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 Degree Discipline: Counseling
Child Parent Relationship Therapy: A Program Evaluation
For the past 40 years, one southwestern US university counseling program has sponsored two mental health training clinics in which master's and doctoral level students have learned to provide child parent relationship therapy (CPRT) services to community parents. In their training, students learn about the positive effects of CPRT, particularly on parental stress. To date, however, no program evaluation has been conducted at these clinics focusing specifically on parental stress outcomes after the completion of CPRT or to determine the demographics and characteristics of parents who pursue CPRT. The purpose of this study was to conduct such an evaluation of archival data spanning 7 years. Participants were 129 parents (70% female, 30% male; 80% Caucasian, 35% Hispanic/ Latino, 6% African American, and 4% Asian; 62% married, 9% separated, 16% divorced). Results from a t-test indicated a statistically significant decrease in self-reported parental stress, with a moderate effect size. Multiple regression revealed that women and those who attended with a co-parent reported greater stress reduction. This study confirmed the benefit of CPRT, provided by counselors-in-training, on reducing parental stress and indicated clientele for which and conditions in which those benefits might be optimized. digital.library.unt.edu/ark:/67531/metadc862821/
The Impact of Family Resilience Factors and Parent Gender on Stress Among Parents of Children with Autism
Parents of children with autism experience high degrees of stress. Research pertaining to the reduction of parental stress in families with a child with autism is needed. In this study, the relationship between family resilience, parent gender, and parental stress was examined. Seventy-one parents of young children with autism were surveyed. Regression and correlational analyses were performed. Results indicated that the vast majority of respondents reported significantly high levels of stress. Lower degrees of parental stress were correlated with higher degrees of family resilience. Family resiliency factors were significant contributors to the shared variance in parental stress. Mothers of children demonstrated higher levels of stress than fathers. Suggested explanations of these findings are presented and clinical and research implications are provided. The findings of this study provide evidence for the importance of facilitating family resilience for parents of children with autism and affirm differing stress levels between mothers and fathers. digital.library.unt.edu/ark:/67531/metadc862763/
The Effects of Child Parent Relationship Therapy (CPRT) for Adoptive Families
Adoptive parents often struggle to understand and meet the social-emotional behavioral needs of their adopted child, particularly when the child's pre-adoption experience lacked a secure relationship with an attuned and responsive caregiver. This randomized controlled study, a replication of Carnes-Holt and Bratton's 2014 research, investigated the effects of child parent relationship therapy (CPRT) for adoptive families who reported attached-related concerns such as difficulties establishing a mutually satisfying parent-child relationship as well as concerns about the adopted child's behavior and parental stress. Participants were 49 adoptive parents (61% female; 7% couples; 86% European American, 6% Latino, 6% Asian, and 2% Black American) with adoptees between the ages of 2.5 to 9 (50% female; 35% European American, 22% Asian, 12% Latino, 10% Black American, and 21% Biracial or other). Eighty-four percent of children were adopted internationally or from the foster care system. Parents were randomly assigned to CPRT or treatment as usual (TAU). Results from 2 (group) by 2 (time) repeated measures ANOVAs indicated that compared to the TAU control group, parents who participated in CPRT reported statistically significant improvement in child behavior problems, parent-child relationship stress, and parental empathy, with a large treatment effects on all measures. Findings confirmed results from Carnes-Holt and Bratton's study and provided strong support for CPRT as a responsive intervention for adoptive parents and their children. digital.library.unt.edu/ark:/67531/metadc862867/
Group Activity Play Therapy for Preadolescents: Effects on Low Self-Esteem
Research shows that preadolescent females are more prone to negative self-perceptions than their male counterparts which places them at greater risk of developing mental health problems stemming from low self-image. The purpose of this randomized, controlled outcome study was to examine the effectiveness of group activity play therapy (GAPT) compared to an evidenced based social skills/self-esteem group. Participants were 29 fourth and fifth grade girls in two Title I schools in the southwest U.S. referred by teachers and school counselors as presenting with low self-esteem. Participants identified as 45% Latina, 38% Caucasian, 14% African American, and 3% Asian. Children were randomly assigned to either 16 sessions of GAPT (experimental group; n = 15) or 13 sessions of an evidenced based social skills/self-esteem group intervention (control group; n = 14). Results from a 2 (Group) by 3 (Times) repeated measures ANOVA indicated that, compared to the control group over time, the GAPT group reported statistically significant improvement in self-esteem with a moderate to large treatment effect. Teachers did not report a statistically significant difference between the two groups over time. However, teachers reported noteworthy improvement for children in both treatment groups, with generally stronger improvement for the GAPT group. Overall, results indicate that GAPT may be a promising school-based intervention for preadolescent females suffering with low self-esteem. digital.library.unt.edu/ark:/67531/metadc862864/
Social-Emotional Competencies of African American Children: Impact of Child-Centered Play Therapy
African American children experience risks due to heightened socio-environmental problems and responding to negative racial messages in their environments. Child Centered Play Therapy (CCPT) is one viable intervention for the development of social emotional competence among African American children to help mediate adverse conditions. I sought to explore the effects of CCPT on the social emotional competencies of African American children utilizing Social Emotional Assets and Resilience Scale-Parent & Teacher (SEARS-P; SEARS-T) reports. Thirty-seven African American participants with a mean age of 6.68 years were recruited from four suburban elementary schools in the southwest U.S. Twenty participants were randomly assigned to the intervention group receiving a mean of 13.3 CCPT sessions over 8 weeks, and 17 participants were assigned to the waitlist control group. Factorial ANOVA results indicated that parents reported statistically and practically significant improvement for children who participated in CCPT in overall social-emotional competencies. Follow-up analysis revealed statistical and practical improvement in children’s empathy, as well as practical improvement in self-regulation/responsibility and social competence. Teacher-reported results indicated practical but non-statistically significant improvement in overall social-emotional competencies for children who participated in CCPT, including statistical and practical improvement in children’s responsibility, as well as practical improvement in self-regulation, social competence, and empathy. Thus, CCPT showed promise as a culturally responsive treatment intervention to improve African American children’s social-emotional competencies digital.library.unt.edu/ark:/67531/metadc849602/
Master Therapists' Decision Making Process Concerning Adolescent Confidentiality: A Grounded Theory Approach
Ethical codes and laws provide counselors with guidance for how to approach confidentiality, but there is a gap in the literature surrounding counselors' process of decision-making when managing confidentiality with a adolescent clients. This study explored the decision-making process of master therapists concerning adolescent clients. I conducted semi-structured interviews with peer identified master therapist (N=10), all of whom were licensed professional counselors with 15 or more years of counseling experience and whose case load contained 25% or more adolescent clients. Participants included seven females and three males; nine participants identified as Caucasian, and one participant identified as Hispanic. Participants ages ranged from 39-61. I analyzed the data, along with two research partner, according to Grounded Theory (GT) methodology. Through constant comparative analysis, a grounded theory emerged from the data in which participants converged understanding of client safety, relationships, clinical intuition in a process of integrated experience and consultation. With the exception of mandated reported and mortal danger, ethical guidelines and laws did not seem to factor into participants' decision making. Implications for counseling practice, preparation, and research are provided. digital.library.unt.edu/ark:/67531/metadc849705/
Child Centered Play Therapy with Children Exhibiting Aggressive Behaviors
Aggressive behaviors in childhood currently serve as the leading cause of counselor referrals within the United States. Children exhibiting maladaptive aggressive symptomology are at an increased risk for highly externalized and problematic behaviors across the lifespan. Emotional self-regulation and empathy are two constructs currently believed to be closely related to aggression, but a lack of research exploring these variables currently exists in the counseling literature. In this study I examined the effect of child-centered play therapy (CCPT), is a manualized, developmentally responsive, and nondirective intervention, on these variables. Participants were 71 students from four Title 1 elementary schools in the southwest U.S. referred by teachers for aggressive behavior (12 females, 59 males; age range 5-10 years with mean age 6.28. The sample consisted of 52.1% (n = 37) children identified as African American, 21.1% (n = 15) as Latina/Latino, 19.7% (n = 14) as Caucasian, and 7% as multiracial (n = 5). Participants were randomly assigned to 8 weeks of a twice-weekly CCPT experimental group (n = 36) or a waitlist control group (n = 35). Results of descriptive discriminant analyses (DDA) of the Social Emotional Assets and Resilience Scale and the Children’s Aggression Scale scores revealed that parents perceived children’s group membership in CCPT as significant and reasonably predictive of improvement in children’s aggression, self-regulation, and empathy. However, teachers did not perceive a statistically significant difference between the two groups with respect to these variables. These results suggest the relevancy of CCPT for parents in providing children with a developmentally responsive intervention to reduce aggressive behaviors and support their healthy development. digital.library.unt.edu/ark:/67531/metadc849767/
Individual and Group Child-Centered Play Therapy: Impact on Social-Emotional Competencies
