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Full-Text Articles in Social and Behavioral Sciences
Suicidality Among Black Women: Considering Resiliency Within The Historic And Societal Context Of Risk, Samantha J. North
Suicidality Among Black Women: Considering Resiliency Within The Historic And Societal Context Of Risk, Samantha J. North
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Suicide is a global health challenge that has been historically understudied among Black women. The interpersonal-psychological theory of suicidality (IPTS) is a primary theory examined in suicidality; however, the three factors within the theory (lack of belongingness, perceived burdensomeness, and capability to die) focus on the individual. The purpose of the current study was to examine these factors in an expanded context of the historical and societal impact of oppression. A mixed methods Qualtrics study was administered to Black women who voluntarily completed the survey anonymously. Quantitatively, the study found significant differences between the impact of the IPTS factors on …
Empowering Providers To Empower Their Patients: One Model To Expand Knowledge, Competency, And Awareness For The Perinatal Substance Use Workforce, Jacqueline Jacobs
Empowering Providers To Empower Their Patients: One Model To Expand Knowledge, Competency, And Awareness For The Perinatal Substance Use Workforce, Jacqueline Jacobs
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Perinatal substance use (PSU) is a serious and growing public health concern. It is associated with a variety of adverse health outcomes for both mother and child and has been shown to negatively impact the parent-child relationship. Despite the growing prevalence of PSU, there are notable deficits in provider knowledge regarding, and comfortability with, PSU. Moreover, providers report feelings of judgment, resentment, fear, and hesitancy related to their work with women with PSU. Subsequently, women with PSU struggle to find appropriate, compassionate, and effective treatment for their substance misuse. Widespread and accessible training is needed to bolster provider knowledge base, …
Perinatal Through 5-Years-Old Referral List, And Full Referral Flow Process For The Professional Psychology Clinic And Associated Clinics, Lauren V. Cruz
Perinatal Through 5-Years-Old Referral List, And Full Referral Flow Process For The Professional Psychology Clinic And Associated Clinics, Lauren V. Cruz
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Referrals are an important and underacknowledged component of ethical clinical practice. While clinical care is understandably the core focus for most organizations, effective and efficient referrals can aide in improving client outcomes through successful connections to services, effective use of conjunctive services, and increased trust in mental health and healthcare systems/providers. In addition, improvements in the referral process can serve to decrease undue burden on providers and organizations. This document aims to review the literature on the need for and use of referrals, as well as elements of successful referrals, to inform the development of a referral self-assessment and flow …
Adapting Grief And Bereavement-Focused Cognitive Behavioral Therapy For Chinese-Identifying Individuals In America: A Cultural Analysis, Ian Tsang
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Anti-Asian hate as well as shifting circumstances brought on by current events all around the world highlight the increased need for mental health support and services in an ever-growing Chinese population in the United States, particularly in regard to grief work. Additionally, Chinese Americans demonstrate a disproportionate and lower utilization of mental health services, especially in comparison to the general population in the country. This paper discusses the various factors contributing to this phenomenon before presenting recommendations for culturally adapting evidence-based approaches to grieving individuals in the target population. More specifically, a cultural analysis consisting of topics such as Chinese …
An Intersubjective Approach To The Role Of Anger In Differentiation And The Development Of A Cohesive Self: A Case Study, Hannah Schriber
An Intersubjective Approach To The Role Of Anger In Differentiation And The Development Of A Cohesive Self: A Case Study, Hannah Schriber
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
The anger-turned-inward theory of depression has been extensively explored in psychodynamic literature. Still, little has been written about how modern relational approaches work with anger to aid patients in developing a healthy self-concept. This paper will first focus on a literature review of anger in Self Psychology and Intersubjective Systems Theory. These theories view anger as the manifestation of asserting one’s self after narcissistic injury. This paper will explore the relationship between anger and depression with an intersubjective lens utilizing the case study of Martha. Here I conceptualize depression as an introjective defense against misattuned early relational experiences. I explore …
