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We argue for the importance of multitheoretical integrative clinical intervention and training. Mental health professionals, including clinical social workers, are frequently primarily committed to a single dominant therapeutic theory, perhaps one that was favored by a school, fieldwork agency, inspiring teacher, or influential supervisor. However, each such theory tends to target just one aspect of the extraordinarily complex human meaning system that scientific research has shown to operate at biological, neuroscientific, behavioral, cognitive, unconscious, family-systems, and cultural levels in complexly interacting ways. We know that any monotheoretic intervention approach likely fails to help a substantial number of clients, implying an ethical imperative not to equate failure to respond to monotheoretical treatment with clinical failure. Thus, there are persuasive scientific and ethical arguments supporting the move toward psychotherapy integration in which multiple theories and their associated techniques are seen as part of a larger theoretical and interventive metasystem. Such integration is especially urgent in clinical social work with its diverse and often multi-problem clients. In this article, we consider the reasons for integration, review the levels of the human meaning system that interact in normal and abnormal functioning and thus justify a multitheoretical approach, examine recent research in support of integrationist practices, and offer the example of the natural conceptual convergence occurring between cognitive and psychodynamic approaches to illustrate how, as theories mature, they tend to converge and recognize the same reality of the human meaning system.

This article is an examination of the empirical literature published in peer-reviewed journals, which investigated samples of adults aged 50 and older, who had experienced trauma, in childhood with follow-up of the impact on later life mental and physical health. Articles were identified through searches of EBSCO host databases, such as PubMed, SocioIndex, and PsychoLit. Search terms such as childhood trauma and cumulative trauma were paired with the term older adults in varying combinations. The collective findings of 23 studies published between 1996 and 2001 suggested that trauma first documented as occurring in childhood is associated with later life mental and physical health. Methodological limitations and future directions as well as recommendations for practice, policy, and research with older adults and trauma are delineated. Language: en

Drawing on the ability-motivation-opportunity model, this meta-analysis examined the effects of three dimensions of HR systems—skills-enhancing, motivation-enhancing, and opportunity-enhancing—on p...

This paper addresses generalized anxiety disorder in poor families and argues that DSM definitions have led to an expansion in the domains of what is considered disorder. Social factors, which are importantly involved in many samples used to study GAD, have been overlooked. This was a secondary analysis of data from the Fragile Families and Child Wellbeing Study (N = 4,898). The findings confirmed that the poorest mothers had greater odds of being classified as having generalized anxiety disorder. We also conducted a structural equation model. Our findings suggest that anxiety in poor mothers is not psychiatric, but a reaction to severe environmental deficits. Thus assessment and interventions should be targeted at the environmental level and diagnostic labels should be used judiciously.

Social work researchers often use variable-centered approaches such as regression and factor analysis. However, these methods do not capture important aspects of relationships that are often imbedded in the heterogeneity of samples. Latent class analysis (LCA) is one of several person-centered approaches that can capture heterogeneity within and between groups. This method is illustrated in the present study, in which LCA is used to explicate differences in symptomatology in a nonclinical, national representative sample of youths. Data (N= 14,738) from the National Longitudinal Study of Adolescent Health were analyzed using externalizing and internalizing behavioral constructs and then validated against a number of sociodemographic characteristics and behavior outcomes typically associated with type and severity of symptomatology. Findings revealed important differences within the externalizing symptomatology construct and class differences across racial and ethnic groups, gender, age categories, and several behavior outcomes. Research and clinical implications on the importance of modeling heterogeneity using a person-centered approach are discussed. KEY WORDS: Add Health; latent class analysis; mixture modeling; person-centered analysis ********** Attention to the variability of human experience is fundamental to social work research and practice. Issues such as differences in prevalence, treatment effects, coping strategies, and normal within-group variations permeate both practice and research agendas. In addition, social work is often concerned with racial and ethnic differences, sociodemographic characteristics, and other variables that may influence or modify focal study relationships (Kataoka, Zhang, & Wells, 2002). Thus, capturing identifiable differences in subpopulations is an important area of social work inquiry. Traditionally, much research, including protocols and evidence-based practice, has been based on variable-oriented methods that capture information about relationships between the variables of interest for the overall sample. In contrast, person-oriented methods capture information at the personal level, enabling researchers to distinguish patterns of characteristics in subgroups (Nurius & Macy, 2008). Person-oriented methods, such as latent class analysis (LCA), enable the researcher to identify important intraindividual and interindividual differences and thus model distinct configurations of heterogeneity within a given sample. Although traditional variable-level studies contain valuable information, they have also been criticized because they obscure diversity and foster the misleading and over-generalized conclusion that study findings represent the overall sample (von Eye & Bergman, 2003). A comment by Bogat, Levendosky, and von Eye (2005) illustrates this obfuscation: "[R]esearchers often write about these analyses 'as it" they say something about individuals, but they are really statements about variables" (p. 50). The importance of significant heterogeneity within subsets of populations has been noted within the larger social sciences (Costello, Mostillo, Erkanli, Keeler, & Angold, 2003). Inadequate attention to the heterogeneity inherent in the complexity of human social activity, such as the variations in symptom manifestations, or the reliance on categorical-based assessments to obtain a particular diagnosis by dichotomizing symptomatology as either being present or not (Krueger & Piasecki, 2002) has resulted in a number of important phenomena left largely unexplored. LCA comes under the rubric of structural equation modeling and is a type of person-centered analysis that uses finite mixture modeling to empirically determine whether interrelationships exist among observed variables that explain the underlying (that is, latent) phenomena (McCutcheon, 1987). Latent variables are statistically inferred from the direct measures, as in factor analysis. …

