International Tourists' Reactions to a Natural Disaster: Experiences of the 2015 Earthquake in Nepal Among Israeli Travelers.

There is a scarcity of research exploring the experiences of foreign travelers exposed to natural disasters while abroad. This qualitative study explored the experiences of the 2015 earthquake in Nepal among international travelers immediately following the earthquake. In-depth interviews were conducted with 21 Israeli backpackers who were traveling in Nepal at the time of the earthquake. Thematic analysis revealed 4 themes: emotional turmoil, quick recovery, springing into action, and connection to the army. Findings suggest that foreign travelers initially respond with emotional turmoil to the disaster. Then they actively search for ways to effectively cope with the situation by problem solving, creating a community of action and support, and searching their own history for similar circumstances that can provide a sense of competence or clear directions for coping. Implications and limitations of the study, as well as suggestions for future research are discussed.

A snapshot of patients' perceptions of oncology providers' cultural competence.

In this paper, we describe an anonymous cross-sectional survey with a sample of 100 racially diverse adult oncology patients using a newly developed patient-reported measure of providers' cultural competence, the Physicians' Cultural Competence for Patient Satisfaction Scale (PCCPS) [1, 2], which was developed using a US midwestern sample of primary care patients. Our primary aims were to examine the reliability of the PCCPS in a more racially diverse urban oncology clinical setting and to identify salient domains of oncology provider cultural competence based on patient-reported satisfaction with direct clinical encounters. Results suggest that patient-reported satisfaction was significantly associated with one of the four domains measured by the PCCPS, physician's patient-centered cultural competence (r = 0.40, p = 0.01), and female patients were more satisfied (t (91) = 5.23, p = 0.02). The PCCPS demonstrated good reliability in an urban diverse cancer patient population. Results help to inform the development of clinical tools that can improve oncology providers' cultural competency.

"I knew from day one that i'm either gonna fight this thing or be defeated": African American parents' experiences of coping with breast cancer.

Few studies have explored how African American parents navigate breast cancer while parenting their school-age children. This focus-group study examined how African American parents cope with the diagnosis and treatment of breast cancer. Three focus groups were conducted with nine African American parents coping with breast cancer. Interviews were analyzed using content analysis. Participants described a variety of coping strategies. Five primary themes emerged: involvement in community of support, relationship with cancer, being the family emotional regulator, highlighting positives, and spirituality. Findings suggest that providers can improve the care of African American breast cancer patients and their families by facilitating patient advocacy, encouraging patients to reach out to various support systems, discussing with patients their children's functioning, and integrating spirituality into available support programs. Developing more culturally sensitive support groups that promote shared family understanding and open communication among African American parents and their children can facilitate better coping.

A culturally adapted family intervention for African American families coping with parental cancer: outcomes of a pilot study.

OBJECTIVES: The primary objective of this 2-year pilot study was to evaluate the effectiveness of a culturally adapted family intervention in improving family communication among African American parents coping with cancer and their school-age children. A secondary objective was to determine its impact on other symptoms of psychosocial distress (depression and anxiety). The third objective was to assess for acceptability and feasibility. METHODS: Using a two-arm pre-intervention and post-intervention prospective design, 12 African American families received five bi-monthly sessions of either a culturally adapted family intervention (n=7 families) or psycho-education treatment (n=5 families). Parents and their children completed pre-intervention and post-intervention questionnaires assessing perceptions of family communication, quality of their relationship, and symptoms of depression. School-age children additionally completed a questionnaire assessing their levels of anxiety. Consumer satisfaction was also evaluated at post-intervention. RESULTS: Parents and school-age children who completed the culturally adapted family intervention reported significantly better communication with each other and were more satisfied compared with the psycho-education control group. No changes were noted in symptoms of anxiety or depression. The culturally adapted family intervention was acceptable based on our findings, families' feedback, and rates of retention. Feasibility is uncertain because our oncology clinic approach to recruitment was slower than expected. CONCLUSIONS: Providing culturally adapted family intervention programs to African American families who are coping with parental cancer may result in improved family communication. This pilot study serves as the first step in the development of culturally adapted family intervention programs to help African American families cope with parental cancer.

African American parents' experiences navigating breast cancer while caring for their children.