Paternal Perinatal Psychopathology And Stigma Related To Nicu Admission, Hudson Holland Jones
Paternal Perinatal Psychopathology And Stigma Related To Nicu Admission, Hudson Holland Jones
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Stigma or the belief that mental health difficulties stem from a personal weakness, moral failing, or poor choices and will subject one to shame, embarrassment, scrutiny, victimization, oppression, and ostracization is a reason people choose to avoid, not to obtain or fully engage in mental health treatments despite their demonstrated effectiveness (Corrigan, 2004;Vogel et al., 2006). Gender differences have been found in experiences of stigma; for example, men were found to self-stigmatize to justify avoiding counseling to a greater degree than women (Judd et al., 2008). As such, stigma has been identified as a gender-salient variable that serves as a …
Weplay Denver: The Why And How: Background And Implementation Manual, Lauren Gross
Weplay Denver: The Why And How: Background And Implementation Manual, Lauren Gross
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
WePlay Denver (WePlay and Nosotros Jugamos; see glossary) is a program providing caregiver-infant playgroups designed to teach families with young children the value of play as well as provide information and resources on topics related to child development, family wellbeing, and mental health. WePlay and Nosotros Jugamos are a collaboration between the University of Denver’s Graduate School of Professional Psychology (GSPP) and the Children’s Museum of Denver, Marsico Campus, and are based on a similar program from the Chicago Children’s Museum. WePlay offered its first playgroup in 2019, while Nosotros Jugamos began in 2020.
A Qualitative Analysis Of Treatment Providers’ Understanding And Assessment Of Trauma And Autism, Leah Hanson
A Qualitative Analysis Of Treatment Providers’ Understanding And Assessment Of Trauma And Autism, Leah Hanson
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Patients with autism spectrum disorder (ASD) are particularly vulnerable to traumatic experiences and further development of posttraumatic stress disorder (PTSD). Underlying traumatic stress is commonly missed and remained untreated in the autism population. In a previous pilot study, Hanson and Richards (2021) gathered providers’ understandings on trauma and autism The current study is a further, systemic content analysis on archival data from Hanson and Richard’s pilot study. Results from the current content analysis of the responses to Question 1 (How do you assess for trauma in your patients?) revealed that providers assess patients’ trauma primarily by interviewing caregiver and patients, …
Cognitive Assessment Of Latinx/E Bilinguals In The United States: A Fictitious Case Study, Vanessa Magro
Cognitive Assessment Of Latinx/E Bilinguals In The United States: A Fictitious Case Study, Vanessa Magro
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Despite a growing body of literature and best-practice guidelines and considerations, assessment providers working with Latinx/e populations are left with numerous questions about how to translate these ideas into practice. This paper is meant to begin to answer some of these questions for Spanish-speaking providers administering cognitive tests to bilingual Latinx/e clients in the United States. The basis for these answers is a comprehensive literature review and my experience providing culturally-responsive assessment services to a bilingual Latinx/e population in the United States. A fictitious case study is included so that providers can get a concrete idea of how to bring …
Parental Misattunement And The Production Of Shame Of Existing: How To Address The Shame Of Existing Through An Intersubjective Systems Approach, Tal Ginsburg
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Shame is at the root of many commonly encountered psychopathologies. Its development has often been attributed to early childhood emotional misattunement. In severe cases, individuals can develop an extreme form of shame called the “shame-of-existing”. This paper primarily intends to contribute to the limited research about the shame-of-existing, which includes psychoanalytic perspectives from 1950-1990s, and theoretical analysis in 2014. The concept of shame of existence will be explored through an in-depth case study analysis of a 31-year-old, heterosexual, cisgender, white male who presented to psychotherapy with low-self-worth, and shame in acknowledging his own emotions and needs. This client was treated …
