Prevention Pub 12

PREVENTION IN
COUNSELING PSYCHOLOGY:
THEORY, RESEARCH, PRACTICE AND TRAINING
A Publication of Prevention Section in Division 17 of American Psychological Association
Volume 4 Issue 1 April 2012
Garden Grace by Curtis Carmen Davis, http://prismaticembers.com

Prevention in Counseling Psychology: Theory, Research, Practice and Training is a publication of the Preven-
tion Section of the Society for Counseling Psychology. The publication is dedicated to the dissemination of information on
prevention theory, research, practice and training in counseling psychology, stimulating prevention scholarship, promoting
collaboration between counseling psychologists engaged in prevention, and encourages student scholars. The publication
focuses on prevention in specific domains (e.g., college campuses) employing specific modalities (e.g., group work), and
reports summaries of epidemiological and preventive intervention research. All submissions to the publication undergo
blind review by an editorial board jury, and those selected for publication are distributed nationally through electronic and
hard copies.
Editorial Board Chair

Michael Waldo
New Mexico State University
Managing Editor
Julie M. Koch
Oklahoma State University
Production Editor
Jonathan P. Schwartz
New Mexico State University
Members of the Editorial Board

Aimee Arikian, University of Minnesota
Kimberly Burdine, Oklahoma State University
Stephanie Chapman, Baylor College of Medicine
Simon Chung, University at Albany
Michael Gale, University at Albany
Michelle Murray, University at Albany
Submission Guidelines
The Prevention Section of the Society of Counseling Psychology publishes Prevention in Counseling Psychology: Theory, Re-
search, Practice and Training. This is a blind peer-reviewed publication presenting scholarly work in the field of prevention
that is distributed nationally. Contributions can focus on prevention theory, research, practice or training, or a combina-
tion of these topics. We welcome student submissions. As a publication of the Prevention Section of Division 17, presenta-
tions and awards sponsored by the section will be highlighted in these issues. We will also publish condensed reviews of
research or theoretical work pertaining to the field of prevention. All submissions need to clearly articulate the prevention
nature of the work. Submissions to this publication need to conform to APA style. All submissions must be electronically
submitted. Please send your documents prepared for blind review with a cover letter including all identifying information
for our records. Submissions should be emailed to Julie Koch, Managing Editor, at julie.koch@okstate.edu.
2 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 4, No. 1
Volume 4 April
Issue 1
PREVENTION IN 2012
COUNSELING PSYCHOLOGY
Section News
Message from the Chair 4
Sally M. Hage
Greetings from the Editorial Board 5
Editorial Board
Message from Your Graduate Student Representative 6
Erin Ring
Theory, Research, Practice and Training
Development of a Narrative Therapy Experiential Parents Group Model Used to 7

Train School Counselors Working with Elementary School Children Who Bully
Audrey Ham, Munyi Shea
Preventing Disparities in Primary Healthcare for LGBT Patients 15
Ginger L. Dickson, Anthony P. Rinaldi
Prevention Abstracts
Enhancing Transformative Mediation to Address Family Conflict 21

Natasha M. Ali, Michael Waldo
Self-Efficacy in Relapse Avoidance: A Model of Prediction Using 22
Drug Use History, Resilience, & Depression
Natalie J. Gildar & Felipe Gonzlez Castro
Factors Correlated with Moral Resilience among Children at High Risk 23
of Criminality: A Review of the Literature
Samantha J. Toale, Thomas M. Brunner
Parent and Romantic Partner Attachment Styles Among 24
Chinese/Chinese-Americans and European-Americans
Juliana V. Yam
Parent and Romantic Partner Attachment Styles Among 24
Cambodian/Cambodian-Americans
Juliana V. Yam, Sheila J. Henderson
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 4, No. 1 3
Section News
Message from the Chair

Sally M. Hage
University at Albany
Prevention Section Initiatives

As Chair of the Prevention Section, I have the honor of working with so many committed, visionary leaders in preven-
tion. Several of these talented leaders have put together this exciting new issue of the Prevention in Counseling Psy-
chology: Theory, Research, Practice and Training. This issue inaugurates a new cycle of the prevention section publi-
cation. Our publication will be released twice a year, including a midwinter issue in February and a midsummer issue in
July. I encourage you to consider submitting a brief report of a research project and/or a theoretical article or book re-
view on a prevention related topic for one of the next issues!
Another exciting initiative of the Prevention Section is the development of the Prevention Guidelines for Psychologists,
which are undergoing final revision as APA practice guidelines. These practice guidelines will provide psychologists
with recommendations to facilitate best practices in prevention within psychological specialty areas. The Prevention
Guidelines are organized into 4 specialty areas within the field of prevention psychology: a) practice b) research and
evaluation c) education and training and d) social policy and legislative action.
Upcoming Events
The section sponsored symposium at APA Orlando this year will focus on the application of the Prevention Guidelines
to diverse practice contexts, titled, An Ounce of Prevention: Applying the Prevention Guidelines to Real World Con-
texts. This symposium brings together an amazing group of scholars, including Andy Horne, Rebecca Toporek, Keith
Herman, and Stephanie Coard, and the discussant will be Isaac Prilleltensky. These scholars from across specialty areas
in psychology will share their ideas and real world examples of how they apply prevention practice, research, training
and social action contexts. Dont miss it!
The Third Annual Prevention Section Social, Award Ceremony and Poster Session will be held at APA. If you are a
student, consider submitting a poster proposal to the Prevention Section for the 2012 APA conference in Orlando in
August. Your proposal will be considered for both the SCP Poster Session and the Prevention Section Poster Social/
Award Ceremony, both in Orlando. Also, consider nominating your favorite prevention scholar for the Lifetime Preven-
tion Award. The recipient will be honored at the APA social event.
Signs of Hope
In closing, I am encouraged by so many signs of hope around us that a prevention orientation is beginning to take hold
across the nation. One indicator of this shift was the release of the National Prevention Strategy (National Prevention
Council, 2011) on June 16, 2011, by members of the Obama administration, led by members of the National Preven-
tion, Health Promotion, and Public Health Council. Also, a recent poll indicated that 71 percent of Americans favor in-
creasing our investment in disease prevention and making prevention a top priority in future health reform (Trust for
Americas Health, 2009). Finally, Healthy People 2020 is now available, providing a comprehensive set of 10-year,
national goals and objectives for improving the health and wellbeing of all Americans. Find it at healthpeople.gov/2020.
Thank you to all of the staff, contributors and editorial board members who put together this special issue. See you in
August in Orlando!
Section News
Greetings from the Editorial Board

Welcome to the Winter 2012 issue of Prevention in Counseling Psychology: Theory, Research, Practice and Training,
the publication of the Prevention Section of the Society of Counseling Psychology. The goal of this publication is to
promote prevention theory and research. Within these pages, you will find new research that highlights recent efforts in
prevention.
Ham and Shea provide an example of prevention in practice. They share their experiences from a pilot project with La-
tino parents of children who bully, a narrative therapy experiential group held at an elementary school. The authors pro-
vide a nice outline of an eight-session group that is replicable and highly relevant for the potential prevention of bully-
ing through parental involvement. In another article, Dickson and Rinaldi review the literature related to health care
disparities among LGBT patients. They provide suggestions for counseling psychologists, including ways in which
counseling psychologists can promote the welfare of LGBT patients through collaboration with, and training of,
healthcare providers.
You will also find five abstracts published here, four of which summarize work that was presented at the Prevention
Section Student Poster Session at the APA Convention in Washington, DC in 2011. Ali and Waldo summarize a study
about how the use of transformative mediation shows promise in helping families significantly improve their empathic
listening and interpersonal learning. Gildar and Gonzalez Castro share a summary of a study of the prevention of drug-
use relapse and its relation to self-efficacy. Toale and Brunner provide a review of the literature examining factors relat-
ed to moral resilience among children at high risk of criminality. Yam summarizes a study of Chinese/Chinese-
American and European-American attachment styles and, with Henderson, a study of Cambodian/Cambodian-
American attachment styles. We are delighted that we are able to showcase these cutting edge prevention studies. More
information on each of them can be obtained by contacting the authors.
Next issue, we would like to publish a description of your prevention work. We accept manuscripts addressing preven-
tion theory, research, practice and training. We believe this is an excellent forum for sharing your work with prevention
oriented colleagues. We encourage you to submit your own work for our next issue to Julie Koch, Managing Editor, at
julie.koch@okstate.edu. The deadline for our Summer 2012 issue is May 15, 2012.
Section News
Message from Your Graduate Student Representative

Erin Ring
University at Albany
Special greetings to the students of the Prevention Section! Are you looking to advance your professional development
and enhance your leadership skills? We enjoy collaborating with students in the field. Id like to mention a few opportu-
nities in our section geared specifically for you:
Submit a proposal for the Division 17 Poster Session at the 2013 APA convention. Note that the Prevention Section
also has a conference poster session specifically for our students. The poster session is a great opportunity to pre-
sent your research, network with other students and professionals in the field, and meet recipients of the Prevention
Section's annual research and achievement awards. By submitting your proposal to the Prevention Section for the
Division 17 Poster Session, your proposal will automatically be considered for both poster sessions, allowing you to
present at one or the other.
Earn experience reviewing manuscripts by serving as a reviewer of the Prevention Sections peer reviewed publica-
tion: Prevention in Counseling Psychology: Theory, Research, Practice, and Training. Contact Michael Waldo at
miwaldo@nmsu.edu for more information.
Submit your own research or abstracts to be included in our peer reviewed publication. Contact Julie Koch at ju-
lie.koch@okstate.edu.
Help the Section with online media updates, including our website and social networking.
If you are interested in any of the above opportunities, or have additional ideas for your own involvement, please dont
hesitate to contact me at ering@albany.edu and I can provide you with some more information. I look forward to hear-
ing from you!
Development of a Narrative Therapy Experiential Parents Group

