Social work,psychoanalytic psychotherapy and mental handicap: A reading list

Abstract

This article, in two parts, describes first the development of a seminar group which Win Roberts and I set up for social workers, to promote the use of group work with clients in hospital settings. Each fortnightly seminar consisted of a discussion on aspects of group work theory and practice, followed by our experiential group. The second part describes one of the client groups that was established for people attending hospital for sub-fertility treatment. Parallels are drawn between group processes in the seminar group and the client group, indicating the value of such a seminar group to provide training, supervision and experience of group work.     

Therapists’ Assessment and Treatment of Internet Infidelity Cases

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists’ age, therapists’ gender, how religious therapists reported they were, and the extent of therapists’ personal experience with infidelity.     

Working with Families Who Experience Parental Mental Health and/or Drug and Alcohol Problems in the Context of Child Protection Concerns: Recommendations for Service Improvement

Child abuse and neglect often occur within the context of multiple risk factors, in particular parental mental health (MH) and/or drug and alcohol (D&A) problems. Interventions aimed at improving parental MH and D&A issues can have a positive impact on children now, as well as in the future. However, implementing sustainable service models that facilitate positive change for families with multiple risk factors is challenging. The purpose of the present study was to gain feedback from key stakeholders on a service model targeted at families where there are parental D&A, MH and child protection concerns to identify possible strengths and limitations of the model. This identified possible strategies for service improvement from the perspective of discharged clients and clinical staff. Gaining feedback from key stakeholders on service models is increasingly recognised as central to service evaluation and development. Ten interviews were conducted with clinical staff and twenty interviews with discharged clients of a pilot service that works with families where the child or children are at risk of significant harm in the context of parental MH and/or D&A issues. The interviews with clinicians highlighted difficulties working with this complex client group and its impact on staff burnout. Clinicians suggested how the model could be changed to better support clinical staff from burnout. Interviews with discharged clients highlighted the importance of the relationship with the worker in establishing client engagement and facilitating change. The way in which these recommendations informed the design of the service model is discussed.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

Is Fear to Intervene with Problem Gamblers Related to Interveners’ Gender and Status? A Study with VLT Operators

We assess how video lottery terminal (VLT) operators’ self-perceive their ability to recognize a problem gambler, to what extent they are approached by problem gamblers seeking for assistance, how many detections and interventions they report, and the reasons they give for not intervening with clients who show signs of problem gambling. We also examine how these variables are related to the operators’ gender and status in the establishment. 177 VLT operators anonymously completed a structured questionnaire at the beginning of a responsible gambling training class held in different French-speaking Swiss towns. The operators felt confident in their ability to detect problem gambling behaviors, were rarely approached by problem gamblers seeking assistance, and reported fewer interventions compared to the number of detections. This reluctance to intervene was mainly attributed to the fear of potential negative reactions from the client. Female staff were the most reluctant to intervene and the most fearful of potential negative reactions from the client. Responsible gambling training programs should include coping strategies for dealing with potential negative reactions from clients. Our findings suggest that staff gender and status are two individual characteristics that should be taken into account when planning responsible gambling trainings.     

What Lies Beneath: Trauma Events,PTSD, and Alcohol Misuse in Driving Under the Influence Program Clients

The prevention and reduction of alcohol misuse is one of the Grand Challenges of Social Work. Addressing client needs beyond alcohol misuse can improve client outcomes. Driving under the influence program clients (N = 1,248) were screened for trauma events and posttraumatic stress disorder (PTSD). Results found that males more often reported having been assaulted with a weapon or that they caused injury to someone else. Females more often reported sexual assault and other unwanted sexual experience. About 26% overall screened positive for PTSD. Social workers need to be alert to various types of trauma and help clients identify the connection between trauma and alcohol misuse.     

Socioeconomic evaluation of a correctional programme in Sweden—long-term effects Samhällsekonomisk utvärdering av ett kriminalvårdsprogram i Sverige—långsiktiga effekter

The present article focuses on the long-term socioeconomic outcome of a correctional programme in Sweden, called KrAmi (n=62), using a systematic comparison with a control group of probation clients (n=51). The evaluation, which had a quasi-experimental design, was based on actual costs for each client (n=113) for a period of five years, from 1995 to 1999. The follow-up period was two years, during which the socioeconomic costs decreased step-wise for both groups, probation groups more so than programme groups. The deteriorations were 70–80% compared to the period before treatment. Rehabilitation to labour market, measured in pension points, was more successful for programme groups than for control groups. Thanks to this, as well as lower costs during the treatment period, the programme groups’ socioeconomic profitability, measured with a 15-year cost–benefit analysis (CBA), was greater than that of the control groups. The cost–effectiveness analysis (CEA) shows that the KrAmi groups are better off in work rehabilitation, depreciation time (one year compared with two and a half years for probation groups) and repayment ratio (14 SEK compared to 6 SEK for probation groups) although cost savings are greater for probation groups.     

