HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents.

Results of a preliminary effectiveness evaluation of a school-based postwar program for war-exposed Bosnian adolescents are described. The evaluation centered on a manualized trauma/grief-focused group psychotherapy protocol for war-traumatized adolescents based on 5 therapeutic foci: traumatic experiences, trauma and loss reminders, postwar adversities, bereavement and the interplay of trauma and grief, and developmental impact. Fifty-five secondary school students (81% girls; age range?=?15–19 years, M?=?16.81) from 10 Bosnian schools participated in the evaluation. Students completed pregroup and postgroup self-report measures of posttraumatic stress, depression, and grief symptoms and postgroup measures of psychosocial adaptation and group satisfaction. The evaluation yielded preliminary but promising results, including reduced psychological distress and positive associations between distress reduction and psychosocial adaptation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of parent death and an intervention on the adjustment of adolescents whose parents have HIV/AIDS.

The impact of parental death and the efficacy of a coping-skills intervention were examined on the adjustment of 211 adolescent children of parents with HIV/AIDS (PWH) over a 2-year period. During the follow-up period, 35% of the PWH died. Using longitudinal structural equation model, controlling for prior measures of adjustment at baseline, the authors found that children of deceased PWH reported significantly more emotional distress and problem behaviors 2 years later. Youth randomized with their parent to a coping-skills intervention reported significantly fewer problem behaviors and sexual partners 2 years later. Also, adolescents were better-adjusted 2 years later when their parents had reported less emotional distress and less severe physical health symptoms at baseline. Female adolescents reported more emotional distress at baseline and at 2 years than males; male adolescents reported more problem behaviors at baseline than the females. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Set a place for Elijah: Problems of the spouses and parents of psychotherapy patients.

Results of a questionnaire administered to 20 spouses and parents of psychotherapy patients engaged in analytically oriented treatment suggest that the patients are not alone in their tranference to their therapist. Responding to in-depth questioning, Ss reported, via their own fantasies, transferencelike reactions to their family members' treatment. While not direct participants in the psychotherapy process, Ss appear to be affected not only by the realities of time, money, and the intimacy that they must share with an unknown therapist, but also by their own fantasies and anxieties. Often the therapist is viewed as an intruder disrupting family relationships. It is suggested that the specific nature of these tranferencelike fantasies bears a close resemblance to Ss' reports about their own lives and intrapsychic concerns. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of psychotherapy with children and adolescents: A meta-analysis for clinicians.

How effective is psychotherapy with children and adolescents? The question was addressed by meta-analysis of 108 well-designed outcome studies with 4–18-year-old participants. Across various outcome measures, the average treated youngster was better adjusted after treatment than 79% of those not treated. Therapy proved more effective for children than for adolescents, particularly when the therapists were paraprofessionals (e.g., parents, teachers) or graduate students. Professionals (with doctor"s or master"s degrees) were especially effective in treating overcontrolled problems (e.g., phobias, shyness) but were not more effective than other therapists in treating undercontrolled problems (e.g., aggression, impulsivity). Behavioral treatments proved more effective than nonbehavioral treatments regardless of client age, therapist experience, or treated problem. Overall, the findings revealed significant, durable effects of treatment that differed somewhat with client age and treatment method but were reliably greater than zero for most groups, most problems, and most methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Living with HIV/AIDS: the voices of HIV-positive mothers

The study reported here was undertaken to investigate the experiences of HIV-positive mothers with the system of services designed to help them, how they cope with the infection, particularly as it relates to parenting, and their concerns, preferences and plans for the future care of their children. A focus group method was selected because it is well suited for this type of exploratory research. A total of 40 HIV-positive mothers participated in six different focus groups. The issues that emerged from the data analysis revealed that, using systems theory, they could be logically classified by the type or level of system in which the issue was primarily located. The three system levels were (1) individual and family, (2) organizations and providers, (3) policy and community. Within each of these categories, issues could be further delineated by whether they provided women with resources or presented them with additional stress. Conclusions and recommendations for providers are made based on the systems framework that gave structure to the results.     

Support groups for people living with HIV/AIDS: a review of literature

For more than a decade, support groups have been proposed as a key intervention for people living with HIV and AIDS (PLWAs). Despite this fact, there are still only a few articles that evaluate and compare outcomes of support groups so as to provide a scientific base for their usefulness and effectiveness. The purpose of this article is to critically review selected published literature on support groups and to assess gaps in research. In general, the reviewed literature evaluated support groups as an effective intervention, which is evident for this widespread support. However, because diverse populations of PLWAs have specific needs, the group and intervention should be designed to meet those needs. Specific recommendations for further research about support groups for PLWAs are offered.     

