Methodological and terminological issues in animal-assisted interventions: An umbrella review of systematic reviews

Recently, animal-assisted interventions (AAIs), which are defined as psychological, educational, and rehabilitation support activities, have become widespread in different contexts. For many years, they have been a subject of interest in the international scientific community and are at the center of an important discussion regarding their effectiveness and the most appropriate practices for their realization. We carried out an umbrella review (UR) of systematic reviews (SRs), created for the purpose of exploring the literature and aimed at deepening the terminological and methodological aspects of AAIs. It is created by exploring the online databases PubMed, Google Scholar, and Cochrane Library. The SRs present in the high-impact indexed search engines Web of Sciences and Scopus are selected. After screening, we selected 15 SRs that met the inclusion criteria. All papers complained of the poor quality of AAIs; some considered articles containing interventions that did not always correspond to the terminology they have explored and whose operating practices were not always comparable. This stresses the need for the development and consequent diffusion of not only operational protocols, but also research protocols which provide for the homogeneous use of universally recognized terminologies, thus facilitating the study, deepening, and comparison between the numerous experiences described

Embodied Creative Arts Therapy Interventions with Trauma: A Qualitative Study

With the primary purpose to extend therapists’ knowledge base, open dialogue on treatment efficacy, and stimulate creative yet effective interventions, this two-phase qualitative study pursued the guiding research question, How do creative arts therapists use embodied interventions in the treatment of psychological trauma? Phase One of the study was conducted with music therapists who had extensive experience with trauma and reported on their experiences with and awareness of embodied trauma treatment through a broad spectrum of creative modalities. Phase Two was grounded in theories of body awareness and creative arts therapy applications and included therapists specializing in music, dance/movement, art, drama, or expressive therapies modalities. This dissertation focuses on a presentation of the data analyzed during the study’s second phase. Seven creative arts therapists participated in Phase Two of the study. Participation entailed semi-structured, 45- to 60-minute interviews. Thematic qualitative data analysis revealed seven themes and nine subthemes, which are examined under the categories of factors in facilitation and interventions. Factors in facilitation include (1) a client-centered approach, (2) safety,(3) sociocultural factors, and (4) therapist resources. The themes categorized as interventions are (5) somatic awareness and interventions, (6) relational enactments, and (7) creative interventions. Themes of safety, sociocultural factors, and a client-centered approach pointed to participant support of a flexible, individualized approach to trauma work based on clients’ specific needs. Participants noted the need for sufficient therapist resources when treating trauma, which led to subthemes of clinical supervision, personal therapy, and individual creative exploration. Participant awareness of clients’ bodies as well as somatic countertransference led to somatic interventions. Participants also examined enactments inside the therapeutic relationship and included multiple forms of creativity in the treatment process. Outcomes may contribute to future research into multi-modal creative therapeutic treatment, client-centered approaches, and embodied trauma interventions

Provider Perspectives: Working with the Male Lifer Reentry Population

The passage of Proposition 57 in California creates a path to parole for individuals who experienced long-term continuous incarceration. For the first time, men who experienced long-term incarceration are joining reentry populations in California, establishing an emerging subpopulation of men on parole who were incarcerated for life sentences or experienced long-term continuous incarceration. In the San Francisco Bay Area, most of these men will receive mental health services provided by Community Mental Health agencies or California Department of Rehabilitation and Correction (CDRC). Research suggests that men who experience continuous long-term incarceration may have symptoms of Post-Incarceration Syndrome (PICS). However, few studies have investigated mental health professionals’ experiences of working with individuals who have been released after experiencing long-term continuous incarceration. Interpretive phenomenological analysis was utilized by the researcher because of the strong need to explore and better understand what providers with clinical expertise are currently experiencing while working with this population. The researcher interviewed four licensed mental health professionals who provide psychological services to this population. Qualitative analysis produced novel findings on 1) how providers understand this unique population, 2) the clinical presentation of PICS, 3) building therapeutic alliances with men who have experienced long-term incarceration, 4) current treatment interventions, and 5) the importance for more clinical training to support the needs of this emerging population. This study also provided insight into treatment implications and the need for further research that supports clinical best practices

