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Mental and Social Health

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Full-Text Articles in Social and Behavioral Sciences

Psilocybin With Acceptance And Commitment Therapy (Act) For The Treatment Of Social Anxiety Disorder (Sad), Aspen E. Allred Mar 2024

Psilocybin With Acceptance And Commitment Therapy (Act) For The Treatment Of Social Anxiety Disorder (Sad), Aspen E. Allred

University Honors Theses

Social Anxiety Disorder (SAD) is a debilitating mental health condition characterized by an overwhelming fear and anxiety of social rejection that can lead to chronic patterns of social behavioral avoidance. Despite the existence of traditional efficacious treatments, a significant number of individuals either do not respond to treatment or experience a recurrence of symptoms over extended periods, spanning 10-12 years. Acceptance and Commitment Therapy (ACT), a form of acceptance-based behavioral therapy considered part of the "third wave" of cognitive behavioral therapies, has shown promising results in early studies, comparable to those of Cognitive Behavioral Therapy (CBT) that is considered the …


Applying The Self-Determined Learning Model Of Instruction To The Psychotherapeutic Context For People With Intellectual/Developmental Disabilities, Richard Chapman, Jessica Schuttler, Karrie Shogren, Sydney Walls, Hannah Adams, Aderonke O. Oyetunji Jul 2023

Applying The Self-Determined Learning Model Of Instruction To The Psychotherapeutic Context For People With Intellectual/Developmental Disabilities, Richard Chapman, Jessica Schuttler, Karrie Shogren, Sydney Walls, Hannah Adams, Aderonke O. Oyetunji

Developmental Disabilities Network Journal

The Self Determined Learning Model of Instruction is an evidence-based intervention for supporting self-directed goal setting and problem solving. Traditionally, the SDLMI has not been applied in the psychotherapeutic context, however we propose that the SDLMI is an approach that could be integrated into such a context to support self-determination, goal setting, and goal attainment. In this paper, we specifically focus on connections between the SDLMI and cognitive behavior therapy (CBT) and how the approaches can be used jointly, during psychotherapy to support teens and young people with intellectual and developmental disabilities to set, work towards, and reach goals. Implications …


Experiences And Perceptions Of Bilingual Spanish-English Latinx Clients And Bilingual Spanish-English Latinx Therapists In Psychotherapy: A Systematic Review, Irvin I. Navarrete Jan 2023

Experiences And Perceptions Of Bilingual Spanish-English Latinx Clients And Bilingual Spanish-English Latinx Therapists In Psychotherapy: A Systematic Review, Irvin I. Navarrete

Theses and Dissertations

As the bilingual Spanish-English Latinx population in the United States increases, so will the need for culturally and linguistically competent mental health therapists. While past research has focused on providing culturally competent care, the role of language in the process of psychotherapy has received limited attention. This study aimed to comprehensively analyze the existing literature on bilingual Spanish-English Latinx clients’ and bilingual Spanish-English Latinx therapists’ experiences and perceptions within a bilingual psychotherapy setting and identify recommendations to enhance language proficiency. A systematic review was conducted and identified nine studies for inclusion. Results highlight seven themes focusing on bilingual Spanish-English Latinx …


Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez Dec 2022

Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez

Graduate Theses and Dissertations

Studies suggest that health disparities occur when people from marginalized communities receive care that is inadequate based on their cultural needs (USDHHS, 2011). Multicultural competence (MCC) models have been proposed to provide a framework of the competencies that therapists should develop to work with multicultural populations (Sue et al., 1992). Researchers have questioned the validity of measures, which are mostly based on therapist self-report (Cartwright, 2008). The multicultural case conceptualization ability task has been used in previous studies as a measure of demonstrated cultural competence using a vignette to assess case conceptualization abilities (Ladany et al., 1997). However, it has …


Classical Music In Depth Psychology: Listening To The Unconscious In Active Imagination, Ellen Wimmer Sheahan Feb 2022

Classical Music In Depth Psychology: Listening To The Unconscious In Active Imagination, Ellen Wimmer Sheahan

Counseling and Family Therapy Scholarship Review

This article aims to explore the role of classical music in depth psychology, with insight from the author’s experience as a classical musician and psychotherapist. The author posits that classical music possesses deep archetypal wisdom that supports awareness for client individuation. Through personal reflection and case examples, the author examines archetypal potentials when classical music arises in active imagination. This writing aims to substantiate the importance of sound and music, as well as image, in the field of depth psychology.


