health outcomes with higher risk for depression and anxiety than their non-Black counterparts (McClain et al., 2016; Mushonga & Henneberger, 2019). The African American activism work done by Black college students has become increasingly visible and influential since the creation of the Black Lives Matter (BLM) movement and student protests aimed at improving university climates for minority students. Using Critical Race Theory (CRT) as a framework, this study investigated the roles of racial identity attitudes and sociopolitical attitudes on the relationships between race-related stress and mental health, and race-related stress and African American activism for Black college students in the U.S. The results indicated that increased race-related stress was associated with worsened mental health outcomes but increased engagement in activism, negative sociopolitical attitudes were related to poorer mental health, positive sociopolitical attitudes were related to decreased activism, and the six racial identity attitudes varied in their associations to mental health and activism based on racial centrality. The Internalization Multiculturalist Inclusive racial identity attitude was found to moderate the relationship between race-related stress and an indicator of mental health, and the Internalization Afrocentricity identity attitude strengthened the relationship between race-related stress and activism. The discussion addresses implications for future counseling psychology research and practice.

Grieving the deaths of immediate and extended family members as well as friends is a common experience among traditional-age college students. The overarching purpose of this study was to provide a more nuanced understanding of how various family grief communication factors (i.e., frequency, quality, willingness to communicate—personal/perceived family, reasons for grief communication avoidance—self-protection/relationship-protection) and self-construal might be related to the post-loss functioning of grieving traditional-age college students. Using hierarchical multiple regressions, I analyzed survey data from 369 grieving college students who were between ages 18 and 24 and had experienced the death of at least one individual they considered as family member within the last two years. First, the current findings indicated that the more frequent grieving students communicated about their grief with their family, the stronger their grief reactions. Second, the more students reported family grief communication of high quality, the weaker their grief reactions and the higher their post-loss family satisfaction. Third, there were no relationships between grieving college students’ personal willingness or their perceived family willingness to communicate about grief and their own grief reactions. Fourth, grieving students’ post-loss family satisfaction levels were similar regardless of how personally willing they were to communicate their grief, but increased as they perceived their family members as more willing to communicate about their grief. Fifth, the more grieving students avoided family grief communicate for self-protection reasons, the stronger their grief reactions and the lower their post-loss family satisfaction. Sixth, college students reported similar levels of grief reactions and post-loss family satisfaction regardless of how much they reported avoiding grief communication to protect their family relationships. Seventh, quality, personal and family willingness to communication, and reasons for grief communication avoidance did not moderate the relationship between the frequency of family grief communication and grieving students’ post-loss functioning. Eighth, grieving students reported similar levels of grief reactions and post-loss family satisfaction regardless of how much they identified with interdependent self-construal, independent self-construal, or a combination of both. Finally, the relationships between grieving students’ reasons for grief communication avoidance (i.e., self-protection, relationship protection) and their post-loss functioning (i.e., grief reactions, post-loss family satisfaction) remained similar regardless of how much they identified with independent or interdependent self-construal. The results of this study may be used to inform clinical interventions and outreach efforts for grieving traditional-age college students and their family members.

As of June 2020, there were nearly 71 million displaced persons worldwide fleeing their homes due to conflict and war (“Figures at a Glance,” UNHCR, 2020). One of the critical needs following displacement and subsequent resettlement is to address the immense psychological turmoil refugees may have endured. Despite the need for care, refugees often face barriers to accessing mental health care after resettlement, including inadequate translation services, poor provider cultural competence, and difficulty navigating services (Asgary & Segar, 2011). An important aspect in meeting the mental health needs of resettled refugees in the U.S. are the refugee resettlement agencies that help refugees rebuild their lives post-resettlement. Thus, this study focused on the mental health providers working with resettled refugees within refugee resettlement agencies. Through the use of mixed methods, this study collected quantitative and qualitative data across three phases to 1) obtain a greater understanding of the available mental health services within refugee resettlement agencies, 2) examine cultural competence in mental health providers working within these agencies, and 3) identify the culturally competent strategies mental health providers use to improve access to mental health services in this context. The results of this study, including an integration of the data across phases, and a discussion complete with 12 suggestions for mental health providers working with resettled refugees are presented. We hope the results and implications of this study will contribute to our understanding of, and subsequently address, the issues related to mental health service accessibility experienced by resettled refugees.

The study aimed to understand and advance the dynamics that influence psychological aggression. Psychological aggression can be defined as, verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or control another person. In our society, the occurrence of psychological aggression in relationships is far more tolerated then physical aggression, but the effects can be more long term and harmful. The study hypothesized that an individual’s level of differentiation of self--a person’s ability to differentiate between feeling and thinking in times of stress--and their gender have a role in the severity of psychological aggression. The study was approved by IRB and using an online survey through MTurk asked participants about experiencing and perpetrating psychological aggression in their romantic relationships. The study had 192 participates in the multiple regression analyses, who provided some support that the level of differentiation of self and severity of psychological aggression, experiencing and perpetrating, have a negative significant relationship. Gender was found to not impact the relationship between differentiation of self and severity of psychological aggression. Clinical implications, limitations, and future directions for research were addressed.