Faculties across disciplines have noted an increasing number of students who are highly distressed over grades, and this distress is accompanied by pervasive demands on professors. The student behavior takes several forms, including demands for higher grades, expectations of special accommodations by faculty, and the predictions of dire outcomes for grades less than an A. This study surveyed a group of MSW students using an instrument consisting of the Academic Entitlement Scale and the Rosenberg Self-Esteem Scale. Using Latent Class Analysis, 2 distinct subgroups were identified: students with high and low self-esteem. High self-esteem students were more likely to make pervasive demands on professors. Findings suggest this behavior is a coping response to internal distress. Suggestions and implications follow.

Wakefield JC, Schmitz MF, Baer JC. Relation between duration and severity in bereavement-related depression. Objective: Prolonged duration is commonly used as an indicator that bereavement-related depression (BRD) is pathological. DSM-IV replaced the traditional 1-year pathology cut-point by a 2-month cut-point. Yet, little evidence exists regarding the validity of these cut-points in indicating increased BRD severity. This study evaluated the validity of the 2-month and 1-year cut-points in differentiating less severe from more severe BRDs in a nationally representative U.S. sample. Method: National Comorbidity Survey respondents with BRD’s (n = 152) lasting 0–8, 9–52 and >52 weeks were evaluated for depression severity using six severity indicators. Cut-point validity was established by discontinuities in severity levels between durations below and above the cut-point. Results: Bereavement-related depressions of >52-week duration were significantly higher than 9- to 52-week BRDs on four of six severity indicators and on a cumulative overall severity measure of mean number of severity indicators per person, whereas ≤8-week and 9- to 52-week durational categories differed on one severity indicator and not on overall severity. Additional analyses using durations 0–12, 13–26, 27–52 and >52 weeks suggested that alternative

This study examined gender, family structure, SES and language usage as predictors of cultural orientation and family cohesion. Ethnic differences in trajectories of family cohesion were tested within a hierarchical linear modeling framework. The sample consisted of 4156 adolescent respondents, measured at three time points during three consecutive years. The three study groups consisted of Mexican Americans oriented to Mexican culture (N = 738), Mexican Americans oriented to majority American culture (N = 867), and Non-Hispanic Whites (N = 2551). Family cohesion was assessed using the cohesion subscale of the Family Adaptability and Cohesion Scale (FACES III). Analyses consisted of hierarchical linear modeling (HLM) in which a linear trajectory of family cohesion for the three groups was computed followed by a test for the effects of ethnicity with the inclusion of control variables. Thus, ethnic differences in the trajectories of family cohesion over time were examined. Neither group of Mexican Americans was significantly different from Non-Hispanic Whites in initial status. However, Mexican Americans oriented to Mexican culture showed a significant increase in family cohesion at mid adolescence.

