Secondary Traumatic Stress in Mental Health Providers

Kevin Petersen, Fielding's School of Psychology

A cross-sectional sample of 228 mental health providers completed an online survey to explain the factors relating to the development of secondary trauma in mental health workers. Risk factors were measured by the Life Event Checklist and the Secondary Exposure Scale. The Self-Care Checklist, Shared Power Scale, and the Post Traumatic Growth Inventory Short-Form were used to measure protective factors. A structural equation modeling approach was used to determine the general compatibility of the model with the data, and examine the strength and direction of relationships that predict elevated symptoms of secondary trauma. The results support the compensatory resilience model and suggest that protective factors such as self-care and workplace empowerment are very important in lessening the risk of developing trauma symptoms in mental health professionals.


A Narrative Study of the Relationships Between Women Diagnosed with Borderline Personality Disorder and Their Therapists

Shari E. Goldstein, Fielding's School of Psychology

The goal of improving therapy experiences for individuals diagnosed with borderline personality disorder (BPD) requires that the relationships between this patient population and the clinicians who treat them be better understood (Clearly, Siegfried, & Walter, 2002; Commons-Treloar, 2009; Westen, 1990). Though studies suggest that the therapy relationships of BPD-diagnosed patients are unusually fraught with miscommunications and mutual feelings of frustration and dissatisfaction (Clearly, Siegfried, & Walter, 2002; Fallon, 2003; Muller & Poggenpoel, 1996; Nehls, 1999), little is known about how these tensions develop, particularly from the viewpoint of the patients. The purpose of this qualitative study was to explore the interpersonal therapy experiences of seven female participants previously diagnosed with BPD using participants’ narratives as the primary data source. An additional purpose was to consider the impact of participants’ object relations patterns on their therapy relationship experiences. Prominent interpersonal patterns were identified from three sources--participants’ narratives, results from the Core Conflictual Relationship Theme-Relationship Anecdotes Paradigm (CCRT-RAP) interview (Luborsky, 1990), and my interpersonal reactions to each participant. The results were analyzed by participant and by group. Identified object relations patterns contributed significantly to each participant’s interpersonal therapy experiences, including experiences of alliance ruptures and outcomes. Sustainability of therapy relationships was closely linked to participant reports of how their therapists responded to interpersonal tensions. As a group, the seven participants desired therapists who demonstrated caring and kindness and who joined them in their experiences through a deep form of listening and validation. These conditions were necessary but not adequate for the development of a healing alliance. Participants also desired clinicians who were confident, skilled, knowledgeable about BPD, and who maintained a collaborative approach, balancing strength with flexibility. Therapist neutrality, withholding, and inactivity were experienced as aversive and participants expressed a desire for explicit evidence of clinician humanity. Though participants were aware of the stigma associated with BPD, especially within the mental health community, they experienced relief and hope in receiving a diagnosis. The results support further investigation into how identified object relations patterns can assist clinicians in developing more intricate conceptualizations of client interpersonal experiences and how these may serve to moderate counter-therapeutic experiences. The significance of therapist contributions to what develops in the interpersonal context is also highlighted.

Key words: borderline personality disorder, therapy relationships, narrative research, object relations, intersubjectivity, reflexivity