Model Used to Train School Counselors Working with
Elementary School Children Who Bully
Audrey Ham and Munyi Shea
California State University, Los Angeles
The age-old aggressive behavior of bullying continues to be prevalent in schools, extending to younger populations including at
the elementary level. Bullying behavior puts students at risk physically, emotionally and academically. Communities are asking
schools to respond to this negative behavior while at the same time the schools financial and personnel resources are increasing-
ly limited. Parents play a critical role in the emotional and behavioral development of their children. By including parents in a
group bullying intervention, schools can potentially reach a greater number of individuals with fewer personnel and potentially
positively impact the future behavior of the children. This paper describes a Narrative Therapy experiential group for the parents
of children who bully, intended as a bullying prevention tool used by future school counselors. The group model discussed in this
paper was a Spanish language group conducted by school counselors in training at an elementary school on the outskirts of Los
Angeles. The group functioned as an intensive training experience for counseling graduate students in Narrative Therapy and as a
pilot for the development of a bullying prevention and intervention for the elementary school.
Schools are being asked to respond to the needs of greater sive school approach that has spawned many of the current
numbers of students with less financial and personnel re- bullying programs (Kallestad & Olweus, 2003). Additionally,
sources. These needs increasingly include addressing aggres- in economically austere times, including parents in school-
sive behavior in children as young as elementary age students. based group intervention allows school counselors to provide
Bullying behavior impacts the physical, mental and academic comprehensive and integrated services to greater numbers of
well being of students including the victim, perpetrator and of- children and their families. The ideas for the research underly-
ten the bystander (Swearer, Espelage, Vaillancort & Hymel, ing this paper were an outgrowth of observations by both au-
2010). While there are as yet no best-practice models of thors and their experiences in the schools. The first author
school-based interventions targeted to reduce and prevent bul- was a researcher and School Counselor for many years in New
lying, evidence suggests the critical need to include parents York City. The second author worked extensively as a re-
when attempting to address these and other behavioral issues searcher in primary and secondary schools. Both authors iden-
in children (Cunningham, Cunningham, Ratcliffe & Vaillan- tified the need for the school community to provide school
court, 2010; Swearer, Espelage, Vaillancourt & Hymel, 2010). based involvement with parents and support for them that
School-based interventions may involve a whole school ap- could significantly impact the success of their students.
proach to bullying prevention as well as parental participation. The importance of this paper is that it presents the develop-
Parents may be more accessible than counselors, and minimize ment of a narrative therapy group experiential model that with
stigma associated with seeking help from traditional mental further development could be part of a larger school-wide bul-
health settings. However, research has yet to conclusively vali- lying prevention program. The experiential group was piloted
date this approach (Hong, 2009; Soriano & Hong, 1997; as a school-based, culturally responsive intervention for the
Swearer, Espelage, Vaillancour & Hymel, 2010;). However, parents of Latino elementary school-age children involved in
parent information and discussion sessions are a key compo- bullying. The paper presents the curriculum used in the group
nent of the Olweus Bully Prevention Program, a comprehen- sessions and explores the challenges of recruiting and involv-
ing parents in a bullying prevention intervention. The focus of
this paper is the development of the training model. The paper
Correspondence concerning this article should be does not provide outcome data evaluating the group interven-
directed to: tion.
The Narrative Therapy Experiential Parents group on-site
Dr. Munyi Shea, California State University, Los An- at a Los Angeles elementary school was developed to address-
geles (CSULA), Psychology Department, 5151 State es a critical counseling need for children who bully and their
University Drive, LA, CA 90032. parents, while at the same time providing a fertile training op-
mshea3@calstatela.edu portunity for graduate level counseling students as facilitators
of these groups. The parents group took place in the spring of
Narrative Therapy Experiential Group
2011 in a Los Angeles area elementary school. The major ten- on social emotional skills and the process of self-reflection,
et in developing the group was to create a bullying interven- growth and development, as well as the parental peer connec-
tion and prevention tool for the school that addressed parents tion forged by their common experiences. In particular, the
own growth and development, as well as the key role that par- emphasis of the Narrative Therapy Experiential Group is to
ents play in childrens behavior. The Narrative Therapy Expe- take the blame off of the parents and encourage a collaborative
riential Group provided specific training for graduate student environment where parents can develop alternative and em-
facilitators to add to their repertoire of culturally sensitive powered stories with each other that increase their own coping
skills used to service parents in school communities with lim- as well as their childrens coping skills. The group aimed to
ited counseling resources. Graduate level counselors were not only promote parents coping skills but to help parents un-
trained in narrative therapy and conducted the experiential derstand their childs experience, and increase their parenting
group on-site with Latino parents whose elementary school self-efficacy.
children had been referred by the principal for aggressive be-
havior. Bullying and Parental Connections
Narrative therapy, a post-modern therapeutic approach for Bullying is an age-old problem that today is being more
addressing problems of individuals and family systems, allows formally recognized as an increasingly problematic and de-
for a divergent perspective on bullying behavior in children. structive behavior (Esbensen & Carson, 2009; Rigby, 2003).
The narrative therapy approach is known for the belief in ex- Not only has it extended to younger populations (Hartung, Lit-
ternalizing the problem; the person is not the problem but the tle, Allen & Page, 2011), but also it has grown in proportion,
problem is the problem (White, 2007). Furthermore, it ex- as the level of violence is more extreme, at times resulting in
pands the discourse from that of the individual or family sys- fatalities (Klomek, Marrocco, Kleinman, Schonfeld & Gould,
tems to a larger contextual arena (i.e., society, oppression, in- 2007). In the school context, a bully is defined as a student
ternalized belief systems). From this stance, the individual or who has acted aggressively toward another or multiple stu-
individuals are not in a position of being blamed and bullying dents. According to the 2001 National Institute of Child
behavior can be explored from multiple perspectives. Health and Human Development (NICHD) at the National In-
Parents or primary caregivers are critical players in shaping stitutes of Health (NIH), one out of four children have report-
the thoughts, behaviors and feelings of the children they raise. ed being bullied, and one out of five children have reported
Research that implicates the role of adults (e.g., parents, teach- victimizing another child. The common elements of bullying
ers) in childrens bullying, their school experience, and inter- include repeated, intentional aggressive acts in which there are
ventions to date has mainly focused on individual characteris- differences of power between the perpetrator and the victim
tics of either the child or parent. That research has proposed (Olweus, 1993, 2001). Bullying can take the form of either
resolving bullying on the individual level (Espelage, Bosworth physical or verbal assaultsranging from actual contact be-
& Simon, 2000). Additionally, numerous studies have found tween perpetrator and victim (i.e., extortion, name-calling,
correlations between the bullying behavior of children and the teasing, or threatening with harm)to psychological or rela-
role of the parent, suggesting parenting is an ameliorating fac- tional harassment (i.e., spreading rumors, refusing to talk to
tor or one that increases the risk of bullying behavior in the someone, encouraging others to participate in bullying).
child (Georgiou, 2008; Holt, Kantor & Finkelhor, 2009). And Several family and parenting characteristics have been im-
it is likely that this relationship is reciprocal. Parents thinking, plicated in bullying (Smokowski & Kopasz, 2005). Some stud-
behavior and feelings are also impacted by their children. Par- ies suggest that bullies come from homes with permissive
ents of children who have been deemed to exhibit problematic mothers and absent father figures (Curtner-Smith, 2000).
behaviors have been reported to demonstrate decreased parent- However, blaming parents for their childrens behavior rein-
ing self-efficacy (Johnston & Mash, 1989). From both per- forces already engrained beliefs about parenting inadequacies.
spectives, there is inherent blame that either the parent or the A more comprehensive view of the role of the parent includes
child is causing a disruption in the functioning of the other. parents as a critical protective factor for children. Research has
Bullying intervention and prevention programs in schools supported parents roles as significant protective factors in
have had mixed results (Cunningham, Cunningham, Ratcliffe childrens developmental trajectories (Masten &Coatsworth,
& Vaillancourt, 2010; Hong, 2009; Jenson & Dieterich, 2007; 1998; Werner, 1996). Direct parental involvement has been
Merrell, Isava, Gueldner, & Ross, 2008; Swearer, Espeleage, found to be associated with childrens academic achievement
Vaillancourt & Hymel, 2010). Some schools have addressed (Epstein, 2001), positive school experience, enhanced social
student bullying behavior and parental difficulties by offering skills (Kohl et al., 2000), and reduced problematic behavior
student skills groups or voluntary or mandated parenting skills (Burke, Loeber, & Birmaher, 2002). The focus on parenting
classes (Koffman, Ray, Berg, Covington, Albarran, strengths is critical as positive child/parent interactions in-
&Vasquez, 2009). A narrative therapy, experiential parents crease childrens resilience, self-esteem, communication skills,
counseling group is wholly distinct from a didactic, skill or be- and peer relationships (Arbona & Power, 2003).
haviorally oriented parenting skills group that is commonly The caretaker/child connection is an important protective
used to educate parents about parenting skills. The difference factor for all children but becomes even more important to
between teaching- and skill- based groups and our Narrative bolster resilience in children who are at risk because of exter-
Therapy model is the experiential aspectnamely the focus nal factors (Masten & Coatsworth, 1998). Fostering healthy
parent communication and reducing parental stressors through Externalizing the problem (or in other words, including al-
a narrative therapy group approach is intended to insulate par- ternative perspectives) helps parents understand their stressors
ents from societal demands that ultimately impact their inter- within a larger contextual framework that de-emphasizes indi-
actions with their children. The first author noticed during her vidual parental pathology and acknowledges these societal
8 years as a School Counselor in New York City that differ- barriers and challenges. Narrative therapy fits perfectly with
ences in acculturation levels between the child and the parent, the basic philosophy and tenets of multicultural awareness and
demanding work schedules, and being an adolescent parent are skills, and was hypothesized to work well with disadvantaged
a few external factors that contribute to the difficulties parents immigrant families in that it: (a) embraces the construction of
experience in connecting with their children. The protective multiple realities and appreciates diversity of voices; (b) helps
factor of the caring adult connection becomes compromised in individuals or families to challenge the oppressive values and
households with difficulty communicating and a lack of beliefs of the dominant culture, including prejudice and dis-
parent/child connection (Baldry & Farrington, 2005; McCabe, crimination; and (c) is strength-based and emphasizes social
Goehring, Yeh & Lau, 2008; Perren & Hornung, 2005). justice and advocacy for marginalized groups.
Stressors in the home and conflicts with parents increase chil-
drens stress levels, decrease coping and lead to behavioral Rationale for the Group
and school performance problems. There is a notable lack of Despite the prevalence of bullying in low-income neigh-