Social And Cultural Considerations In Accessing Mental Health Treatment In The Gambia, West Africa, Safiya Njai Jan 2022

Social And Cultural Considerations In Accessing Mental Health Treatment In The Gambia, West Africa, Safiya Njai

Antioch University Full-Text Dissertations & Theses

This study examines the social and cultural considerations in accessing mental health treatment in The Gambia, West Africa. Participants were recruited from The Gambia for a qualitative study that included semistructured interviews (N = 17). A team of analysts identified five themes. The results highlighted social and cultural conceptualizations of mental health and mental illness, sociocultural determinants of health, interventions, barriers to care, and the legal framework to support mental health change. These findings are important for counselors to understand different perceptions of mental health and mental illness and the associated stigma. Furthermore, several opportunities for advocacy in The Gambia …


The Role Of Social Work In Health Care For Veterans In The United States Of America (Praca Socjalna W Lecznictwie Weteranów Służby Wojskowej W Usa), Jaroslaw Richard Romaniuk Jun 2020

The Role Of Social Work In Health Care For Veterans In The United States Of America (Praca Socjalna W Lecznictwie Weteranów Służby Wojskowej W Usa), Jaroslaw Richard Romaniuk

Faculty Scholarship

Clinical social work in the American system of health care and its specific features in the Veterans Affairs (VA) of veterans are described in this paper. VA hospitals are the largest employers of social work worldwide. Because health care for veterans is paid for from government funds, VA hospitals are subject to regulations developed on the basis of research into the system’s effectiveness and efficiency. Clinical social workers cooperate with physicians and nurses to comprise an integral part of the health care team. Social workers fulfill the usual tasks related to social well‑being but also act as health educators and …


Systematic Literature Review Of Cognitive Behavioral Treatments For Patients With Classical, Secondary, And Idiopathic Trigeminal Neuralgia, Linnea B. Herzog Jan 2020

Systematic Literature Review Of Cognitive Behavioral Treatments For Patients With Classical, Secondary, And Idiopathic Trigeminal Neuralgia, Linnea B. Herzog

Honors Undergraduate Theses

Trigeminal neuralgia is a painful neuralgia with a complicated pathology that is not clearly understood. Due to the ambiguity of the condition, patients often have to search for medical providers that specialize in trigeminal neuralgia, and even with the guidance of a specialist, some patients do not respond well to treatment.1 Despite the uncertainty surrounding the specifics of the disease, there are treatments available that can provide some level of pain relief for patients suffering from this disorder. When a patient does not respond well to medical therapy, surgery can be the next appropriate step in patient care management. …


A Commentary On Trauma’S Different Layers, Mike Kaufman , M.A., L.M.F.T. Dec 2019

A Commentary On Trauma’S Different Layers, Mike Kaufman , M.A., L.M.F.T.

Counseling and Family Therapy Scholarship Review

This article highlights how trauma may be caused by factors aside from catastrophic events, physical violence or accidents resulting in physical injury. Examples of trauma beyond the more commonly known causes are detailed. This article also emphasizes how individuals engaging in psychotherapy may at times lack awareness that their self-reported dilemma, or symptoms, may stem from early relational trauma. The following commentary originated with first-hand clinical experience and was reinforced by literature. It is important to recognize that individuals reporting symptoms of depression and anxiety are most effectively treated in psychotherapy when past trauma is accurately identified as the root …


Power In The Counseling Relationship: The Role Of Ignorance, Izaak L. Williams, Peg O'Connor Oct 2019

Power In The Counseling Relationship: The Role Of Ignorance, Izaak L. Williams, Peg O'Connor

Journal of Human Services: Training, Research, and Practice

This article explores the role of therapist self-disclosure in clinical settings. Distinctions are made between the enmeshed concepts of privacy, secrecy, and confidentiality to elucidate the role of ignorance in maintaining the power dynamics in therapeutic relationships. While some measure of privacy is essential to counseling practice, secretive behavior (in which the counselor divulges too little about themselves) can have a negative impact on the therapeutic relationship and the client’s therapeutic outcomes. There is, therefore, an under-appreciated and delicate balancing act between withholding information to protect the client and the counselor and revealing enough personal details to empower the client’s …