A randomized controlled trial study was conducted to test the effectiveness of 16 sessions of the modalities of individual and group child-centered play therapy (CCPT) on improving social-emotional assets, including self-regulation/responsibility, social competence, and empathy. Participants were 56 students in four urban elementary schools in north central Texas, referred by teachers for disruptive or problematic behavior: 10 female and 46 male; ages 5 to 10 years with mean age 7.12; and 21 identifying as Hispanic, 17 as White, 8 as Multiracial, 1 as Asian, and 9 unspecified. Teachers and parents completed the Social and Emotional Assets and Resilience Scale (SEARS; Merrill, 2011) at pre- and post-treatment. With a significance criterion of p< .05, teacher reports provided no statistically significant results. However, parent reports indicated a statistically and practically significant interaction effect with a medium to large effect size, indicating a substantial improvement in children's scores from pre- to post-test attributed to group assignment. Mean differences indicated substantial gains in overall social-emotional assets, according to Total scores, in both individual and group treatment conditions as compared to the waitlist control group. Additionally, both individual and group play therapy was correlated with significant improvement with a large effect for the constructs of self-regulation/responsibility and social competence, with the group condition having a larger effect than the individual condition. Regarding empathy, neither modality resulted in significant improvement, though individual CCPT resulted practically in a large effect. These results indicate CCPT may provide a developmentally appropriate treatment for clinicians working with children in schools and in the community to foster their social and emotional competencies. digital.library.unt.edu/ark:/67531/metadc849659/
Addressing Multicultural Issues in the Counselor Education Classroom: a Phenomenological Analysis
Multicultural education in counselor education is a popular topic among counselor educators and scholars. To date, scholars have focused on understanding the experiences of counselor educators who teach dedicated multicultural courses. However, less attention has been given to other counselor educators who are required by ethical and training standards to address multicultural issues across the curriculum. The purpose of this study was to understand counselor educators’ experiences addressing multicultural issues in courses that do not have a specific multicultural or diversity focus. I used phenomenological methodology to explore the experiences of counselor educators who hold doctoral degrees in counseling or a related field, have taken a multicultural/diversity course in their graduate training, are full-time clinical or tenure-line faculty members in CACREP-accredited programs, and have never taught courses dedicated to multicultural or diversity issues. Twelve participants (six men and six women), ranging in age ranged from 31 to 65, participated in the study. Ten participants identified as White, one African-American, and one Hispanic. The research team identified eight themes: (1) reasons for avoidance, (2) constraints, (3) qualities and practices, (4) educator as a factor in student development, (5) infusion, (6) personal background, (7) awareness of biases and assumptions, and (8) counselor educator responsibility/gatekeeping. Findings from this study will add to the literature regarding infusion of multicultural issues across the curriculum. Additionally, the implications offered will serve as a resource for counselor educators as they experience unique personal and professional challenges when addressing multicultural issues in classrooms beyond the main multicultural or diversity course offered in counseling programs. Implications for this study may lead to development of more focused guidelines on how to increase the increase the comfort of counselor educators as they facilitate multicultural discussions and assist counselors-in-training in working toward cultural competence. digital.library.unt.edu/ark:/67531/metadc822760/
The Impact of Kinder Training on Early Elementary School Children’s On-task Behavior: a Single Case Design
Teachers appear to feel challenged by children’s off-task behavior in the classroom. Children’s off-task behavior can result in reduced academic engagement, increased teaching stress, and strained teacher-child relationships. The purpose of this study was to investigate the impact of kinder training on young children’s on-task behavior in the classroom. This study utilized an experimental single-case methodology and a multiple baseline across subjects design. Three elementary school teachers conducted weekly individual play sessions with students they identified as frequently exhibiting off-task behavior. The three children ranged in age from five to six years: two males and one female, two Caucasian non-Hispanic and one biracial. Two trained observers repeatedly assessed the child participants’ on-task behavior using the Direct Observation Form throughout the baseline and intervention phases. The findings provide support for kinder training as an effective play-based professional development-training model that can improve children’s on-task behavior. Results demonstrated that all child participants showed improvement in on-task classroom behavior. Visual analysis revealed that all child participants demonstrated a positive change in on-task behavior during the intervention phase. All teacher participants reported observing improvement in the child participants’ on-task behavior and teacher-child relationships. Teachers’ post-intervention reports supported the notion of reciprocal interactions among teacher-child relationships, understanding of children’s lifestyle and goals of misbehavior, and children’s on-task behavior. digital.library.unt.edu/ark:/67531/metadc804936/
A Canonical Correlational Analysis Exploring Characteristics of Children Presenting to Counseling for Grief and Loss
To date, researchers who have explored the complexity of childhood bereavement have utilized unstandardized assessment instruments and/or have independently evaluated specific constructs rather than factoring in the dimensionality of loss. The purpose of this study was to use parents' completion of established instruments--the Child Behavior Checklist and the Parenting Stress Index--to examine the multivariate shared relationship between characteristics of bereaved children referred for counseling--their ages, genders, ethnicities, types of loss, and life stressors--and their behavioral manifestations as well as the relationship between these characteristics and levels of parent-child relational stress. Utilizing archival clinical files, I examined these characteristics from bereaved children (N = 98) whose parents sought counseling services from two university-based counseling clinics. The sample consisted of 67 boys and 31 girls between the ages 3 and 11 years old (M = 6.28). The majority of participants (67%, n = 66) identified as Caucasian, 10% (n = 10) as African American, 10% (n = 10) as Hispanic/Latino, 6% as Bi-racial (n = 6), 4% as Native American (n = 4), and 2% as Asian (n = 2). A canonical correlational analyses (CCA) was conducted to examine relationship between characteristics of children and their subsequent behavioral manifestations. The full model was found to be statistically significant using the Wilks’s λ = .611 criterion, F(25, 328.41) = 1.862, p = .008. The R2 type effect size was .389, which indicates the full model explains about 39% of the variance shared between the two variable sets. A second CCA was conducted to explore the relationship between characteristics of bereaved children and levels of parent-child relational stress. The full model was found statistically to be significant using the Wilks’s λ = .790 criterion, F(10, 154) = 1.926, p = .045. The R2 type effect size was .210, which indicates the full model explains about 21% of the variance shared between the two variable sets. Overall, correlational findings from this study provided insight into bereaved children’s manifestations of loss and levels of parent-child relational stress as contingent upon specific characteristics. Specifically, results indicated a strong relationship between age and bereaved children’s behavioral manifestations. This finding reinforced the importance for clinicians to understand developmental implications when working with bereaved children. Furthermore, caregivers who reported minimal overall external stressors also reported less parent-child relational interference. This finding further emphasizes the importance for caregivers to maintain utmost stability for bereaved children. digital.library.unt.edu/ark:/67531/metadc804937/
Impact of Child-centered Group Play Therapy on Social-emotional Assets of Kindergarten Children
Early childhood is a critical period during which children develop social-emotional competence that will affect future success. Developing social-emotional assets is of importance for kindergarten children because of their concurrent cognitive and social changes as well as the experience of transitioning from home to school environment. A growing number of schools have adopted social-emotional learning (SEL) programming to focus on fostering children’s prosocial behaviors through direct instruction and engaging activities in classroom settings. However, some researchers have proposed that learning should capitalize on children’s natural interests rather than adult-determined agendas. Based on theoretical assumptions regarding potential effectiveness of child-centered group play therapy (CCGPT) as a treatment modality, I sought to explore the effects of CCGPT on social-emotional assets of kindergarten children utilizing parent and teacher reports across pretest, posttest, and one-month follow-up. Additionally, given that group sizes have been inconsistent and rarely explored across previous studies, I investigated the therapeutic aspect of group sizes in CCGPT outcome by comparing 2-member and 3-member CCGPT groups. Forty-three participants with mean age of 5.14 were recruited from three elementary schools, including 19 Hispanic, 14 Caucasian, and 10 African American. Twenty-one participants were randomly assigned to the intervention group receiving a mean of 15.32 CCGPT sessions over 8 weeks, and 22 participants were assigned to the waitlist control group. Six mixed between-within ANOVAs were conducted applying an alpha level of .05 to interpret statistical significance and η2 calculation to assess practical significance. Results indicated a statistically significant interaction effect on SEARS-P Total score, F (2, 72) = 4.533, p = .014, with medium effect size of η2 = .101. Post Hoc analyses indicated a non-statistically significant interaction effect on SEARS-P Self-Regulation/Responsibility subscale with a small effect, F (1.868, 67.248) = 1.776, p = .179, η2 = .043; a statistically significant interaction effect on SEARS-P Social Competence subscale with a medium effect, F (1.696, 61.049) = 3.413, p < .05, η2 = .079; and a statistically significant interaction effect on SEARS-P Empathy subscale with a medium effect, F (1.439, 51.79) = 4.592, p < .05, η2 = .106. Thus, participants in the CCGPT group showed a non-significant increase in the ability to self-regulate emotions and to take responsibility for actions and a significant increase in competence to interact socially with others and in empathy for others. Teacher reports did not show statistically significant results with a small effect, F (2, 70) = .917, p = .404, η2 = .013. Results on group sizes indicated that no statistical differences were detected between two-member and three-member groups with no effect, F (1.493, 25.377) = .039, p = .942, η2 = .001. Moreover, the results on follow-up supported that a certain level of the effects of CCGPT lasted one month after the intervention. Overall, children seemed to benefit from CCGPT, and CCGPT may be considered a viable treatment for enhancing kindergarten children’s social-emotional development. digital.library.unt.edu/ark:/67531/metadc804822/
The Essence of African Americans’ Decisions to Seek Professional Counseling Services: a Phenomenological Study