studies that include racial ethnic group comparisons in the ex- borhoods, research has provided limited information on best
amination of the correlation between home stressors and chil- practice and effective prevention programs in these often pre-
drens behavior. Moreover, although Latinos are one of the dominately minority neighborhoods (Hong, 2009). Latino im-
largest and fastest-growing ethnic minority groups in the Unit- migrant families, particularly those of low income, are likely
ed States (U.S. Department of Homeland Security, 2009), they to encounter a host of contextual and cultural challenges, such
continue to be underrepresented in bullying research and inter- as language barriers, intense work demands, racism and dis-
ventions (U.S. Department of Health and Human Services, crimination, and acculturative stress (Cardona et al., 2009).
2001). However, group interventions have been found to be an Immigrant parents may also experience parenting difficulties
efficacious intervention modality with Latino clients (Rivera, due to long working hours, transportation problems, limited
2003). English proficiency, as well as unfamiliarity with the U.S. ed-
ucational system and American culture. Any of these factors
A Narrative Therapy Theoretical Orientation could result in parents inability to provide guidance for their
Narrative therapy was chosen as the theoretical framework childrens school development and their disengagement from
for training and group facilitation. The fundamental concepts the school (Ramirez, 2003; Turney & Kao, 2009). Different
of narrative therapy resonated strongly with the graduate stu- levels of acculturation and language preference could further
dents in training and ultimately with the parents. The graduate intensify family stress and conflict between parents and child
students expressed enthusiasm about learning a specific theo- (Costigan & Dokis, 2006; Santisteban, Muir-Malcolm, Mi-
retical approach to work with parents, and they valued the trani, & Szapocznik, 2002). Children of these immigrants are
postmodern stance of an inquirer seeking to generate alterna- also more likely to live in low-income families where 50%
tive perspectives for the clients. Narrative therapy conceptual- have income well below the poverty level (Fortuny, Capps,
izes the problem as external to the individual rather than as a Simms, & Chaudry, 2009).
defining element of the persons identity, and expands the nar- The Narrative Therapy Parents Group was designed as a
rative to include the impact of oppressive cultural and societal preventive family intervention intended to serve a large num-
forces (White, 2007). By separating and externalizing the ber of parents whose children are at the elementary level. The
problem from the individual and the family, a new, healthier purpose was to improve family functioning and reduce famili-
and affirming narrative can evolve and develop (White & Ep- al conflict that creates stress in the family system, which im-
ston, 1990). The focus of narrative therapy on deconstructing pedes the learning at school and at home. It was our premise
problem-saturated stories, re-authoring alternate stories by that by using a Narrative Therapy model, parents who are part
seeking unique outcomes to problems and preferred realities, of a brief interpersonal experiential peer group will be more
uncovering strengths, and identifying internal and external re- able to handle conflict and become better communicators
sources. Narrative therapy is thought to be especially benefi- within the family, and thus improve the management of their
cial for immigrant parents who may feel helpless and dis- own stressors. We hypothesized that increased parental aware-
tressed about their childs school functioning (White & Ep- ness of family processes in a supportive peer group will lead
ston, 1990). Moreover, the de-centered, not-knowing inquiry to a change in parenting behavior that impacts childrens bul-
stance of Narrative therapys postmodern approach views cli- lying in school, which in turn will improved academic func-
ents as the experts in their life, and signifies a position of re- tioning for their children.
spect that is valued by Latino cultures (White & Epston, 1990, The overall goals of the group were to: (a) help parents ex-
Cardona et al., 2009). This is a unique approach to examining plore their own challenges and identify internal and external
bullying behavior and the children who bully by locating the resources; (b) enhance parents social and problem-solving
problem in the cultural landscape versus blaming the individu- skills to build parenting self-efficacy; and (c) empower parents
al (Winslade & Monk, 2007).
in the school community to assist one another and support cluded readings, an all day didactic and experiential seminar,
their children during their educational development. an all day experiential workshop in the Tavistock method of
the study of group dynamics, and weekly on-site supervision
Method by the first author.
The unique opportunity for graduate students to receive
Our narrative therapy, school-based, interpersonal, experi- specialized training and skills was part of the project goals.
ential parents group was developed to be part of the services These students were trained as group facilitators in the urban
to assist parents of children who have engaged in bullying be- schools where they will eventually work as professional
havior offered by an urban elementary school. Graduate stu- school counselors. The training presented a unique opportunity
dents in a school counseling program were trained by an invit- for the graduate students to receive the specialized training
ed trainer and the authors to facilitate the group. Sessions took and skills they would eventually use as professional school
place at an elementary school in the Los Angeles vicinity pri- counselors. The students in Californias urban school system
marily populated by low-income, ethnic minority immigrant also benefited. This is a population that is traditionally under-
students of Latino and Asian decent. Our group was comprised served due to lack of consistent access to mental health, psy-
of Latino parents recruited through a process of self-selection chosocial and other vital support systems. The language abil-
following specific outreach to parents whose children had re- ity, race and ethnicity of the facilitators closely mirrored those
ceived referrals to the principal for aggressive behavior. of the student body at the elementary school. The facilitators
Groups were initially offered in both Spanish and English. On- were asked to write weekly journals in order to further the
ly first generation Spanish speaking parents electing to attend. learning experience and to receive individual feedback.
The focus on parents of children who bully was intentional; it
was hypothesized that changes in the behavior of the children Recruitment and Retention
would be observable after the parent intervention. Bullying be- Development of the parenting groups at the elementary
havior is easily documented, particularly by school personnel school was the first experience for the school community and
who can observe and document changes in students behavior. principal in hosting a parents group facilitated by practition-
ers from outside of the direct school community. Recruitment
Participants for the groups was challenging. The downturn in the economic
Parents and primary caregivers of children identified as situation during November 2010-June 2011particularly as it
bullies by school personnel were recruited for the group, with related to education in the State of Californiagreatly impact-
a focus on those whose children had received referrals to the ed recruitment for the group. During the recruitment period,
School Principal for aggressive behavior. The parents were in- the principals attention was diverted from recruitment due to
formed that they were recruited to be part of a parenting sup- pressure related to California State student achievement
port group because their children had received referrals for scores. This resulted in a relatively small pool of parents to
services from the Principal for bullying behavior. The parents contact, as well as delays in communication and receipt of cru-
were also informed that there would be no negative school re- cial information to assist in the recruitment process.
percussions for choosing not to attend the group sessions. Additional difficulties with recruitment were due to our
Those who agreed participated in a total of 8 sessions, which narrow criteria for referring parents, which were intended to
included an orientation session, six group sessions and a sum- target bullying behavior. Instead, the school was referring stu-
mary session. The group was conducted in Spanish by two bi- dents with a wide range of behavioral infractions. For exam-
lingual facilitators. ple, two parents were originally referred whose children had
serious behavioral issues beyond bullying. These students
Program Descriptions and Procedures were transferred out of the school after the first group session
Group sessions were held once a week after school in a and thus the parents declined to continue with the group. In
classroom for 1.5 hours for eight weeks. The elementary another case, a parent was referred for a single incident of bul-
school personnel assisted in recruiting and referring parents, lying behavior. After attending several group sessions, the
providing classroom space, snacks, and staff for after school group facilitators, who had come to know the parent, ques-
child-care for participating parents. During the orientation ses- tioned the referral since it appeared that it was an isolated inci-
sion, the purpose and the structure of the group were explained dent and the child was otherwise a model student.
to the participants. Being outsiders to the school community was possibly the
greatest barrier to recruitment. We tried to forge relationships
Training of the Facilitators with parents by establishing a presence on campus. Group fa-
For the purposes of this project, a cohort of Masters level cilitators attended parent-teacher conference days, parent as-
graduate students was trained as group facilitators in Narrative semblies and handed out flyers after school. The first author
Therapy Techniques. These students were enrolled in a School was on-site before, during and after the group sessions, to
Counseling program at a public university on the West Coast. meet with parents and build rapport and answer questions. Ex-
MaryAnna Domokos-Cheng Ham, a Psychologist and Counse- perience with recruiting for the development group confirmed
lor Educator specializing in Family Therapy with expertise in our intuition and the research findings; establishing rapport
Narrative Therapy, conducted the training. The training in- with the community of parents and creating a word of mouth
reputation and network is critical to recruitment and engage- home? What actions work with your child? What are your
ment (Rodriguez, Rodriguez & Davis, 2006). After the origi- unique strengths that keep you going during this time? Narra-
nal group sessions, parent participants enthusiastically volun- tive therapy questions and circular questioning such as the ex-
teered to recruit for future groups and reported interest from amples given were used (Nelson, Fleuridas & Rosenthal,
parents who had heard about the group. Parents commented 1986; White & Epston, 1990; Winslade & Monk, 2007). These
that the group was an important opportunity to get feedback questions were asked of the parents in the group and they were
from other parents and have a place to share their concerns. also asked to consider the questions in relation to other mem-
Measures were taken to schedule groups on days of the bers of the family unit.
week and at times that were conducive to parents schedules. The facilitator skills that were emphasized during this se-
Childcare and snacks were provided for both parents and chil- cond session were continued in hopes of rapport building, as-
dren by the school in order to encourage parents to attend. Re- sessment of the group dynamics, and exploring the present and
gardless of the measures taken to facilitate engagement, par- future tense of the narrative. For example, what were the par-
ents still have to manage external demands, including limited ents expectations for the future? In this way, the facilitators
time to attend and life stressors that impede attendance began the process of externalizing the conversation and looked
(Dumas, Nissley-Tsiopinis, & Moreland, 2007). Parents were for themes throughout the different parents narratives (White,
also made aware that the group was confidential and that the 2007). Facilitators examined the strengths in the stories, the
principal and teachers would not be informed of the content of struggles that were overcome, and the transformations that oc-
the discussions. Despite the attempts to promote attendance, curred. Facilitators also attempted to discover what behaviors
external demands on the parents greatly impacted their group the parents were interested in changing in their respective situ-
participation for the 8 sessions. The following sections de- ations and talked explicitly about change.
scribe the individual group sessions. The primary goal of the work in this second session was to
help parents conceptualize the parent/child relationship from
