Background Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden. Methods We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally. Findings Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1–100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0-0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2.35 mmol/L (91 mg/dL) and 1.0 mmol/L (39.5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High- sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3.0 mg/dL in 360 (51%) Tsimane participants. Interpretation Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined. Funding National Institute on Aging, National Institutes of Health; St Luke's Hospital of Kansas City; and Paleocardiology Foundation.

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The purpose of the present study was to identify, categorize, and model clients' understanding of early counseling alliance formation factors. Forty participants who had received counseling services were interviewed and asked about what observable behaviors and verbalizations they thought had helped establish the alliance with their counselor. Alliance formation factors were recorded on index cards, and 31 participants returned and sorted these statements into self-defined, conceptually homogeneous categories. Multivariate concept-mapping statistical techniques were used to compute the "average" sort across the participants. Seventy-four client-identified common factors were elicited and reliably organized into 11 categories:

Counselling psychology, established in 1987 as a specialization within Canadian professional psychology, has developed a distinctive identity and specific underlying approach to training and practice. To date, the field in Canada has evolved without benefit of a formal definition of the specialization. Over three years, a task force charged with development of a definition of Canadian counselling psychology engaged in a broad survey of extant literature and member consultation, and proposed a definition that was adopted by the Board of Directors of the Canadian Psychological Association in June 2009. The present work discusses the process that informed development of the definition, provides a description of the characteristics of a Canadian counselling psychology approach to research and practice, and enumerates challenges to the continued development of the specialization.

The therapeutic alliance has been shown to be a robust predictor of counselling outcome. However, the specific counsellor behaviours that relate to the alliance have not been clearly and consistently identified, and prior attempts to identify these variables have not been typically based on client-derived conceptualizations of the alliance. A total of 79 adult counselling clients participated in a study examining the relationship between 15 client-identified counsellor behaviours and the strength of the therapeutic alliance. Correlational analyses revealed that 11 of the 15 behaviours moderately to strongly correlated with the strength of the alliance, and hierarchical regression analyses found that three particular counsellor behaviours (making encouraging statements, making positive comments about the client, and greeting the client with a smile) accounted for 62% of the variance in alliance scores. The findings suggest that seemingly small, strengths-fostering counsellor micro-behaviours can play a key role in strengthening therapeutic alliances. Given the role that alliance plays in positive counselling outcomes, it is suggested that these behaviours be tactfully implemented early on in the counselling process.

The professional practices of counseling and psychotherapy were developed in the Western world to address problems common in Western countries in a manner consistent with Western understandings. There is a small but growing awareness that (a) counseling and psychotherapy are cultural by-products rather than universal healing practices, and (b) counseling and psychotherapy share important therapeutic elements with many well-established indigenous healing practices from other countries. Despite these notions, counseling and psychotherapy are being exported to other countries at a high rate and often without enough scrutiny. Although this is generally done with good intentions to promote global mental health and to address differences in mental health across the world, these practices can be inconsistent with the societal values and collective beliefs of individuals in non-Western countries and can sometimes lead to more harm than good. Providing counseling and psychotherapy to such individuals would be equivalent to offering a westernized individual an indigenous healing practice from a different part of the world that does not fit within a Western belief structure. Therefore, counseling and psychotherapy may not be as effective as long-standing indigenous healing practices for individuals who do not subscribe to the assumptions, customs, cultural principles, and culturally promoted objectives that underlie the Western practices of counseling and psychotherapy. Therefore, these practices should not be always recommended in non-Western cultures. Instead, promoting traditional healers and indigenous healing practices and integrating them with culturally adapted counseling and psychotherapy is recommended to reduce international mental health disparities.

Although the link between client ratings of therapeutic alliance quality and psychotherapy outcome has been well established by previous research, there is still much to be done to clarify what variables are important to clients, particularly men, in the formation of an alliance. Thirty-seven male clients currently undergoing psychotherapy categorized 74 critical incidents for alliance formation in an open-ended manner on the basis of self-perceived relatedness. Multivariate concept-mapping statistical techniques were used to identify the typical way in which the participants conceptualized variables that are important to alliance formation. Nine categories of variables were identified (Bringing out the Issues, Nonverbal Psychotherapist Actions, Emotional Support, Formal Respect, Practical Help, Office Environment, Information, Client Responsibility, and Choice of Professional). Bringing out the Issues emerged as the highest rated and most consistently understood category across the men in this study. The results of this study add to a small but growing body of research on the client's perspective of alliance formation and provide an initial conceptual model of how men understand the variables of common alliance formation. The developed model also provides several hypotheses, which are presented for verification in future research and clinical practice.

This study investigated the incidents that male clients found to be most detrimental to the formation or strengthening of the therapeutic alliance with their mental health professionals, using an abbreviated version of the qualitative critical incident technique, which focused on hindering incidents only. The Conformity to Masculine Norms Inventory was administered as a measure of participants’ adherence to traditional masculine gender norms to better describe the sample. Participants were 86 adult males, almost all of whom were receiving individual counseling or psychotherapy at the time of the study. After redundant statements had been eliminated, a total of 56 unique critical incident statements were obtained. The statements were initially sorted into self-defined, conceptually homogenous categories by 3 returning participants, and a consensus classification structure (based on the participants’ categorization of the incidents) was then created by the researchers. The consensus structure was modified based on feedback and reliability data gathered from a subset of participants. The final category scheme contained 7 categories describing what clients in this study perceived as detrimental to the formation or strengthening of the alliance. The categories were as follows: Not the Right Fit/Approach, Counselor/Psychotherapist Pressuring the Client, Client Uncertain or Untrusting, Counselor/Psychotherapist Acting on Assumptions About the Client, Client Unsure of What to Expect in Session, Client Not Putting in Enough Effort, and Time/Timing Problems. These categories can aid practitioners in providing gender-sensitive care by helping them become alert to the ways in which problems may manifest in alliances with male clients.