Self-Care Effects On Anxiety In Doctoral Students

Ashlee Brooke Orozco, Fielding's School of Psychology

This study investigated the effects of self-care practices on anxiety in doctoral students. The Burns Anxiety Inventory (Burns, 1999) was used to measure feelings, thoughts, and physical symptoms associated with anxiety. The Self-Care Assessment Worksheet (Saakvitne & Pearlman, 1996) was used to examine the self-care activities frequently practiced by doctoral students, including physical, psychological, emotional, spiritual, and professional activities. Lower self-care scores were expected to be associated with higher anxiety scores. In addition, physical self-care subscale scores were expected to explain significantly more of the variance in anxiety scores than the other self-care subscales. Participants (N= 161) were recruited through Fielding Graduate University’s communication system and asked to complete a survey on their self-care practices and their anxiety levels. A simple linear regression was conducted and the findings suggest that the self-care scores contributed to the variance in anxiety scores. A multiple linear regression was conducted to examine the relationship of the five SCAW subscales and the total score on the Burns Anxiety Inventory. As expected, physical self-care subscale scores explained significantly more of the variance on the total scores of the Burns Anxiety Inventory than the other self-care subscales. However, psychological, emotional, and workplace or professional self-care subscales also contributed significantly to the variance and therefore, may also be useful predictors.

Keywords: self-care, anxiety

Leadership Dynamic Analyzed and Assessed through an Autoethnographic Lens

Michael Patterson, Fielding's School of ELC

Leadership is one of the most widely written about topics and has increasingly gained mainstream popularity. Countless leadership practitioners and academics often produce works that give advice on how to be an effective leader. Much of this information attempts to examine and typologize existing leadership theories as well as seeking to provide new insights on this complex and diverse area of inquiry (Northouse, 2012). In this dissertation, I explore the vast conceptual and theoretical landscape of leadership within mostly corporate settings through the lens of autoethnography. The overall aim is to present the frames of reference and variations of three distinct leadership models: autocratic, servant, and situational. These are articulated through three vignettes seeking to demonstrate how the culture of each organization played an integral role in the shaping of the leadership philosophies examined (Bergquist & Pawlak, 2008).

Implications of the results for future research and practice as well as the current study’s limitations are discussed. This dissertation seeks to make a contribution to leadership learning by exploring actual situations that occurred during my 30-year leadership tenure, which continues to evolve. This study reveals elements of the nature of leadership while sharing the actual development of an individual learned leadership practice. Names of people and organizations in the vignettes have been changed to protect the confidentiality of all parties.

Keywords: Autoethnography, Autocratic Leadership, Servant Leadership, Situational Leadership, Management, Leadership.

Mechanisms of Behavior Change within Peer-Implemented Alcohol Interventions

Erica M. Eaton, Fielding's School of Psychology

College campuses have experienced a large increase in referred students due to alcohol violations. Offenses vary in severity and therefore all mandated students do not necessarily need extensive treatment. Further, in the effort to reduce the demand on university alcohol programs, there has been a trend to use peer-implemented interventions. Fifteen-minute peer-based minimal interventions (PMIs) are a promising approach to reduce alcohol use and problems among mandated students. However, little is known about how these minimal interventions facilitate behavior change in at-risk college students. By examining the mechanisms of behavior change (MOBC) within these sessions, defined as the process leading to therapeutic improvement (Kazdin & Nock, 2003), the field will gain a better understanding of how minimal interventions influence post-session behaviors. Participants (N = 146; M age = 18.7, SD = 0.90; 67% male gender; 94% Caucasian) were college students who violated campus alcohol policy at a small northeastern liberal arts college. The current project conducted secondary data analyses with audio-recorded session tapes from a clinical trial delivering PMIs with mandated students. Peer therapist behaviors consistent (MICO; e.g., affirming) and inconsistent with motivational interviewing (MIIN; e.g., warning), along with therapist global scores, client change talk (CT), counter-change talk (CCT), and client self-exploration were coded using the Motivational Interviewing Skill Code (MISC). In addition, past-month alcohol consumption and alcohol-related negative consequences were assessed at baseline and 6-week follow-up. Regression analyses revealed a significant positive relationship between MICO peer therapist behaviors and CT (p < .01) and client self-exploration (p < .05). Peer therapist global scores (acceptance, empathy, and MI spirit) were also positively related to CT (p < .05) and client self-exploration (p < .05). No associations were found between MIIN peer therapist behaviors and CT or client self-exploration, but a positive association was found between MIIN peer therapist behaviors and CCT (p<.05). Furthermore, a significant negative relationship was supported between CT and alcohol-related problems (p =.04), average drinks per occasion (p = .02), peak drinks per occasion (p = .02), typical BAC (p = .002), and peak BAC (p = .003) at the 6-week follow-up. Specifically, increase in CT was related to lower levels of alcohol-related problems, average drinks per occasion, peak drinks per occasion, typical BAC, and peak BAC. No significant relationship between CCT and drinking outcomes was found. This study suggests that peer-implemented behaviors influence client behaviors, and subsequently alcohol-related consumption. Results will be discussed further as they relate to training of peer therapists. Future research directions and limitations will also be noted.