A model of time-effective group psychotherapy for patients with personality disorders: the clinical model

This article describes a model of time-limited psychotherapy for patients with personality disorders that emphasizes the group as a social microcosm. The patient population described is relatively high functioning, although the majority of the group members meet DSM-III-R (American Psychiatric Association, 1987) criteria for an Axis II diagnosis. The clinical model's key theoretical concepts, for example, interpersonal focus; active therapist stance; emphasis on group interaction and processes; use of time limits; primary care/intermittent treatment philosophy; and emphasis on patients' strengths, goals, and resources are described. The relationships between the phases of group therapy and the key theoretical concepts are delineated.     

Techniques for psychotherapy with defiant, aggressive adolescents.

Defiant, aggressive adolescents are among the most difficult and challenging of all psychotherapy clients. This article presents a number of techniques and strategies for working with this population, along with several case examples illustrating their proper use. The techniques are intended to supplement existing approaches and focus on motivating apathetic clients and directly addressing anger and violent impulses. A few of the techniques mentioned are therapeutic "button-pushing," disengaging the motor controls, addressing the hurt, externalizing, and resurrecting empathy. Strategies are aimed toward managing countertransference and strengthening the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nutritional care of the patient with HIV/AIDS

Confluence in technologic advances in medical electronics, the availability of new intravenous pharmaceuticals, increasing sophistication of home care delivery systems and the economic motivations imposed by Diagnosis-Related Groups and capitated care payment mechanisms stimulated dramatic developments in intravenous delivery technologies, both for the hospital and the outpatient environment. Success in the use of these sophisticated drug delivery systems, however, depends on appropriate patient selection, optimal selection of a delivery alternative and careful patient monitoring for both desired therapeutic response, health delivery quality and patient safety.     

The social relations model: A tool for group psychotherapy research.

The social relations model presented in this article provides a solution to some of the problems that plague group psychotherapy research. The model was designed to analyze nonindependent data and can be used to study the ways in which group members interrelate and influence one another. The components of the social relations model are the constant (i.e., group effect), the perceiver effect, the target effect, the relationship effect, and error. By providing estimates of the magnitude of these 5 factors and by examining the relationships among these factors, the social relations model allows investigators to examine a host of research questions that have been inaccessible. Examples of applications of the social relations model to issues of group leadership, interpersonal feedback, and process and outcome research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: Longitudinal effects on grief.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual functioning in ambulatory men with HIV/AIDS

Sexual functioning is often neglected in the care of HIV-infected patients. Little information exists about the relationship between hormonal factors, psychological factors, medication, HIV disease stage and sexual functioning among persons with HIV disease. In this study, 50 HIV+ men completed the Derogatis Sexual Functioning Inventory (DSFI), and had serum hormonal assays drawn (testosterone, thyroid function test, leuteinizing hormone, prolactin and oestradiol). Although all the subjects reported some degree of sexual dysfunction, persons with symptomatic HIV/AIDS reported more negative mood, lower sexual satisfaction scores and worse body image than persons with asymptomatic HIV. Persons with asymptomatic HIV also tended to have normal testosterone levels compared with persons with symptomatic HIV/AIDS. No relationship was found between medications and low testosterone, although numbers were small. These results suggest that sexual dysfunction is prevalent among persons with HIV disease, is more common as patients become symptomatic and progress to AIDS and that both physiological (low testosterone) and psychological issues play a role.     

Willingness to provide care and treatment for patients with HIV/AIDS

This paper is derived from the findings of a larger study which examines nurses' and doctors' attitudes towards mainstreaming of hospital inpatient services for individuals with HIV/AIDS in general hospital wards. The aim of this paper is to discuss the factors which influence nurses' and doctors' willingness to provide care and treatment for patients with HIV/AIDS. Two methods of study are used in this research--a survey questionnaire and semi-structured interviews. The findings of this study provide several themes about the positive attributes associated with caring for and treating patients with HIV/AIDS. These include: that caring for and treating is personally and professionally rewarding; the need to be non-judgemental and accepting of others; that previous work or social experience is related to willingness to work with patients; the influence of family and colleague support in the work environment; and having a duty of care.     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric/adolescent AIDS: From disclosure to dialogue in psychotherapy.

Presents a case study that used a 3-step psychotherapeutic treatment to inform a 13-yr-old African-American boy that he had been infected with the HIV virus from birth. Step 1 consisted of establishing a supportive and trusting relationship with the S. In Step 2, the S was provided with concrete information about his diagnosis. In Step 3, the S was provided with an opportunity to emotionally process this information within a psychotherapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)