African American parents who are navigating breast cancer while parenting their school-age children are an understudied population. We used family systems and sociocultural theories to conduct three focus groups with a total sample of 9 African American parents to understand how they cared for their school-age children (ages 11 to 18) while coping with the diagnosis and treatment of breast cancer. Our content analysis of these focus groups yielded themes that described a variety of ways they protected their children from the emotional consequences of breast cancer. Seven primary themes emerged: (a) increased desire to protect their children, (b) parental concerns for children's coping, (c) openness and transparency with children, (d) reliance on children for support, (e) calibration of their own responses, (f) use of the illness experience as a teachable moment for children, and (g) reliance on others for parenting support. Clinicians and researchers can improve their care by developing culturally sensitive family intervention programs that promote family resilience.

Lessons learned in developing a culturally adapted intervention for African-American families coping with parental cancer.

Prior clinical research supports the effectiveness of cancer support groups for cancer patients and their families, yet African-American families continue to be underrepresented in cancer support groups and in cancer clinical research studies. In order to fill this gap, we developed and evaluated a culturally adapted family support group for African-American families coping with parental cancer. We encountered unexpected challenges in overcoming barriers to recruitment, partnering with oncology providers, and building trust with the African-American community and African-American families coping with parental cancer. We describe actions taken during the two phases of this study and lessons learned along the way about recruiting and engaging African-American families in cancer support group studies, partnering with oncology providers, networking with the African-American community, and the importance of demonstrating cultural sensitivity to overcome the understandable historical legacy of mistrust.

'We are survivors too': African-American youths' experiences of coping with parental breast cancer.

OBJECTIVE: To explore how African-American youth cope with the diagnosis and treatment of parental breast cancer, and to identify culturally sensitive ways to recruit and sustain participation of this vulnerable population in intervention programs. METHODS: Three qualitative focus groups which were part of a larger study were conducted with 12 African-American youth between the ages of 11 and 18, currently coping with parental breast cancer from the Northeastern part of the United States. Interviews were audio-taped and transcribed verbatim, and analyzed using content analysis. RESULTS: African-American youth described fear and uncertainty about the mortality of their parent, their unpredictable future, and discomfort in negotiating breast cancer's relationship with the entire family. Four primary themes emerged which were coping with cancer, it affects us too, changes in family functioning, and growth through pain. African-American youth described feeling overlooked by their families and oncology staff treating their parents, often being in the role of protecting their parents physically and emotionally. CONCLUSIONS: This study suggests that clinicians can improve the care of African-American breast cancer patients and their adolescent children by being more family-centered. Adolescents need more developmentally appropriate preparation for the family changes likely to occur when a parent is diagnosed and treated for breast cancer. Developing a support group comprised of other youth coping with parental breast cancer from diagnosis throughout treatment was described as a preferred intervention to promote a shared understanding in order to overcome feelings of isolation, worry, and fear.

"They paid no mind to my state of mind": African American breast cancer patients' experiences of cancer care delivery.

This qualitative study describes experiences of cancer care delivery for nine African-American breast cancer patients. Three focus groups captured participants' experiences with the diagnosis and treatment of breast cancer and parenting their children. Spontaneous accounts describing their interactions with oncology staff were reported by all breast cancer patients. Content analysis revealed five themes: interaction with physicians, power and authority of physicians, collaboration between physicians and mental health professionals, navigating the system, and involvement of the family in the treatment process. These themes may help in developing culturally sensitive training programs for oncology providers to improve the quality of cancer care.

"It has been a good growing experience for me": growth experiences among African American youth coping with parental cancer.

This qualitative focus group study describes posttraumatic growth experiences of African American adolescents currently coping with parental breast cancer. Twelve adolescents participated in three focus groups assessing their experiences with parental cancer. Spontaneous accounts of posttraumatic growth were reported by all participants. A content analysis revealed reports in four of the five domains of posttraumatic growth identified by Tedeschi and Calhoun (1996) which included: greater appreciation for life, enhanced interpersonal relationships, increased sense of personal strengths, and changed priorities. An additional domain, change in health behaviors and attitudes, also emerged. These findings add important knowledge to the developing field of research in posttraumatic growth in populations where available research is scarce, especially among adolescents and racial minorities.

Does the Person-of-the-Therapist Training (POTT) Promote Self-Care? Personal Gains of MFT Trainees Following POTT: A Retrospective Thematic Analysis.