The validity of the insecure/disorganized attachment pattern has been clearly established in over 80 studies with more than 100 samples. However, given that child maltreatment is considered one of the most important causes of insecure/disorganized attachment, it is notable that few studies have been published specifically examining the maltreatment/insecure attachment hypothesis. The purpose of this paper was to review the research findings and conduct a meta‐analysis to examine the effect size of maltreatment and insecure attachment across studies. A second goal was to conduct a subpopulation analysis to investigate effect size by type of maltreatment. Following a literature search which yielded 25 articles, we identified eight studies (n = 791) that: (a) consisted of children who experienced different types of maltreatment including cases of malnutrition and failure‐to‐thrive, (b) consisted of children under 48 months of age, (c) used the Strange Situation or a modification of it to measure attachment, ...

This study was an investigation of intergenerational relationships related to the individuation process as reported by Mexican (N = 2,388) and European American (N = 2,907) adolescents. The primary aim was to examine the construct within theories of adolescent development that emotional separation in parent-adolescent relationships is an inherent aspect of the developmental process that occurs across the two ethnic groups. The authors conducted confirmatory factor analyses on a subscale INFUS of an instrument developed to measure family process, the Personal Authority in the Family System Questionnaire (PAFS-Q) developed by Bray, Williamson, and Malone. In sum, findings indicate (a) the need for better measurement testing, (2) the need to revisit the concept of autonomy from the family as a universal task during adolescent development, and (3) caution in the clinical use of concepts such as fusion and independence when delivering mental health services to Mexican adolescents and their families.

This article provides an explanatory model of the way in which trauma leads to serious delinquency. Using perspectives from information processing, social learning, and self-regulation theories, we present evidence to suggest that adolescents whose lives were shaped by trauma perceive and encode social cues differently than non-traumatized individuals. A number of assessment tools and therapeutic interventions are recommended, followed by suggestions for advocating on the behalf of adolescents incarcerated in the juvenile justice system.

This study investigated linear aspects of family cohesion using a cohort sequential design. Adolescents (N = 4,677) were surveyed and followed in three cohorts from 6th to lOth grade. Family cohesion was measured using the cohesion subscale of the Family Adaptability and Cohesion Scales. Latent Growth Curve Modeling procedures were conducted to explore whether family cohesion decreased, increased, or remained stable from early to middle adolescence. Results show a linear trajectory with statistically significant decreases in family cohesion from 6th through ]Oth grades. The findings support the linear nature of the trajectories but the decrease in levels may not be substantive because of the large sample size. Key Words: adolescence, cohort sequential design, family cohesion. Contemporary research on the contextual aspects of adolescent development often includes family processes as these relate to risk, resiliency, and developmental outcomes. Family cohesion, a process considered important to family functioning, has been implicated in both positive and negative outcomes. Definitions of family cohesion generally include affective qualities of family relationships such as support, affection, and helpfulness (Moos, 1974). Olson, Russell, and Sprenkle (1983) define family cohesion as "bonding within the family," whereas Epstein, Bishop and Baldwin (1982) use the definition "affective involvement." Problematic to investigations of family cohesion is conceptualizations that tie levels of cohesion to both pathological and adaptive family functioning. Such conceptual models posit a curvilinear relationship between cohesion and family functioning. Within these models high levels of cohesion represent enmeshment, a pattern of family relating that facilitates psychological and emotional fusion resulting in poor individuation and foreclosed psychosocial maturity (Barber, Olsen, & Shagle, 1994; Olson, et al., 1983). Conversely, low levels of cohesion are termed disengagement and represent a failure in affective involvement. Mid levels indicate that family members are both separated and connected and thus mid levels are considered the most viable for family functioning (Barber et al., 1994; Beavers, Lewis, Gossett, & Phillips, 1975; Olson et al., 1983). Some scholars have criticized the conflation of enmeshment with cohesion (Anderson & Sabatelli, 1990) and some research has not supported the curvilinear hypothesis (Anderson, 1986; Anderson & Gavazzi, 1990; Farrell & Barnes, 1993). Alternative models conceptualize cohesion solely as a protective factor and a global indicator of family support that is positively and linearly related to family functioning (Farrell & Barnes). It is notable that family cohesion is often conceptualized as static in the literature; what has not been fully addressed, however, is a more dynamic approach to variations in levels of family cohesion. It may be the case that levels shift across the family life cycle. For example, there are theories of adolescent development that hypothesize changes in the qualities of relationships as a function of development and the launching phase (Conger & Ge, 1999; Laursen & Collins, 1994; Smetana, 1988). Theories that propose such shifts include psychoanalytic, sociobiological, and cognitive. Psychoanalytic models propose emotional distancing and the withdrawal of psychic energy from parents as a part of the maturation process (Blos, 1979). Sociobiological models suggest emotional distancing functions as a prelude to the selection of sexual partners and cognitive-developmental models postulate distancing as fundamental to shifts from unilateral to greater mutuality in decision making (Smetana, 1988). Empirical support for the distancing hypothesis, with decreases in family cohesion, has been reported by Conger and Ge (1999). In contrast, the social-relational models postulate continuity in the emotional bonds between the parent and the adolescent rather than emotional distancing. …

