Medicine and Health Sciences Commons^™

Beyond English Only: Addressing Language Interpretation In Professional Psychology Training, Timothy B. Smith, Clay A. Frandsen, Derek Griner, Domenech Rodriguez, Guillermo Bernal

Faculty Publications

Professional guidelines direct that psychologists working with clients with limited English proficiency should involve an interpreter if a mental health professional fluent in the client’s language is unavailable. However, complexities of interpreted therapy require training. We describe nine relevant areas of trainee skill acquisition and also surveyed 102 multicultural course instructors in APA-accredited psychology programs regarding current professional training. Only 55 (54%) instructors reported providing any training on working with language interpreters, with 16 (16%) providing more than 2 hours of training. Instructors ranked nine proposed skill areas and gave recommendations for over coming barriers and working with interpreters to …

Adding Psychotherapy To The Naltrexone Treatment Of Alcohol Use Disorder: Metaanalytic Review, Rizwan A. Ahmed, Vijaya P. Kotapati, Ali M. Khan, Nuzhat Hussain, Mudasar Hussain, Sara Dar, Jeevan Kumar, Gulshan A. Begum, Michael Esang, Navjot Brainch, Saeed Ahmed

School of Medicine Publications and Presentations

Background

It remains unclear if naltrexone combined with psychotherapy is superior to naltrexone alone in treating alcohol use disorders (AUD). The current meta-analysis examined the hypothesis that psychotherapy is a significant moderator that influences AUD-related outcomes and that naltrexone combined with psychotherapy is associated with significantly better AUD-related outcomes than naltrexone alone.

Methods

A total of 30 studies (Nnaltrexone = 2317; Nplacebo = 2056) were included. Random effects model meta-analyses were carried out for each of the studied outcomes. Subsequently, the random effects model pooled estimates from studies with and without psychotherapy were compared using a Wald test. A mixed-effect …

Mdma-Assisted Psychotherapy For Posttraumatic Stress Disorder: A Review Of The Literature, Erin Solomon

Student Works

A growing number of people suffer chronic, treatment-resistant posttraumatic stress disorder (PTSD; Amoroso & Workman, 2016; Buoso, Doblin, Farré, Alcázar, & Gómez-Jarabo, 2008; Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011; Oehen, Traber, Widmer, & Schnyder, 2013). The most popular treatments, including exposure therapy, may not be effective for some people (Amoroso & Workman, 2016; Mithoefer et al., 2011). Treatment dropout and suicidality are high among people for whom therapy is minimally effective (Amoroso, 2015; Amoroso & Workman, 2016; Mithoefer et al., 2011; Oehen et al., 2013). Researchers have begun to investigate 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy as a possible treatment for PTSD …

Treatment For Depression And Health-Related Quality Of Life Among Adults With Arthritis, Drishti Shah, Pragya Rai, Nilanjana Dwibedi, Usha Sambamoorthi

Clinical and Translational Science Institute

Depression treatment has been proven to relieve depressive symptoms and pain and may therefore improve the health-related quality of life (HRQoL) among adults with arthritis. The objective of the current study was to examine the HRQoL associated with depression treatment among adults with arthritis and depression. A retrospective longitudinal cohort study design using data from the Medical Expenditure Panel Survey (2009–2012) was adopted. The study sample consisted of adults (≥21 years) with co-existing arthritis and depression (N = 1692). Depression treatment was categorized into: antidepressants only, psychotherapy with or without antidepressants, and neither antidepressants nor psychotherapy. Multivariable Ordinary Least Square …

Effects And Moderators Of Psychosocial Interventions On Quality Of Life, And Emotional And Social Function In Patients With Cancer: An Individual Patient Data Meta-Analysis Of 22 Rcts, J. Kalter, I. M. Verdonck-De Leeuw, M. G. Sweegers, N. K. Aaronson, P. B. Jacobsen, R. U. Newton, K. S. Courneya, J. F. Aitken, J. Armes, C. Arving, L. J. Boersma, A. M.J. Braamse, Y. Brandberg, S. K. Chambers, J. Dekker, K. Ell, R. J. Ferguson, M. F.M. Gielissen, B. Glimelius, M. M. Goedendorp, K. D. Graves, Sue P. Heiney, R. Horne, M. S. Hunter, B. Johansson, M. L. Kimman, H. Knoop

Faculty Publications

Objective: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. Methods: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied …

Mind The Hype: A Critical Evaluation And Prescriptive Agenda For Research On Mindfulness And Meditation, Nicholas T. Van Dam, Marieke K. Van Vugt, David R. Vago, Laura Schmalzl, Clifford D. Saron, Andrew Olendzki, Ted Meissner, Sara W. Lazar, Catherine E. Kerr, Jolie Gorchov, Kieran C. R. Fox, Brent A. Field, Willoughby B. Britton, Julie A. Brefczynski-Lewis, David E. Meyer

Clinical and Translational Science Institute

During the past two decades, mindfulness meditation has gone from being a fringe topic of scientific investigation to being an occasional replacement for psychotherapy, tool of corporate well-being, widely implemented educational practice, and “key to building more resilient soldiers”. Yet the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed. Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and explicates crucial methodological issues for …

Effects And Moderators Of Psychosocial Interventions On Quality Of Life, And Emotional And Social Function In Patients With Cancer: An Individual Patient Data Meta‐Analysis Of 22 Rcts, J. Kalter, I. M. Verdonck-De Leeuw, M. G. Sweegers, N. K. Aaronson, P. B. Jacobsen, Robert U. Newton, K. S. Courneya, J. F. Aitken, J. Armes, C. Arving, L. J. Boersma, A. M.J. Braamse, Y. Brandberg, S. K. Chambers, J. Dekker, K. Ell, R. J. Ferguson, M. F. M. Gielissen, B. Glimelius, M. M. Goedendorp, K. D. Graves, S. P. Heiney, R. Horne, M. S. Hunter, B. Johansson, M. L. Kimman, H. Knoop, K. Meneses, L. L. Northouse, H. S. Oldenburg, J. B. Prins, J. Savard, M. Van Beurden, S. W. Van Den Berg, J. Brug, Laurien M. Buffart

Research outputs 2014 to 2021

Objective

This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics.

Methods

Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied …

Feelings Of Enlightenment: A Hermeneutic Interpretation Of Latent Enlightenment Assumptions In Greenberg's Emotion-Focused Therapy, Alex A. Gomez

Antioch University Full-Text Dissertations & Theses

The purpose of this dissertation is to explore how a mainstream theory of psychological practice might inadvertently conceal and ignore contemporary values and ideologies and their pathological consequences. Through a hermeneutic approach, I interpreted Leslie Greenberg’s Emotion-focused therapy: Coaching clients to work through their feelings (2^nd ed), a popular and widely used theory in psychotherapy. As a practitioner with humanistic foundations, this was also an opportunity for the author to understand his own unexamined values as a therapist. Specific EFT constructs and concepts that reflected Enlightenment assumptions and values were examined. EFT was situated within Enlightenment philosophy, particularly …

Prevention Of Recurrent Affective Episodes Using Extinction Training In The Reconsolidation Window: A Testable Psychotherapeutic Strategy., Robert M Post, Robert Kegan

Psychiatry and Behavioral Sciences Faculty Publications

Stressors may initially precipitate affective episodes, but with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. If this were the case, cognitive behavior therapy targeted toward extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window (which opens about 5 min to 1 h after active memory recall) can revise, reverse, or eliminate the long term memories associated …

Depression Treatment Patterns Among Adults With Chronic Obstructive Pulmonary Disease And Depression, Arijita Deb, Usha Sambamoorthi

Clinical and Translational Science Institute

Objective—To estimate rates and the patterns of depression treatment among adults with Chronic Obstructive Pulmonary Disease (COPD) and depression. Methods—We used a retrospective, cross-sectional study design, pooling data from 2010 and 2012 Medical Expenditure Panel Survey (MEPS). The study sample consisted of 527 individuals aged 21 years or older, diagnosed with COPD and depression. Depression treatment was grouped into 3 categories based on those who received: 1) neither antidepressant nor psychotherapy; 2) antidepressants only; and 3) psychotherapy combined with antidepressants (combination therapy). We conducted chi-squared tests and multinomial logistic regressions to examine factors (demographic, socio-economic characteristics, healthcare access, health status, …

A Systematic Review On The Use Of Psychosocial Interventions In Conjunction With Medications For The Treatment Of Opioid Addiction, K Dugosh, A. Abraham, B. Seymour, K. Mcloyd, M. Chalk, David Festinger

PCOM Scholarly Papers

Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions …

How Clinicians Feel About Working With Spouses Of The Chronically Ill, Douglas Ingram

NYMC Faculty Publications

Clinicians who provide psychotherapy to spouses or partners of the chronically ill were solicited through listserves of psychodynamic and other organizations. The current report excluded those therapists working with spouses of dementia patients. Interviews were conducted with clinicians who responded. The interviews highlight the challenges commonly encountered by psychotherapeutic work with this cohort of therapy patients. A comparison is drawn that shows both overlap and distinctions between the experiences of those therapists engaging with spouses of chronically ill patients without a dementing process and those working with spouses of chronically ill patients who do suffer from a dementing process.