Group Sessions alternative perspectives. The hoped for outcome was for par-
Session 1: Welcome and introduction. This first session ents to succeed in articulating issues related to the problem
was considered to be critical for development of the group as and begin to feel comfortable as active members of the group.
it set the tone for subsequent groups. Presented as a support Session 3: Constructing meaning: Parents narratives
group intended for parents who are experiencing challenges of their story. In session 3, parents were invited to share their
with their children, parents were told the group would be an narratives, including examples of their own early memories of
opportunity for them to tell their stories and learn new ways to being parented. Facilitators asked questions such as: What are
think about their childrens behavior. Facilitators were advised your early life stories about being parented? Who were your
to focus on rapport building during all interactions, whether models for how to be a parent? What did you learn about par-
didactic or process oriented. Logistics were presented and dis- enting from these models? Who did you go to for support and
cussed with a focus on including the parents as authority fig- help? Facilitators continued mapping and externalizing the
ures and equal members of the group. Facilitators were con- problem and assessed the connections between the child and
scious of the possible power dynamics within the group and parent. The group was encouraged to help other group mem-
members were invited to discuss their expectations and what bers evaluate the effects of the problem on the family. A criti-
they hoped to achieve during the sessions. Student facilitators cal question for all members was: What could the problem be
were asked to notice inter-group dynamics (e.g., alliances, os- if the problem isnt the childs bad behavior?
tracizing), along with verbal and non-verbal comfort levels Counselor skills that were the focus of this session were
and language issues. The anticipated outcome for parents from encouraging an expanding narrative of the problem that in-
session 1 was that parents would be introduced to the group cluded historical and familial contexts. The counselor asked
format, the members, and the facilitators. parents to think about cultural, historical contexts and possible
Session 2: Telling the story: Parents narratives of their histories of oppression. Facilitators acknowledged the power
childrens problem behaviors. In this session we invited par- of the narrative in parents lives and helped parents express
ents to identify situations that occurred with their children in curiosity and interest from a new and different stance or per-
school and at home, with a focus on the effect of these situa- spective. Every story has historical component and the story-
tions on the parent/child relationship. The facilitators explored teller interprets the events with particular attachments to the
the family constellation, asking parents questions about who story. He or she chooses where to begin the story and what
resides in the home. Part of the work for the parents included events to communicate, including placing the story in a specif-
helping them to externalize and map the problem, investigat- ic time frame. Counselors assisted group members to examine
ing the length, breadth and depth of the problem (Winslade & how the parent/child relationship was situated in history and
Monk, 2007; White, 2007). Examples of questions included: how it could be retold in the present. Reducing the influence
How long have you had this problem? What are its effects, and of the problem on the family by heightening other aspects of
how deeply has it affected you as parent and/or other members the parent/child relationship was stressed. Interventions by
of the family? Other important questions included: What was counselors helped parents become aware of how the bad be-
it like for you to learn about your childs behavior from the havior influenced the structure of the family. Although the
school? What impact is the childs behavior having on you at problem still existed, counselors explored how to shift the or-
ganizing principal of the family away from the problem. Issues childs problem? Facilitators stressed helping parents to recog-
of immigration were salient during this session, as were differ- nize the special skills and abilities each parent has, and what
ences between parents immigration narratives and those of knowledge helped him or her to overcome the problem. Par-
their children. Immigration was explored as an issue that fami- ents were able to add new people to their storiesproviding
lies could be united around. Expanding the landscape of the an opportunity to upgrade some stories and downgrade others.
problem continued to be the parent outcome from group ses- By changing the membership around a problem, the problem
sion 3. can take on a different position in the life of the parent and
Session 4: Contextual issues: The impact of the domi- child.
nant discourse and understanding the context of challeng- In session 6, facilitators continued to use circular question-
es. The concepts in this session correlate with Whites concept ing aimed at helping parents to see that they are parenting
of re-authoring conversations (2007). In this session the focus within an extended community of people (e.g., extended fami-
was on the inclusion of what members had learned from their ly, friends, and acquaintances from community activities).
participation in the group and from other group members Session 7: Landscape of action (White, 2007). This ses-
about their stories. They were encouraged to include in their sion focused on a summary of the impact of examining prob-
new narratives some of the unspoken parts of the story, recog- lems through the unique perspective of the group. Facilitators
nizing that stories usually connect problems to a person unless used a group focus and asked parents to identify similarities
the story is expanded (White, 2007). Parental values, decision- and differences in their parenting stories with those of the oth-
making styles, and coping styles were examined through a er members stories they heard. Parents were then asked to
multicultural lens that included immigration and acculturation identify areas of competence in all of the stories. Parents dis-
issues, as well as race, ethnic, gender and socio-economic fac- cussed support systems currently in place in their lives that
tors. Facilitators asked parents to consider if the situation with would help them to continue developing new ways of think-
the child caused the parent to react in a certain way, and what ing, feeling and behaving. Parents were also asked to assess
ideas the parent might have about why they reacted this way. their learning experience, and discuss what approaches in the
Counselors skills in session 4 focused on the inclusion of sessions worked best for them.
multiple perspectives and the impact of the diverse perspec- Group dynamic process skills and clarification of themes
tives on the system. Facilitators looked at the variety of sys- were important counselor skills. The desired parent outcome
tems influencing the parents (e.g., family, school, the parent- of Session 7 was to help parents identify child, personal, fa-
ing group, community). A systems versus individual perspec- milial and group member strengths. Specifically, facilitators
tive was highlighted, thus the facilitator was encouraged not to asked members to identify a specific life story of another
evaluate one reality but to allow multiple realities to be ex- member and state what he or she was drawn to or moved by in
pressed. The use of metaphors was an important skill for facil- the story.
itators as they embraced a not knowing stance towards the Session 8: Termination. The final session was an oppor-
problem (White, 2007). Parents identifying contextual ele- tunity for reflections and goodbyes. At this time parents were
ments related to the problem was the intended outcome of this given books as a gift for their children. Parents were reluctant
session. to end the group and expressed a desire to continue sessions
Session 5: Continuing to externalize and re-author the and help with recruiting efforts for future groups.
problem. Session 5 examined the influence of the childs
problem on the parents confidence. Facilitators asked ques- Future Directions
tions such as: Does the problem make you want to give up?
How much do cultural differences between the parent and The experiential, Narrative Therapy group for parents was
child impact the problem? Parents were also asked to explore a unique service offered to a Los Angeles area elementary
how their own parents and grandparents handled problem situ- school. The school had never collaborated with a local univer-
ations using memories and stories from the past. sity to receive such a service. Since schools are pressed for
Learning how to track family history themes such as listen- mental health resourcesyet the demand for such services is
ing for the commonalities over various generations was the prevalentschool based interventions that target the needs of
counselor skill focused on during Session 5. The intended out- more than the individual are in demand. Services are particu-
come of this session was to help parents become aware and larly needed at the elementary level in the Los Angeles area
acknowledge that they have learned parenting skills from other where schools often do not have a full-time school psycholo-
generations, and that parent/child interactions may be similar gist or school counselors. Schools are the logical place for an
to those they had with their own parents and grandparents. experiential parenting group since they are often conveniently
Session 6: Re-authoring, discovering competence and located and parents are familiar with the facility and the per-
constructing alternate stories. Session 6 focused on continu- sonnel. The Narrative Therapy model was a useful model for
ing to help parents construct alternate stories and support these our experiential group because it helped parents to externalize
stories. Questions emphasized examining areas of the parents their respective problems, viewing each from multiple per-
lives that remain unaffected by the problem. For example: spectives and rewriting a problem narrative by examining indi-
What have each of you noticed about when the problem hasnt vidual strengths and locating networks of support. Parents
been so bad? What have friends, relatives noticed about your
bonded with each other through sharing experiences and ex- Curtner-Smith. M. E. (2000). Mechanisms by which family pro-
ploring the narrative of these experiences. cesses contribute to school-age boys' bullying. Child Study
We hope that the outline for the development of our group Journal, 30, 169-187.
provides a useful template for others to experiment with im- Dumas, J., Nissley-Tsiopinis, J., & Moreland, A. (2007).From in-
plementing experiential focused parenting groups. Whole tent to enrollment, attendance and participation in preventive
school prevention programs to reduce bullying have generally parenting groups. Journal of Child and Family Studies, 16, 1-
had disappointing results, possibly because of the complexity 26. doi:10.1107/s10826-00609042-0.
of the issue and lack of an overarching efficacy based theoreti- Epstein, J. L. (2001). School, family, and community partner-
cal approach (Swearer, Espelage, Vaillancourt & Hymel, ships: Preparing educators and improving schools. Boulder,
2010). Our efforts were to develop a prototype to evolve and CO: Westview Press.
test that could be part of a larger comprehensive school based Esbensen, F., & Carson, D. (2009). Consequences of being bul-
program. Statistical analysis of the impact of our group was lied: Results from a longitudinal assessment of bullying vic-
limited due to the small number of participants. Future en- timization in a multisite sample of American students. Youth
deavors to conduct school-based experiential groups need to & Society, 41, 209-233.
address recruitment issues, including articulating clearer crite- Espelage, D.L, Bosworth, K., & Simon, T.R. (2000). Examining
ria for participation and enlisting parents participation in the the social context of bullying behaviors in early adolescence.
recruitment process. Possible future papers based on the devel- Journal of Counseling and Development, 78, 326-333.
opment of this group will include analysis of the qualitative Fortuny, K., Capps, R., Simms, M., Chaudry, A. (2009). Children
content of the group sessions. of Immigrants: National and State Characteristics. The Urban
Feedback from our participants indicated that our group Institute, 9.
was helpful to the parents. They expressed gratitude for the Georgiou, S. (2008). Bullying and victimization at school: The
opportunity to express their feelings in the group and receive role of mothers. British Journal of Educational Psychology,
support from each other. The group also provided an enhanced 78, 109-125.
on-site learning experience for our students who will be future Hartung, C., Little, C., Allen, E., & Page, M. (2011).A psycho-
School Counselors in the Los Angeles area. metric comparison of two self-report measures of bullying
and victimization: Differences by sex and grade. Journal of
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Preventing Disparities in Primary Healthcare