Keywords: alcohol, mandated college students, peer therapists, motivational interviewing, therapy process

Canadian Aboriginal Professionals’ Accounts of Success: Stories of Strength and Resilience

Chez-Roy Birchwood, Fielding's School of Psychology

A growing number Aboriginal Canadians obtain successful professional careers, despite multilevel psychological, economic, social, and political challenges. This study utilizes a qualitative narrative approach to examine how Aboriginal professionals understand their professional development in the context of socioeconomic obstacles and related psychological difficulties. Twelve Aboriginal Professionals between the ages of 32 and 55 were interviewed. The results indicated that the sample of participants had similar socioeconomic challenges to other Aboriginal Canadians and revealed 11 other themes associated with overcoming obstacles to professional accomplishment. These themes are as follows: Responding to Racism; Resolving Aboriginal Identity Struggles; Family Support; Spiritual Life; Specialized Educational Access and Support Programs; Psychological Insight and Therapy; Adjustment to Transiency and Relocations; Recesses, Retreats, and Timeouts; Finding a Voice; Perseverance and Determination; and Professional Pursuits in the Contexts of Personal Development and Community Engagement. Each theme had discrete utility in accounting for professional successes, however there were points of overlap between themes. The themes were then organized around four transformative elements and presented on an Aboriginal Medicine Wheel.

Improving Post-Incident Trauma-Informed Care for Drive-By Shooting Victims/Survivors by Building Collaborative Leadership Systems among Agencies and Their Clients

Secret Charles-Ford, Fielding's School of Educational Leadership for Change

Drive-by shooting incidents are a part of the broader discussion and policy deliberations that regard community gun violence. Non-gang-related drive-by shootings are not well researched, but news and media accounts and law enforcement reports suggest that non-gang related drive-by shootings constitute a major proportion of the drive-by shootings to which law enforcement respond. Children and adolescents in the United States and worldwide are among those commonly exposed to traumatic events, yet practitioners treating these young people to reduce subsequent psychological harm may not be aware of or use interventions based on the best available evidence (Wethingten et al., 2008). Given the magnitude and urgency of this issue, communities always are admonished, and admonish themselves, to mobilize and collaborate to address the issue of gun violence.

Although numerous studies exist that articulate the effect of traumatic events on children and adolescents, very few studies concentrate on the families, including the adults, of the victims/survivors of drive-by shootings to help them process through grief and successful recovery.

This qualitative study addresses the research question, “How are multiple-agency collaborations used to improve post-incident trauma-informed care for survivors, individuals, families, and communities victimized by gun violence, especially drive-by shootings, in a metropolitan area?” Semi-structured interviews were conducted with one or more representatives from three separate agencies that work with trauma associated with both fatal and non-fatal gun violence. In addition, semi-structured interviews were conducted with three adult family members of drive-by shooting victims/survivors. A fictional story based on real events offers insight into the nature of post-incident trauma-informed care among victims and their family members.

After careful analysis the data revealed that more work needs to be done to serve low-income and minority populations. Law enforcement, currently the primary community resource in addressing drive-by shooting incidents, and other community service groups only marginally help with both prevention and postvention services for victims/survivors of violence. Bringing attention to the personal trauma suffered as the result of drive-by shootings may inspire improved future changes in trauma-informed services. Such social change is a slow process, but creating hope for our children and communities is seen as important by all interviewees. Hopefully this work will have inspired increased collaboration to better serve drive-by shooting victims/survivors and their families with post-incident trauma-informed care.

