A critical review of the Social Cognition and Object Relations Scale-Global and Thematic Apperception Test in clinical practice and research: Psychometric limitations and ethical implications.

The Social Cognition and Object Relations Scale-Global (SCORS-G) has been used increasingly in multimethod psychological assessment contexts as a framework for eliciting personality information from narrative data collection techniques, the most popular of which is the Thematic Apperception Test (TAT). Although research on the reliability and validity of the SCORS system has evolved over the last decade, there are numerous psychometric and procedural shortcomings (and corresponding ethical issues) that should be considered when applying this methodology to the TAT in clinical and research settings. Chief among these concerns is a lack of normative benchmarking, variability in TAT card batteries that are administered across contexts (which limit generalization and direct research comparisons), ambiguous reliability and validity evidence (and lack of incremental validity), and redundancy in published studies (i.e., versions of the same data/samples presented repeatedly across research). There is also a dearth of information about how SCORS-G data are influenced by factors such as culture, language, cognitive functioning, and other variables that may impact narrative output, word count, and richness (and subsequent interpretation and clinical decision making). The review concludes with a discussion of the ethical implications of using the SCORS-G in clinical practice, and recommendation for a moratorium on its use until minimum psychometric standards can be established and greater clarity is achieved surrounding its use with diverse and vulnerable populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A national survey of doctoral psychology education and training in suicide risk and violence risk assessment and management.

INTRODUCTION: When, in the judgment of a mental health professional, patient suicide risk and/or patient violence risk are considered imminent, they have been referred to as behavioral emergencies. Past surveys have suggested that education and training with these emergency situations have been inadequate. The present study was undertaken to obtain more current information on the training that psychologists receive in these areas of practice. METHOD: All directors of APA-accredited graduate psychology programs and all directors of APA-accredited predoctoral psychology internship programs were asked to complete an online survey inquiring about such training provided in their programs. RESULTS: Results indicated that both sets of directors rated such doctoral training in suicide risk assessment and management as very important. Internship directors, however, were significantly more likely than graduate program directors to state that psychologists should be required to complete continuing education courses on other-directed violence risk. Serious gaps in training were identified; that is, only 59.2% of psychology graduate directors reported that their program offered training in safety planning for suicide risk and only 25.4% reported that their program offered training in safety planning for violence risk. CONCLUSION: Given that serious injury and even death can occur from patient suicidal behavior and/or a patient violent behavior, the implications of these findings are discussed.

The Experience of Psychosis in Psychiatric Inpatients During the COVID-19 Pandemic Among Unhoused Individuals.

This research investigates the impact of Coronavirus-2019 on individuals without housing and experiencing psychosis using semi-structured qualitative interviews and a case study format. We found that for our participants, life in the pandemic was generally more difficult and filled with violence. Further, the pandemic seemed to impact the content of psychosis directly, such that in some cases voices referred to politics around the virus. Being unhoused during the pandemic may increase the sense of powerlessness, social defeat, and the sense of failure in social interactions. Despite national and local measures to mitigate virus spread in unhoused communities, the pandemic seemed to be particularly hard on those who were unhoused. This research should support our efforts to see access to secure housing as a human rights issue.

(In)Equality and Beyond: Achieving Justice in Gender-Affirming Hormone Initiation.

ABSTRACT: The World Professional Association for Transgender Health (WPATH) is an international organization that aims to advocate for transgender and gender-diverse (TGD) people by promoting safe and effective ways to access and deliver healthcare to maximize psychological health and well-being. One way this is achieved is through the WPATH's published Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, a set of guidelines for gender-affirming care that is based on the available science and expert consensus. In anticipation of the release of updated guidelines (Standards of Care Version 8) in 2022 the Radcliffe Institute for Advanced Study at Harvard University hosted an Exploratory Seminar in December 2021 that brought together experts from the United States, Mexico, and the United Kingdom to share knowledge across disciplines in order to propose revisions to the WPATH's updated guidelines. This article shares the workgroup's high-level consensus and recommendations.

Diversity, Equity, and Inclusion Committee: An Instrument to Champion Diversity Efforts Within a Large Academic Psychiatry Department.

Diversity, equity, and inclusion (DEI) have become increasingly recognized as essential to the practice of high-quality patient care delivery and the support of members of the clinical environment. A solid understanding of DEI contributes to a better grasp of what drives health care disparities and yields improved clinical outcomes for minority populations. This column discusses how individuals can practically promote DEI by describing the design and implementation of DEI in an academic psychiatry department. The authors highlight the powerful role of departmental initiatives in establishing best practices for DEI and lessons learned through the work of the psychiatry department's DEI committee.

Telemedicine and Inequities in Health Care Access: The Example of Transgender Health.

Due to concerns about the risk of infectious exposures during the coronavirus disease 2019 (COVID-19) pandemic, the uptake of telemedicine has increased rapidly, aided by increased acceptance by clinicians and patients and a reduction in regulatory and reimbursement hurdles. The increased access to telemedicine may have benefits beyond the reduction in contagious risk, especially for vulnerable populations. By breaking down some of the common barriers to care for vulnerable populations, the broad implementation of telemedicine may help reduce some inequities in health care access, but telemedicine does raise other challenges that need to be considered and addressed. One vulnerable group that can benefit from telemedicine is transgender and gender nonbinary (TGNB) individuals, who have less access to both gender-affirming and general medical care due to the consequences of stigma, discrimination, and marginalization. Telemedicine allows TGNB individuals to access clinical expertise even if it is not available locally, and without the expense of travel and without the concern for exposure to discrimination and mistreatment. However, lack of access to or expertise in navigating the required technology, lack of a safe and confidential space to access care, and an unpredictable regulatory and reimbursement environment remain hurdles for harvesting the full benefits of telemedicine.