Staff and client perspectives on the Journey Mapping online evaluation tool in a drug court program

The purpose of this study was to assess staff and client perspectives on the Internet-based Journey Mapping program evaluation tool. A drug court program was chosen for a case study research design. Six staff and 10 clients participated in interviews and observations, and also responded to a questionnaire. A staff survey provided additional data. The study revealed evidence that (1) Journey Mapping was user-friendly, saved time, promoted positive thinking, facilitated communication, increased learning, and created client voice; (2) Journey Mapping, as a program evaluation tool, supported both administrative and treatment functions of the drug court; and (3) Journey Mapping's positive orientation supplied momentum for clients’ treatment progress. Journey Mapping's distinctive technology offered a viable option for including narrative methods along with quantitative methods in program evaluation.     

Closing the Need-Service Gap: Gender Differences in Matching Services to Client Needs in Comprehensive Substance Abuse Treatment

Despite the broad recognition in social work that services are more effective when they are tailored to individual client needs, we have only limited evidence of the impact that services matched to client needs have on treatment outcomes. This study examines gender differences in the impact of matched services, access services, and outcome-targeted services on substance abuse treatment outcomes by using data collected from 1992 through 1997 for the National Treatment Improvement Evaluation Study, a prospective, cohort study of substance abuse treatment programs and clients. The analytic sample consists of 3,027 clients (1,105 women and 1,922 men) who reported needed services from 59 treatment facilities. Findings from the study indicate that overall programs have only limited success in targeting services to client needs, but when they do, receipt of substance abuse counseling and matched services predicts both remaining in treatment and reduced posttreatment substance use for both women and men, but especially for women.     

Youth engagement and service dosage in a mandated setting: A study of residential treatment centers

Treatment theory in residential treatment centers (RTCs) is conceived as a two-stage process of first engaging the client and then delivering services or interventions aimed at presenting problems. This treatment logic has been criticized for “creaming clients” or reserving services for clients easier to engage or more amenable to treatment but less in need. The present study examines whether higher early levels of engagement by youth in RTCs leads to more intervention and compares the relative effects of engagement and seriousness of presenting problems on the quantity of services provided by the mid-point in the adolescents' stay. Data come from interviews with a clinical sample of 71 male and 59 female adolescents in two RTCs in an eastern state. Findings indicate that higher level of engagement predicts more treatment interventions. Treatment staff delivered higher dosages of services to youth with more current behavioral problems, not those with problematic behaviors at intake. Youth with positive peer group backgrounds also received more services. Findings extend knowledge of how treatment staff provide treatment to clients and the role engagement plays in RTC service delivery.     

Mastering group leadership. An active learning experience

Leading therapeutic groups is an underused but viable treatment role for nurses in all specialty areas. A dynamic psychoeducational group model provides structure as nurses invest and collaboratively participate to actively learn the group leader role. this article highlights the sequencing of instruction of group theory and skills with examples from a baccalaureate nursing curriculum. Samples from student journals reveal their growing assimilation of the group leader role as learners actively participated in groups, collaborated, and reflected on their learning. Examples of creatively adapted group exercises, as well as selected nursing group leader interventions, demonstrate group leadership as a skill that can increase nurses' repertoire of therapeutic responses. Therapeutic groups are both exciting and cost-effective treatment strategies for use with mentally ill clients. The skills of an accomplished group leader are transferable from within the psychiatric population to working with families, bereavement groups, and other client populations, ranging from people with diabetes to survivors of catastrophic crises. Group leadership ability complements the management and negotiation skills needed in professional nursing roles. When students and staff nurses grow in group leadership expertise, clients in various settings will be better served with this currently underused treatment option.     

