Relational processes in the DSM-V revision process: Comment on the special section.

With the aim of stimulating research in advance of the revision process of the Diagnostic and Statistical Manual of Mental Disorders, "A Research Agenda for DSM-V" (D. A. Kupfer, M. B. First, and D. A. Regier, 2002) was published, highlighting areas for further study. A white paper included in the research agenda (M. B. First et al., 2002) identified the limited provision for the diagnosis of relational disorders as one of the most important gaps in the current DSM-IV (American Psychiatric Association, 1994). Specific recommendations in the research agenda included developing assessment modules, determining the clinical utility of relational disorders, determining the role of relational disorders in the etiology and maintenance of individual mental disorders, and considering aspects of relational disorders that might be modulated by individual mental disorders. In parallel with the 11 research planning conferences organized by the American Psychiatric Association from 2004 to 2007 under the title "The Future of Psychiatric Diagnosis: Refining the Research Agenda," a research planning conference sponsored by the Fetzer Institute was convened to promote research necessary for more empirically informed deliberations about the role of relational disorders in DSM-V. The current special section summarizes the conference proceedings and should serve as a valuable resource for the DSM-V revision process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational diagnosis--A brief historical overview: Comment on the special section.

Various mental health disciplines have attempted to bring the significance of relational interaction and dysfunction to the attention of the entire field. Over the past 20 years, these efforts have been initiated and developed both independently and collaboratively, and although progress has been made, results have been incremental and insufficient. The inclusion of the Global Assessment of Relational Functioning (GARF) as an option on Axis IV of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) was a milestone but fell short of recognition as a major disorder on Axis I. This article summarizes and provides a background for the historical efforts that have occurred and suggests possibilities for greater prominence of relational disorders in DSM-V. Renewed interest by coalitions of researchers and practitioners in recent years indicates a positive prognosis for greater acceptance of a classification of couple and family dysfunction in the mental health professions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational disorders and relational processes in diagnostic practice: Introduction to the special section.

The special section addresses a number of salient issues that will arise as the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) unfolds and the role of relational processes in mental health is considered. This collection of articles, which emphasize historical, conceptual, and empirical contributions to the discussion, is intended to stimulate debate in the field and to serve as a resource for individuals charged with proposing new diagnostic guidelines. Jointly, the articles make it clear that the authors can improve on the current treatment of relational processes in the DSM and that there is a solid foundation of family research that can inform any discussion on this topic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pursuit and adjustment of goals during unemployment: The role of age.

This longitudinal study investigated the predictive value of 2 self-regulatory processes (goal pursuit and goal adjustment) on mental health and reemployment success over a period of 8 months. A total of 87 unemployed job seekers participated in this study. There is some evidence that age moderated the relationship between goal pursuit and goal adjustment with mental health and reemployment success. Contrary to expectations, goal pursuit was positively related to mental health for relatively older individuals. The authors found no effects of goal adjustment on mental health. However, as expected, goal adjustment had a negative relationship with reemployment success for relatively younger individuals. The authors found no moderator effects of age on the relationship between goal pursuit and reemployment success. Thus, the study revealed different relationships between self-regulatory processes and mental health as well as reemployment success for younger and older individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goals and methods of alcohol assessment.

Given the prevalence of alcohol disorders among psychiatric patients, all mental health professionals must pay greater attention to the assessment of alcohol use and related problems. The primary goals of alcohol assessment relevant to mental health settings are (a) identification, (b) diagnosis, and (c) treatment planning and outcome assessment. In this article, the authors describe each goal and provide examples of assessment tools used to address each goal. The structure, length, validation evidence, and limitations of each assessment method are considered. This scheme is proposed as a guide to psychologists in their task of assessing alcohol use and its related problems in their clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use.

In this study, the authors examined the role of parental beliefs about the causes of child problems in predicting later mental health service use in a large, diverse population of at-risk youths. Study hypotheses were that parental beliefs consistent with biopsychosocial causes would be associated with later mental health service use; sociological, spiritual, or nature disharmony etiologies would be negatively associated with service use; and beliefs would partially mediate the relationship between race/ethnicity and service use. Of the 5 biopsychosocial beliefs, 2 were positively related to later mental health service use. Unexpectedly, of the 6 parental beliefs related to sociological, spiritual, or nature disharmony etiologies, only 1 was negatively associated with later service use patterns. Parental endorsement of etiologies relating to physical causes, relational issues, trauma, and prejudice was found to partially mediate the relationship between race/ethnicity and service use for Asian/Pacific Islander American and Latino youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of help seeking for emotional distress among Chinese Americans: Family matters.