for LGBT Patients
Ginger L. Dickson Anthony P. Rinaldi
New Mexico State University University of Iowa
The realities of unequal access to healthcare, substandard Unique Needs of LGBT Patients
treatment, and negative healthcare outcomes among minority The healthcare needs of the LGBT population have been
and marginalized populations have been well documented historically overlooked by researchers and practitioners alike
(Agency for Healthcare Research and Quality [AHRQ], 2003). (IOM, 2011). Recently, however, research into the unique
As sexual and gender minorities, lesbian, gay, bisexual, and medical needs and experiences of LGBT individuals within
transgendered (LGBT) individuals have unique medical and the healthcare system has increased. It was not until the third
emotional needs that have historically gone unaddressed issue of their public health policy document that the United
(Institute Of Medicine [IOM], 2011). Many of the obstacles to States Public Health Service (USPHS, 2000) issued a call for
adequate healthcare that LGBT individuals face can be at- research examining medical and psychological needs within
tributed to the effects of stigma related to non-heterosexual the LGBT community in an attempt to promote optimal health
identities, orientations, and behaviors (IOM, 2011). and wellness among sexual and gender minority individuals.
Although lesbian, gay, bisexual, and transgender individu- Healthy People 2010 (USPHS, 2000) issued a mandate for
als have unique experiences, needs, and issues, members of medical research to further explore and establish the needs of
these distinct groups are often referred to collectively by the LGBT individuals, so that they could be addressed in the fu-
term sexual or gender minority or by the acronym LGBT. De- ture policy document that is issued every ten years.
spite their differences, individuals from each group share the Taking up the call of Healthy People 2010 (USPHS, 2000),
experiences of marginalization and oppression as a direct re- several researchers documented the unique medical and psy-
sult of their sexual identities, orientations, gender identities chological needs and risk factors of members of the LGBT
and/or gender nonconformity (Harper, Jenerewall, & Zea, community. Perhaps the most effective of these studies have
2004). Thus, for the purpose of this discussion the term sexual been those that examined data from state and national health
or gender minority and the acronym LGBT will be used to and behavior surveys. For example, Dilley, Simmons, Boysun,
represent members of any or all four of these populations who Pizacani, and Stark (2009) examined data collected between
experience obstacles to equal healthcare as a result of stigma. 2003 and 2006 from the Washington State Behavioral Risk
Recent models of primary healthcare that coordinate be- Factor Surveillance System, an on-going, population-based
havioral health and primary healthcare services, integrative survey administered randomly over the telephone. The re-
models, show promise in assuaging the obstacles that LGBT searchers found that lesbian and bisexual women were more
individuals face in attaining optimal health and wellness likely than heterosexual women to have generally poor physi-
(Butler et al., 2008). As members of integrative healthcare cal and mental health, asthma, diabetes, to be overweight,
teams, counseling psychologists are well situated to aid health smoke, and drink alcohol excessively. Also, in comparison to
care professionals in preventing many of the obstacles faced heterosexual men, gay and bisexual men were more likely to
by LGBT patients (Tucker et al., 2007). have generally poorer mental health, engage in greater health-
The purpose of this article is to highlight the unique medi- limited activities and be more likely to smoke (Dilley et al.,
cal and psychosocial needs of LGBT patients as well as some 2009).
of the obstacles obstructing those needs. Moreover, this article Conron, Mimiaga and Landers (2010) examined data col-
will discuss the roles that counseling psychologists can as- lected between 2001 and 2008 by the Massachusetts Behavior-
sume within primary care to help prevent disparities in prima- al Risk Factor Surveillance survey, administered by a joint op-
ry healthcare among LGBT populations. eration between the Centers for Disease Control and Preven-
tion and the Massachusetts State Department of Public Health.
The researchers found that sexual minorities were significantly
more likely to report activity limitation, worry, smoking, drug
Correspondence concerning this article should be use, asthma, and lifetime sexual victimization (Conron, Mim-
directed to: iaga & Landers, 2010). Additionally, they found that gay men
were less likely to report annual prostate exams, while lesbi-
Ginger L. Dickson ans were more likely to report being overweight and having
gdickson@nmsu.edu multiple risks for cardiovascular disease. Finally, they found
that bisexual women were more likely to report binge drinking
Preventing Disparities for LGBT Patients
and lifetime physical intimate partner victimization (Conron, stance, 33% of surveyed physicians endorsed disagreeing or
Mimiaga & Landers, 2010). strongly disagreeing with same-sex marriage (Smith & Mat-
Buchmueller and Carpenter (2010) also examined health thews, 2007). Similarly, 42% of those surveyed would not al-
disparities between men and women in same-sex versus differ- low an asymptomatic student with HIV into a medical school,
ent-sex relationships using data collected through the Massa- while 66% would not refer a patient to an asymptomatic gen-
chusetts Behavioral Risk Factor Surveillance survey between eral surgeon with HIV. In addition, the results indicated that
2000 and 2007. The researchers found statistically significant homophobia was significantly correlated with HIV stigma.
differences between same-sex and different-sex couples. Com- The researchers noted that year of graduation from medical
pared to women in different-sex relationships, women in same school and level of homophobia predicted HIV stigma (Smith
-sex relationships were less likely to have health insurance, & Matthews, 2007).
less likely to have had a checkup within the past year, more Rondahl, Innala and Carlsson (2004) found that 36% of a
likely to report unmet medical needs and were less likely to sample of nurses and nursing students endorsed a statement
have had recent mammogram and Pap tests (Buchmueller & indicating that they would abstain from seeing a homosexual
Carpenter, 2010). Similarly, they found that men in same-sex or bisexual patient if they were given the option. Similarly,
relationships were less likely to have health insurance and Riordan (2004) found a common theme among LGBT health
more likely to report unmet medical needs than men in differ- workers in passing, or presenting themselves as heterosexual,
ent-sex relationships (Buchmueller & Carpenter, 2010). in order to avoid potential intolerance from patients (Riordan,
Healthy People 2020 (USPHS, 2010) summarized the 2004). Recently, Wynn (2010) interviewed LGBT medical
unique health disparities and risk factors within the LGBT students regarding their experience of prejudice in medical
population, such as increased prevalence of depression and su- school. The interviews revealed a high report of active dis-
icide rates, obesity, substance abuse, and a lack of adequate crimination among students against openly homosexual or bi-
health insurance. The report identified the goal to improve sexual students, the degree of which was found to be prevent-
the health, safety and well-being of lesbian, gay, bisexual and ing closeted students from coming out. In addition, some stu-
transgender (LGBT) individuals (USPHS, 2010). Moreover, dents reported inadequate training in working with LGBT pa-
it advocated for continued practice of successful efforts to tient populations (Wynn, 2010).
eliminate health disparities, such as physicians inquiring about The impact of heterosexism, homophobia, and heteronor-
a patients sexual orientation and identity and medical schools mativity within the healthcare system has been evidenced in
providing students and residents with greater exposure to surveys of LGBT patients. For instance, LGBT individuals
LGBT patients (USPSHS, 2010). have reported experiencing discrimination from health care
providers that include rude behaviors, verbal abuse, the provi-
Obstacles to Health and Wellness sion of inadequate treatment, and even refusal of treatment as
The Institute of Medicine (2011) identified two types of a result of their sexual orientation and/or gender identity
obstacles, personal and structural, that stand between LGBT (Kenagy, 2005; Scherzer, 2000; Sears, 2009).
patients and optimal medical and psychological wellness. Of- Previous discriminatory experiences with health care pro-
ten, these obstacles can be traced to negative stigma attached viders, fears of discrimination, internalized stigma and/or prej-
to non-heterosexual orientations, identities, and behaviors. udice may prevent LGBT individuals from tending to their
Personal-level barriers are the result of stigma and include the own healthcare needs. For instance, Willging, Salvador and
attitudes, beliefs, and behaviors of both health care providers Kano (2006) found that prevalent social stigma within a rural
and LGBT patients (Institute of Medicine, 2011). New Mexico community engendered safety concerns in
Recent studies have shown that personal-level barriers con- LGBT residents, resulting in their unwillingness to seek men-
tinue to exist within the medical field. These barriers may take tal health care directly from mental health professionals for
the form of heterosexism, or the belief in the superiority of fear of having to reveal their sexual identities. Instead, these
heterosexuality as a sexual identity; homophobia, or active individuals frequently utilized social support systems, such as
feelings of dread or hatred against sexual minorities; and het- family, community, and religious contacts, to attempt to meet
eronormativity, or the assumption that heterosexual relation- their mental health needs (Willging, Salvador & Kano, 2006).
ships and practices are the universal norm within society LGBT individuals may also internalize stigma related to
(Irwin, 2007; Haley-Bailey, Adams, Dickson, Hitter & Luna, non-heterosexual identities and/or behaviors and consequently
in press; Surtees & Gunn, 2010). Although active prejudice view themselves as undeserving of optimal health. As a result,
against members of the LGBT community has significantly LGBT individuals may delay seeking necessary medical care,
decreased since the early 1980s (Perrin, 2002; Smith & Mat- may not reveal their sexual orientation or other relevant infor-
thews, 2007), it has not been altogether eliminated. Smith and mation to health care providers, and may acquiesce to practic-
Matthews (2007) re-administered a survey from 1982 to assess es and policies that are discriminatory (Ponce, Cochran, Pizer,
levels of homophobia and HIV stigma among a sample of & Mays, 2010).
practicing physicians. The results did indicate a drastic drop in Structural barriers to optimal health care can exist in the
both measures when compared to the 1982 results, but sug- absence of prejudiced attitudes among individuals. They can
gested a continued presence of homophobia and HIV stigma include institutionalized policies and procedures that limit
within the medical field (Smith & Matthews, 2007). For in- LGBT individuals access to insurance and to practitioners
who are knowledgeable and affirming of LGBT issues. For health care) with medical professionals (primary care) in order
example, Irwin (2007) identified heteronormativity within pa- to meet the biopsychosocial needs of patients (Blount, 2003;
tient admission forms administered by nurses. These forms in- Weaver, 2008). Research indicates that these integrative ser-
cluded questions that assumed heterosexuality in asking about vice models can be effective in reducing health disparities and
marital status and in presuming that a patients next of kin improve patient health outcomes (Butler et al., 2008). Coun-
would be a spouse or biological family member. Kitts (2010) seling psychologists are especially well prepared to make
found that a majority of a sample of resident and attending unique contributions to the provision of integrative primary
physicians did not report engaging in best-practice techniques care and the prevention of disparate care for LGBT patients.
when working with adolescents who identified as homosexual Working within a multicultural paradigm is an integral
or bisexual. For instance, of the physicians surveyed, 29% re- component of the current training model for counseling psy-
ported regularly discussing sexual orientation with adolescent chologists. Counseling psychologists are well versed in the tri-
patients, 11% reported regularly discussing sexual attraction partite model of multicultural practice; they are aware of their