Biopsychosocial nursing assessment: a way to enhance care plans

1. A psychiatric nursing assessment tool reinforces the primary nursing care model; re-establishes nursing's input at comprehensive treatment plan meeting; reorients the staff to the total nursing needs of the client; and provides a tool for establishing nursing diagnoses. 2. Implementation of the nursing assessment form has educated other staff about professional nursing practice, as well as promoted a greater understanding of the nursing process and reinforced accountability for the nurses. 3. The form enables clients to be viewed from a holistic biopsychosocial nursing context, and nursing care plan recommendations are more individualized and inclusive of the total aspects of patient needs.     

Agency and clientship in public encounters: co‐constructing ‘neediness’ and ‘worthiness’ in shelter placement meetings

This article seeks to develop our understanding of the agency of vulnerable groups who at first sight may not seem to have much agency in their lives. It explores the co‐constructed nature of agency in three Danish homeless shelters. Unlike earlier interview‐based studies, our research is based on naturalistic data drawn from 23 video‐recorded placement meetings. Using concepts from Goffman, we examine how versions of the neediness and worthiness of homeless people are negotiated verbally and bodily between staff and clients. We find that homeless people have to juggle two partly contradictory roles when they are given or take the roles of either a (active) citizen or a (passive) client. Clientship is actively negotiated by both parties and demonstrates the agency of homeless people: they can collaborate with (as clients) or challenge (as citizens) the staff’s attempts to formulate solutions to their troubles. We further examine how the professional ideology of client centredness affects the meeting between the two parties. However, we show that, like any discourse, client centredness has no intrinsic meaning and is played out by actors in very different ways. In work with the homeless, the discourse of client centredness is related to discourses of ‘neediness’, ‘worthiness’ and ‘value for money’ that define agency in different ways and make three different client positions available: the resolute client, the acquiescent client and the passive client.     

Health Care Professionals' Experience,Knowledge, and Attitudes Concerning Homosexuality

The purpose of this study was to examine the experience with attitudes towards, and knowledge about homosexuality of three groups of health care professionals. Subjects were 97 registeres nurses, social workers, and psychologists who responded to a six-page mailed questionnaire. Professional discipline of the subject, gender of the client, and gender of the client's lover in a fictitious scenario did not significantly affect ratings or suggested diagnoses of the client. Most subjects felt that they needed moer training in working with homosexual clients, which was consistent with their high but not perfect scores on a knowledge test. Subject's mean scores of the Attitudes Toward Lesbians (ATL) and Gay Men (ATGM) scales of Herek (1998) reflected significantly less prejudice than his college samples. More knowledgeable respondents were less prejudiced and had more positive attitudes about working with gay and lesbian clients; those with more positive attitudes toward clients also showed less prejudice on the ATL and ATGM scales. The authors argue that training health care professionals to be more knowledgeable about gay and lesbian issues would lead to more positive attitudes and better services for gay and lesbian clients.     

The impact of therapist pregnancy on the treatment process

Therapist pregnancy is a powerful emotional stimulus and a real-life event that affects clients and the treatment process. In the present paper, previous literature is reviewed and clinical experiences of the author in a university counseling center are reported to address how therapist pregnancy influences clinical treatment. Although therapists often hesitate in emphasizing their pregnancy, evidence suggests that it is easy to underestimate the importance of the pregnancy for clients. Case examples are presented which demonstrate client responses and the significance of the pregnancy for four female clients. Gender differences in client reactions are not fully understood, and it may be particularly difficult to facilitate male clients in dealing with issues stimulated by the pregnancy. These clinical findings suggest that in a variety of settings, understanding and working with clients' reactions to the therapist's pregnancy can enhance treatment.     

Expanding the joys of cooking: How class shapes the emotional experience of family foodwork

The emotional experience of foodwork is often considered along a continuum, where pleasure exists in opposition to labor, and where inequalities restrict pleasure. Analyzing qualitative interviews, recall conversations and cooking observations with 34 primary cooks in families, this article explores how diverse parents experience pleasure through family foodwork. Doing so reveals five conditions facilitating pleasure: time, choice, aesthetic freedom, connection, and appreciation. It then analyzes how access to these conditions is shaped by class inequalities, while being attentive to intersections with gender and race/ethnicity. This analysis reveals how socio-economic inequalities fashion negative emotional relationships to foodwork by imposing disproportionate stressors on low-income home cooks, but do not necessarily predict cooking pleasure. Through examining intersections between the sensory and material aspects of foodwork, this article furthers theoretical understanding into how foodwork reinforces gendered, racialized, and classed oppression, while simultaneously identifying how agency and empowerment operate through cooking pleasure for low-income groups.