The Misattuned Music Industry: An Intersubjective Perspective On The Music Industry's Mental Health Crisis, Jonathan Fricke
The Misattuned Music Industry: An Intersubjective Perspective On The Music Industry's Mental Health Crisis, Jonathan Fricke
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Research shows that professional musicians tend to experience higher rates of mental health challenges compared to the general population. While there are a number of underlying factors and historical experiences that may help us to better understand these psychological struggles, I will be examining the relational system between musician and the music industry beginning at the time in which an amateur musician transitions to the professional realm. With this transition comes incredible demand and pressure from the industry. Professional musicians are at the mercy of grueling tour schedules where they spend months away from loved ones, must be "on" at …
Psychedelic Assisted Psychotherapy: Equity Through Contextual Frameworks, Emanuel Hermosillo
Psychedelic Assisted Psychotherapy: Equity Through Contextual Frameworks, Emanuel Hermosillo
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Psychedelic assisted psychotherapy (PAP) is a psychotherapeutic modality in which the non-ordinary states of consciousness that result from the consumption of psychedelic medicines are utilized to facilitate therapeutic healing. A wide range of cultures have used a variety of these psychotropic substances as medicines since ancient times, and there has been a resurgence of interest in their beneficial properties across many disciplines including psychology. Given that there are extra dimensions of vulnerability in using these medicines therapeutically, increased attention needs to be given to diversity, equity, and inclusion across psychedelic research and clinical practices. This paper focuses on how internal …
The Necessity Of Trauma-Focused Curricula In Mental Health Graduate Programs: Advocating For Comprehensive Trauma Etiology And Treatment Education With Proposed Course Outline, Aaron S. Gillespie
The Necessity Of Trauma-Focused Curricula In Mental Health Graduate Programs: Advocating For Comprehensive Trauma Etiology And Treatment Education With Proposed Course Outline, Aaron S. Gillespie
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
During the past four decades, it has become increasingly clear how prevalent trauma, polytrauma and co-morbid trauma-related disorders are within our shared, global communities. A growing body of research continues to uncover the mind-boggling impact these overwhelming experiences have on individuals, their families, and the communities that support them, including mental health professionals. It behooves us as allied mental healthcare providers to learn what trauma is, how it may affect the individual across the lifespan, as well as how to effectively identify and treat the trauma-related symptoms our clients present with. However, despite a proliferation of research demonstrating the growing …
Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn
Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
This paper seeks to articulate lessons learned from feedback received after a severe injury in order to help guide neuropsychologists provide effective feedback to patients. Given that there is no agreed upon conceptual framework for providing neuropsychological assessment feedback, parallels are drawn from what works in clinical psychology – the working alliance. I use personal examples to highlight how the working alliance, as well as other psychological principles, can help inform neuropsychologists provide the most effective feedback to patients.
An Assessment Of Adhd/Ld Support In Psyd Programs From The Perspective Of Faculty Advisors, Mac Zimdars
An Assessment Of Adhd/Ld Support In Psyd Programs From The Perspective Of Faculty Advisors, Mac Zimdars
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Among psychologists and doctoral psychology students, 14.3% and 10.7% reported having Attention Deficit Hyperactivity Disorder (ADHD) or learning disabilities (LD), respectively; 67.3% of those with any disability experienced disability-related impediments and discrimination during graduate school or the application process (Lund et al., 2014). This paper is focused on assessing current PsyD program supports for students with ADHD/LD from a faculty advisor perspective. Specifically, this research assesses the faculty advisor-advisee relationship, as well as available support services and resources. Data was collected from an anonymous survey and utilized an empirical mixed-methods approach. Three themes emerged from the study: (1) Advisors lack …
Athletic Injury And Resources For Student-Athletes: A Proposal For An Athlete Injury Playbook, Jessica J. Pauley