Mental health disparity is an emerging national concern with evidence suggesting individuals from non-dominant populations are less likely to seek and persist in mental health services compared to their dominant culture peers. In particular, African Americans may underutilize professional counseling services due to factors such as stigma, healthy cultural mistrust, and cultural values. To date, researchers have paid limited attention to ways to break through barriers to mental health equity. The purpose of this phenomenological study was to explore African Americans’ experiences and decision-making seeking professional counseling services. I addressed the following questions: How do African Americans make meaning of their decision to seek counselor services? What considerations are involved in decision- making with African Americans who decide to seek professional counseling services? Participants included 10 African American women who had attended counseling with a licensed professional counselor (LPC) or LPC Intern in the past three years. I identified six emergent themes through adapted classic phenomenological analysis: feelings prior to attending counseling, coping mechanisms utilized prior to counseling, barriers to treatment, motivation to attend counseling, characteristics of counselor, and post counseling experiences. Participants reported increased personal growth, insight, and desire to recommend counseling to others. Findings inform communities about what counseling is (and is not) as well as different types of support that can be obtained from a professional counselor. Limitations and future research directions are discussed. digital.library.unt.edu/ark:/67531/metadc804978/
Intensive Short-term Child Centered Play Therapy and Externalizing Behaviors in Children
Play therapists use children’s natural symbolic play as a method of mental health treatment (Landreth, 2012). Meta-analysis research has demonstrated the effectiveness of treating children with play therapy (Bratton, Ray, Rhine, & Jones, 2005), and child-centered play therapy (CCPT) has proven to be an effective treatment for children with externalizing behaviors such as aggression and other disruptive behavior (Bratton & Ray, 2000; Bratton et al., 2005). Some studies have demonstrated the effectiveness of brief and short-term CCPT, such as twice weekly within two to three months (Blanco & Ray, 2011; Shen, 2002) and when delivered in an intensive format, conducting 12 sessions within three weeks (Jones & Landreth, 2002). In this current study, I sought to determine the effectiveness of intensive CCPT with children identified as having externalizing problem behaviors. Participants were recruited from public schools in the urban area of Darwin, Northern Territory, Australia area. A total of 24 participants completed the study: 18 boys and 6 girls aged 6 to 9 years old (M = 7); 17 Australian Caucasians, 1 English (UK) Caucasian, 1 Asian, 3 Hispanic/Latino, and 2 Biracial. Participants were randomly assigned: 12 to the experimental group and 12 to the wait-list control group. Children in the experimental group received 20 intensive CCPT sessions: twice daily for 10 days. For each child participant, a parent completed the Child Behavior Checklist (CBCL) and a teacher completed the CBCL Teacher’s Report Form (TRF) three times: at pretest, posttest, and one-week follow-up. Mixed between-within ANOVAs were conducted applying an alpha level of .05 to interpret statistical significant and η2 calculation to assess practical significance. Follow-up results indicated a statistically significant interaction effect on CBCL Externalizing score, F (2, 44) = 14.747, p < .001, with a large effect size of η2 = .277. Results also indicated a statistically significant interaction effect on the TRF Externalizing score, F (2, 44) = 4.042, p = .024, with a large effect size of η2 = .135. Therefore, both parents and teachers indicated that children with externalizing behaviors who received intensive CCPT showed a significant decrease in those behaviors. The results of this study indicate that when time and financial resources call for short-term, intensive CCPT for children with problematic externalizing behaviors, practitioners may use it with confidence that its effectiveness has been demonstrated through this research. digital.library.unt.edu/ark:/67531/metadc804984/
Effectiveness of Relational Equine-partnered Counseling (Repc) on Reduction of Symptoms of Ptsd in Military Veterans: a Single Case Design
There is currently a crisis in military veteran mental health care. At 5-30% of veterans receive a PTSD diagnosis. Veterans face a large gap that exists in accessing and receiving high quality care. One intervention that is becoming more popular is equine assisted counseling (EAC). The purpose of the present study was to examine the effectiveness of Relational Equine-Partnered Counseling (REPC) in reducing symptoms of PTSD in military veterans. I also examined specific PTSD symptom clusters including intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The present study utilized a single-case design consisting of a baseline phase, intervention phase, and post-intervention phase. Participants included four military veterans presenting for war zone-related PTSD: four males and one female, aged 32-67 years, two White/European non-Hispanic, one African American non-Hispanic, and one mixed ethnicity. Symptoms were assessed weekly using the Clinician-Administered PTSD Scale and the PTSD Checklist (PCL-5). The data were analyzed by visual analysis and statistical effect size. The results were mixed across the participants. All participants experienced decreased means between the baseline and intervention phases. However, interpretation of the results indicated that the intervention was effective in some areas for some of the participants. All participants reported that the intervention was beneficial in targeting specific symptoms. Overall, the results indicated that REPC may have some benefit in reducing distress related to PTSD. More research is needed to further explore the effectiveness of REPC on the reduction of PTSD-related distress. digital.library.unt.edu/ark:/67531/metadc804906/
Graduate Counseling Students’ Preferences for Counselor Educators’ Teaching Dispositions, Orientations, and Behaviors: a Q Methodology Inquiry
Teaching is a central role of counselor educators. However, teaching in counselor education lacks guiding standards or best practice recommendations. Existing scholarly dialogue predominantly features the perspectives of educators and addresses content knowledge, techniques, activities, and assignments for courses across the curriculum with relatively less emphasis on foundations of teaching. The purpose of this study was to develop greater understanding of counselor educator dispositions, orientations, and behaviors that students perceive as important to their learning. Q methodology was utilized to gather and distill counselor education students’ (N = 48) preferences for characteristics identified via focus groups and a comprehensive literature review. Factor analysis revealed four distinct factors, upon which 45 participants’ sorts loaded and which accounted for 41% of total variance. The findings of this study support the importance of the person of the counselor educator in the teaching and learning process in addition to behavioral characteristics. Moreover, these findings support the use of student learning style assessments and customization of course facilitation to fit students’ unique preferences and values. digital.library.unt.edu/ark:/67531/metadc804886/
Sexual Identity Development: Findings From an Exploratory Grounded Theory Study
Counselors and other mental health professionals lack training on healthy sexuality and sexual identity development (SID). To begin to construct a comprehensive model of SID that can be used in counseling and counselor education, I conducted an exploratory study utilizing a grounded theory approach to collect and analyze SID stories from a purposive sample of eight adults from the Dallas-Fort Worth, Texas area: four male and four female; seven White Caucasian-American and one Asian American; and self-identified as two gay, one lesbian, three heterosexual, and two sexually fluid. Participants elucidated a process model of the sexual-self that incorporated biological, psychological, social, cultural, and spiritual factors. Emergent themes included discovering, distinguishing, placing boundaries around, differentiating, and integrating the sexual-self. This preliminary model advanced a more holistic understanding of SID that counselors and other mental health professionals, educators, and researchers may find useful within their respective disciplines. digital.library.unt.edu/ark:/67531/metadc804926/
A Predictive Model of Adolescent Persistence in Counseling
Adolescence is a developmental period characterized by profound social and emotional changes. Counseling can serve as a protective factor for decreasing the long-term negative emotional effects. Despite this fact, counselors continue to struggle with high rates of attrition among adolescent clients. When examining trends of client persistence in counseling across the lifespan, researchers found a relationship between the presence of internalizing and externalizing behaviors. Additionally, they found that high levels of familial stress predicted premature termination from counseling. The purpose of the current study was to create a predictive model of adolescent persistence in counseling. I examined both personal and environmental characteristics of adolescents who sought counseling services (N = 72) from an on-campus university counseling clinic that serves as a training facility for master’s and doctoral students at an accredited counselor education program in the southwestern United States. Participants were predominantly White (67.6%, n = 50), with a mean age of 14.23 (SD = 1.65). Nearly 60% (n = 44) of the clients were female, and 37.8% were male (n = 28). Beyond descriptive variables, eight predictor variables were examined: adolescent involvement in their intake, time spent on the wait list, four domains of parental stress, and parent perceptions of adolescent internalizing and externalizing behaviors. A multiple linear regression was conducted to understand how much of the variance in the number of counseling sessions attended by adolescent clients was explained by the predictor variables. The regression analysis was statistically significant (p = .008) and accounted for 29.1% (R2adj = .192) of the variance in sessions attended. Of the variables examined, externalizing behaviors (42.82%) accounted for the most variance in sessions attended, followed by whether the adolescent was involved in the intake (29.16%), internalizing behaviors (12.96%), and parent-focused stress (10.30%). An examination of the two strongest predictors in correlation to the number of sessions attended revealed a negative relationship with externalizing behaviors and a positive relationship with involvement in the intake, suggesting that adolescents who present with externalizing behaviors and who are not involved in their intake are likely to attend fewer counseling sessions. To understand the differences among adolescents who prematurely terminate from counseling and those who persist in counseling, I conducted a series of univariate and multivariate analyses. Comparing the means of the predictor variables revealed no significant differences between any of the predictor variables examined, although internalizing and externalizing behavior scores fell within the borderline clinical range for adolescents who persisted in counseling. Finally, a predictive discriminant analysis to assess to what degree identified variables predicted premature termination from or persistence in counseling yielded a 75% hit rate. Given this knowledge, counselors may be able to pro-actively identify adolescents who are at risk of prematurely terminating from counseling and implement retention strategies. digital.library.unt.edu/ark:/67531/metadc799521/
Play Therapy for Children with Autism Spectrum Disorder: a Single-case Design