In this article, the use of the Vanderbilt Psychotherapy Process Scale as a tool for evaluating clinical practice is offered as an addition to the use of single system designs of evaluation. An overview of the scale as a framework for teaching and evaluation of the therapeutic relationship is presented.

The measurement change over time permeates much of social work research. Within this rubric are investigations on the effectiveness of interventions, research on the emotional sequelae of disorders, and explorations of the pathways that lead to risk, resilience, prevention, and amelioration. In all these areas a common focus is change on some attribute that is functionally related to time. Moreover, many areas of social work are concerned with change as a process. This process view requires more than an index of the amount of change between arbitrary time points because underlying dynamic pathways often are proposed to generate chronometric change (Burchinal & Appelbaum, 1991). The shifting dynamics of these pathways suggest the need for longitudinal studies that can capture both inter- and intraindividual change as well as the predictors of this change. This research note addreses the study of change over time by the use of a cohort sequential design (CSD), and data analysis using latent growth curve modeling (LGM). The Cohort Sequential Design In the CSD researchers conduct several short-term longitudinal studies to simulate a much longer longitudinal study (Duncan, Duncan, & Hops, 1996; Nesselroade & Baltes, 1979). Participants of varying ages are sampled at a single time point and then followed for several years. The age of the participants defines a cohort, and the overlapping measurements of these cohorts are linked together to determine a common growth curve or developmental trend. Figure 1 is a pictorial representation of the combination of the CSD with a latent growth curve model. The figure depicts the generation of a five-year growth trajectory (grades 6 through 10) from three years of data (wave 1 = sixth, seventh, eighth; wave 2 = seventh, eighth, ninth; wave 3 = eighth, ninth, 10th). [Figure 1 ILLUSTRATION OMITTED] There are several advantages to the CSD. First, the follow-up period for data collection is shorter (for example, three years versus five years), thus reducing expenses and attrition. Second, unlike panel data that confound age effects (those related to maturation) and period effects (those due to historical events), observations between same-age participants at time 1, time 2, and time 3 can be contrasted. (Note: The example shown in Figure 1 displays seventh graders at waves 1 and 2; eighth graders at waves 1, 2, and 3; and ninth graders at waves 2 and 3.) Comparison of seventh, eighth, and ninth graders at two and three different points in time is not possible in a standard longitudinal design that follows only one age group. There are disadvantages to the CSD. One disadvantage is that age-cohort interaction effects may be confounded, and important information about intervening variables that influence the course of development or change may be lost (Raudenbush & Chan, 1992). Therefore, it is important to consider the type of change process being investigated and whether the CSD, notwithstanding its limitations, adequately addresses the research questions and the behavior of interest (Duncan et al., 1996). Also, as noted by Raudenbush and Chan accelerated longitudinal designs such as the CSD are most credible when adjacent cohorts share "more rather than fewer points of overlap' (p. 391). Latent Growth Curve Modeling Latent growth curve modeling (LGM) resembles classic confirmatory factor analysis. LGM uses repeated measures raw-score data as indicators of the latent factors that are interpreted as chronometric common factors representing individual differences over time (McArdle, 1988). LGM combines elements of MANOVA and structural equation modeling (SEM) to capture aspects of longitudinal change. Unlike MANOVA, LGM takes into account variance in the latent variable (Duncan et al., 1996; Meredith & Tisak, 1990) and differs from traditional SEM in that it computes a mean for the latent variable (Willett & Sayer, 1994). …