Arts, Health and Well-Being across the Military Continuum

Is there an active, meaningful role for the arts and creative arts therapies in addressing this vast array of critical human readiness issues across the military continuum? In general, "readiness" is the #1 issue for the military at all times. The connection of the arts to the human dimension of readiness is key. Military leaders say we need every weapon in our arsenal to meet the many challenges we face today. However, one of the most powerful tools we have in our arsenal -- the arts -- is often under-utilized and not well understood within the military and the healthcare system. The arts and creative arts therapists are -- and have been -- a part of military tradition and missions across all branches, supporting military health services, wellness, and mission readiness, including family support. For example, the War Department ordered the use of music in rehabilitation for the war wounded in World War II. In June 1945, the Department of War issued "Technical Bulletin 187: Music in Reconditioning in American Service Convalescent and General Hospitals." This bulletin was a catalyst for the growth and development of music therapy being used as a rehabilitative service for active duty service members and veterans alike during and after WWII. Although many gaps exist in our knowledge regarding the arts in military settings, what we do know to date holds great promise for powerful outcomes for our service members, veterans, their families, and the individuals who care for them. Today, a growing number of members of the public and private sectors are eager to collaborate with military leaders to help make these outcomes a reality.Nowhere was the momentum for greater collaboration more evident than in October 2011, when the first National Summit: Arts in Healing for Warriors was held at Walter Reed National Military Medical Center (now referred to as Walter Reed Bethesda) and the National Intrepid Center of Excellence (NICoE). Rear Admiral Alton L. Stocks, Commander of Walter Reed Bethesda, hosted the National Summit, in partnership with a national planning group of military, government, and nonprofit leaders. The 2011 Summit marked the first time various branches of the military collaborated with civilian agencies to discuss how engaging with the arts provides opportunities to meet the key health issues our military faces -- from pre-deployment to deployment to homecoming.Building upon its success, a multi-year National Initiative for Arts & Health in the Military was established in 2012, with the advice and guidance of federal agency, military, nonprofit, and private sector partners (see Figure 2). The National Initiative for Arts & Health in the Military (National Initiative) represents an unprecedented military/civilian collaborative effort whose mission is to "advance the arts in health, healing, and healthcare for military service members, veterans, their families, and caregivers."Members of the National Initiative share a commitment to optimize health and wellness, with a deep understanding and awareness that the arts offer a unique and powerful doorway into healing in ways that many conventional medical approaches do not. The Initiative's goals include working across military, government, private, and nonprofit sectors to: 1. Advance the policy, practice, and quality use of arts and creativity as tools for health in the military; 2. Raise visibility, understanding, and support of arts and health in the military; and 3. Make the arts as tools for health available to all active duty military, medical staff, family members, and veterans

Clients in the Driver’s Seat, not Asleep at the Wheel: A Qualitative Study of the Client Role in Transpersonal Psychotherapy

Despite the power of the therapeutic alliance in effective therapy and its larger-thanthe- individuals-comprising-it (transpersonal) qualities, the client’s contribution to the therapeutic process has been largely overlooked in both conventional and transpersonal literatures. This study asked 35 transpersonal practitioners, what is the role of the client in transpersonal psychotherapy? The study examined client traits, attitudes and role demands in Jungian therapy, sandplay therapy, dream analysis, guided imagery, regression and hypnotherapy, nondual psychotherapy, and psychedelic-assisted psychotherapy using inductive thematic analysis. The results distinguish transpersonal therapy clients from conventional ones, indicating that the transpersonal client role characteristics and behaviors are unavoidably more developed by the very demands of transpersonal modalities—as are the demands on the therapist. For most, but not all, transpersonal modalities, the therapeutic alliance is a peer relationship, with the client firmly in the driver’s seat. The findings suggest that transpersonal psychotherapy may be adjunctive or complementary to conventional therapy, and that conventional therapy may only work for some clients up to a point. Finally, transpersonal modalities could be integrated into conventional therapy based on client need and therapist openness to trans-egoic dynamics

How do psychological therapy practitioners, in their therapeutic approach, understand and work towards the empowerment of women who have been victims of violence?

Violence against women and women’s oppression are reciprocally related – just as oppressive patriarchal contexts are conducive to violence, violence is also a tool for subjugating women. Women’s empowerment is therefore often cited as a goal for psychological therapies provided to women who have been subjected to violence. However, literature surrounding empowerment within therapy holds various contradictions, gaps and problematic implications for women. Little is known about how UK practitioners navigate these issues. This research explored how practitioners conceptualise and approach empowerment within their therapeutic work with women subjected to violence. Semi-structured interviews were conducted with 12 psychological therapy practitioners representing a range of modalities, experienced in working with women subjected to violence. A reflexive thematic analysis, through a critical realist and feminist lens, was used to analyse participants’ reports. Three overarching themes were constructed: understanding empowerment, ‘what I do with clients’, and ‘a hand tied behind our back’: practitioners face barriers to empowering therapeutic practice. Participants predominantly aligned with an individualistic approach to empowerment centred around connection, coping, and reparation; and highlighted systemic barriers to ideal practice. Implications, limitations and suggested further research are discussed

Worry and rumination: a rationale for a transdiagnostic approach to treatment

Worry and rumination are implicated in various disorders and are believed to contribute to the symptoms that create and maintain psychopathology. The current critical review will examine worry and rumination in the context of depression, Generalized Anxiety Disorder (GAD), Posttraumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Social Anxiety Disorder (SAD). The review will focus on these two types of repetitive negative thinking more specifically the (a) definition, (b) process, (c) theories, and (d) maintenance of psychopathology; as well as similarities and differences between these two processes. A second emphasis will be on the importance of cultural considerations when treating individuals with emotional disorders. A third focus of the analysis will be on the rationale, overview, and literature associated with a transdiagnostic treatment named the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) . Finally, this review will conclude by highlighting futures research studies that can be implemented to improve upon the existing UP research

