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OBJECTIVE To identify challenges veterinarians faced during the COVID-19 pandemic, explore how they coped, identify coping strategies associated with greater resilience, and determine incentives and barriers to performing healthy coping behaviors. SAMPLES 266 surveys completed by veterinarians in the Potomac region. PROCEDURES A cross-sectional survey was distributed electronically through veterinary medical boards and professional associations between June and September 2021. RESULTS Most survey responses came from veterinarians working in Maryland (128/266 [48%]) and Virginia (63/266 [24%]) who were predominantly white (186/266 [70%]), female (162/266 [61%]), and working in small-animal clinical practice (185/266 [70%]). The greatest workplace challenges experienced were increased workloads (195/266 [73%]) and reevaluating existing workflows (189/266 [71%]). Separation from loved ones (161/266 [61%]) was the greatest personal challenge. Of the veterinarians who completed the 10-point Connor-Davidson Resilience Scale (n = 219), which measures resilience on a scale from 0 (no resilience) to 40 (greatest resilience), the mean score was 29.6 (SD, 6.9), with a median of 30 (IQR = 10). Intrinsic factors most strongly associated with greater resilience were increasing age (P = .01) and later career stage (P = .002). Job satisfaction, autonomy, good work-life balance, and approach-focused coping strategies were positively associated with resilience. Overwhelmingly, the primary reported barrier to performing healthy coping behaviors was limited time to devote to self-care (177/266 [67%]). CLINICAL RELEVANCE A combination of individual approach-focused coping strategies and organizational interventions are crucial to support a resilient veterinary workforce.

Abstract. Background: Suicide is a serious public health problem for LGBTQ+ adolescents and young adults. Attachment-based family therapy (ABFT) is one of the few suicide treatment models that has been tested with this population. The challenge remains in how to implement ABFT into the ecology of LGBTQ+ service settings. Aims: In this study, we tested the feasibility, acceptability, and preliminary effectiveness of ABFT in LGBTQ+ community settings. Method: Ten participants were enrolled in 16 weeks of ABFT across three LGBTQ+ organizations. Feasibility (treatment completion) and acceptability (Working Alliance Inventory [WAI]; opinions about treatment [OAT]) were measured for youth and caregivers. Depression and suicide outcomes were assessed for nine participants. Results: ABFT was demonstrated to be both feasible and acceptable. All participants completed treatment, and there were no dropouts. Adolescents/young adults and their caregivers reported high WAI and adequate OAT scores throughout treatment. There was a significant decrease in suicidal ideation (β = −12.16, t(10) = −3.14, p < .01). Decreases in depression, however, were not significant (β = −1.83, t(9.11) = −0.88, p = .40). Limitations: The small sample limits our ability to estimate treatment effectiveness. A larger effectiveness trial is warranted. Conclusion: ABFT is a promising treatment for LGBTQ+ service settings.

Close relationships are consequential for youth depressive symptoms and suicide risk, but nuanced research examining intersecting factors is needed to improve identification and intervention. This study examines a clinical, residential sample of 939 adolescents and young adults ages 10 to 23 years old (M = 15.84, SD = 1.53; 97.7% white, 99.5% non-Hispanic, 55% female). The final model found that family conflict, parental criticism, verbal bullying, and interactions with friends were associated with depressive symptoms in the expected directions, and there were significant interactions with family, peer, and demographic variables. However, most associations with suicide risk were indirect. Associations involving family factors, peer factors, depressive symptoms, and suicide are not always straightforward, and should be understood within a microsystemic context.

The COVID‐19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment‐based family therapy (ABFT) in the context of telehealth and COVID‐19. ABFT is an empirically supported treatment model designed for adolescents and young adults struggling with depression, anxiety, trauma, and suicide. ABFT is a semi‐structured, process‐oriented, and trauma‐informed family therapy model which presents its own unique challenges and benefits in telehealth environments. We present our adaptations based on years of telehealth clinical experience and address how this model supports the impact of COVID‐19 on families.