Athletic Injury And Resources For Student-Athletes: A Proposal For An Athlete Injury Playbook, Jessica J. Pauley
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Athletic injury happens frequently and is rarely predictable. While injury is common in sport involvement at all levels, this proposal focused on National Collegiate Athletic Association (NCAA) student-athletes and expanding the resources they have available to them. The vast literature on athletic injury and rehabilitation in sport has served researchers and academic consumers, and unfortunately, has lacked an easily accessible resource for student-athletes and sports medicine professionals to utilize. Therefore, the purpose of this doctoral paper was to propose a resource focused on post-athletic injury and written for collegiate student-athletes to understand called, The Secret Playbook. This playbook included information …
Psychologists’ Graduate Training Experience And Attitudes In Religion And Spirituality, Kristi Santiago
Psychologists’ Graduate Training Experience And Attitudes In Religion And Spirituality, Kristi Santiago
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
In a nationwide poll, 76% of the population of the United States identifies with a formal religion of some kind (Gallup Organization, 2021). Despite the prevalence of religion and spirituality (R/S) throughout the country, graduate programs appear to neglect training on this multicultural issue. The purpose of this paper is to better understand psychologists’ attitudes toward the quality and depth of their graduate training in R/S, determine how competent psychologists feel at managing discussions of R/S within psychotherapy, and recommend necessary improvements to graduate training in R/S. Data was collected using a 24-item, online survey, which was circulated throughout college …
La Luz: Illuminating The Effects Of Language And Considering The Role Of Culture In A Postpartum Depression Prevention Program For Spanish- And English-Speaking Mothers, Erin Flanagan
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Postpartum depression (PPD) is a common and concerning mental health condition. Many prevention programs and interventions have been researched to prevent or alleviate symptoms of postpartum depression. The current study aimed to examine the effects of a psychoeducational PPD prevention program (ROSE), administered in the early postpartum period, on reported PPD symptoms and parenting self-efficacy beliefs in both English and Spanish speaking women. The study investigated the hypotheses that: a PPD prevention program which has been validated in the prenatal period would be efficacious in reducing depressive symptoms when administered postpartum; the PPD prevention program would improve parenting self-efficacy; and …
Psychologists On Interdisciplinary Teams: Barriers To Interdisciplinary Work For Psychologists At The Pre-Doctoral Level And Beyond, Alison C. Swisher
Psychologists On Interdisciplinary Teams: Barriers To Interdisciplinary Work For Psychologists At The Pre-Doctoral Level And Beyond, Alison C. Swisher
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
With the shift of psychologists into practice in interdisciplinary medical settings, where might these providers receive adequate training for effective entry into these roles? The field of health psychology struggles to adequately keep up with the need for specialized psychologists within medical settings. Training programs have historically failed to provide training opportunities within interdisciplinary medical settings. This project examined the interviews of three psychologists with experience working and training pre-doctoral level students in interdisciplinary, health-focused, medical settings. Based on the information gathered herein, it appears that the barriers to training pre-doctoral psychology students within medical establishments stem from the following …
It Takes A Village: Tribalism As A Premise To Understand Societal Responsibility And Impact Of Mass Violence, Paige D. Schultz
It Takes A Village: Tribalism As A Premise To Understand Societal Responsibility And Impact Of Mass Violence, Paige D. Schultz
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
What is a mass shooter? This is difficult to answer as there is no single definition. The definition of a mass shooter depends on contextual factors including victim count, setting, and motivation (Gramlich, 2019). The Federal Bureau of Investigation (FBI) defines active shooters as “one or more individuals actively engaged in killing or attempting to kill people in a populated area” (Federal Bureau of Investigation, 2021, page 1). While other definitions are used to identify a mass shooter, given the breadth of study in this area by the FBI, this paper will use the FBI definition.