Piloting A Psychotherapy Group For Transgender Clients: Description And Clinical Considerations For Practitioners, Nicholas C. Heck, Leslie C. Croot, Jennifer S. Robohm

Psychology Faculty Research and Publications

The likelihood that a psychologist will work with a transgender client is greater today than ever before; however, many psychologists report being unfamiliar with the challenges faced by this population. Training programs provide minimal exposure to transgender issues by way of coursework and practicum experiences, and many barriers prevent transgender persons from accessing quality mental health care. The provision of group psychotherapy services in psychology training clinics may help reduce barriers to treatment, but there is little literature to guide professionals interested in facilitating such a group. In response, this article provides psychologists with a description of an experiential/process psychotherapy …

Uncovering The Concealed Part Of Motherhood-Postpartum Depression In Mothers, Hunaina Hadi, Shamsa Hadi

School of Nursing & Midwifery

Introduction: Motherhood is the most pleasing experience of a woman's life. Birth of a child gives birth to new hopes and ambitions. But Post-partum Depression is a condition when this blessing turns into curse. It can affect the mother, the partner and the child and can even lead to infanticide as well as maternal death, often by suicide.

Method: A qualitative systematic review was conducted through electronic medium to explore the relevant literature. Various databases i.e. Pubmed, Google search engines, Science Direct, JPMA, the Cumulative Index to Nursing and Allied Health Literature CINHAL and SAGA were used. Manual search was …

Spiritual Pathways To Healing And Recovery: An Intensive Single-N Study Of An Eating Disorder Patient, Kawika Allen, Troy Lea, P. Scott Richards, Peter W. Sanders, Jason A. Mcbride

Faculty Publications

This article presents an in-depth single case study of 8 sessions of spiritually integrated psychotherapy with a 20-year-old woman recovering from an Eating Disorder. The inclusion and utility of session-to-session outcome data as well as systematic follow up data in conjunction with in-depth qualitative interviews are shown. Dr. H and client’s perspectives are highlighted over the course of treatment. Clinical areas of focus were extracted from the the qualitative interviews and the therapeutic process is described. Single-case study statistical analyses were conducted to highlight clinical gains and maintenance.

Bringing Spiritually Oriented Psychotherapies Into The Health Care Mainstream: A Call For Worldwide Collaboration, Kawika Allen, P. Scott Richards, Peter W. Sanders, Troy Lea, Jason A. Mcbride

Faculty Publications

The purpose of this article is to describe an overall strategy and specific plans for bringing spiritually oriented treatment approaches into the health care mainstream. We describe Bridges, a practice-research network created in 2012 that is devoted to helping practitioners, researchers, educators, and pastoral professionals collaboratively pursue this goal. We describe the achievements of Bridges thus far, which include a website for networking, an online psychotherapy research system, several completed studies, and grant funding for future collaborative research studies. We conclude with an invitation to health care professionals around the world to join with us in efforts to mainstream spirituality …

Common Psychosocial And Spiritual Factors Among Individuals Who Have Healed From Chronic Lyme Disease, Frederick Green

Antioch University Full-Text Dissertations & Theses

This dissertation examined the subjective experience of individuals who have healed from Chronic Lyme Disease (CLD). Despite significant attention paid to the controversy over CLD diagnosis and treatment, scholarly research has neglected the psychosocial and/or spiritual factors that facilitate healing from the perspective of CLD sufferers. This study addressed this research gap by using Interpretive Phenomenological Analysis (IPA) to explore the barriers and facilitators of healing among those who have healed from CLD. Six participants who had suffered from CLD and considered themselves healed from the disease were recruited and interviewed. The qualitative data was reduced to meaning units, which …

Low Vision Depression Prevention Trial In Age-Related Macular Degeneration: A Randomized Clinical Trial., Barry W. Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, Allen C Ho, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD).

DESIGN: Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months.

PARTICIPANTS: Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188).