Key Words: post-incident trauma-informed care, recovery and healing, agency collaborations, drive-by shootings, gun violence, mental health and trauma, fear of law enforcement, fictional therapeutic writing

Delusions and Cognitive Functioning in Alzheimer's Disease

Claire Milgrom, Fielding's School of Psychology

Alzheimer’s disease (AD) is a neurodegenerative disease of unknown etiology that affects cognitive functioning and functioning of daily living, and is frequently accompanied by behavioural and psychological symptoms (BPSD) including delusions, hallucinations, apathy, agitation, aggression, and depression. The presence of delusions in dementia patients is generally thought to be indicative of more advanced cognitive decline. Delusional thinking in people with dementia has also been found to be associated with aggressive behaviour, increased caregiver burden, high rates of institutionalization, and significant morbidity. Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), this study focused on the relationship between delusions in individuals with AD, their impairment in global and specific neuropsychological functioning (e.g., memory, executive functioning), and their functioning in daily living. It compared the neuropsychological functioning and daily functioning of AD patients with and without delusions. It also examined if the presence of delusions was associated with greater decline over time in global functioning, in specific cognitive domains, and in activities of daily living for patients with AD.

The results showed that delusions in AD patients may be more associated with the stage and progression of the illness rather than overall cognitive functioning or any specific neurocognitive indices. The results also indicated greater decline in daily functioning over time for AD patients who experienced delusions when compared to those who did not. This is an important finding in terms of its clinical application to assessment and intervention with AD patients.

Central to this study was the theoretical explanation of delusions using deficit or defect models. These models view delusions as “disorders of belief,” that is, “disruptions or alterations in the normal functioning of belief mechanisms such that individuals come to hold erroneous beliefs with remarkable tenacity” (McKay, Langdon & Coltheart, 2007, p. 933). A deficit model explains delusions as the result of fundamental cognitive or perceptual abnormalities stemming from disturbances in neurobiologically based cognitive-perceptual apparatus, distorted cognitive processes, or both.

Video Modeling for Children and Adolescents with Autism Spectrum Disorder: A Meta-Analysis

Teresa Thompson, Fielding's School of Psychology

The objective of this research was to conduct a meta-analysis to examine existing research studies on video modeling as an effective teaching tool for children and adolescents diagnosed with Autism Spectrum Disorder (ASD). Study eligibility criteria included (a) single case research design using multiple baselines, alternating treatment designs, or reversal designs; (b) evaluation of the efficacy of video modeling as an intervention strategy for children or adolescents exclusively diagnosed with ASD; (c) outcome measures that targeted social skills, communication skills, or behavioral functioning; (d) graphically presented data; (e) more than 1 participant; (f) a minimum of 3 data points in each phase for each participant; and (g) publication in English in a peer-reviewed journal between 1994 and 2010. Two competing nonoverlap-based single case effect size approaches were compared: (a) the Nonoverlap of All Pairs (NAP; Parker & Vannest, 2009), and (b) the newer TauU method which controls for trend (Parker, Vannest, Davis, & Sauber, 2010). Positive and statistically significant effect sizes were found: 12 in the upper moderate range and 4 in the large effect size range including these results using data obtained from baseline to intervention, baseline to maintenance, and baseline to follow-up: TauU (k = 35, N = 116), = 0.74, 95% CI [0.71; 0.77], p < .001; NAP (k = 35, N = 116), = 0.87, 95% CI [0.84; 0.91], p < .001. Additional study findings indicated there was a statistically significant difference between various groups of communication levels: c2(2, N = 29 = H =5.88, p = .05), with a mean rank of 19.40 for nonverbal (N = 5), 16.87 for verbal (N = 15), and 9.44 for low verbal (N = 9), indicating that scores of video modeling usage were highest for the group that was nonverbal. Results support video modeling as an effective intervention strategy that meets criteria as an evidence-based practice that can successfully address social and communication skills, as well as behavioral functioning in children and adolescents with ASD. These findings will encourage general use of video modeling and thus promote independent functioning of students with ASD in their least restrictive environments.