Traumatic Stress in South Africa

Taking both a historical and contemporary perspective, the book covers the extent of and manner in which traumatic stress manifests, including the way in which exposure to such extremely threatening events impacts on people’s meaning and belief systems. Therapeutic and community strategies for addressing and healing the effects of trauma exposure are comprehensively covered, as well as the particular needs of traumatised children and adolescents. Illustrative case material is used to render ideas accessible and engaging. The book also provides a comprehensive and up-to-date overview of theory and practice in the field of traumatic stress studies, incorporating both international and South African specific findings

Therapeutic Horseback Riding With Military Veterans: Perspectives of Riders, Instructors, and Volunteers

Statistics reveal that over 353,000 military members have been diagnosed with PTSD and/or TBI resulting from war-related activities. With the rising number of war stress injuries, there have not been enough psychotherapeutic services to meet the current demand for the care of returning veterans from Iraq and Afghanistan. Although some intervention strategies have been deemed successful, the current standards of care (e.g., exposure therapy, cognitive therapy) are limited by training inadequacies, accessibility, and outcomes (e.g., retention, early drop out, resistance, non-responsiveness). Furthermore, it is unclear whether these treatments are efficacious in addressing the unique symptom presentations of this population. The unavailability of services and their tendency to inadequately address the needs of veterans has opened the door to the development of alternative and complementary approaches. One such new approach was the therapeutic use of animals, specifically horses, as a treatment option for returning military members. Preliminary studies of therapeutic horse activities, while methodologically flawed, suggest clinical benefits for veterans. The purpose of this qualitative case study was to describe the activity and unique experience of THR as an intervention used with military veterans struggling with war stress injuries. The perspectives of nine veterans, equine instructors, and volunteers were collected through in-depth interviews, observations, and audio/visual material. Through phenomenological analysis, a comprehensive understanding of THR, what it involves, what happens to the veterans as they relate to the horse and interact with it, and how this intervention impacts the veterans’ recovery process was garnered. Four primary themes were identified: community support, relationship, transferable skills, and motivation. The data from this study reflected clinically significant results, suggesting THR was efficacious for veterans and their recovery process, especially for those who did not respond well to traditional treatments. It is recommended that future research efforts be conducted to support the development of standardized curriculum, therapeutic practice, and assessment measures in order to refine THR and allow insurance panels, stakeholders, and providers to fund, resource, integrate, and recommend THR; increasing its accessibility for members of the military with war stress injuries. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/et

Mobilizing to empower and restore: Dance/movement therapy with children affected by war and organized violence.

This literature-based study engages a revisioning of dance/movement therapy ascommunity-based practice, capable—through a program emphasizing restoration andempowerment—of responding effectively to the needs of children affected by war andorganized violence. Half of the world's 35 million refugees are children, and most comefrom the developing world. For these children, experiences of uprooting, displacement, poverty, and repression exacerbate those of exposure to the extreme stressors of armed conflict. A risk factor vs. protective factor analysis of stress and resilience is applied toward assessing the multiple dimensions of children's vulnerability and strength in the face of atrocity and deprivation. Given a preponderance of evidence to support adifferential association between exposure to stressors in such contexts and subsequentemotional or psychological disturbance, investigations of factors conducive toadaptational outcomes are highlighted, as these may provide foundation for preventiveinterventions.Issues of cultural difference between children from the developing world andtherapists from the developed are explored, and such constructs as "trauma" discussedwith reference to the ethnocultural relevance of posttraumatic stress disorder and itsalternatives. Ethnographic studies of the construction of identity in holistic, collective—or "sociocentric"—cultures are introduced, and complemented with insights from psychological investigators and therapists from the developing world. The theory that rituals hold transformative potential for societies disrupted by the forces of armed conflict is advanced, and shown relevant to therapeutic objectives among war-affected populations for whom the restoration of sociality may be a principal need. Interventions that integrate Western intrapsychic and "traditional" techniques are deemed especially germane to dance/movement therapy, given the modality's predication on an integral connectedness of mind and body. A sample "traditional dance"-based program for a resilient group of war-affected, resettled refugee youth from the Southern Sudanillustrates a re-imagining of such integrative psychotherapeutic intervention. This project, informed by an understanding that social reintegration is pivotal to mental health in sociocentric groups, recasts the dance/movement therapist as a community organizer focused on empowering as well as restoring. An Inventory of Psychosocial-Cultural Interaction is provided as a tool for the development of culturally relevant interventions with such groups.M.A., Creative Arts in Therapy -- Drexel University, 200