In the wake of the COVID‐19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi‐square analyses, a t‐test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in‐person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.El suicidio es un problema de salud pública cada vez mayor entre los adolescentes. Si bien la mayoría de los jóvenes transgénero y de géneros diversos (TGD) son saludables, muchos tienen pensamientos y conductas suicidas. Debido a la discriminación y al estigma, los índices de intento de suicidio en los jóvenes TGD son más altos que en los jóvenes heterosexuales, cisgénero e incluso LGBQ cisgénero. A pesar de esta vulnerabilidad al suicidio, se han desarrollado y se han evaluado pocos tratamientos para esta población. Un tratamiento, la terapia familiar basada en el apego (TFBA), se ha adaptado para trabajar con jóvenes LGBQ y puede ser prometedor para adolescentes TGD en riesgo de suicidio. Este artículo ofrece un resumen de nuestras modificaciones a la TFBA para los jóvenes TGD con pensamientos de suicidio. Específicamente, ilustramos cómo los resultados del tratamiento, en un solo caso práctico, se relacionan con los procesos dentro de las tareas del tratamiento clínico. El caso práctico demuestra la aplicación de estas modificaciones de la TFBA con un adolescente que se identificó como de género no conforme (y que recientemente había intentado suicidarse) y sus cuidadores. Se recopilaron las valoraciones de una evaluación del tratamiento durante el transcurso de 24 semanas para ilustrar el avance clínico del joven. Los síntomas de suicidio del joven disminuyeron notablemente al final del tratamiento. Además, la familia informó una mayor capacidad para resolver problemas y una comunicación más abierta al concluir el tratamiento.自杀是青少年中一个日益严重的公共卫生问题。虽然大多数变性和性别多样化（TGD）的青少年是健康的，但许多人经历过有自杀的念头和有自杀行为（STB）出现的时候。由于歧视和感到被污名化，TGD青少年试图自杀的比例高于异性恋、双性恋，还有双性恋的LGBQ青少年。尽管这类人群很容易有自杀的可能性，但针对这一人群的治疗方法很少被开发和试验出来。有一种治疗方法，即基于依恋的家庭治疗（ABFT）已被应用于针对LGBQ青少年的治疗方法，并可能对有自杀风险的TGD青少年有帮助。本文概述了我们对有自杀想法的TGD青少年进行干预的ABFT的实践。具体来说，我们在一个单一的案例研究中，说明了治疗结果与临床治疗任务的过程之间的关系。该案例研究展示了这些ABFT调适之后的应用，对象是一个自我认同的、性别不一致的青少年（他最近曾试图自杀）和他的照顾者。在24周的时间里，治疗评估措施都被汇总，以说明该青少年的临床进展。在治疗结束时，该青少年的自杀症状明显减少了。此外，家庭报告说，在治疗结束时，其解决问题的能力有所提高，沟通也更加开放。.

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 = 181, p = .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 = 12.61, p < .0001; effect size, d = 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 = 10.88, p < .0001; effect size, d = 1.93). Response rates (ie, ≥50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators. Clinical trial registration information: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419. Published (Publication status)

Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14–24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms. Published (Publication status)

Family factors have continually been identified as potential risk and protective factors for youth at risk for suicide. This paper reviews family processes that not only are associated with suicide risk, but also might be malleable enough to target in treatment. We also review family intervention components that have been incorporated into most youth suicide treatments. Unfortunately, research on if and how these family processes moderate, mediate or change as a result of treatment is limited. Recommendations for future research are offered.

Suicide is a serious public health problem among adolescent and young adults. Indeed, 12.1% of adolescents contemplate suicide, 4.0% make a plan, and 4.1% make an attempt (Nock et al., 2013). LGBTQIA+ youth (i.e., lesbian, gay, bisexual, transgender, questioning/queer, intersex and/or asexual adolescents and young adults) are particularly vulnerable to suicide (CDC, 2016; Liu & Mustanksi, 2012; Peters et al., 2019). While many LGBTQIA+ youth are healthy and resilient (Ream & Savin-Williams, 2005) they often report higher rates of both suicidal ideation and behavior than their heterosexual (Haas et al., 2011) and cisgender (James et al., 2016) peers. The purpose of this paper is to provide a structured review the state of suicide treatment research for LGBTQIA+ youth and offer recommendations for future directions. Published (Publication status)

Suicide ideation and behavior are pervasive public health issues. Given that positive interpersonal relationships can be a protective factor against suicide risk, we conducted a systematic review to examine peer-reviewed publications from 2010 to 2019 that included empirical data, tested an intervention with at least some family component, and included a suicide-related outcome measure. We reviewed and synthesized findings from 22 articles covering 7 intervention categories with 12 interventions to examine the treatment components and the quality of evidence to support them. Using Southam-Gerow and Prinstein's (Child Adolesc Psychol 43:16, 2014) guidelines, we identified two well-established intervention categories that met the highest standards for interventions and three probably efficacious intervention categories. All interventions found focused solely on suicide risk in adolescent populations. More studies are needed for adult populations and to explore the role of family moderators and mediators to test whether suicide outcomes are reduced by improvement in the family environment.