Keywords: autism spectrum disorder, meta-analysis, teaching strategies, video modeling

Workplace Stigma Toward Employees with Intellectual Disability: A Descriptive Study

Maureen E. Gormley, School of Human and Organizational Development

Individuals with intellectual disability (ID) have always been part of society but the ways in which they have been characterized and perceived has changed over time. A legacy of stigma remains towards these individuals despite decades of advocacy efforts aimed at promoting their social inclusion. This study explores workplace stigma, as assessed through coworker perceptions over time, toward transition-age youth (i.e., 18–22 years of age) with ID who entered a mainstream workforce through a formalized, school-to-work transition program. The conceptual framework that informs the study includes (a) transition-age youth with ID, (b) stigma, and (c) school-to-work transition. The study asked: In what ways do coworkers describe their perceptions over time of transition-age youth with ID hired in a coworkers’ unit within the context of a formalized, school-to-work transition program? This qualitative, descriptive design used thematic analysis to analyze data collected on 15 coworkers of individuals with ID from 14 organizations that had implemented the formalized, school-to-work transition program. The setting for the study was Project SEARCH, a school-to-work transition model that began at Cincinnati Children's Hospital in the mid-1990s. Study findings supported the framework that youth with ID face challenges as they seek employment in fully immersed work settings, including stigma—initial negative perceptions related to their capabilities and behaviors. Findings suggest that participants addressed and overcame negative perceptions where workplace concerns about anticipated performance and behavioral challenges shifted to positive contributions they reported the youth with ID made. In this instance, the school-to-work transition program played a major role in bringing about this shift. Eliciting coworker perceptions is an important part of the dialogue concerning the ways in which youth with ID are stigmatized as they transition from school to the world of employment.

KeyWords: school-to-work transition, stigma, intellectual disability, youth, coworker perceptions

The Experience of Family Caregivers Within the Acute Care Hospital Setting: An Institutional Ethnography

Petrina McGrath, Fielding's School of Human and Organizational Development

This thesis examines the experience of family caregivers when their family member is admitted to an acute care Canadian hospital. Family caregivers play a critical role in the Canadian health care system. In 2012, 28% of Canadians over the age of 15 were engaged in a caregiving role (Turcotte, 2013). Several studies have explored the interpersonal relationships between professionals and family caregivers, but few have expanded their understanding by exploring the social and organizational activities that intersect with this relationship. This study used Intuitional Ethnography (IE) to examine critically the acute care hospital experience from the standpoint of the family caregiver. Interviews made visible the work that family caregivers engage. This work included: a) support work, b) knowledge development work, c) knowledge exchange work, and d) advocacy work. Organizational and professional processes that intersect with family caregivers work surfaced and were traced to broader organizational discourses of hospital efficacy and professional knowledge as expert. Family caregivers are caught in a complex web where public policy views family caregivers as knowledgeable consumers who take on primary responsibility for the care of their family member at home, yet once they enter the acute care hospital setting, the discourse of professional knowledge as expert and managerial discourse of efficiency can situate the family caregiver in an environment of tension where their knowledge is not consistently elicited or utilized. This study will assist patient and family advocates to understand the broader organizational activities that influence the family caregiver experience and support health care professionals and administrators to understand the impact of broader policy and system activities on the family caregivers experience and patient family centered care strategies.