INTERVENTIONS: Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment …

Ketamine Psychedelic Psychotherapy: Focus On Its Pharmacology, Phenomenology, And Clinical Applications, Eli Kolp, Harris L. Friedman, Evgeny Krupitsky, Karl Jansen, Mark Sylvester, M. Scott Young, Anna Kolp

Mental Health Law & Policy Faculty Publications

Meant to be an authoritative guide for psychiatrists and others interested in understanding and applying ketamine psychedelic psychotherapy (KPP), this paper focuses on its pharmacology, phenomenology, and clinical applications. Ketamine is a dissociative anesthetic widely used by physicians and veterinarians in the United States. In addition to its anesthetic and dissociative properties, ketamine also has a multitude of other psychological and pharmacological properties, which include analgesic, sedative, neuroprotective, anxiolytic, antidepressant, stimulant, euphoriant, and hallucinogenic effects. The literature on the clinical application of KPP is comprehensively reviewed, practical advice for using KPP is given, and the pharmacology and phenomenology of ketamine-induced …

Improving Sexual Health In Men With Prostate Cancer: Randomised Controlled Trial Of Exercise And Psychosexual Therapies, Prue Cormie, Suzanne K. Chambers, Robert U. Newton, Robert A. Gardiner, Nigel Spry, Dennis R. Taaffe, David Joseph, M Akhlil Hamid, Peter Chong, David Hughes, Kyra Hamilton, Daniel A. Galvão

Research outputs 2014 to 2021

Background: Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men …

Measuring Fragmentation In Dissociative Identity Disorder: The Integration Measure And Relationship To Switching And Time In Therapy, M. Rose Barlow, James A. Chu

Psychological Sciences Faculty Publications and Presentations

Background: Some people with dissociative identity disorder (DID) have very little communication or awareness among the parts of their identity, while others experience a great deal of cooperation among alternate identities. Previous research on this topic has been sparse. Currently, there is no empirical measure of integration versus fragmentation in a person with DID. In this study, we report the development of such a measure.

Objective: The goal of this study was to pilot the integration measure (IM) and to address its psychometric properties and relationships to other measures. The IM is the first standardized measure of integration in DID. …

Seasoned Psychotherapists' Experience Of Difficult Clinical Moments, Kirk J. Honda

Antioch University Full-Text Dissertations & Theses

Purpose: This phenomenological study was concerned with the clarification of the experience of the difficult clinical moment which is defined as a discrete moment in which the psychotherapist experiences distress as a result of his or her work with a client. Method: Retrospective descriptions of experience of difficult clinical moments were obtained from a diverse sample of ten seasoned psychotherapists in the Seattle area. The interviews were transcribed, analyzed, and summarized, and these summaries were confirmed by each participant as being an accurate representation of their experience. Results: Thematic analysis revealed six themes of experience during a difficult clinical moment: …

Antipsychotic Prescriptions For Children Aged 5 Or Younger: Do We Need Policy Oversight Standards?, Ana Lopez-De Fede, Medha Vyavaharkar, Jessica D. Bellinger

Publications

The use of antipsychotics in very young children is of concern given the lack of empirical evidence in their efficacy and long-term impact on children’s health. This study examined the prescription of antipsychotics among children aged ≤5 years enrolled in a state Medicaid program. Secondary data analysis was conducted using the Medicaid administrative data of a southeastern state. Using SAS 9.3, descriptive statistics were performed to examine socio-demographic characteristics, psychiatric diagnoses, off-label use, receipt of medications from multiple psychotropic drug classes, and receipt of non-pharmacologic psychiatric services among children aged ≤5 years who received antipsychotic prescriptions in calendar year (CY) …

Factors That Promote And Inhibit Client Disclosure Of Suicidal Ideation, Robert William Orf

Antioch University Full-Text Dissertations & Theses

Approximately 36,000 people commit suicide in the U.S. each year, making it the fourth leading cause of death for adults between 18 and 65-years-old. Clients participating in psychotherapeutic treatment are at elevated risk for suicide, due to the emotional distress that drives their entry into psychotherapy. Therapists cannot know the full extent of their clients’ risk for suicide if clients do not fully confide their thoughts and intentions. The current study sought to discover factors that inhibit and promote client disclosure of these thoughts and behaviors. The study utilized the Suicidal Ideation in Psychotherapy Questionnaire (SIPQ), a questionnaire developed for …

Psychotherapy And The Embodiment Of The Neuronal Identity: A Hermeneutic Study Of Louis Cozolino's (2010) The Neuroscience Of Psychotherapy: Healing The Social Brain , Ari Simon Natinsky