The purpose of this study was to explore the impact of child-centered play therapy (CCPT) on the social competence, empathy, and self-regulation of children diagnosed with autism spectrum disorder (ASD). The constructs of social competence, empathy, and self-regulation were measured using the Social-Emotional Assets Rating Scale (SEARS). This study utilized a single-case design; the researcher collected data throughout the duration of the study, including baseline, treatment, and follow-up phases. The sample included 5 children ranging from ages 6 to 8 years old: 3 Caucasian males, 1 African-American female, and 1 Latin-American female. Mothers of the participants completed the parent form of the SEARS once per week throughout all phases of the study. During the treatment phase of the study, the children participated in CCPT approximately 2 times per week for 30 minutes each time. Visual analysis of the data indicated play therapy was beneficial for three participants, as they demonstrated improvements in social competence, empathy, and self-regulation. Two participants responded to the intervention with mixed results. Discussion includes implications for clinical practice and future research as well as limitations of the study. digital.library.unt.edu/ark:/67531/metadc700000/
Children’s Experiences in the Therapeutic Relationship: Development and Validation of a Self-report Measure
Most counselors agree that the therapeutic relationship is essential in counseling. However, the current evidence-based treatment movement has resulted in a focus on treatment protocols and techniques in outcome research. Researchers have called for the inclusion of relationship variables in future outcome research. Child-centered play therapy (CCPT) is an empirically-supported, developmentally responsive intervention for children that emphasizes building a therapeutic relationship based on the philosophy of person-centered theory. Exploring the impact of the relationship on CCPT outcomes would be beneficial, but no current quantitative measure exists for obtaining the child’s view of the therapeutic relationship. The purpose of this study was to create a developmentally appropriate instrument to measure children’s perceptions of the therapeutic relationship. Established instrument development procedures were followed to create the Relationship Inventory for Children (RIC), a 15-item instrument for use in outcome research that measures the child’s perspective of the therapeutic relationship. Participants were 33 child experts who participated in interviews and preliminary testing of the instrument as well as 100 children whose scores on the 31-item pilot instrument were submitted to exploratory factor analysis (EFA). Children (62% male) ranged in age from 6 to 9 years (M = 6.92) and 53% identified as Caucasian, 14% as Hispanic, 14% as African American, 2% as Asian American, 0.8% as Native American, 8% as Multiracial, and 9% unreported. The EFA resulted in three factors: Positive Regard, Unconditional Acceptance, and Empathy. Implications for further development of the RIC, for use of the RIC in research, and for application of the RIC to person-centered theory are discussed. digital.library.unt.edu/ark:/67531/metadc699964/
Child-Centered Play Therapy Parent Services: a Q-Methodological Investigation
Child-centered play therapy (CCPT) is an empirically supported and developmentally appropriate counseling intervention for young children. Despite the clinical effectiveness of CCPT with children, no known study has been conducted in which parents were surveyed or interviewed regarding the services they have received as a part of their children’s participation in CCPT. Therefore, this study was designed to gain a better understanding of parents’ reported needs and expectations in CCPT. This study utilized Q-methodology in which participants completed a Q-sort by actively sorting 40 items on a continuum of least important to most important. Items included services and processes regarded by CCPT scholars and child therapy practitioners as being important to working with parents. Data was collected from 19 parents of children receiving CCPT services in a community-based counseling clinic. Participants included 16 females and 3 males; 15 Caucasian and 4 Hispanic; and 14 biological parents, 2 adoptive parents, and 3 other biological caregivers. Data was analyzed using centroid factor analysis, and results revealed a one factor solution representing 18 of the 19 participants. Eighteen parents reported similar beliefs regarding the processes they consider most and least important to their experience in working with child-centered play therapists. In general, parents’ beliefs aligned with CCPT philosophy, particularly in regards to respecting children’s natural pace of development and healing. Furthermore, parents shared preferences for play therapists who demonstrate expert knowledge and training and who understand the individual needs of their children. Discussion includes implications for the practice of CCPT and training of future play therapists, limitations of the study, and implications for future research. digital.library.unt.edu/ark:/67531/metadc700088/
Experiences Learning Interpersonal Neurobiology: an Interpretative Phenomenological Analysis
Neuroscience is increasingly part of the national dialogue regarding mental health. The field of interpersonal neurobiology may offer a framework for helping mental health professionals identify and apply the most relevant neuroscience principles to counseling. This study explored mental health professionals’ experiences learning IPNB. I conducted semi-structured interviews with participants (n = 6), all of whom were licensed mental health professionals and had completed a year-long study in the application of IPNB through Nurturing the Heart with the Brain in Mind. I analyzed the data, along with a research partner, according to interpretative phenomenological analysis (IPA) protocol. Four super-ordinate themes emerged from the analysis: (1) learning process as dynamic and engaging, (2) deepening knowledge and understanding of self and others, (3) personal and professional growth, and (4) impact on therapeutic practice. A number of sub-ordinate themes also emerged through the analysis , including experiential learning; learning through group process; influence of the past on the present; increased understanding of the change process; increased compassion, empathy, and acceptance for self and for others; increased confidence; using IPNB to educate clients; using IPNB to conceptualize clients; and using IPNB to select interventions. Finally, I identified three higher-order constructs that appeared embedded within and across themes: learning as ongoing, person of the participant, and person of the instructor. The findings in this study suggest that participants’ learning of IPNB had a significant impact on their personal and professional development, specifically in areas related to characteristics of effective counselors. The findings also suggest that these meaningful changes occurred in a learning environment characterized by emotional engagement, experiential activities, and group process. Limitations to this research, as well as further discussion of the results are included. Implications for future research, clinical practice, and counselor education are also offered. digital.library.unt.edu/ark:/67531/metadc699972/
Descriptive Analysis of Counseling Techniques Used by Selected Child Welfare Workers
The problem with which this study is concerned is that of a descriptive analysis of counseling techniques being used by selected child welfare workers. The method determining the counseling techniques being used was a questionnaire. Seven counseling techniques were tested on the questionnaire. The questionnaire was developed through the use of various sources. Validity and reliability of the questionnaire were not tested. The findings were inconclusive, based upon the data. The workers tended to show eclectic use of techniques. Psychoanalysis and client-centered therapy did poll the greatest number of positive responses. Z-scores and probability between the counseling techniques were determined. The findings supported the responses received by psychoanalysis and client-centered therapy. No recommendations were made. digital.library.unt.edu/ark:/67531/metadc504645/
Effects and Mediation of Child-centered Play Therapy on Young Children Who Are Anxious
Anxiety is one of the most pervasive childhood disorders, with a poor prognosis if left untreated. Traditional methods of treating anxiety have been less effective with young children. Based on theoretical assumptions regarding the potential effectiveness of child-centered play therapy (CCPT) as a treatment approach, I sought to explore the effects and mediating factors of CCPT on young children with symptoms of anxiety. Fifty-three participants between the ages of 6 to 8 years old were recruited from four elementary schools, including 36 males and 17 females. Of participants, 11 were African American, 24 were Caucasian, 10 were Hispanic/Latino, one was Asian, and seven were biracial. Twenty-five participants were randomly assigned to an experimental group receiving a mean of 15 sessions of individual CCPT, and 28 participants were assigned to an 8-session active control group. Five factorial analyses of variance (ANOVA) were conducted applying an alpha level of .05 for interpretation of statistical significance and Cohen’s d to assess practical significance. ANOVA results indicated a statistically significant interaction with a large effect size on Total Anxiety score of the Revised Children’s Manifest Anxiety Scale-2nd edition (p = .013, d = .715). Subscale ANOVA results indicated a statistically significant interaction effect with large effect size on the Worry subscale (p = .006, d = .795), no statistically significant interaction on the Defensiveness subscale (p = .710, d = .110), no statistically significant interaction but moderate effect size on the Physiological subscale (p = .076, d = .506), and no statistically significant interaction but moderate effect size on the Social Anxiety subscale (p = .162, d = .398). Statistically significant differences with large practical effects were found in total anxiety and worry, suggesting that children who received CCPT decreased their overall levels of anxiety and worry whereas children who were in the active control group increased their levels of anxiety and worry. When examining differences in relationships between groups, the CCPT group relationship scores were significantly higher than the control group relationship scores, as reported by counselors. Although the groups were different in their relationships, the relationship was not considered a statistical mediator of anxiety due to the lack of correlation between relationship scores and outcome. Overall, children seemed to benefit from CCPT, and it may be considered a viable treatment for children who are anxious. Due to the lack of mediation of relationship found in this study, further research is encouraged to consider other mediating and/or moderating effects when attempting to investigate the therapeutic relationship as a mediator. digital.library.unt.edu/ark:/67531/metadc500145/
The Effects of Adlerian Play Therapy on Maladaptive Perfectionism and Anxiety and in Children
I used singlecase A-B-A experimental design to examine the effectiveness of Adlerian play therapy (AdPT) for children identified with clinical levels of perfectionism on the Conners Parent Rating Scale-Revised and Conners Teacher Rating Scale-Revised. Participants were 2 children, a 10 year-old Hispanic male and a 7 year-old Caucasian female. To examine the effect of AdPT on maladaptive perfectionism and anxiety, the Child-Adolescent Perfectionism Scale and the Revised Children’s Manifest Anxiety Scale were administered to the children twice weekly over 3 phases of the study: baseline (6 administrations), intervention (12-16 administrations), and maintenance (6 administrations) for a total of 24 to 29 data points. Additionally, parents and teachers completed the Conners Rating Scales-Revised5 times: (1) prior to study, (2) following baseline/prior to treatment, (3) midpoint of treatment, (4) following treatment, and (5) following maintenance phase.During the intervention phase, the male and female participants attended 21 and 16 play therapy sessions, their mothers attended 6 and 5 parent consultations, and their teachers attended 6 and 3 teacher consultations, respectively. Analysis of the child self-report assessments indicated mixed and inconclusive results regarding the effects of AdPT on target behaviors. However, results of the parent and teacher reports indicated clinically significant reductionsin maladaptive perfectionism and anxiety over the five points of measurement for both participants. The participants’ maladaptive perfectionism moved from the clinical to the normal range. Implications for practice and future research are indicated. digital.library.unt.edu/ark:/67531/metadc500041/