Development Of The Sexual Minority Affirmative Practice Scale, Ryan Craig Ebersole Jan 2019

Development Of The Sexual Minority Affirmative Practice Scale, Ryan Craig Ebersole

Legacy Theses & Dissertations (2009 - 2024)

Literature on the practice of affirmative psychotherapy with sexual minority (SM) clients has steadily increased over the past two decades in recognition of the unique experiences and mental health needs of this marginalized population. SM-affirmative psychotherapy is an approach to psychotherapy that is culturally-responsive, actively affirms the validity of SM identities and experiences, and promotes the resilience of SM clients in the face of stigma. To date, much of the extant research on SM-affirmative psychotherapy has focused on therapist factors and perspectives. Further, most previous research on SM clients’ experiences in therapy has been qualitative, due in part to the …


A Behavior Analytic Translation Of Erving Goffman's Frame Analysis, Tim Chi Jan 2019

A Behavior Analytic Translation Of Erving Goffman's Frame Analysis, Tim Chi

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

The sociologist Erving Goffman's 1974 work, "Frame Analysis," is an attempt to account for how people construct and organize meaning in their experiences. The central principle in this approach is that of the frame: An abstractive concept that refers to the totality of environmental events and stimuli exerting some influence on how people behave in a particular setting and time, with respect to the expectations, roles, and norms to be observed.

Though Frame Analysis was developed within the discipline of sociology, it converges in apparently useful ways with the work of clinical psychology, both in its content and epistemology. Goffman's …


Predictors Of Psychotherapy Attrition Among Refugees, Emily Robin Pichler Jan 2019

Predictors Of Psychotherapy Attrition Among Refugees, Emily Robin Pichler

Graduate College Dissertations and Theses

It is estimated that approximately one in five patients will terminate therapy early, before participating in full treatment and obtaining maximum therapeutic benefits. Millions of people are forcibly displaced as refugees each year, and therefore at increased risk for poverty, discrimination, and complex mental health needs, yet no research has yet examined rates or predictors of psychotherapy attrition among refugees. The current study draws upon a sample of refugee clients seeking treatment at a community clinic (N = 196), and a comparison group of 165 non-refugee clients at the same clinic. Logistic regression was employed to (1) compare rates of …


The Efficacy Of Equine Assisted Therapy In The Treatment Of Autism Spectrum Disorders, Amy Hofmann Aug 2018

The Efficacy Of Equine Assisted Therapy In The Treatment Of Autism Spectrum Disorders, Amy Hofmann

Electronic Theses and Dissertations

This study examines the effects of equine-assisted psychotherapies in children with an autism spectrum disorder. The CARS-2 and Children’s Sleep Habits Questionnaire parent-report questionnaires were used for evaluation, as well open-ended questions. A single researcher contacted and visited many PATH-certified centers in the United States. Facilities that participated were all located in the Mid-Atlantic to Northeast region. There were 16 participants, from 11 different farms, that completed both the initial and follow-up questionnaires which were given 7 weeks apart. A $25 Amazon gift card was used as an incentive to increase participation. Participating facilities also completed a questionnaire.

Overall, results …


Examining Ritual In Dance/Movement Therapy, Jessica Michele Flores May 2018

Examining Ritual In Dance/Movement Therapy, Jessica Michele Flores

Expressive Therapies Capstone Theses

Ritual practices have long been a part of numerous cultures’ history as mind-body actions performed for healing. Modern day rituals can be observed in baptisms, weddings, or funerals. Rituals have also been adapted into various psychotherapy approaches as effective, time-limited transformative additions through Van Gennep’s transition phases among varying populations. Ritual and dance/movement therapy are established as effective healing processes through similar concepts including sociality, dance, non-verbal communication and being body-based approaches. This literature review revealed the inner workings of ritual performance and dance/movement therapy through neuroscience. This literature review intends to present relevant research on the unique molding qualities …


The Impact Of Sudden Gains And Deteriorations On The Psychotherapy Process, Joanna Mary Drinane Jan 2018

The Impact Of Sudden Gains And Deteriorations On The Psychotherapy Process, Joanna Mary Drinane