As we recognize how taxing our profession can be, therapist's self-care has become a salient topic in mental health. However, we are still discerning how to promote self-care in our practice and in training. In this paper, we present a study on the personal gains that MFT students experienced after participating in the Person-of-the-Therapist Training (POTT). We propose that the reported changes (better understanding of self, change to self, relational changes, and change as a process) constitute improvements in the trainees' well-being, and can therefore be considered self-caring behaviors and practices. We state that models like POTT, that focus on embracing our vulnerability, can help clinicians be more caring toward ourselves. We conclude this paper by presenting clinical and training recommendations.

Training for Connection: Students' Perceptions of the Effects of the Person-of-the-Therapist Training on Their Therapeutic Relationships.

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use their selves to effectively connect, assess, and intervene with clients. This study explored CFT students' perceptions of the effects of POTT on their ability to create positive therapeutic relationships. Course papers and final reflections were collected from 70 CFT students. Directed content analysis looking for evidence-supported elements of positive therapeutic relationships revealed 5 elements: empathy, management of countertransference, balancing multiple alliances, positive regard, and bond. Findings support the idea that a structured program focused on the training of the personal aspects of the therapists, like POTT, can promote the evidence-supported elements that make a therapeutic relationship effective.

Strategies Used by Foreign-Born Family Therapists to Connect Across Cultural Differences: A Thematic Analysis.

With the growing diversity in the United States among both clinicians and clients, many therapeutic encounters are cross-cultural, requiring providers to connect across cultural differences. Foreign-born therapists have many areas of differences to work through. Thus, exploring how foreign-born family therapists in the United States connect to their clients can uncover helpful strategies that all therapists can use to establish stronger cross-cultural therapeutic connections. A thematic analysis was conducted to understand strategies 13 foreign-born therapists used during therapeutic encounters. Four themes were identified: making therapy a human-to-human connection, dealing with stereotypes, what really matters, and flexibility. Findings suggest that developing a deep therapeutic connection using emotional attunement and human-to-human engagement is crucial for successful cross-cultural therapy. Clinical and training implications are provided.

"It's a horrible sin. If they find out, I will not be able to stay": Orthodox Jewish gay men's experiences living in secrecy.

This qualitative study examined the intersection of sexual orientation and religion in the Jewish Orthodox community by exploring 22 Orthodox Jewish gay men's experiences living in secrecy. Analysis of in-depth interviews conducted with these men revealed four primary themes: emotional turmoil, ways of coping, impact on family relationships, and importance of the context. Findings from this study describe the daily struggles these men experienced keeping their homosexuality a secret. The findings suggest that in order to design effective interventions with this population, it is crucial to consider the larger community and religious context.

Perceived professional gains of master's level students following a person-of-the-therapist training program: a retrospective content analysis.

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use themselves at the moment of contact with their clients in order to connect, assess, and intervene effectively. This qualitative study explored the experiences of 54 master's-level students who were enrolled in an accredited marriage and family therapy program in the United States and examined their perceived professional gains following a 9-month POTT course. Content analysis of trainees' reflections which they wrote at the end of the training revealed 6 primary themes: (a) increased awareness, (b) emotions, (c) improved clinical work, (d) humanity and woundedness, (e) meta-awareness, and (f) factors that contributed to the learning process. Findings suggest that key outcomes of this training curriculum are congruent with its stated goals. Clinical and training recommendations are additionally provided. Video Abstract.

"If I can grapple with this i can truly be of use in the therapy room": using the therapist's own emotional struggles to facilitate effective therapy.

This study premises that self-of-the-therapist work is pivotal in the development of effective therapists. However, therapy models vary in their goals for this work and the means of accomplishing them. This study presents the perspective of the person-of-the-therapist Training (POTT) model that prioritizes the ability to consciously and purposefully use the self-as-is at the moment of contact with the client over the traditional goal of therapists working to resolve their issues. A key underlying assumption of the model proposes that therapists' core issues (referred to as "signature themes") are potent resources that can be tapped into to connect, assess and intervene effectively with clients. The study presents the model and illustrates the use of signature themes in clinical work.

Creating synergy in practice: promoting complementarity between evidence-based and postmodern approaches.

Postmodern and evidence-based practice (EBP) are compared and contrasted with the primary aim of adapting evidence-based practice with a more flexible epistemological lens. We begin by reviewing the epistemological underpinnings of postmodern and EBP within the field of marriage and family therapy (MFT). We next discuss how these contrasting philosophies inform therapists' traits and practice in the context of translational research and practice-based evidence. Finally, we point toward some promising directions for a flexible adaptation of evidence-based practice in which both modern and postmodern clinicians can practice, and ways to incorporate some of these more flexible principles into the clinical training of MFT students.