The Devil’S Advocate: The Relational Therapist As Jung’S Fourth In The Treatment Of Queer Christian Clients, Whitney Wilson
The Devil’S Advocate: The Relational Therapist As Jung’S Fourth In The Treatment Of Queer Christian Clients, Whitney Wilson
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
This paper is an exploration of C.G. Jung’s essay, A Psychological Approach to the Dogma of the Trinity, and how he inadvertently provides a relational psychodynamic lens for working with queer Christian clients who are differentiating from their harmful, embedded theologies. Jung hypothesizes that the Christian Trinity archetype – the Father, Son, and Holy Ghost, cannot exist without a fourth member, the Devil, who holds an essential role in the successful differentiation of the Trinity. The relational therapist is called to act as the Devil when working with queer Christian clients - inviting in seemingly mischievous and dangerous thoughts that …
Bipolar Disorder & Substance Use Treatment In Adults: A Tool For Recovery, Kaitlin Vieweg Parker
Bipolar Disorder & Substance Use Treatment In Adults: A Tool For Recovery, Kaitlin Vieweg Parker
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Bipolar Disorder is an affective disorder characterized by moderate to extreme lability in emotional states where individuals experience symptoms of mania, hypomania, mixed mood and/or depression. Individuals may be diagnosed with bipolar I disorder, which is hallmarked by extreme mood lability between mood states of mania and depression. Alternatively, bipolar II disorder is distinguished by fluctuating hypomanic and depressive episodes (DSM-V, 2014). Cyclothymia is defined by shifting mood states that are less severe than bipolar I or II. According to the National Alliance on Mental Illness (NAMI, 2017), 2.8% of adults in the United States are diagnosed with a type …
The Intersubjective Perspective: An Effective Treatment Model For Incarcerated Clients, Zachary Grant Weiss
The Intersubjective Perspective: An Effective Treatment Model For Incarcerated Clients, Zachary Grant Weiss
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Although there is already a large body of theoretical literature on the utility of Intersubjective Systems Theory in working with more challenging clinical presentations, little has been written about the use of this approach in working with incarcerated clients. In this paper, I will be making the case for the utility and need for the Intersubjective Perspective in working within the forensic system. This paper will first focus on building a general framework for Intersubjective Systems Theory, and its theoretical understanding of clients’ striving towards health, love and connection. Next, this paper will take time to focus on a brief …
Unreality And Loss Of Self: Dissociative Experiences In Buddhist Practitioners, Jill Loving
Unreality And Loss Of Self: Dissociative Experiences In Buddhist Practitioners, Jill Loving
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
On the surface, the Buddhist idea of emptiness and experiences of depersonalization and derealization seem to have significant overlap. Meditations on emptiness in the Buddhist tradition seek to lead meditators to observe the ego as illusory and empty of inherent content as one step in the journey to liberate oneself from suffering. Conversely, dissociation is generally an involuntary, automatic response to severe trauma that can become more common or chronic in an individual over time. Topographically, these experiences may look similar; both include a sense of unreality of the self and often of the broader world. However, differences in stimulus …
Attachment Theory To Inform Intervention In Correctional Populations With Adverse Childhood Experiences And Substance Use Disorders, Samantha Mendoza
Attachment Theory To Inform Intervention In Correctional Populations With Adverse Childhood Experiences And Substance Use Disorders, Samantha Mendoza
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Research shows a correlation exists between Adverse Childhood Experiences (ACEs) and poor mental health such as psychiatric and substance use disorders (Adshead, 2018). Research further suggests a correlation between ACEs and insecure attachment in adults (Adshead, 2018). The National Institute on Drug Abuse (2020) estimates 85% of the correctional population either has a substance use disorder or was incarcerated for a drug-related offense. This paper theorizes that those involved in the correctional system with a history of high ACE scores and substance use also experience insecure attachment, which is not currently addressed in correctional SUD programs. Attachment theory moderates the …
Can Brazilian Jiu Jitsu Be A Viable Treatment Option For Law Enforcement Officers With Ptsd?, Megan Rinderer