Electronic Theses and Dissertations

Within the field of psychotherapy research, there has been significant evidence to suggest that people change and improve because of treatment (Lambert & Ogles, 2004). One common phenomenon that has been observed when looking more closely at outcome trajectories has been termed sudden gains/deteriorations. These are defined as sudden changes in outcome (either positive or negative) of 25% or more from the pre-change level of symptoms that are in turn sustained over time (Tang & DeRubeis, 1999). Although there are data regarding how people who experience sudden gains end up after treatment, no studies have examined the impact that sudden …


Evaluating The Attitudes And Practices Of Exercise Prescription Among Psychotherapists, Igor Vasilj Jan 2018

Evaluating The Attitudes And Practices Of Exercise Prescription Among Psychotherapists, Igor Vasilj

Theses and Dissertations--Educational, School, and Counseling Psychology

Exercise has been shown to improve mood, anxiety, stress, and promote neuroplasticity (Conn, 2010; Donaghy, 2007; Josefsson, Lindwall, & Archer, 2014; Silveria et al., 2013; Stathopoulou et al., 2006). However, limited research on the topic suggests that many psychologists and mental health providers are not incorporating exercise into psychological treatment, and many lack the confidence to do so (Burton, Pakenham, & Brown, 2010; Weir, 2011). The purpose of this study was to evaluate current exercise prescription trends among practicing psychologists and trainees, including identifying their current beliefs, attitudes, training, and the perceived barriers hindering psychotherapists from recommending and prescribing exercise. …


Cinematherapy With Inside Out: A Theoretical And Practical Guide, Jessica Rosenfeld Jan 2018

Cinematherapy With Inside Out: A Theoretical And Practical Guide, Jessica Rosenfeld

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Since its release in 2015, the Disney/Pixar film "Inside Out" has received widespread critical and commercial acclaim. Despite the film's basis in established psychological theories, little has been published regarding its clinical applicability, particularly for adolescent and adult clients in traditional talk therapy. Through the use of cinematherapy, a deeper examination of the film is offered, and suggestions for treatment use are provided. Via the lens of modern psychodynamic (Intersubjectivity) and behavioral (ACT) techniques, this paper offers diverse options for integrating "Inside Out" in psychotherapy and proves that it contains clinical applicability for a wide range of practitioners.


Horses In Therapy: The Practice Of Equine Facilitated Psychotherapy, Mandi J. Turner Jan 2018

Horses In Therapy: The Practice Of Equine Facilitated Psychotherapy, Mandi J. Turner

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Horses are being used in psychotherapy at increasing rates despite a lack of evidence establishing efficacy of the practice (Anestis, Anestis, Zawilinski, Hopkins, & Lilienfeld, 2013; Selby & Smith-Osborne, 2013). Without common and consistent practices based on a working theory of how Equine Facilitated Psychotherapy (EFP) creates change, it is unknown how varied the practice is across the United States (Anestis et al., 2013). A lack of studies establishing efficacy leaves providers to determine effectiveness based on anecdotal evidence that may be at risk for bias (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2014). The American Psychological Association (APA) provides recommended …


Feelings Of Enlightenment: A Hermeneutic Interpretation Of Latent Enlightenment Assumptions In Greenberg's Emotion-Focused Therapy, Alex A. Gomez Jan 2018

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 (2nd 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 …


Stay-At-Home-Fathers Navigating Depression: A Consensual Qualitative Research Study, William Douglas Meyers Caperton Jul 2015

Stay-At-Home-Fathers Navigating Depression: A Consensual Qualitative Research Study, William Douglas Meyers Caperton

Dissertations (1934 -)

Evidence suggests that the practices through which men are socialized to become masculine may serve both to restrict their potential in ways that lead to psychological distress, and also to restrict the ways in which they respond to such distress (Addis & Mahalik, 2003; Mahalik, Good, Tager, Levant, & Mackowiak, 2012; O’Neil, 2008). While we are beginning to understand masculine depression (Cochran & Rabinowitz, 2000; Magovcevic & Addis, 2008) and paternal depression (Paulson & Bazemore, 2010; Ramachandani & Psychogiou, 2009), almost nothing is known about how SAHFs experience depression, nor their experiences and beliefs regarding help-seeking and psychotherapy. The trend …


Psychotherapy In Family Medicine, Saadia N. Hameed May 2015

Psychotherapy In Family Medicine, Saadia N. Hameed

Electronic Thesis and Dissertation Repository

Abstract

Aim: To explore the perspectives and practice of psychotherapy of family physicians, and analyze Ontario’s mental health policy documents within the context of psychotherapy.