Confirming the Constructs of the Child Interpersonal Relationship and Attitudes Assessment
The purpose of this study was to confirm the four-factor model of the Child Interpersonal Relationship and Attitudes Assessment (CIRAA) in order to establish the instrument’s factor/structure validity using a sample different than that used in instrument development. The CIRAA was the first parent-report instrument based on child-centered theory and designed to measure play therapy outcomes. Its four factors are Self-Regulation (formerly Self-Control), Interpersonal Relationships, Coping Skills, and Internal Locus of Evaluation. For this study, the CIRAA was administered to 206 parents; their children were 75 females and 131 males aged 3 to 10 years old. The distributions of children’s genders and ages in this study were similar to the distributions of the sample used to develop the CIRAA. Based on confirmatory factor analysis results of overall goodness-of-fit indices; localized areas of strain; and interpretability, size, and statistical significance (p < .001) of the model's parameter estimate, the four-factor model of the CIRAA was confirmed with both theoretical and empirical support. Internal consistency reliability for the subscales and total score were acceptable, with an overall reliability coefficient of .928. A medium negative correlation (r = -.417, n = 47, p < .01) was found between the CIRAA total scores and Child Behavior Checklist Total Problems scores, a result in the expected direction. All subscales and total scores, except the Internal Locus of Evaluation score, distinguished differences between non-clinical and clinical samples. Altogether, results indicated that the CIRAA is appropriate for making clinical decisions about individuals. Limitations, additional implications, and future research are discussed. digital.library.unt.edu/ark:/67531/metadc500098/
The Relationship of Counselor Education Program Applicants’ Cognitive Complexity to Other Admission Criteria
Counselor cognitive complexity is a counselor’s ability to recognize and organize multiple characteristics that might affect client needs. I examined whether various admissions criteria–Graduate Record Examination (GRE) Verbal, Quantitative, and Analytical Writing scores; previous coursework grade point averages; and faculty co-leaders’ admissions group interview ratings–for 182 applicants to a southwestern U.S. CACREP-accredited master’s counseling program predicted cognitive complexity scores on a modified Counselor Cognitions Questionnaire (CCQ). Participants were predominantly ages 20 to 30 years (91.8%), female (91.8%), and White (81.3%). Multiple regression analyses showed statistical significance with small effect sizes: the admissions criteria together significantly predicted cognitive complexity differentiation (p = .033), accounting for 6.6% of variance, and cognitive complexity integration (p = .003), accounting for 9.8% of variance. The small effect sizes and low variance percentages support the idea that cognitive complexity measured by the modified CCQ is a substantially different phenomenon from commonly-assessed academic aptitude and personality characteristics. If future researchers confirm these findings with additional samples, subsequent researchers could determine whether one or both domains of cognitive complexity, either alone or in combination with one or more of the commonly used admissions criteria, could help counselor educators better predict which applicants will be successful in master’s programs and the counseling field. digital.library.unt.edu/ark:/67531/metadc500038/
Doctoral Level Counseling Students’ Experiences and Perceptions of Learning in a Cohort Environment
Learning community literature supports the use of student cohorts to enhance learning through increased peer interaction and common course work. Researchers employed the qualitative method of phenomenography to identify various ways doctoral counseling students conceptualize and experience learning in a cohort over the course of a single academic year. Participants were all 10 members of a single southwestern U.S. university counseling program doctoral cohort of full-time students between 20 and 59 years of age with 5 members 20-29, 4 members 30-39, 1 member 50-59; 8 female, 2 male; 9 White non-Hispanic, 1 African-American. Data were transcripts from 30 one-hour interviews, three for each participant over the course of their first year of study. The research team that analyzed the data consisted of three advanced counseling program doctoral students, each with research methods coursework. Results revealed nine dynamic structural aspects of learning: dialogue, diversity, knowledge, motivation, support, shared experience, relationship development, interpersonal awareness, and conflict. Findings support the use of learning communities in doctoral level counselor education programs. Cohort members demonstrated increasing awareness of the potential learning benefits of cohort interaction and developed more in depth strategies over time to utilize the cohort to enhance learning. Future counselor educators may now with greater confidence design learning communities and curriculum to facilitate doctoral cohort development for optimal student interaction. digital.library.unt.edu/ark:/67531/metadc500134/
Congruence, Unconditional Positive Regard, and Empathic Understanding in Child-centered Play Therapy
The purpose of this study was to explore how the therapist-provided conditions of congruence, unconditional positive regard, and empathic understanding were experienced and conveyed in child-centered play therapy (CCPT). Although the therapist-provided conditions are considered essential to the therapeutic process in CCPT, a gap exists between child-centered theory and empirical exploration of the process and dynamics of these relational variables in CCPT. Due to the limited research in this area, a grounded theory approach was utilized to explore how the three variables emerge in CCPT. Participants included four advanced doctoral students, all Caucasian females with extensive training in CCPT, and 12 children ranging from 4 to 8 years of age receiving weekly, individual CCPT. One individual CCPT session was observed and video-recorded for each therapist-child dyad (n = 12). Following each observation, play therapists were interviewed regarding the observed play session (n = 12). During each interview, the researcher and therapist watched the recorded play session in its entirety and discussed noteworthy interactions between the child and therapist. The video-recorded play therapy sessions and therapist interviews were analyzed using a multiphasic, constant comparative method. Results of the analysis included a process-model of the therapist-provided conditions in CCPT, examples of play therapists’ internal experiences and external behaviors associated with the presence and absence of the therapist-provided conditions, and a model of the process play therapists utilize to respond to breaks and barriers to congruence, unconditional positive regard, empathic understanding, and unconditional positive self-regard in CCPT. Implications for clinical practice, training, supervision, and research are discussed. digital.library.unt.edu/ark:/67531/metadc500177/
Development of the Knowledge and Attitudes Toward Near-death Experiences Scale
The purpose of this study was to develop an instrument to measure healthcare professionals’ knowledge and attitudes about near-death experiences (NDEs) that would demonstrate acceptable psychometric properties. In consultation with a focus group of six NDE experts, I developed the 50-item Knowledge and Attitudes toward Near-Death Experiences Scale (KANDES), including the 24-item KANDES–Attitude subscale (KANDES-A) and the 26-item KANDES–Knowledge subscale (KANDES-K). Including a pilot administration in which feedback indicated no need for revision, a total of 256 professional and student counselors completed the KANDES. Separate reliability and validity analyses were conducted for each subscale. For the KANDES–A, Cronbach’s alpha was .909, and Pearson’s r for test-retest was .748, both indicating acceptable reliability. An exploratory factor analysis indicated four factors to retain and yielded a factor solution that explained 54.87% of the variance, an acceptable amount of variance to substantiate construct validity. For the KANDES–K, Cronbach’s alpha was .816, indicating acceptable reliability. For each of the scale’s three domains, Cronbach’s alpha was .816 for Domain 1: NDE Content, .817 for Domain 2: NDE Aftereffects, and .631 for Domain 3: Experiencer Characteristics, indicating acceptable reliability. Pearson’s r for test-retest on the total KANDES–K was .812, further demonstrating acceptable reliability. digital.library.unt.edu/ark:/67531/metadc500204/
Intimate Relationships of Adult Children of Alcoholics
Difficulties developing and maintaining intimate relationships are often attributed to adult children of alcoholics (ACAs). However, the focus of the literature has been on those obtaining psychological treatment and has primarily involved clinical impressions. The purpose of this study was to examine intimacy in the close friendships and love relationships of ACAs. Autonomy and intimacy in respondents' families of origin were also analyzed. Comparisons were made between ACAs currently in (n = 59) and not in (n = 53) therapy, and comparisons who had (n = 48) and had not (n = 77) received therapy. Alcoholics were eliminated. It was hypothesized that ACAs would score significantly lower than comparisons on love and friendship intimacy and autonomy and intimacy in their families of origin. Among the ACAs, those in therapy would score lower than those not in therapy. Hypotheses were tested using MANOVAS. ANOVAs were administered where there were significant differences, and Newman-Keuls contrasts further delineated the divergence. Multiple regression analyses were conducted to obtain explanatory data. The two ACA groups seem to represent distinct populations with those not in therapy failing to report intimacy differences previously ascribed to them. While all of the groups were similar in friendship closeness, only the ACAs in therapy had significantly less intimacy in love relationships. Furthermore, clinical ACAs differed from the other groups by having less family of origin health, more physical and sexual abuse, more maternal drinking, more depression, and more suicidal thoughts and behaviors. Family of origin health predicted intimacy in a love relationship. Family characteristics encompassing honesty, empathy and respect, which may or may not involve alcoholism, seemed to create an atmosphere of faulty parenting in the ACA clinical group which may have subsequently affected the child's intimacy in a love relationship. Results of the study support a developmental model and demonstrate the importance of including nonclinical ACAs as well as clinical comparisons in future research. digital.library.unt.edu/ark:/67531/metadc331220/
The Impact of a Telephone Warm Line on Latchkey Children