The majority of sexual minority adolescents are well-adjusted and healthy, however, on average, 28% report suicidal ideation and between 15% and 40% make a suicide attempt each year. These rates are two to seven times higher than those found among heterosexual youths. Research has shown the protective function of parental support and acceptance, as well as the deleterious effects of parental criticism, invalidation, and rejection on the mental health of sexual minority adolescents. Given these risk and protective factors, these adolescents might benefit from an intervention that targets family relationships. Toward this goal, Attachment-Based Family Therapy (ABFT) specifically aims to improve the quality of adolescent–parent relationships. In prior treatment developmental work, ABFT was adapted and pilot tested for depressed and suicidal lesbian, gay, and bisexual (LGB) adolescents. By adopting an evidence-based case study format, this paper provides a case summary to illustrate how the therapy was conducted. The case study consists of a vignette, followed by therapy task descriptions and illustrative transcripts. Examples of key therapeutic moments in ABFT, for depressed and suicidal LGB adolescents, are discussed in the context of the case. Published (Publication status)

Adolescent anorexia nervosa (AN) has a significant and long-standing impact for the health and well being of young people and their families. The determinants of illness are multi-factorial, however, adolescent AN has been consistently associated with parental distress (e.g., depression, anxiety, alcoholism), family conflict, and low parental warmth toward the adolescent. Whilst Family Based Therapy (FBT) for adolescent AN is the recommended first line of treatment, a substantial proportion of patients do not experience remission by the end of therapy or may relapse following remission. Although a range of adjuncts to FBT have been proposed, no preferred model has emerged. In this paper, we compare and contrast Attachment-Based Family Therapy (ABFT) with FBT, and argue that ABFT’s focus on relationships, rather than behaviours, could make a substantive contribution to the practice of FBT. We present a case study to demonstrate how ABFT may help to alleviate some of the maintaining factors of adolescent AN through the repair of parent–child relational ruptures. Published (Publication status)

Despite condemnation of same-sex attraction by certain religious groups, few studies have explored the relationship between religion, same-sex attraction, and suicidality. This study examined the moderating effect of same-sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two-way dichotomous (same-sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same-sex attraction but fewer attempts in those reporting opposite-sex attraction only.

Background. Although therapeutic alliance is a robust predictor of treatment outcomes in child and adolescent psychotherapy, less is known about relational factors, such as youth’s attachment, to mothers and fathers. The current study investigated anxious or avoidant attachment to mothers or fathers as predictors of early formation of the therapeutic alliance in a high-risk sample of depressed and suicidal adolescents. Methods. Changes in adolescents’ alliance ratings between the first and fourth treatment sessions was examined in a comparative efficacy trial (N = 115) of Attachment Based Family Therapy and Family Enhanced Non-Directive Supportive Therapy for suicidal and depressed adolescents. Multilevel regression analysis accounted for nested data by therapist and treatment condition. Results. After accounting for significant random effects in our multilevel model associated with therapist to treatment condition, results revealed a significant effect of perceived insecurity to mothers leading to lower levels of therapeutic alliance at session four (β = -0.49, p < .05). Discussion. The quality of adolescents’ attachments to parents may play an important role in adolescents’ ability to form strong working relationships with a therapist. Findings suggested that adolescents with avoidant attachment styles may be more difficult to engage in treatment and could benefit from specific interventions focused on alliance-building. Published (Publication status)

Attachment-Based Family Therapy (ABFT) is an evidence-based model designed to treat depressed and suicidal adolescents. ABFT works with adolescent psychopathology in the context of family relationships by addressing ruptures in the parent–child relationship and restoring parents’ caregiving capacities and adolescents trust in attachment security. This paper provides a rational for family-based treatments for this disorder, an overview of clinical model and a review of some of the empirically work supporting the treatment efficacy and effectiveness.

Theories in career development have discussed the importance of career decision-making self-efficacy (CDMSE); however, there has been little development in this area for the lesbian, gay, and bisexual (LGB) community. Research has shown that LGB individuals may experience disruptions in career development if psychological energy is diverted to developing sexual identity. The present study sought to determine if authenticity, a strength-based characteristic, predicted CDMSE among LGB individuals. Survey results from 95 LGB-identified individuals indicated that components of authenticity, specifically unbiased processing and awareness, accounted for a significant amount of variance in CDMSE. Implications for social service professionals are discussed. © 2014 © Taylor & Francis Group, LLC. Published (Publication status)

Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT. Published (Publication status)

Journaling is a thread that ties together all aspects of the POTT model. The POTT model then expects students to focus their journals on the use of this self-awareness to actively, positively and purposefully use themselves, with whatever their personal issues, as a therapeutic tool. The grading of journal content deepens to match the student's immersion in the model. The goal is to expose students to experience the dual process of the POTT model. Journaling guidelines for the winter term direct students to connect their signature themes to their clinical work. The purpose of building the clinical example into journals is to enhance students' ability to apply the POTT model actively in their clinical placements. The goal of the journal-grading framework is to spur students to reach the point where they be readily recognize and access what they personally bring to the clinical process, and use it as a mechanism to relate, assess and intervene instinctively in their clinical work.