Methods: In the first study descriptive qualitative methodology was used. Eighteen family physicians were interviewed and the results were presented thematically. In the second study, a policy analysis of Ontario’s mental health policy documents was conducted. The qualitative policy analytic methodology of Peter et al. was used.

Findings: Psychotherapy is an effective treatment of mental illness and is practiced by family physicians. Lack of training and time are barriers, while patient needs and …


Preferences For Evidence-Based Depression Treatments: An Emphasis On Patient-Focused Care, Lauren A. Frye May 2015

Preferences For Evidence-Based Depression Treatments: An Emphasis On Patient-Focused Care, Lauren A. Frye

Dissertations

Research indicates most depressed patients in the general U.S. adult population seek depression treatment in primary care settings where the prevailing method of treatment is antidepressant medication. Although primary care physicians regard this approach as a preferable first line method of depression treatment, studies indicate many patients do not. Several studies have found depressed patients in these settings prefer psychotherapy or counseling over anti-depressant medication. Many advocate patient preferences should be integral to the treatment decision making process. There is a demonstrated propensity towards psychotherapy or counseling over antidepressant medication among depression patients. However, it is unclear which psychological depression …


Effectiveness Of Psychotherapy For Youth In Poverty: A Benchmarking Study Of A Public Behavioral Health Agency Using A Client Feedback System, Jonathan Kodet Jan 2015

Effectiveness Of Psychotherapy For Youth In Poverty: A Benchmarking Study Of A Public Behavioral Health Agency Using A Client Feedback System, Jonathan Kodet

Theses and Dissertations--Educational, School, and Counseling Psychology

Objective: The purpose of this study was to evaluate the effectiveness of a public behavioral health (PBH) agency that had implemented continuous outcome feedback as a quality improvement strategy.

Method: I investigated the pre-post treatment outcomes of 4,389 ethnically diverse youths (6 to 17 years old) at or under the poverty line participating in treatment (from January 2008 to March 2014) for a broad range of primary diagnoses including depression and anxiety disorders (23%); adjustment disorders (27%); Attention Deficit/Hyperactivity Disorder (13%), various V-codes (18%); bipolar disorders (3%); and substance use disorders (2%). I also investigated the treatment outcomes …


Same-Sex Couples' Lived Experiences Of The Repeal Of The Defense Of Marriage Act's (Doma) Section Three, Alicia Anne Bosley Jan 2014

Same-Sex Couples' Lived Experiences Of The Repeal Of The Defense Of Marriage Act's (Doma) Section Three, Alicia Anne Bosley

Department of Family Therapy Dissertations and Applied Clinical Projects

Same-sex couples are affected by the social and political climates in which they live, as these create the difference between acceptance and legalization, and discrimination and prohibition, of their relationships. This contingence is made increasingly impactful by the privileges and protections afforded to married couples by the federal government; same-sex couples, along with other couples that choose not to, or cannot, marry, are excluded from these benefits. Following the June 26, 2013 ruling that Section Three of the Defense of Marriage Act (DOMA), which defined marriage as between a man and a woman, was unconstitutional, same-sex couples were given access …


Seasoned Psychotherapists' Experience Of Difficult Clinical Moments, Kirk J. Honda Jan 2014

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: …


Factors That Promote And Inhibit Client Disclosure Of Suicidal Ideation, Robert William Orf Jan 2014

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 Jan 2014

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 Oct 2013

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 …


Clients' Perceptions Of Protective And Risk Factors Influencing Substance Abuse Recovery, Bev Nora-Lea Scott Jan 2012

Clients' Perceptions Of Protective And Risk Factors Influencing Substance Abuse Recovery, Bev Nora-Lea Scott

Theses Digitization Project

The purpose of this study was to identify client perceptions of protective and risk factors that might influence recovery from substance abuse. Fifty clients in an outpatient drug treatment program in San Bernardino, California completed a survey containing both multiple choice and open-ended questions related to protective and risk factors the literature suggested might be related to recovery.