and only 8.5% reported regularly discussing gender identity. own values and biases, knowledgeable about the populations
Additionally, of the physicians surveyed, only 14% reported with which they work and have the skills to intervene in a cul-
that they would regularly assess whether sexual orientation turally appropriate manner (Ponterotto, 1997; Haley-Baileyet
was a contributing cause if an adolescent patient presented al., In press). In addition, counseling psychologists have been
with depression, while only 12% reported that they would do trained to address the influences of factors such as identity de-
so if an adolescent patient presented with suicidal ideation or velopment, culture, family, and social/work environments on
intent. Kitts (2010) also found that 22% of surveyed physi- patients health issues (Suzuki & Ponterotto, 2008). Clearly,
cians reported that they did not know that there is a link be- counseling psychologists can use their expertise to aid primary
tween being an LGBT adolescent and depression, while 33% care providers in overcoming the obstacles to meeting the
reported that they did not know that a similar link exists be- health care needs within the LGBT population.
tween being an LGBT adolescent and suicide. Finally, 51% of
surveyed physicians openly admitted that they did not believe Contributions of Counseling Psychologists
they had acquired the skills needed to work effectively within Tucker et al. (2007) outlined specific roles and strategies
the adolescent LGBT population (Kitts, 2010). that counseling psychologists can utilize to augment patient
Studies have shown that health care providers lack essen- health and prevention. Specifically, Tucker et al. (2007) dis-
tial training regarding the unique needs of LGBT patients and cussed the roles of health care staff trainer and consultant, pa-
are ill-prepared to provide them with culturally competent care tient and community health empowerment coach, health coun-
(Makadon, 2006; Tesar & Rovi, 1998). The Association for selor and psychotherapist, and health researcher. Counseling
American Medical Colleges Group on Student Affairs and the psychologists can provide direct and indirect services within
Association of American Medical Colleges Organization of each of these roles to help ameliorate the health disparities ex-
Student Representatives {AAMC GSA; AAMC OSR}(2007) perienced by LGBT patients in primary healthcare.
recommended specific training to facilitate effective commu- Research has shown that although interventions at the
nication with LGBT patients about sexual orientation and gen- training level, through medical school curriculum and didactic
der identity. However, a recent survey of medical school deans training, are the most effective means of increasing knowledge
indicated great variability in regard to the content and quality and skills and reducing prejudice, medical schools have fallen
of such training across different medical schools (Obedin- short in providing that training (Lock, 1998; Obedin-Maliver
Maliver et al., 2010). In fact, over two-thirds of the deans sur- et al., 2010). Assuming the role of health care staff trainer and
veyed rated their curriculum related to LGBT issues as fair consultant, counseling psychologists can work on an organiza-
or worse (Obedin-Maliver et al., 2010). tional and individual level to enhance healthcare providers
Current laws such as those preventing same-sex marriages knowledge about LGBT issues and how to better address their
are also structural barriers that have a negative impact on the unique needs. First, counseling psychologists can assist prima-
health and wellbeing of LGBT individuals. For example, in- ry health care professionals and facilities in assessing their or-
surance companies extend coverage only to same-sex married ganizational policies and procedures related to LGBT
partners and families; hence LGBT couples and their families healthcare equality (Association of Gay and Lesbian Psychia-
are more likely to be uninsured than married heterosexual cou- trists [AGLP] (2007).) For instance, counseling psychologists
ples and their families (Ponce et al., 2010). Clearly, difficul- can adapt the rating criteria provided in the Healthcare Quali-
ties in obtaining health insurance can limit access to affordable ty Index (Human Rights Campaign Foundation, 2010) to eval-
primary health care for LGBT individuals and ultimately re- uate the organizations policies regarding patient rights, com-
sult in unmet medical needs. petency training, and equal employment as they relate to the
LGBT population. Based on the information gleaned from the
Integrative Healthcare assessment, counseling psychologists can develop and imple-
Recent models of health care incorporate a holistic ap- ment a plan to help ameliorate any disparities identified.
proach to meeting the medical and psychosocial needs of pa- Second, as health care staff trainers and consultants, coun-
tients. Collaborative or integrative models of healthcare coor- seling psychologists can work directly with students, resident
dinate the services of mental health professionals (behavioral physicians, and other healthcare workers by providing training
that focuses on LGBT issues and medical needs, multicultural waiting rooms (GLMA, 2006). Additionally, they can assist
competence, and communication skills. Counseling psycholo- healthcare workers in modifying patient forms to ensure that
gists can use the on-line training curriculum sponsored by they contain inclusive language regarding partner status and
AGLP (2007) to expose healthcare professionals to didactic gender identity (GLMA, 2006).
information regarding the unique risk factors and medical is- Counseling psychologists can also help promote wellness
sues of the LGBT individuals and best practices for working within the LGBT population by acting as patient and commu-
with members of the LGBT population (AGLP, 2007). Coun- nity health empowerment coaches (Tucker et al., 2007). Coun-
seling psychologists can use their expertise in multicultural seling psychologists can educate LGBT clients about their
counseling (Ponterotto, 1997; Haley-Bailey, et al., In press) to unique health care needs and risk factors and encourage them
coordinate and/or provide workshops and didactic presenta- to utilize resources to advocate for their needs. Counseling
tions dedicated to engendering knowledge, awareness, and psychologists can teach LGBT clients behavioral techniques,
skills specific to working with LGBT patients. such as assertiveness training, to aid them in acquiring em-
By assessing the attitudes of healthcare providers toward powering communication skills to use as medical patients.
LGBT individuals, counseling psychologists can help increase These skills would also be useful in empowering LGBT cli-
awareness of negative attitudes and identify specific areas that ents to directly address public policy issues, including inequal-
need to be addressed through training (Tesar & Rovi, 1998). ities regarding health insurance (Buchmueller & Carpenter,
To increase awareness and knowledge, counseling psycholo- 2010; Haley-Bailey et al., In press). Counseling psychologists
gists presentations might focus on deconstructing biases and can familiarize themselves with community resources so that
stereotypes surrounding the LGBT community and encourag- they can connect LGBT patients with social networks, advoca-
ing critical thinking Haley-Bailey et al., In press). Including cy groups, and organizations from which they can draw sup-
panel presentations by LGBT health care professionals can be port (Matthews & Adams, 2009). Moreover, they can apply
an effective means of countering stereotypes and mispercep- for federal grants to establish programs that engender collabo-
tions (GLMA, 2006). To increase knowledge and skills, train- rations between LGBT organizations and health care centers
ing could be focused on taking detailed sexual histories of all (Tucker et al., 2007).
patients, which include asking about sexual orientation, part- As health counselors and psychotherapists, counseling psy-
ner status and sexual partners (GLMA, 2006). In addition, if a chologists can work directly with LGBT clients to promote
patient does belong to the LGBT community, health care health and prevention (Tucker et al., 2007). First, counseling
workers can be taught to always assess for the specific risk psychologists can address psychosocial barriers occluding op-
factors unique to the community (American Academy of Fam- timal health in their LGBT patients. For instance, they can
ily Physicians [AAFP], 2011). help LGBT patients dispute stereotypical myths that may con-
Tucker et al. (2007) suggested that counseling psycholo- tribute to their internalization of homophobia, which, in turn,
gists are, on a most fundamental level, expert communicators. may prevent them from seeking necessary medical care
As such, counseling psychologists can teach health care pro- (Dickson, 2009). Second, counseling psychologists can help
viders how to engage in patient-centered communication by patients explore beliefs and attitudes surrounding health and
means of using effective verbal and non-verbal interview wellness that may be detrimental to their health. Using tech-
skills and conveying empathy and understanding (Tucker et niques such as motivational interviewing, counseling psy-
al., 2007). As health care staff trainers and consultants, coun- chologists can help patients change detrimental health behav-
seling psychologists can teach health care providers how to iors prominent within the community, such as tobacco, drug
operate with cultural sensitivity and effectiveness (Tucker et and alcohol abuse and obesity (Dilley et al., 2009; Conron,
al., 2007). Specifically, counseling psychologists can empha- Mimiaga & Landers, 2010). Finally, counseling psychologists
size the necessity of being non-judgmental of LGBT patients can help LGBT clients cope with the effects of high risk dis-
and asking open-ended questions regarding partner status and eases, such as HIV/AIDS, on themselves, friends, family and
sexual relations (GLMA, 2006). Additionally, they can inform loved-ones (Tucker et al, 2007).
healthcare providers of the importance of using inclusive and Finally, as counseling psychologists are trained as scientist-
gender-neutral language, such as referring to ones partner practitioners, they can help promote prevention and wellness
rather than spouse, and to avoid making heteronormative in LGBT patient populations by conducting health research
statements such as asking male patients about their wives or (Tucker et al., 2007). Given the scant research into LGBT
girlfriends (GLMA, 2006). health and wellness, counseling psychologists can challenge
Consistent with patient-centered communication, counsel- heterosexism within primary care through research that is af-
ing psychologists can train health care providers to follow firming of the healthcare issues faced by the LGBT population
their patients leads when it comes to how they describe their (Matthews & Adams, 2009). Counseling psychologists can,
gender and sexual identities (GLMA, 2006). Health care pro- for instance, conduct outcome research to examine the effec-
viders can also be instructed about indirect forms of communi- tiveness of training in multicultural competency and commu-
cation, such as conveying positive messages through health nication skills for health care providers in promoting LGBT
care settings or within patient forms. For instance, counseling wellness. Such research could also examine the effectiveness
psychologists can suggest the importance of displaying LGBT of specific elements of this training in reducing disparities for
materials, such as Safe Space posters and brochures, in patient LGBT patients. Counseling psychologists can present this re-
search at academic and medical conferences and publish in differences in adult health. American Journal of Public
peer-reviewed journals as a means of more effectively dissem- Health, 100(5), e1-e7.
inating conclusions (Turner et al., 2007). Dickson, G. L. (2009). Homophobia/heterosexism. In B. T.
Erford (Ed.), The ACA Encyclopedia
Conclusion of Counseling (pp. 267-268). Alexandria, VA: American
LGBT individuals experience multiple obstacles in achiev- Counseling Association.
ing optimal health and wellness, many of which can be at- Dilley, J. A., Simmons, K. W., Boysun, M. J., Pizacani, B. A.,
tributed to the effects of stigma related to their sexual orienta- Stark, M. J. (2009). Demonstrating the importance and fea-
tion and/or gender identities. Counseling psychologists are sibility of including sexual orientation in public health sur-
uniquely qualified to address many of the personal- and struc- veys: Health disparities in the Pacific Northwest. American
tural-level barriers that LGBT individuals face in accessing Journal of Public Health, 99(10), 1-10.
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Enhancing Transformative Mediation to References