Antioch University Full-Text Dissertations & Theses

In recent years, there have been several ways in which researchers have attempted to integrate psychotherapy and neuroscience research. Neuroscience has been proposed as a method of addressing lingering questions about how best to integrate psychotherapy theories and explain their efficacy. For example, some psychotherapy outcome studies have included neuroimaging of participants in order to propose neurobiological bases of effective psychological interventions (e.g., Paquette et al., 2003). Other theorists have used cognitive neuroscience research to suggest neurobiological correlates of various psychotherapy theories and concepts (e.g., Schore, 2012). These efforts seem to embody broader historical trends, including the hope that neuroscience …

Social Compass Curriculum: Three Descriptive Case Studies Of Social Skills Outcomes For Students With Autism, Louanne E. Boyd, Deborah M. Ward

Engineering Faculty Articles and Research

The Social Compass Curriculum (SCC) was investigated for its effectiveness in improving core social skills in three descriptive case studies of students with autism. Treatment fidelity of the SCC was also measured in the school setting. The Social Responsiveness Scale and the Autism Social Skills Profile were completed by parents to measure pre- and postintervention social skills for three students aged 8 to 11 years who participated in the present multisite pilot study. Fidelity of implementation data were collected via a checklist during observations for three educators who implemented the intervention. Results indicate that the SCC improved core social deficits …

Freeing The Voice Within Through Guided Imagery And Music, Amy Clements-Cortés

Music Faculty Publications

This paper presents the case study of a 38-year-old female, "Joy," and her Guided Imagery and Music (GIM) process. Joy was born in Hong Kong and immigrated to Canada in 2008 to pursue further studies along with her husband. Joy is a music educator who was drawn to GIM to explore issues with her parents, husband, anxiety and stress in order to lead her to improved well-being and healing. This paper provides the relevant background information on GIM, and several important topics in Joy's therapeutic process, including: gender issues being raised in Hong Kong, effects of parental gambling on child …

Predicting Optimal Cancer Rehabilitation And Supportive Care (Polaris): Rationale And Design For Meta-Analyses Of Individual Patient Data Of Randomized Controlled Trials That Evaluate The Effect Of Physical Activity And Psychosocial Interventions On Health-Related Quality Of Life In Cancer Survivors, Laurien M. Buffart, Joeri Kalter, Mai Jm Chinapaw, Martijn W. Heymans, Neil K. Aaronson, Kerry S. Courneya, Paul B. Jacobsen, Robert Newton, Irma M. Verdonck-De Leeuw, Johannes Brug

Research outputs 2013

Effective interventions to improve quality of life of cancer survivors are essential. Numerous randomized controlled trials have evaluated the effects of physical activity or psychosocial interventions on health-related quality of life of cancer survivors, with generally small sample sizes and modest effects. Better targeted interventions may result in larger effects. To realize such targeted interventions, we must determine which interventions that are presently available work for which patients, and what the underlying mechanisms are (that is, the moderators and mediators of physical activity and psychosocial interventions). Individual patient data meta-analysis has been described as the ‘gold standard’ of systematic review …

Measurement Of A Model Of Implementation For Health Care: Toward A Testable Theory, Joan M. Cook, Casey O'Donnell, Stephanie Dinnen, James C. Coyne, Josef I. Ruzek, Paula P. Schnurr

Dartmouth Scholarship

Greenhalgh et al. used a considerable evidence-base to develop a comprehensive model of implementation of innovations in healthcare organizations [1]. However, these authors did not fully operationalize their model, making it difficult to test formally. The present paper represents a first step in operationalizing Greenhalgh et al.'s model by providing background, rationale, working definitions, and measurement of key constructs.A systematic review of the literature was conducted for key words representing 53 separate sub-constructs from six of the model's broad constructs. Using an iterative process, we reviewed existing measures and utilized or adapted items. Where no one measure was deemed appropriate, …

Psychotherapy Clients’ Online Behavior And Opinions Regarding Internet Searches Conducted By Therapists, Emily B. Gale

Department of Psychology: Dissertations, Theses, and Student Research

The Internet has become possibly the most popular medium to find information and communicate in our society. For the field of psychology, the Internet offers a new way to collect data and communicate with both study participants and, for practicing psychologists, possibly clients. Little is known, however, about the implications of interacting with clients online. The existing empirical studies in this area (DiLillo & Gale, 2011; Lehavot, Barnett, & Powers, 2010; Taylor et al., 2010) have focused on psychology graduate students’ actions online. These studies highlight the importance and paucity of research regarding the online behaviors of psychotherapy clients and …