Incorporating Administrative Staff in Trans-Affirmative Care Training: A Cognitive-Behavioral Learning Approach.

Administrative staff play an integral role in providing trans-affirmative health care. However, few trans-affirmative education and training interventions have been developed for non-medical health care staff. In this short report, we describe the development and piloting of a trans-affirmative care training intervention designed expressly for administrative staff. Based on our piloting, we put forth recommendations for the inclusion of administrative staff in trans-affirming education and training in health care systems. We hope to stimulate further development and evaluation of our approach, as well as changes in policies, so as to create more inclusive, trans-affirming health care systems.

How Should Trainees Be Taught to Have Compassionate Intention When Force Is Necessary to Care Well for Patients?

Trainees are expected to encounter clinical training environments and situations that utilize methods of force as a component of clinical care. These include emergency care, critical care, and psychiatry. Several educational recommendations are offered in this paper related to these situations-including de-escalation training and crisis management skills, trauma-informed care, person-centered care approaches, and compassionate care approaches-to support trainee development across clinical care settings. Trainees require supervisors' focused attention to consider and implement force when caring for a diverse range of patients and retraumatization risk. Minimization of the need for forced care and the implementation of compassionate force in treatment require thoughtful and comprehensive educational plans.

"You Really Never Forget It!" Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient.

OBJECTIVE: Suicide is the second leading cause of death in children, adolescents, and young adults ages 10-34 and the rates continue to rise in the USA. An estimated 30-60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event. METHOD: Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis. RESULTS: The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient's death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics. CONCLUSIONS: The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.

Editorial: Improving health care for gender diverse youth through education and training.

As a global community, there is increasing understanding and acceptance that children and adolescents must not conform their gender identity and expression to that of their sex assigned at birth. Until recently, the cultural norm was an expectation that children and adolescents would be raised by their caregivers to express themselves in ways that matched their sex assigned at birth. While there has been a significant cultural shift to identify gender identity as an important concept that is related to human development, there is not yet consensus on how caregivers and healthcare systems ought to attend to this awareness.

Skills-Based Psychotherapy Training for Inpatient Psychiatry Residents: a Needs Assessment and Evaluation of a Pilot Curriculum.

OBJECTIVE: The study's objectives were to assess the psychotherapy interests and needs of psychiatry residents, to develop a psychotherapy didactic curriculum for psychiatry residents on the inpatient service, and to evaluate residents' self-reported understanding and confidence with skills-based interventions. METHODS: Psychiatry residents within a major metro region in the Northeast were asked if they would voluntarily participate in a survey to assess their interest and skills. Based on the results of this survey, the authors devised an 8-week course for seventeen residents on the inpatient unit. Topics included general cognitive behavioral therapy (CBT), sleep hygiene, behavioral activation, dialectical behavioral therapy (DBT), mind-body skills, and motivational interviewing. Residents completed post-course questionnaires on comprehension and confidence in providing psychotherapy skills using 5-point Likert scales. RESULTS: Participants (N = 39) reported a strong interest in learning psychotherapy and in education focused on inpatient skills-based interventions. At the end of the course, 12/17 (70.6%) participants provided feedback to indicate that 9/12 (75%) respondents experienced increased confidence in therapy skills, 10/12 (83.3%) reported a basic understanding of skills-based psychotherapy, and 10/12 (83.4%) believed they could teach at least one new technique. CONCLUSION: Psychiatry residents in this study overwhelmingly requested additional training focused on skills relevant to inpatient service, and the curriculum the authors developed led to a subjective self-reported understanding of and confidence in providing these psychotherapy skills on the inpatient unit. These very preliminary results suggest that provision of increased skills-based psychotherapy training for inpatient psychiatry residents is important and beneficial within resident education.

Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD?

BACKGROUND: Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. AIMS: This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). METHOD: Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. RESULTS: Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. LIMITATIONS: Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. CONCLUSION: Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

African American and European American veterans' perspectives on receiving mental health treatment.

Little is known about client attitudes, especially veterans', toward the types of structured interventions that are increasingly being offered in public sector and U.S. Department of Veterans Affairs mental health clinics, nor is the possible impact these attitudes may have on treatment engagement well understood. Previous work indicates that attitudes of African Americans and European Americans toward treatment may differ in important ways. Attitudes toward treatment have been a proposed explanation for lower treatment engagement and higher dropout rates among African Americans compared with European Americans. Yet to date, the relationship between race and attitudes toward treatment and treatment outcomes has been understudied and the findings inconclusive. The purpose of this study was to explore African American and European American veteran attitudes toward mental health care, especially as they relate to structured treatments. Separate focus groups were conducted with 24 African American and 37 European American military veterans. In general, both groups reported similar reasons for seeking 0treatment and similar thoughts regarding the purpose of therapy. Differences emerged primarily regarding therapist preferences. In both groups, some participants expressed favorable opinions of structured treatments and others expressed negative views; treatment preferences did not appear to be influenced by race.

Treatment of Women Veterans with Posttraumatic Stress Disorder and Serious Mental Illness in an Inpatient Mental Health Treatment Setting: A Case Study.

This article discusses the challenges of providing treatment for women with complex dual diagnostic mental health needs. In particular, the focus is on the intersections between posttraumatic stress disorder (PTSD), serious mental illness (SMI), female gender, and veteran status. Utilizing a clinical case example, we focus our discussion on psychotherapy goals and interventions, including the advisability of engaging in trauma-focused therapy on an inpatient unit with a patient who carries an SMI diagnosis. We also address benefits and challenges of providing this type of treatment, provider reactions including burnout and diagnostic bias, and recommendations for future care for persons with similar presentations and needs.