Marriage and family therapists grapple with the intersection of societal influence and African American clients’ presenting problems. Questions include: what impact has the historical trauma of slavery had on African Americans and what are the clinical implications of this trauma? This paper reviews the literature on the various residual effects of slavery (RES) within the African American community. A case vignette and a broad discussion of therapeutic techniques will be used to highlight the clinical implications of RES.

Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) youth exhibit significantly higher rates of mental health problems, including anxiety, depression, suicidal ideation, and nonsuicidal selfinjury than their heterosexual peers. Past studies tend to group LGBQ youth together; however, more recent studies suggest subtle differences in risk between sexual minority groups. This study examined differences in mental health symptoms across male and female youth who are attracted to the same sex (gay and lesbian), opposite sex (heterosexual), both sexes (bisexual), or are unsure of whom they were attracted to (questioning) in a sample of 2,513 youth (ages 14e24 years). Methods: Data were collected using the Behavioral Health Screenda Web-based screening tool that assesses psychiatric symptoms and risk behaviorsdduring routine well visits. Results: Bisexual and questioning females endorsed significantly higher scores on the depression, anxiety, and traumatic distress subscales than did heterosexual females. Lesbians, bisexual females, and questioning females all exhibited significantly higher lifetime suicide scores than heterosexual females. Interestingly, bisexual females exhibited the highest current suicide scores. Gay and bisexual males endorsed significantly higher scores on the depression and traumatic distress subscales than did heterosexual males. Gay males also exhibited higher scores on the anxiety subscale than heterosexual males, with bisexual males exhibiting a nonsignificant trend toward higher scores as well. Conclusions: Findings highlight varying level of risk across subgroups of LGBQ youth and suggest the importance of considering LGBQ groups separately in the context of a behavioral health assessment, especially for females. Published (Publication status)

Research shows that gay and bisexual males are at increased risk for disordered eating symptoms (DES); however, studies examining DES amongst lesbians and bisexual women have produced mixed findings. Furthermore, few studies have included questioning or “unsure” individuals. This study examined DES symptoms in adolescents and young adults across self-reported sexual attraction and behavior. Participants were recruited from ten primary care sites in Pennsylvania and administered the Behavioral Health Screen (BHS) – a web-based screening tool that assesses psychiatric symptoms and risk behaviors – during a routine visit. As expected, males who were attracted to other males exhibited significantly higher disordered eating scores than those only attracted to members of the opposite sex. Males who engaged in sexual activities with other males also exhibited significantly higher scores than those who only engaged in sexual activities with females. Amongst females, there were no significant differences in DES scores between females who were only attracted to females and those only attracted to males. Those who reported being attracted to both sexes, however, had significantly higher scores, on average, than those only attracted to one sex. More surprisingly, females who were unsure of who they were attracted to reported the highest DES scores of all. These findings are contrary to previous assumptions that same-sex attraction plays a protective role against eating pathology in females. Females who are unsure or attracted to both sexes may actually be at increased risk for developing DES. Published (Publication status)

Views on therapists- attraction have influenced the ethical and professional development of the mental health fields. Because the majority of therapist attraction literature (63.6%) has been conducted from a psychoanalytic standpoint, approaches to attraction from feminist perspectives have not been adequately developed. Considering the lack of a feminist voice regarding attraction, this article attempts to offer a feminist perspective on this issue. The purpose of this article is to offer a feminist perspective on the phenomenon of attraction in order to raise awareness about the importance of power inequalities, intersectionalities, contextual variables and the need for action in the field., {"references":["American Psychological Association. Ethical standards of Psychologists\n(Rev. ed.). Washington, D.C.: Author, 1977. (a)","American Psychological Association. Standards for providers of\npsychological services. Author, 1977. (b)","Beauvoir, S. d. (1989). The Second Sex, trans. H. M. Parshley, New\nYork: Vintage Books.","Bernsen, A., Tabachnick, B. G, & Pope, K.S. (1994). National survey of\nsocial workers' sexual attraction to their clients: Results, implications,\nand comparison to psychologists. Ethics & Behavior, 4, 369-388.\ndoi:10.1207/s15327019eb0404","Brayner, I. A. (1996). Erotic transference and countertransference in the\nanalysis of children and adolescents: Aggressivity and eroticism.\nRevistaBrasileira de Psicanalise ,30,4, 1147-1156. Retrieved from\nhttp://www.datenschlag.org/english/bisam/year/index.html","Cantor, J.R., Zillmann, D., & Bryant, J. (1975) Enhancement of\nExperienced Sexual Arousal in Response to Erotic Stimuli Through\nMisattribution of Unrelated Residual Excitation. Journal of Personality\nand Social Psychology, 32, 69-75. doi: 10.1037/h0076784","Corey, G. (2008). Theory and Practice: Counseling and Psychotherapy.\nBelmont, CA: Cenage Learning.","Davies, J. M. (1994). 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