Termination in integrated primary care behavioral health.

Termination with patients in integrated primary care behavioral health (IPCBH) is driven by elements that are present in other psychotherapies but more strongly emphasized under the primary care model. All treatments are, by design, time limited, and require transparent communication and almost immediate preparation for termination. Because treatment occurs within a primary care relationship, however, termination conveys a different message than it does in other settings-the conclusion of an episode, but not of a treatment relationship. As with primary care for medical conditions, the expectation is that the patient may return to treatment in the future to address new problems or recurrence of the previously treated condition, possibly making the brevity of treatment episodes more acceptable. This article discusses the process of termination in IPCBH and indicates with a case example how conversations around termination evolve throughout the brief treatment process. Suggestions for addressing termination in IPCBH are adapted from the literature on termination in more traditional psychotherapies. There is currently no published research on termination in the IPCBH setting, and research is needed to clarify how termination discussions affect treatment outcomes and patient satisfaction. As IPCBH models become more common, the meaning of termination in psychotherapy may change, with decreasing emphasis on the dyadic relationship of an individual therapist and patient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neuroscience and Racism: The Power of Groups for Overcoming Implicit Bias.

Recent developments in brain imaging have enhanced our understanding of how individuals respond to racial cues and stereotypes. Evidence suggests that racial stereotypes are more emotional in nature than other phenotypic stereotypes. One challenging emotion that may be evoked is shame. The experience of shame may impede self-reflection, interfere with one's awareness of potential implicit racial biases, and impede the exploration of racial considerations. The group therapy setting provides a rich context for addressing racial bias as well as the emotions and challenging interactions that often accompany it. Practical techniques are presented for managing shame along with other emotions that may emerge in discussing race or addressing racial dynamics in groups.

Major depressive disorder in the African American population: meeting the challenges of stigma, misdiagnosis, and treatment disparities.

This article examines major depressive disorder (MDD) in the African American population. As prevalence rates and severity of depression in African Americans are investigated, the findings indicate many blacks are underdiagnosed. Further, African Americans seem to have more severe episodes of depression compared to Caucasians. Explanations for this difference are that African Americans with MDD often present with somatic symptoms, leading physicians to miss a MDD diagnosis. Depression is often stigmatized in the African American population, seen as a "personal weakness." Educating the community about depression and educating physicians to make cultural competent diagnoses are necessary. Treatment disparities emerge as African Americans are more likely uninsured, and many are nonresponsive to traditional pharmacological interventions for depression. African American and other ethnic groups differ in the way they metabolize selective serotonin reuptake inhibitors, leading physicians to have less of an understanding of how to treat the African American patients. The lack of minorities in research trials limits the number of effective medication to treat this population of patients.