A prevention-oriented telephone line intended as an intervention program for latchkey children was studied to determine its impact on the self-esteem, anxiety level, and in-school and at-home behavior of these children. digital.library.unt.edu/ark:/67531/metadc331075/
Adventure Based Counseling: Exploring the Impact of Abc on Adaptive Functioning in High School Males
The purpose of this study was to examine the impact of ABC on adaptive functioning in high school males. Specifically, a pretest/posttest, experimental design (N = 46; Caucasian = 26, Hispanic = 20) was used to examine the changes in adaptive and maladaptive functioning in ABC participants (n = 21) compared to those in a control/waitlist group (n = 25) as measured by the Behavior Assessment System for Children, second edition (BASC-2). Participants randomly assigned to the treatment group engaged in 10 ABC sessions. In order to better understand group process in ABC, I had experimental group participants complete the Group Climate Question Short form (GCQ-S) three times during the intervention. A mixed between/within subjects ANOVA of the BASC-2 scores revealed a statistically significant increase in adaptive functioning for both groups, F(1, 33) = 8.58, p < .01, with a partial eta squared of .21 indicating a large effect. There was no statistically significant difference between the experimental and control/waitlist groups, F(1, 33) = .064, p = .80, and a very small effect size (partial eta squared < .01). A repeated measures ANOVA of the GCQ-S scores revealed a statistically significant increase in engagement, F(2, 38) = 4.067, p = .025, with an eta squared of .21, indicating a large effect. Limitations of the study, implications of the results for practice, and recommendations for future research are presented. digital.library.unt.edu/ark:/67531/metadc283835/
Confirming the Constructs of the Adlerian Personality Priority Assessment (Appa)
The primary purpose of this study was to confirm the four-factor structure of the 30-item Adlerian Personality Priority Assessment (APPA) using a split-sample cross-validation confirmatory factor analysis (CFA). The APPA is an assessment, grounded in Adlerian theory, used to conceptualize clients based on the four personality priorities most commonly used in the Adlerian literature: superiority, pleasing, control, and comfort. The secondary purpose of this study was to provide evidence for discriminant validity, examine predictive qualities of demographics, and explore the prevalence of the four priorities across demographics. For the cross validation CFA, I randomly divided the sample, 1210 undergraduates, at a large public research university (53% Caucasian, 13.1% Hispanic/Latino(a), 21.4% African American, 5.4% American Indian, and 5.8% biracial; mean age =19.8; 58.9% females), into two equal subsamples. I used Subsample 1 (n = 605) to conduct the initial CFA. I held out Subsample 2 (n = 605) to test any possible model changes resulting from Subsample 1 results and to provide further confirmation of the APPA's construct validity. Findings from the split-sample cross-validation CFA confirmed the four-factor structure of the APPA and provided support for the factorial/structure validity of the APPA's scores. Results also present initial evidence of discriminant validity and support the applicability of the instrument across demographics. Overall, these findings suggest Adlerian counselors can confidently use the APPA as a tool to conceptualize clients. digital.library.unt.edu/ark:/67531/metadc283856/
Resilience Among Middle School Students
Resilience is the ability to survive and persevere during difficult times. Resilient people also thrive after overcoming adversity. Adolescents have many developmental tasks to overcome in their quest to becoming adults. Difficulty with these tasks can lead to academic and personal failures. Adolescents with low resilience often struggle with low self-esteem. If students are identified early as having lower levels of resilience, professional school counselors have an opportunity to provide resilience-enhancing activities. Prior to middle school, students are assigned all of their classes. During middle school, students begin to select their elective courses which may be representative of their interests and current emotional status. By looking at students' elective courses, I looked for patterns of resilience that may help professional school counselors proactively identify students in need of additional guidance in order to be academically successful. This study utilized a convenience sample of middle school students enrolled in the 8th grade (N = 190) of a large suburban school district located in the southwest United States to measure levels of resilience and elective course enrollment. Gender of the participants was 107 females and 83 males. The students reported their ethnicity as 5.8% African American/Black, 11.1% Asian, 12.6% Hispanic, 1.1% Native American, 1.6% Pacific Islander, 59.5% Caucasian/White, and 8.4% multiracial. I measured resilience in this study using the Resilience Scale and comparisons based on elective course. Data analyses include descriptive statistics and ANOVAs. Based on a statistical significance criterion of p < .05, students enrolled in athletics scored significantly higher in resilience than did non-athletics students enrolled in physical education/outdoor education (p = .035). Additionally, Caucasian females were significantly less resilient than Caucasian males (p = .031). Limitations of the study, implications of the results for practice, and recommendations for future research are presented. digital.library.unt.edu/ark:/67531/metadc283857/
Pilot of a Learning Management System to Enhance Counselors' Relational Qualities Through Mindfulness-based Practices
Mindfulness-based practices are associated with increased attentional qualities, improved self-focus styles, enhanced empathic understanding, and strengthened self-compassion, making these practices a viable addition to counselor training programs. However, current mindfulness training models are primarily designed for relief of psychological distress, stress reduction, and increased well-being rather than focused on enhancing therapeutic skills and require intensive time commitments that may present logistical difficulties for overburdened curricula and graduate students. This study piloted an on-line, eight-week mindfulness-based practices learning management system for counselors (MBLMS-C) with a specific focus on the cultivation of qualities associated with successful therapeutic relationships. Ten of forty-six recruited counseling master's students enrolled in their first basic skills course at a sample of accredited universities across the United States completed the exit survey. Data were analyzed using multivariate repeated measures analyses comparing pre- post- counselor relational qualities of mindfulness traits, empathy, self-focus style, and self-compassion. Results indicated no statistically significant difference with a partial ?2 = .73. What-if analyses (N = 30) indicated statistical significance may have been obtained given a larger sample. Variance was explained by increased self-compassion (partial ?2 = .34) and mindfulness traits (partial ?2 = .31) and decreased self-focus style rumination (partial ?2 = .23) and empathic personal distress (partial ?2 = .12). Changes were observed in the desired direction for self-focus style reflection and empathic perspective taking/empathic concern. Discussion includes a review of the findings including examination of participant feedback regarding training experience. Study limitations and implications for counselor education, professional enhancement, and suggestions for future research are also offered. digital.library.unt.edu/ark:/67531/metadc271776/
Effects of a Self-care Intervention for Counselors on Compassion Fatigue and Compassion Satisfaction
This study investigated the impact of a psychoeducational and experiential structured counselor self-care curriculum, developed by Drs. Charles and Kathleen Figley, on compassion fatigue and the prevention of professional impairment as measured by the Professional Quality of Life (ProQOL), Version 5. Volunteer licensed professional counselors, supervisors, and interns from four children's advocacy centers in Texas were assigned to treatment group (n = 21; 20 females, 1 male; mean age 34.4 years) or waitlist control group (n = 21; 19 females, 2 males; mean age 34.6 years). Participating counselors identified themselves ethnically as 64% Caucasian, 26% Hispanic, 7% African-American, and 2% Native-American. Employing a quasi-experimental design, three reliability-corrected analysis of covariance (ANCOVA) were utilized to analyze the data with an alpha level of .05 to assess statistical significance and partial eta squared to assess effect size. With pre-test scores as the covariate, results revealed in the experimental group a statistically significant reduction with large treatment effect for burnout (p = .01; partial ?2 = .15), a statistically nonsignificant reduction with a medium effect for secondary traumatic stress (p = .18; partial ?2 = .05), and a statistically nonsignificant increase with a medium effect for compassion satisfaction (p = .06; partial ?2= .09). Findings supported the use of this curriculum to train counselors on self-care as required of professional counselors by the American Counseling Association code of ethics and listed as a necessary skill in the standards of the Council for Accreditation of Counseling and Related Educational Programs. digital.library.unt.edu/ark:/67531/metadc177220/
Latino Students’ School Counseling Needs: an Exploratory Needs Assessment
The purpose of this study was to examine Latino/a student preferences for school counselor activities. The primary focus of research was to determine what school counseling activities Latino/a students perceived as important and which school counseling activities Latino/a high school students perceived as satisfying. The researcher pursued this purpose through administration of a survey instrument developed by the researcher. The instrument consisted of 14 demographic items and 42 5-point Likert scale items based on the domains described in the ASCA’s national model and current literature on experiences of Latino/a adolescents. The sample was comprised of 210 Latino/a high school students from five high schools in three school districts in the suburbs of a large Southwestern U.S. metroplex. The study population consisted of 94 female and 115 male participants ranging in age from 14 to 20 years old with the median age of 17.54 years. Overall, students preferred school counseling activities focusing on college and career readiness. According to the results of this study, students indicated that although they believed college and career activities to be important, they were not satisfied with how their school counselors provided those activities. Multiple regression analyses were utilized to determine which demographic variables were significant predictors of respondents’ perceptions of importance. Results indicated student perceptions of importance did not vary across grades, economic levels, genders, or cultural differences. The results, limitations, and suggestions for school counseling programs were provided within the report. digital.library.unt.edu/ark:/67531/metadc149642/
Licensed Professional Counselors’ Attitudes Toward People with Schizophrenia: Predictors of Interest in Providing Interventions