Ali, N. M. (2010). Enhancing transformative mediation to ad-
Address Family Conflict dress family conflict (Unpublished doctoral dissertation).
New Mexico State University, NM.
Natasha M. Ali and Michael Waldo Bush, R. A. B. & Pope, S. (2004). Transformative mediation:
New Mexico State University Changing the quality of family conflict interaction. In J.
Folberg, A. L. Milne & P. Salem (Eds.), Divorce and fami-
Poorly managed conflict in the family can lead to destructive ly mediation: Models, techniques, and applications (pp. 53-
consequences for children, such as increased aggression 71). New York, NY: Guilford Publications.
(McCoy, Cummings & Davies, 2009) and decreased ability to Chung, G. H., Flook, L. & Fuligni, A. J. (2009). Daily family
adjust to school (Sturge-Apple, Cummings & Davies, 2006). conflict and emotional distress among adolescents from
This outcome has been observed across families of diverse Latin American, Asian, and European backgrounds. Devel-
races and ethnicities (Chung, Flook & Fuligni, 2009; Emery, opmental Psychology, 45, 1406-1415.
1982). Mediation is a secondary prevention intervention that Donohue, W. A., Drake, L. & Roberto, A. J. (1994). Mediator
has the potential to help families constructively manage con- issue intervention strategies: A replication and some con-
flict (Emery, 1982). It has been shown to prevent destructive clusions. Mediation Quarterly, 11, 261-274.
outcomes associated with family conflict (Pearson & Tho- Emery, R. E. (1982). Interparental conflict and the children of
ennes, 1989). Despite its benefits, 30 to 40% of family media- discord and divorce. Psychological Bulletin, 92, 310-330.
tion clients complain of not feeling heard or understood McCoy, K., Cummings, E. M. & Davies, P. T. (2009). Con-
(Pearson & Thoennes, 1984). Mediators have also often failed structive and destructive marital conflict, emotional securi-
to attend to clients discussion of relationship concerns ty, and childrens prosocial behavior. Journal of Child Psy-
(Donohue, Drake & Roberto, 1994), despite clients desire to chology and Psychiatry, 50, 270-279.
gain insight into their own and their ex-spouses feelings Pearson, J. & Thoennes, N. (1984). A preliminary portrait of
(Pearson & Thoennes, 1989). One form of mediation that client reactions to three court mediation programs. Media-
holds promise to prevent destructive outcomes associated with tion Quarterly, 3, 21-40.
family conflict is transformative mediation (Bush & Pope, Pearson, J. & Thoennes, N. (1989). Divorce mediation: Re-
2004). However, no published research on the application of flections on a decade of research. In K. Kressel & D. G.
this mediation model to families currently exists (J. P. Folger, Pruitt (Eds.), Mediation research: The process and effec-
personal communication, October 19, 2010). In the current tiveness of third-party intervention (pp. 9-30). San Francis-
study, a traditional transformative mediation model was com- co, CA: Jossey-Bass.
pared to a version that had two modifications. The enhanced Sturge-Apple, M. L., Davies, P. T. & Cummings, E. M.
version incorporated exposure to Relationship Enhancement (2006). Impact of hostility and withdrawal in interparental
communication skills as a way to improve participants feeling conflict on parental emotional unavailability and childrens
heard and understood. It also included guidance in how to give adjustment difficulties. Child Development, 77, 1623-1641.
and receive interpersonal feedback as a way to improve partic-
ipants discussion of relationship concerns. Using a true ex- This abstract summarizes a study that is currently an un-
periment, pre-test post-test control group design, 32 diverse published doctoral dissertation completed in December 2010
families were randomly assigned to either a control group who (Ali, 2010). Correspondence concerning this abstract should
received traditional transformative mediation or an experi- be addressed to Natasha M. Ali, Counseling Center, Garcia
mental group who received enhanced transformative media- Annex, Room 100, MSC 3575, P.O. Box 30001, Las Cruces,
tion. Sixty-six participants were involved in the study. The NM, 88003. Email: natashaa@nmsu.edu
majority (n = 34) fell into the 36-55 age category, and 30 were
aged 18-35. Males and females were evenly distributed in the
sample. The majority of participants (n = 41) were bilingual
English and Spanish, and identified as Mexican-American (n
= 40). The results showed that no significant differences be-
tween the two groups existed in participants expressive
speaking skills, empathic listening skills, interpersonal learn-
ing, agreement rates, or satisfaction with mediation, all ps
> .05. However, the entire samples empathic listening and in-
terpersonal learning significantly increased from pre- to post-
mediation, (p < .05). These findings suggested that transform-
ative mediation, as practiced in this study, whether traditional
or enhanced, showed promise in helping families significantly
improve their empathic listening and interpersonal learning.
Self-Efficacy in Relapse Avoidance: weeks after treatment, F(7, 123) = 2.546, p = 0.018. Level of
education, R2 = 0.044, F(1, 129) = 5.920, p = 0.016, past
A Model of Prediction Using Drug Use year marijuana use R2 = 0.042, F(1, 125) = 1.426, p = 0.035,
History, Resilience, and Depression and resilience, R2 = 0.037, F(1, 124) = 5.253, p = 0.024 were
significant predictors of self-efficacy in relapse avoidance.
Natalie J. Gildar After controlling for levels of education, greater frequency
Arizona State University of past year marijuana use was associated with lower self-
efficacy in relapse avoidance two weeks after treatment. De-
Felipe Gonzlez Castro pression was not a predictor of self-efficacy in relapse avoid-
University of Texas at El Paso ance. Yet, prior studies have shown that depression among us-
ers significantly decreases after exposure to treatment
Substance use relapse rates are exceptionally high for peo- (Harvard et al., 2006). Conversely, greater resilience was a
ple in treatment, ranging from 50% - 80%, depending on the significant predictor of greater self-efficacy in relapse avoid-
drug and population studied (Moos & Moos, 2006). Self- ance. Future studies should expand on this finding.
efficacy in relapse avoidance is defined as a drug users belief The results of this study also have clinical implications for
that they have the ability to abstain from substance use after preventing substance use relapse. Clinicians could use these
treatment. Higher self-efficacy to avoid substance use is pre- findings to identify patients that may be at the highest risk for
dictive of better treatment outcomes, and is a factor in prevent- relapse. Finally, there were limitations to our study, including
ing relapse (Tate et al., 2008). Velicer, DiClemente, and Pro- data based solely on self-report inventories, a cross-sectional
chaska (1990) developed an integrative model of self-efficacy analytic design with post-hoc recall on some questions, design
among cigarette smokers, which suggested that Positive/ issues that should be addressed in a future investigation re-
Social, Negative/Affective, and Habit/Addictive, are the types garding the role of self-efficacy in relapse prevention.
of situations that determine a users confidence in avoiding re-
lapse. Further analysis is warranted to explore contributing References
factors that predict self-efficacy in relapse avoidance among Havard, A., Teesson, M., Darke, S., & Ross, J. (2006). De-
drug users based on Velicer et al.s categories. Drug use histo- pression among heroin users: 12-month outcomes from the
ry, resilience, and depression were used to represent these cat- Australian treatment outcome study (ATOS). Journal of
egories and research has demonstrated that each is related to Substance Abuse Treatment, 30, 355-362. doi: 10.1016/
self-efficacy in relapse avoidance. For a sample of drug users j.jsat.2006.03.012
in treatment, we hypothesized that: 1) level of education Moos, Rudolf H., & Moos, Bernice S. (2006). Rates and pre-
would be positively associated with self-efficacy in relapse dictors of relapse after natural and treated remission from
avoidance, and 2) lifetime and past year use of marijuana, her- alcohol use disorders. Addiction, 101, 212-222.
oin, cocaine, and methamphetamine, resilience, and depres- doi:10.1111/j.1360-0443.2006.01310.x
sion would predict self-efficacy in relapse avoidance. Tate, S. R., Wu, J., McQuaid, J. R., Cummins, K., Shriver, C.,
The current study draws on a subsample (N = 131) from Krenek, M., & Brown, S. A. (2008). Comorbidity of sub-
the Corazn Life Journeys of Drug Users in Treatment study, stance dependence and depression: Role of life stress and
which examined the lifetime trajectories of illegal drug users. self-efficacy in sustaining abstinence. Psychology of Ad-
Toward the end of their treatment, patients participated volun- dictive Behaviors, 22, 47-57. doi:10.1037/0893-
tarily in an extensive semi-structured interview, which 164X.22.1.47
consisted of multiple measures. The all-male participants Velicer, W. F., DiClemente, C. C., Rossi, J. S., & Prochaska,
ages ranged from 18 to 59 (M = 35.81; SD = 8.79). Partici- J. O. (1990). Relapse situations and self-efficacy: An inte-
pants were of varying ethnic identities, with 79.2% who grative model. Addictive Behaviors, 15, 271-283.
reported being born in the United States, 15.3% indicated that
they were born in Mexico, and 1.9% reported they were born Correspondence concerning this abstract should be addressed
in another country. For the present study, the Demographic to:
Survey, Drug Use Survey, CD-RISC (Connor-Davidson Resil-
ience Scale), CES-D (depression scale), and Self-Efficacy in Natalie J. Gildar, Doctoral Student, Counseling & Counseling
Substance Abuse Scale were used. Variables in domains Psychology, Arizona State University, Tempe, AZ 85287,
identified by previous research as predictors of self-efficacy in ngildar@asu.edu
relapse avoidance were entered into a hierarchical multiple