Using data from the Chinese American Psychiatric Epidemiological Study, the authors examined longitudinal predictors of help seeking for emotional distress in a community sample of 1,503 Chinese Americans. Specifically, they assessed the relative contribution of family relational variables (e.g., levels of family support and family conflict) in predicting help seeking for medical, mental health, and informal services. After traditional need, predisposing, and enabling factors were controlled for in hierarchical logistic regression analyses, family conflict predicted both mental health and medical service use, whereas family support was not predictive of help seeking. In addition to family conflict, mental health service use was predicted by negative life events, emotional distress, and insurance coverage. Implications of the findings for assessing and treating Asian American clients are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-constructing inner and relational processes: Self- and mutual regulation in infant research and adult treatment.

In the current climate of theoretical change, psychoanalysis is seeking a theory of interaction. The authors propose that principles of interactive organization documented in infant research have analogues in adult treatment. A systems model of the integration of self- and mutual regulation is used to draw analogies, but not one-to-one correspondences, between infant research and adult psychoanalysis. The authors specifically address how self- and mutual regulation impact on each other, arguing that internal and relational processes are simultaneously organized, in relation to each other, at all developmental levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiver mental health and racial/ethnic disparities in stroke: Implications for culturally sensitive interventions.

Purpose/Objective: The purpose of this study was to create a set of culturally sensitive mental-health-intervention recommendations for the caregivers of Latino/Puerto-Rican, Black, and White individuals with stroke. The study examined whether the mental health of stroke caregivers and functioning of individuals with stroke differed according to race/ethnicity, changed differentially over time according to race/ethnicity, and showed relationships between the two sets of constructs that differed according to race/ethnicity. Research Method/Design: Data on caregiver mental health and functioning of individuals with stroke were collected from 124 (n = 248) White, Black, and Latino/Puerto-Rican dyads at 1, 6, and 12 months post-hospital discharge. Results: Out of the three racial/ethnic groups, Latino/Puerto-Rican individuals with stroke showed the lowest functioning, and their caregivers showed the poorest mental health, though the mental-health effects did not reach statistical significance. Consistent patterns which differed as a function of race/ethnicity emerged over time in the relationships between caregiver mental health and functioning of individuals with stroke. Conclusions/Implications: Critical knowledge may be lost regarding the connections between caregiver mental health and the functioning of individuals with stroke when researchers and clinicians look only across race/ethnicity as opposed to also within. A monolithic racial/ethnic approach to mental-health interventions for stroke rehabilitation is likely limited, and race/ethnicity may affect how caregiver mental health and functioning of individuals with stroke reciprocally influence each other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The creation of partnerships: perspectives and possibilities

This article re-examines access to treatment and care in the current context of fiscal restriction and change in locus of care. Taking the position that the development of partnerships with all parties who work in the mental health area is an important process, this article argues that such processes are infrequently discussed. Further, creating a partnered relationship with the person with mental disorder is also neglected. The authors examine mechanisms of relationship change as care moved from large, total-care institutions to general hospitals and finally, to the community. How professionals, individuals with mental disorder and their families have been affected by this change in terms of how alliances are constituted and maintained is discussed. The authors conclude with two case examples which illustrate the reconciliation and non-reconciliation of differing points of view between all partners which likely affected clinical outcomes.     

Abortion and mental health: Evaluating the evidence.

The authors evaluated empirical research addressing the relationship between induced abortion and women’s mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women’s responses following abortion. This article reflects and updates the report of the American Psychological Association Task Force on Mental Health and Abortion (2008). Major methodological problems pervaded most of the research reviewed. The most rigorous studies indicated that within the United States, the relative risk of mental health problems among adult women who have a single, legal, first-trimester abortion of an unwanted pregnancy is no greater than the risk among women who deliver an unwanted pregnancy. Evidence did not support the claim that observed associations between abortion and mental health problems are caused by abortion per se as opposed to other preexisting and co-occurring risk factors. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that women’s varied experiences of abortion be recognized, validated, and understood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lessons from Katrina: Disaster mental health service in the Gulf Coast region.