For individuals with schizophrenia and their caregivers, psychosocial interventions have been shown to significantly improve recovery and reduce relapse rates. Although this population is underserved and stigmatized, counselors have been excluded from most research into attitudes toward and interventions for these families. Using a stratified random sample survey design, researchers explored the relationships between participating U.S. Licensed Professional Counselors’ attitudes towards, recovery beliefs regarding, familiarity with, desire for social distance from, and interest in providing services to individuals with schizophrenia and their caregivers. Most of the 111 participants (11.1% response rate) identified themselves as female (83.8%) and Caucasian (86.5%). A few participants described themselves as Hispanic (6.3%) or Black or African-American (5.4%). Respondents ranged in age in years from 20’s to 60’s with the largest group in their 40’s. Descriptive statistics indicated that the majority of LPC participants reported low to moderate stigmatizing attitudes, strong beliefs in recovery, and moderate to high interest in providing interventions for people with schizophrenia and their caregivers. Furthermore, almost half of participating LPCs reported already working with individuals with schizophrenia. Bivariate correlations and hierarchical regressions indicated that high interest in providing interventions for this population was significantly correlated (p < .01) with high frequency of already working with the population (large effect), low desire for social distance (medium effect), high desire to help socially (medium effect), and strong beliefs in recovery (small effect). The results support including LPCs in all areas pertaining to interventions, research, and recovery for people with schizophrenia and their caregivers. digital.library.unt.edu/ark:/67531/metadc149610/
Child Teacher Relationship Training (Ctrt) with Children Exhibiting Disruptive Behavior: Effects on Teachers’ Ability to Provide Emotional and Relational Support to Students and on Student-teacher Relationship Stress
This study investigated the impact of child teacher relationship training (CTRT) on teachers’ ability to provide emotional support in the classroom, teachers’ use of relationship-building skills, and teachers’ level of stress related to the student-child relationship. Teachers and aides from one Head Start school were randomly assigned to the experimental group CTRT (n = 11) or an active control Conscious Discipline group (CD; n = 12). Overall, 21 females, 11 (CTRT) and 11 (CD), and one male (CD) participated in the study. Participating teachers and aides identified themselves as the following: 13 Hispanic/Latino, 5 Black American, and 5 European American. Teachers and aides identified children with clinical levels of disruptive behavior problems for the purpose of selecting children of focus for the study. The children’s mean age was 3.63 for CTRT group and 3.36 for CD group. Overall, 9 females, 2 (CTRT) and 7 (CD), and 10 males, 6 (CTRT) and 4 (CD) participated in the study. Teachers reported children’s ethnicity: 13 Hispanic/Latino, 5 African American, and 1 other. A two-factor (Treatment x Group) repeated measures split plot ANOVA was utilized to analyze the data with an alpha level of .05. According to objective raters blinded to the study using the Classroom Assessment Scoring System (CLASS) and the Child Teacher Relationship Skills Checklist (CTRT-SC) and teacher reports using Index of Teaching Stress (ITS), results revealed a statistically significant interaction effect for the experimental teachers’ use of child-teacher relationship skills (CTRT-SC: p = .036), a non-statistically significant interaction effect for the experimental teachers’ ability to provide emotional support (CLASS: p = .50), and a non-statistically significant interaction effect on teacher stress (ITS: p = .997). Partial eta squared effect sizes were calculated to determine the practical significance of the findings. Compared to the active control, CTRT demonstrated large treatment effects over time on the CTRT-SC (?p2 = .19) and the CLASS (?p2 = .16). Study findings provide support for CTRT as an effective intervention for increasing Head Start teachers’ ability to provide emotional and relational support to at-risk students. digital.library.unt.edu/ark:/67531/metadc149655/
The Emotional Needs of Mothers of Multiple Birth Children
The purpose of this study was to assess the emotional support needs of mothers of multiple birth children based on administration of a survey the researcher developed. The survey consisted of 25 demographic items, six 6-point Likert scale items, and three open-ended questions. Likert scale items were based on amount of perceived emotional support mothers received in their environments at the time of survey administration. Open-ended questions addressed negative and positive aspects of parenting multiples and emotional support needs. The sample consisted of 171 mothers of multiple birth children from 23 states in the United States. Participants ranged in age from 20-50 years old with 38% not reporting age. Participants were 95.3% Caucasian, 0% African-American, 1.8% Asian, 0% Native American and 1.2% other; of these, 5.8% were Hispanic. We used demographic statistics and constant comparison to determine basic demographic characteristics of this sample and to identify emotional support needs of mothers of multiple birth children. We used Pearson product moment correlation to determine potential relationships between variables. Results indicated a statistically significant positive correlation between overall life satisfaction and partner satisfaction (r = .420, n = 170, p < 0.01). Therefore, mothers of multiples experience increased satisfaction with their lives when they receive greater support from partners. Also, results indicated a statistically significant positive correlation between partner satisfaction and partner caretaking responsibilities (r = .305, n = 169, p < 0.01). As partners of mothers of multiples increase contribution to caretaking of children, mothers demonstrate greater relationship fulfillment. Implications for mental health professionals working with mothers of multiple birth children are discussed. digital.library.unt.edu/ark:/67531/metadc149682/
Child Teacher Relationship Training As a Head Start Early Mental Health Intervention for Children Exhibiting Disruptive Behavior: an Exploratory Study
This exploratory study examined the effectiveness of child teacher relationship training (CTRT) with at-risk preschool children exhibiting disruptive behavior. The participants included a total of 23 Head Start teachers and their aides, and children identified by their teachers as exhibiting clinical or borderline levels of externalizing behavior problems. Teacher participants included 22 females and 1 male; demographics were reported as 56% Hispanic ethnicity, 17% Black American, and 22% European American. Child participants included 15 males and 5 females; demographics were reported as 60% Hispanic, 30% Black American, and 10% European American. A 2 by 3 (Group x Repeated Measures) split plot ANOVA was used to analyze the data. According to teacher reports using the Teacher Report Form (C-TRF) and blinded raters’ reports using the Direct Observation Form (DOF) to assess disruptive behaviors, children whose teachers received the CTRT intervention demonstrated statistically significant decreases (p < .05) in externalizing behaviors on the C-TRF and total problems on the DOF from pre- to mid- to post-test, compared to children whose teachers participated in the active control group. The CTRT intervention demonstrated large treatment effects on both measures (C-TRF: ?p2 =.173; DOF: ?p2=.164) when compared to CD, revealing the practical significance of the findings on reducing disruptive behaviors. According to independent raters on the DOF, 90% of children receiving the CTRT intervention moved from clinical levels of behavioral concern to more normative levels of functioning following treatment, establishing the clinical significance of CTRT as an early mental health intervention for preschool children in Head start exhibiting disruptive behavior. digital.library.unt.edu/ark:/67531/metadc149553/
Filial Therapy and the Family: Examining the Impact of Child Parent Relationship Therapy (Cprt) on Family Functioning
Research has indicated that filial therapy, an approach in which parents conduct play sessions with their young children, has strong effects on the participating parents and children. As a result, some have speculated that filial therapy improves the family system; however, minimal research exists to support this claim. Using a single-case, time-series design, I examined the impact of child parent relationship therapy (CPRT), a filial therapy approach, on the functioning of 8 diverse families (two-parent, biological children = 4; two-parent, adopted children = 3; single-parent, biological children = 1). 15 parents and 17 children (male = 15, female = 17) participated in the study. All but 1 parent was Caucasian. The children were more ethnically diverse (Caucasian = 5, Hispanic/Caucasian = 5, Hispanic = 3, Asian = 2). Parents’ ages ranged from 29 to 49 and children’s from 2 to 13. Results from simulation modeling analyses (SMA) indicated that 6 of 7 families experienced a statistically significant improvement in their targeted areas of family functioning, and the average effect size was moderate. Results from self-reported measures indicated that 7 families experienced notable improvements in family satisfaction, 4 in cohesion, 3 in communication, and 1 in flexibility. Data from an observational measure rated by independent assessors also indicated improvements pre- to post-intervention: 5 families in flexibility, 4 families in cohesion, and 4 families in communication. All families reported improved functioning in post-intervention interviews. The results support that the benefits of filial therapy may indeed extend to the family system. digital.library.unt.edu/ark:/67531/metadc115058/
Effectiveness Of Group Activity Play Therapy On Internalizing And Externalizing Behavior Problems Of Preadolescent Orphans In Uganda
This pilot study investigated the impact of group activity play therapy (GAPT) on displaced orphans aged 10 to 12 years living in a large children.s village in Uganda. Teachers and housemothers identified 60 preadolescents exhibiting clinical levels of internalizing and externalizing behavior problems. The participants ethnicity was African and included an equal number of females and males. Participants were randomly assigned to GAPT (n = 30) or reading mentoring (RM; n = 30), which served as an active control. Preadolescents in both treatment groups participated in an average of 16 sessions, twice weekly with each session lasting 50 minutes. Sessions were held in the school located within the village complex. A two (group) by two (repeated measures) split plot ANOVA was used to analyze the data. According to teacher reports using the Teacher Report Form (TRF) and housemother reports using the Child Behavior Checklist (CBCL), children receiving the GAPT intervention demonstrated statistically significant decreases (p < .025) in internalizing behaviors (TRF: p < .001; CBCL: p < .001 ) and externalizing behaviors (TRF: p = .006; CBCL: p < .001) from pretest to posttest compared to children who received RM. The GAPT intervention demonstrated a large treatment effect on reducing orphaned childrenÆs internalizing problems (TRF: ?p2= .213; CBCL: ?p2 = . 244) and a moderate to large treatment effect on reducing externalizing problems (TRF: ?p2= .121; CBCL: ?p2 = .217). The statistical, practical, and clinical significance of the findings provided strong, preliminary support for using GAPT as a developmentally and culturally responsive school-based intervention for troubled Ugandan orphans. digital.library.unt.edu/ark:/67531/metadc103365/
The Relationship Between Professional Sexual Boundary Violation And Sex Addiction: An Exploratory Study Of Post-treatment And Retrospective Pre-treatment Dispositions