Key words: family caregiver, institutional ethnography, acute care hospital, discourse, patient family centered care

Gender Similarities and Differences Among a Sample of Jail Detainees

Katanya K. Goswell, Fielding's School of Psychology

Individual factors such as gender, age, prior mental health and substance abuse treatment, and rates of intoxication at the time of offense were examined among a sample of male and female adult detainees at a regional jail in the Southeastern United States. Additional factors investigated include current charges, alcohol or drug use at time of offense, and number of prior arrests. While large bodies of literature exist on crime, gender, and drug use, less is known about jail detainees across these and other variables such as prior treatment histories, current charges, or number of prior arrests. Detainees completed a self-report measure examining demographic, treatment history, and crime variables. Results showed that female detainees received significantly higher rates of prior mental health treatment than did male detainees but no differences were found in terms of prior substance abuse treatment history. There was a significant effect for having prior mental health treatment and a prior substance abuse treatment history on number of prior arrests. A significant relationship was found between being under the influence at the time of offense and having received prior substance abuse treatment. A significant association was also found between age and number of prior arrests suggesting that in this sample, as age increases, the number of prior arrests decreases. Limitations of the study as well as suggestions for future research are discussed.

Keywords: detainees, jail, gender, alcohol, substance abuse, intoxication, age, mental health treatment, substance abuse treatment

An Exploration of the Relationship Between Emotional Intelligence and Position Within a Social and Organizational Network

Elizabeth Scott, Fielding's School of Human and Organizational Development

The conceptual framework supporting the argument that individuals need to be emotionally intelligent at work is not fully vetted. Little evidence has been found that emotional intelligence predicts behavioral outcomes. As a result this study explores whether there is a relationship between an individual’s emotional intelligence and the structural position he or she holds in his/her informal social or organizational network.

Specifically this study examines the dynamics of both informal social (friendship) network and instrumental organizational (advice) networks within the workplace while looking for evidence that emotional intelligence does impact one’s structural position in a network. While the hypotheses were not supported, the findings prompt interesting implications for social network scholar-practitioners interested in further researching the antecedents for network centrality. This study provides evidence that there is a relationship between demographic characteristics and network centrality, namely organizational tenure and organizational role. In addition to the social network theory implications, this study provides insights for practitioners who might be interested in supporting programs that enhance the emotional intelligence of individuals who are central to the network, who as a result may garner improved social capital.

Workplace Bullying, Cognitive Dissonance and Dissonance Reduction: Exploring the Alleged Perpetrator's Experience and Coping

Lisa DeSanti, Fielding's School of Human and Organizational Development

Workplace bullying is recognized as a global phenomenon and its impacts can be devastating. Much of what is known about this dynamic is largely the result of victim and bystander accounts. Missing from our understanding of workplace bullying is a vital perspective—that of the bully. Applying a phenomenological approach, this study captured the experience of those accused of workplace bullying, from the time of the accusation to the present day. The focus of this research was to assess to what extent those accused of workplace bullying experience cognitive dissonance and to examine the dissonance­­–reduction strategies employed: 14 alleged bullies provided responses to a qualitative online questionnaire and 1 participant also engaged in an interview. A thematic analysis of the responses indicated that participants tended to represent a self-centric and work-centric form of perspective taking; many also justified their behaviors as warranted for the work they were hired to perform. Most not only denied engaging in bullying behaviors, they interpreted the allegation as a form of punishment resulting in a range of distress, injury, and cognitive dissonance. Although participants indicated pursuing a variety of reduction strategies, it is especially interesting that despite the denial, most also sought out coaching, new skills, and/or self-development—along with the desire to pursue other career options. This suggests that participants did not intentionally bully others, and it also points to the enduring injury and dissonance related to the allegation as well as the limited effectiveness of cognitive dissonance reduction strategies. These findings offer new insights into the alleged perpetrator’s experience, challenge what we think we know about workplace bullying and the notion of intentionality, and present a unique application of the study of cognitive dissonance and dissonance reduction in the “real world” that can be used to further inform mitigations and interventions into workplace bullying.

Key Words: Workplace Bullying, Workplace Abuse, Hostile Work Environment, Mobbing, Cognitive Dissonance, Dissonance Reduction, Abrasive Leaders, Abusive Managers, Perpetrators