In this article, 4 mental health professionals provide firsthand accounts of experiences as volunteers in the Gulf Coast region following Hurricanes Katrina and Rita in the fall of 2006. These accounts are provided with the goal of informing psychologists and other mental health providers about the role of volunteers from a frontline perspective. The authors offer these observations as a compliment to formal training in disaster preparedness that psychologists might receive for volunteer service in the wake of a devastating disaster. Specifically, the authors discuss the training they received, the settings in which they worked, and the client needs and mental health skills they used to meet those needs. Last, the lessons the authors learned about providing disaster mental health services are discussed. It is hoped that these observations might inspire others to lend their expertise and compassion in response to future catastrophic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational regulation theory: A new approach to explain the link between perceived social support and mental health.

Perceived support is consistently linked to good mental health, which is typically explained as resulting from objectively supportive actions that buffer stress. Yet this explanation has difficulty accounting for the often-observed main effects between support and mental health. Relational regulation theory (RRT) hypothesizes that main effects occur when people regulate their affect, thought, and action through ordinary yet affectively consequential conversations and shared activities, rather than through conversations about how to cope with stress. This regulation is primarily relational in that the types of people and social interactions that regulate recipients are mostly a matter of personal taste. RRT operationally defines relationships quantitatively, permitting the clean distinction between relationships and recipient personality. RRT makes a number of new predictions about social support, including new approaches to intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of outpatient mental health service use by American youth.

Among American children and adolescents aged 1 to 17 years, the 12- to 17-year-olds represent the largest users of outpatient mental health services. This study utilizes a nationally representative sample of this age group from the 2005 National Survey on Drug Use and Health to illuminate predictors of services use from three treatment settings: day treatment programs, mental health clinics/centers, and private/in-home settings. Univariate analyses were used to calculate the percentages of the study sample that used mental health services in these settings. In bivariate analyses, the authors estimated the strength of the associations between available predisposing, need, and enabling factors and the outcomes. Multiple logistic regressions estimated the independent effects of each covariate on the outcomes. Lifetime depression, lifetime general anxiety, delinquent behaviors, drug dependence, and Medicaid were consistent predictors of services use in the three treatment settings. Several other factors were associated with services use in bivariate analyses but lost most of their statistical significance when the authors adjusted for other confounders. Interpreted in light of its potential limitations, this study has important research and policy significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The abduction of disorder in psychiatry.

The evolutionary cornerstone of J. C. Wakefield's (see record 1999-03409-002) harmful dysfunction thesis is a faulty assumption of comparability between mental and biological processes that overlooks the unique plasticity and openness of the brain's functioning design. This omission leads Wakefield to an idealized concept of natural mental functions, illusory interpretations of mental disorders as harmful dysfunctions, and exaggerated claims for the validity of his explanatory and stipulative proposals. The authors argue that there are numerous ways in which evolutionarily intact mental and psychological processes, combined with striking discontinuities within and between evolutionary and contemporary social/cultural environments, may cause nondysfunction variants of many widely accepted major mental disorders. These examples undermine many of Wakefield's arguments for adopting a harmful dysfunction concept of mental disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repression, suppression, and conscious awareness.

Both “repression” and “suppression” are said to involve removing mental content from awareness. However, repression is generally said to be unconscious, whereas suppression is said to be conscious. The meanings of the terms “unconscious” and “conscious,” though, are open to a variety of interpretations and so the validity of this distinction is uncertain. This paper discusses the relationship between repression and suppression and whether conscious awareness distinguishes these processes. Consciousness and unconsciousness are discussed in terms of a relational account of cognition where “knowing” is understood as a relation between a cognizing subject and a cognized object term. On this view, problems arise from confusing consciousness and unconsciousness with properties or qualities of mental processes. Examined in this light, the present analysis reveals that repression can become conscious and that suppression can occur unconsciously. The role of “resistance” and the recognition of a series of defenses are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health values and preference for mental health resources of Japanese-American and Caucasian-American students.

The authors investigated Asian-American underuse of mental health resources as a function of attitudes about the nature of mental health (mental health values) and resource preference for assistance with serious personal problems, with 91 Caucasian-American and 90 Japanese-American undergraduates. Results from a mental health values questionnaire (MHVQ) revealed that Japanese Americans more strongly related several MHVQ scales to mental health (good interpersonal relations, trustworthiness, and absence of negative personal traits) than did Caucasian Americans. Nevertheless, they were less likely than Caucasian Americans to rank mental health professionals as first choice for assistance with serious interpersonal/emotional problems and more likely to prefer close friends for assistance. Mental health values and attitudes about appropriate help-seeking behavior are discussed in relation to the Asian-American underuse phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)