In this exploratory study, 35 male professionals who had successfully completed residential sex addiction treatment were surveyed. Respondents’ median age was 47.5, and reported ethnicities were White (89%), Asian, (9%) and Hispanic (2%). Prior to intake, 17 respondents had reportedly violated sexual boundaries with patients, clients, or staff (BV group) and 18 reportedly had not (NBV group). Respondents completed a demographic information form and two validated instruments: (a) Sexual Symptom Assessment Scale (S-SAS), measuring symptom severity of Compulsive Sexual Behavior (CSB); and (b) Boundary Violation Index (BVI), assessing frequency of risk factors for Sexual Boundary Violation (SBV). Respondents reported a very large decrease in CSB symptom severity over time (partial 2 = .856), change that was statistically equal for respondents in the BV and NBV groups. Furthermore, respondents reported a large decrease in SBV risk over time (partial 2 = .620); however, the BV group reported a greater decrease in SBV risk than the NBV group (partial 2 = .221). Reductions in both CSB symptoms and SBV risk were stable over time, up to five years post discharge. CSB symptoms and SBV risk were not correlated at retrospective pre-treatment, but for practical purposes, were moderately correlated at post treatment (r = 0.386, n = 25, p = 0.057). Although not significant, correlation at pre-treatment was more than twice as strong for the BV group than for the NBV group. Days of Treatment was a meaningful, although non-significant, contributor to decreases in CSB symptom severity (? = -.323). Similarly, Days of Treatment (? = -.785), Counseling (? = -.303), Recovery Support (? = -.292), and Continuing Education (? = -.259) were meaningful, although non-significant, contributors to decrease in SBV risk. At study participation, 77.1% of respondents had reportedly retained their professional licenses, although 15.4% reported having received a new licensing board complaint. Clinical and professional implications, limitations, and areas for future research are discussed. digital.library.unt.edu/ark:/67531/metadc103359/
South Asian Women’s Experiences In Counseling: An Exploration Of Working Alliance, Multicultural Competence, Acculturation, And Cultural Value Conflicts
The purpose of this study was to examine predictors of client-counselor working alliance by understanding the effects of acculturation, perceived multicultural competence in counselors, and cultural value conflicts among South Asian women. The study was based on a nonrandom sample of women ages 18 to 39 years living in the United States who had completed at least three counseling sessions with a mental health professional in the last 5 years. Forty participants completed the online survey. Participants were recruited through personal contacts, social networking Internet websites, businesses, agencies, and places of worship. The majority of participants were highly educated, second-generation women descending from India or Pakistan. The full survey included an eligibility screening questionnaire, demographic questionnaire, the Working Alliance Inventory-Short Revised with an average mean of 4.82, Cross-Cultural Counseling Inventory-Revised with an average mean of 4.17 and reliability of excellent internal consistency reliability at ? = .92, Asian Values Scale-Revised with an average mean score of 2.44, and Cultural Value Conflicts Scale for South Asian Women with a mean score of 3.33. Participants reported experiencing working alliance often within the therapeutic relationship and experienced middle levels of Asian value adherence, falling in the integration level. The results indicated that participants experienced neutral to agreeable cultural value conflicts. Bivariate correlations indicated a statistically significant, moderate relationship between participants’ perceptions of counselors’ multicultural competence and their reports of working alliance in the therapeutic relationship. All other correlations reflected small to moderate effect sizes; however, these correlations were not statistically significant. Similarly, bivariate regression indicated that perceptions of multicultural counselor competence predicted the client-counselor working alliance to a moderate degree. From the results of hierarchical linear regression, acculturation and cultural value conflicts did not predict client-counselor working alliance even after accounting for perceived multicultural competence in counselors. The strongest predictor of client-counselor working alliance was the perceived multicultural competence of counselors. Probable reasons for the results of this study were discussed, limitations were identified, and suggestions for counseling practice were provided. Implications for the profession of counseling were made, and recommendations for future research were provided. digital.library.unt.edu/ark:/67531/metadc103380/
Parents Of Children With High-functioning Autism: Experiences In Child-parent Relationship Therapy (Cprt)
This qualitative study attempted to capture the experiences of parents of children with high-functioning autistic spectrum disorders participating in child-parent relationship therapy (CPRT). Parents of children with high-functioning autistic spectrum disorders (HFASD) are prone to experiencing stress in the parent-child relationship due to difficulty in social understanding and rigid behavioral patterns often found among children with HFASD. Moreover, parents of children with HFASD may feel challenged to find suitable interventions that are time-limited, affordable, and appropriate for parents and children with HFASD. Because no research currently investigates the perceived acceptability of CPRT for parents of children with HFASD, it was decided that a qualitative study would best capture the experiences of parents of children with HFASD participating in CPRT to understand more fully whether CPRT is an appropriate intervention for these parents. Four parents and one grandparent were interviewed prior to and following their participation in 10 sessions of CPRT. Thematic analysis of the pre- and post-intervention interviews as well as the 10 CPRT sessions revealed eight themes related to the parents overall experience of CPRT and change in the parent, child, and parent-child relationship: understanding of CPRT concepts, reactions to CPRT, group dynamic, child characteristics, parent characteristics, knowledge and experiences with HFASD, family context, and parent-child relationship. The emerging themes indicated that the five participants found CPRT to be a useful intervention for developing skills to deal with child-behavior concerns related to HFASD. The participants also reported developing a better understanding of their children with HFASD and four parents reported increased closeness in the parent-child relationship. The implications for this research are that CPRT may offer parents of children with HFASD a time-limited intervention that meets their needs as parents, as well as possibly helping parents and children with HFASD develop increased closeness in the parent-child relationship. digital.library.unt.edu/ark:/67531/metadc103397/
Combat Near-Death Experiences: An Exploratory, Mixed-Methods Study
This mixed-methods study’s purpose was a systematic comparison of contents and aftereffects of near-death experiences (NDEs) occurring in a variety of circumstances with those occurring in combat. They completed an online survey: a demographic questionnaire, the Near-Death Experience Scale, the Life Changes Inventory-Revised (LCI-R), and four narrative response items. Survey completers were 68 participants: 20 combat near-death experiencers (cNDErs) and 48 non-NDErs (nNDErs). The 29% of participants who met NDE Scale criterion for an NDE was comparable to NDE incidence findings from previous retrospective studies. For statistical analyses, significance was set at p < .05, and effect size (Cohen’s d) was calculated. Mean total NDE Scale scores were significantly lower for cNDErs than variety-of-circumstance NDErs from one of two comparable studies (t = 5.083, p < .0001, d = -1.26), possibly suggesting cNDEs may have “less depth” than other-variety NDEs. Regarding cNDE aftereffects, absence of previous LCI-R data made comparison impossible. Cronbach’s alpha analysis yielded acceptable reliability on the total scale and seven of nine subscales, a finding that matched Schneeberger’s (2010); however, factor analytic results did not support the hypothesized subscale structure of the LCI-R. Although cNDErs did not score significantly higher than nNDErs on the total scale or subscales after Bonferroni correction, results indicated a possible trend toward greater absolute changes (p = 0.02, d = 0.74) and spirituality (p = 0.02, d = 0.67) with the latter finding substantiated by narrative responses. Informal analysis of narrative responses yielded several themes. digital.library.unt.edu/ark:/67531/metadc84208/
Effects of a Play-Based Teacher Consultation (PBTC) Program on Interpersonal Skills of Elementary School Teachers in the Classroom
The purpose of this study was to examine the effectiveness of a play-based teacher consultation (PBTC) program on individual teachers’ interpersonal classroom behaviors and teacher-child relationships. The research questions addressed the application of child-centered play therapy principles and PBTC increasing teacher responsiveness, decreasing teacher criticism, and enhancing teachers‟ perceptions of the teacher-child relationship in elementary school classrooms. Single-case design was utilized to examine eight teachers‟ perceptions over 16 weeks. The sample included 8 White female teachers from three local elementary schools. Teacher ages ranged from 28 to 59 years old. There were 5 kindergarten, 1 first grade, and 2 second grade teachers. The teachers participated in one educational training session followed by play sessions with children of focus and interactive modeling sessions. Trained observers, blind to the study’s purpose, utilized the Interaction Analysis System in classroom observations of the teachers, three times per week, to examine teachers’ interpersonal skills. Additionally, the teachers completed the Student Teacher Relationship Scale for the children of focus before and after the play session phase to examine change in the teacher-child relationship. Visual analysis of the data indicated the PBTC’s overall positive impact. 5 out of 8 teachers demonstrated increases in teacher responding scores at mildly to very effective criteria levels. All 8 teachers demonstrated decreases teacher criticism at effective to very effective criteria levels. The teacher-child relationships indicated mixed results, with 5 out of 8 teachers indicating positive changes in teacher-child relationships. Discussion includes implications for future research regarding single-case design, measurement of teacher change, and modifications of the PBTC model. digital.library.unt.edu/ark:/67531/metadc84185/
A Systematic Review of Research on After-Death Communication (ADC)
In this study, after-death communication (ADC) is defined as spontaneously occurring encounters with the deceased. Reported occurrences of ADC phenomena range widely among published ADC research studies, so a systematic review of 35 studies was conducted. A rubric was developed to evaluate the methodological quality; final inter-rater reliability among three raters was r = .90. Results were used to rank the studies; the methodologically strongest studies were used to arrive at best estimate answers to four research questions/subquestions: (1) How common are experiences of ADC? How does occurrence vary by gender, age, marital status, ethnicity, religious practice, religious affiliation, financial status, physical health, educational level, and grief status? (2) To what extent do ADCrs report ADC experiences to be beneficial and/or detrimental? What are the leading benefits and/or detriments? (3) What is the incidence of research studies in which the researchers mentioned that the research participants appeared mentally healthy? (4) What is the incidence of sensory modalities—for example, visual, auditory, and kinesthetic—in which ADCs occur? Best estimate results were compiled into a one-page fact sheet that counselors and others can use to educate people who seek empirically-based information about ADC. digital.library.unt.edu/ark:/67531/metadc84284/
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