Can Brazilian Jiu Jitsu Be A Viable Treatment Option For Law Enforcement Officers With Ptsd?, Megan Rinderer
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Law enforcement officers (LEO) are more likely to experience symptoms of PTSD when compared to the general population yet are less likely to seek mental health treatment (Jetelina et al., 2020). Given that LEO face unique occupational stressors and repeated exposure to traumatic events, treatment for PTSD among law enforcement populations poses unique challenges for clinicians. The combination of these variables precludes officers from seeking and receiving mental health services. Research regarding the efficacy of Brazilian Jiu Jitsu (BJJ) as a psychotherapeutic intervention is limited. To date, no studies have examined the use of BJJ to mitigate symptoms of PTSD …
The Impact Of A Relationship Education Program On Health Disparities Among Pregnant Women, Anne Clara Biermann
The Impact Of A Relationship Education Program On Health Disparities Among Pregnant Women, Anne Clara Biermann
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Health disparities amongst pregnant individuals of color have long been documented and yet, they persist. While there is growing recognition, the search continues for solutions to close the health disparity gap between White women and women of color. This research is a follow-up to a 2022 study exploring the impact of the MotherWise program on birth outcomes. MotherWise provides an individual-oriented relationship education program and case management service for minority and low-income pregnant women in Colorado. This research further explores a positive trend of the program's impact on preterm birth rates by examining differential effects of participation by race. In …
Psilocybin And The Psychologist: A Proposed Methodology For Exploring The Effects Of Clinicians’ Psychedelic Experiences On Their Clinical Practice, Brian N. Iliescu
Psilocybin And The Psychologist: A Proposed Methodology For Exploring The Effects Of Clinicians’ Psychedelic Experiences On Their Clinical Practice, Brian N. Iliescu
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
This paper proposes a phenomenological exploration of the perceived influence of psychedelic experiences on clinical psychologists’ practice of psychotherapy. The goal of the proposed study is to open-endingly explore the psychedelic experiences of psychologists to identify common themes, underlying phenomena, and the impact that those experiences may have on their individual practice of psychotherapy. At present, no published studies have explored or identified how the perceived long-term effects of psychedelics influence professional mindsets and practices. This paper aims to synthesize the current literature, identify a gap, provide rationale for future queries into the non-clinical uses and effects of psychedelic medicines, …
Unique Types Of Angel And Ghost Memories In Low-Income, Diverse Pregnant Women, Rebecca Spear
Unique Types Of Angel And Ghost Memories In Low-Income, Diverse Pregnant Women, Rebecca Spear
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
This study examined the associations between three types of angel memories, defined as recollections of loving moments with childhood caregivers, and pregnant women’s reported childhood adversity and current PTSD symptoms. Angel memories were coded from the Angels in the Nursery Interview (Van Horn et al., 2008) into three subtypes: protection in the context of harm, rupture in the protective shield, and sensory memories. Participants were 175 ethnically-diverse pregnant women (M age = 28.07, SD = 5.68, range = 18-40 years; 61.1% non-White) who completed the Angels Interview, the Adverse Childhood Experiences scale (ACEs; CDC, 2021) for childhood adversity, and …
“It’S Right Below The Surface”: Clinicians’ Experiences Of Shame In Therapy Work With Adult Clients With Body Shame, Body Image Concerns, Or Eating Disorder(S), Tess Carroll Keeley
“It’S Right Below The Surface”: Clinicians’ Experiences Of Shame In Therapy Work With Adult Clients With Body Shame, Body Image Concerns, Or Eating Disorder(S), Tess Carroll Keeley
Graduate School of Professional Psychology: Doctoral Papers and Masters Projects
Shame–understood as a feeling in which one believes that they are inadequate, or wrong to their core–is a painful emotional experience that seems to be at the crux of many mental health concerns. Despite the pervasiveness of shame as an emotional experience, little research has demonstrated if shame is a clinical theme in therapy, and if so, how it is identified and treated. The purpose of this qualitative study was to explore if, and how, shame manifests during therapy sessions with clients who are experiencing eating disorders and/or body image concerns. A secondary purpose was to discover how clinicians’ training …