This study investigates parent-adolescent relationships in early adolescence, focusing on the effects of dyadic communication, family cohesion, family structure, and SES on family conflict in three ethnic groups: African-American (n =1886), Mexican-American (n =2657), and Euro-American (n =3052). Sixth, seventh and eighth grade girls and boys completed questionnaires and results were analysed using independent samples t -tests and multiple regression. Results showed 3-year increases in family conflict in all three ethnic groups. There were significant differences in scale scores on conflict, communication, and family cohesion between nuclear and single-parent families. Some ethnic and gender differences were also found. Discussion focuses on the implications of the findings for family life.

This was a study of adolescent deviance from a family and developmental perspective. Seventh-, eighth-, and ninth-grade boys and girls from Mexican American (N = 2549), African American (N = 1837), and Euro-American (N = 3025) ethnic groups were surveyed about their family relationships, parental behavior, and their deviant activities. Some significant ethnic and gender differences were found. Implications for practice and prevention are discussed.

As psychiatry has moved from the asylum to the community over the last century, and embraced operationalized descriptive diagnostic criteria, the distinction between nonpsychotic unipolar depressiv...

To reduce false positive diagnoses, DSM-IV added a clinical significance criterion to many diagnostic criteria sets requiring that symptoms cause significant distress or impairment. The DSM-V Task Force is considering whether clinical significance should remain a diagnostic threshold or become a separate dimension, as it is in ICD. Yet, the criterion's effectiveness in validly reducing the prevalence of specific disorders remains unclear. Critics have argued that for some categories, notably major depression, the criterion is redundant with symptoms, which are inherently distressing or impairing. The authors empirically evaluated the criterion's effect on the prevalence of major depression in the community. This report also considers more broadly the relationship of symptoms to impairment in diagnosis.Subjects were respondents, aged 18 to 54 years, who participated in the National Comorbidity Survey Replication (N=6,707). The effect of the clinical significance criterion's distress and impairment components on major depression was assessed in this sample. Distress questions were administered to all respondents reporting persistent sadness (or = 2 weeks) or the equivalent. Questions pertaining to role impairment were asked of all respondents satisfying major depression symptom-duration criteria.Of 2,071 individuals reporting persistent sadness or the equivalent, 97.2% (N=2,016) satisfied criteria for distress. Of 1,542 individuals satisfying depression symptom-duration criteria, 96.2% (N=1,487) satisfied criteria for impairment.These findings support the redundancy thesis. Distress is virtually redundant with symptoms of persistent sadness, even in the absence of major depression, and impairment is almost always entailed by major depression-level symptoms. Thus, the clinical significance criterion does not substantially reduce the prevalence of major depression in the community. The DSM-V Task Force should consider eliminating the criterion and explore alternative ways to identify false positives in the diagnosis of depression. The criterion's status for other disorders should be evaluated on a disorder-by-disorder basis because the diagnostic relationship between symptoms and impairment varies across categories.

This study examined the factor structure of the Emotional Autonomy Scale (EAS) as proposed by Steinberg and Silverberg. Participants were from three independent samples of adolescents in grades 6 (n = 1,842), 8 (n = 1,769), and 10 (n = 1,232), with each sample consisting of three ethnic groups: African American, European American, and Mexican American. None of the confirmatory factor analyses for these samples supported the factor structure proposed by Steinberg and Silverberg. From the three models tested, the EAS is best described by the four originally proposed factors, combined with two method factors, one consisting of the positively worded scale items and one consisting of the negatively worded scale items. Results show that the EAS exhibits poor construct validity and behaves quite differently for the different grade and ethnic groups. The strong impact of method variance on the factor structure is discussed. Although various alternative solutions to the psychometric problems in the EAS are proposed, the most credible solution may be to reexamine the conceptual foundations of emotional autonomy and develop better measures of those concepts for adolescents.