regression analysis. Constructs were entered in planned Felipe Gonzalez Castro, Professor and Director of Health Psy-
blocks: (Block 1 control variable; Block 2 past year drug chology, Department of Psychology, University of Texas at El
use variables; Block 3 resilience; Block 4 depression). Paso, El Paso, TX 79968, fcastro4@utep.edu
This hierarchical regression analysis showed that a linear
combination of these constructs accounted for 7.7% of the var-
iance in predicting self-efficacy in relapse avoidance two
Factors Correlated with Moral Resilience Carroll, A., Hattie, J., Durkin, K., & Houghton, S. (2001).
Goal-setting and reputation enhancement: Behavioral
among Children at High Risk of choices among delinquent, at-risk and not at-risk adoles-
Criminality: cents. Legal and Criminological Psychology, 6, 165-184.
Retrieved June 1, 2011, from the JSTOR database.
A Review of the Literature Greenwood, P. (2008). Prevention and Intervention Programs
for juvenile offenders. The Future of Children, 18, 185-
Samantha J. Toale and Thomas M. Brunner 210. Retrieved June 1, 2011, from the JSTOR database.
Jacobs, J., Vernon, M., & Eccles, J. (2004). Relations Between
This literature review examined a subsection of criminological Social Self-Perceptions, Time Use, and Pro-social or Prob-
literature by asking the central question: What factors are lem Behaviors During Adolescence. Journal of Adolescent
correlated with children who exhibit moral resilience (i.e., Research, 19, 45-54. Retrieved April 1, 2011, from the
moral hardiness or persistence) even though they - due to risk JSTOR database.
factors in their lives - are more likely to commit crimes? A Mednick, S., & Volavka, J. (1980). Biology and Crime. Crime
compelling body of research indicates that children who grow and Justice, 2, 85-158. Retrieved January 6, 2011, from the
up in certain conditions (e.g., low socio-economic status, be- JSTOR database.
ing raised in abusive homes, or having incarcerated parents) PADS+ Home Page. (n.d.). PADS+ Home Page. Retrieved Ju-
are at significantly greater risk of engaging in behavior that is ly 20, 2011.
illegal. By examining the subgroup of youth who are exposed Piquero, A., Farrington, D., & Blumstein, A. (2003). The
to these risk factors and yet still exude moral resilience, we Criminal Career Paradigm. Crime and Justice, 30, 359-
can add to the existing literature identifying protective factors. 506. Retrieved September 24, 2010, from the JSTOR data-
Our review of the literature revealed multiple positive factors base.
that seem to have a positive moral impact upon high risk Wikstrom, P.-O. H., & Svensson, R. (September 07, 2010).
youth. This review summarizes identified biological, perceptu- When does self-control matter? The interaction between
al/cognitive, and environmental protective factors domains morality and self-control in crime causation. European
that seem to deter or minimize the chances of criminality. Be- Journal of Criminology, 7, 395-410.
cause the body of literature assessing factors associated with
youth moral resilience is so small, there are not many clear da- Correspondence concerning this abstract should be addressed
ta based trends currently. However, this review analyzed each to Samantha Toale, sammiejt118@yahoo.com, or Thomas
of these three domains separately and found that prevention Brunner, Ph.D., 6614 E. Carondelet Drive, Tucson, AZ,
programs targeting all three of these domains had significantly 85710, solutions@doctorbrunner.com
better results in shoring up moral resilience among high risk
youth than those that were more narrowly focused. It is worth
noting that the largest scale study of moral development and
resilience indicated that presence and strength of an internal-
ized moral value system is a leading predictor of what we call
moral resilience. The literature indicates that moral resili-
ence is significantly affected by the environmental domain.
Given our review, we suggest future directions for studies of
moral resilience.
References
Aleixo, P., & Norris, C. (2000). Personality and moral reason-
ing in young offenders. Personality and Individual Differ-
ences, 28, 609-623. Retrieved September 24, 2010, from
the JSTOR database.
Blueprints | Center for the Study and Prevention of Violence |
CU-Boulder. (n.d.). University of Colorado Boulder. Re-
trieved July 24, 2011, from http://www.colorado.edu/cspv/
blueprints/
Bogenschneider, K. (1996). Family Related Prevention Pro-
grams: An ecological risk/protective theory for building
prevention programs, policies, and community capacity to
support youth. Family Relations, 45, 127-138. Retrieved
September 24, 2010, from the JSTOR database.
Parent and Romantic Partner Attachment Parent and Romantic Partner Attachment
Styles Among Chinese/Chinese- Styles Among Cambodian/Cambodian-
Americans and European-Americans Americans
Juliana V. Yam Juliana V. Yam and Sheila J. Henderson
Alliant International University/CSPP Alliant International University/CSPP
The study examined anxious and avoidant attachment patterns This study sought to evaluate parent and romantic partner at-
to both parent and romantic partner across two groups, 75 Chi- tachment among Cambodian/Cambodian-Americans, building
nese/Chinese-Americans (ages 18 to 55; mean = 28.32, SD = on a previous study with Chinese-Americans and European-
8.8) and 75 European-Americans (ages 20 to 65; mean = Americans (Yam, 2007). Ninety-three Cambodian/Cambodian
34.40, SD = 13.04). Participants were recruited from the San -American participants (ages 18 to 63; mean = 30.80, SD =
Francisco Bay Area to participate in an online self-report sur- 10.97) were recruited from a Buddhist temple in the North-
vey, the Experiences in Close Relationships-Revised (ECR-R: western United States during a celebration. Two versions of
Fraley, Waller, & Brennan, 2000). The research questions the Experiences in Close Relationship-Revised Scale (a 36-
were: (a) Are there differences between parent and romantic item self-report instrument, ECR-R: Fraley, Waller, & Bren-
partner attachment styles in Chinese/Chinese-Americans and nan, 2000) were utilized, one pertaining to anxious and
European-Americans? (b) Are parent attachment styles associ- avoidant feelings toward a parent, and one pertaining to these
ated with romantic partner attachment styles among Chinese/ feelings toward a romantic partner. The research question was:
Chinese-Americans and European-Americans? The hypothe- Are there differences between parent and romantic partner at-
ses were: (a) There will be differences in the relationship be- tachment styles in Cambodian/Cambodian-Americans? The
tween anxious and avoidant attachment to parent and to ro- hypotheses were: (a) Anxiety and avoidant attachment style
mantic partner among Chinese/Chinese-Americans and Euro- with the parent would be correlated with anxiety and avoidant
pean-Americans; and (b) Anxious and avoidant attachment attachment with the partner; and (b) Gender differences would
style to the parent will be positively correlated with the same be apparent for both parent and romantic partner attachment.
attachment style to romantic partner among both Chinese/ A positive correlation was found between anxiety and avoid-
Chinese-Americans and European-Americans. Significant dif- ance with parent and with romantic partner. Chi-square anal-
ferences were found between the ethnic groups. Chinese/ yses indicated a significant interaction effect between gender
Chinese- Americans endorsed higher attachment anxiety and and attachment to partner, but not to parent. The results sug-
avoidance with both parent and romantic partner than did Eu- gested that parent attachment patterns may tend to be trans-
ropean-Americans. Though anxious attachment to parent and ferred to the romantic partner relationship, consistent with
romantic partner were positively correlated in both ethnic Bowlbys (1973) attachment theory. The study also found that
groups, a positive correlation was found for avoidant attach- women felt less secure in romantic relationships than did the
ment between parent and romantic partner only among Euro- men. One might speculate that war trauma may have been
pean-Americans. These differences might imply cultural dif- passed down inter-generationally, disproportionately affecting
ferences in how individuals relate to their parent and romantic women over men. These findings do not support assertions of
partner, suggesting the need for more cross-cultural research causality, but instead provide data for the formation of new
on parent and adult attachment. Results from additional re- hypotheses. The results may inform the focus of preventive in-
search could inform preventive interventions focused improv- terventions designed to improve relationships for this popula-
ing couples relationships and parenting. tion.
Reference References
Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An Bowlby, J. (1973). Attachment and loss: Separation, anxiety
item response theory analysis of self-report measures of and anger. New York: Basic Books.
adult attachment. Journal of Personality and Social Psy- Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An
chology, 78, 350-365. doi: 10.1037/0022-3514.78.2.350 item response theory analysis of self-report measures of
adult attachment. Journal of Personality and Social Psy-
Correspondence concerning this abstract should be addressed chology, 78, 350-365. doi: 10.1037/0022-3514.78.2.350
to Juliana V. Yam, Department of Psychology, Alliant Inter- Yam, J. V. (2007). Parent and romantic partner attachment
national University/CSPP, One Beach St., San Francisco, CA styles. Unpublished manuscript, Clinical Psychology Ph.D.
94133, jyam@alliant.edu. Program, California School of Professional Psychology.
Correspondence concerning this abstract should be addressed

to Juliana V. Yam, Department of Psychology, Alliant Inter-
national University/CSPP, One Beach St., San Francisco, CA
94133, jyam@alliant.edu.

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