Group Therapy for Survivors of Severe Childhood Abuse: Repairing the Social Contract

ABSTRACT

This article presents a model for conducting time-limited group therapy with adult survivors of severe childhood abuse who are diagnosed with complex post-traumatic and dissociative disorders. While difficult to engage in mixed groups, these clients can succeed in structured, homogeneous groups focused on responsible participation, social connection and symptom management. Group sessions are organized around verbal promises, “social contracts,” that encourage the client's active, attentive engagement. Gentle confrontation of dissociative defenses is integral to the success of each session. Group guidelines, the provision of structure, and common themes are explained, as are the group therapist's complicated countertransference responses to these clients.     

Testing a Sociological Explanation for Rising Rates of White Mortality

This article is a response to Young's (2016) essay on high white death rates in Kansas. I argue that a focus on external causes would further help researchers theorize about how and why certain behavioral factors link declining white populations to various mortality changes. Additional work that examines changing mortality patterns by sex and race and that extends analyses to the entire nation will provide further tests of Young's thesis. In this context, I encourage researchers to consider how intergenerational comparisons and cohort effects may produce some of the observed patterns.     

The Therapeutic Use of Humor With Clients Who Have Schizophrenia

A positive worker/client relationship contributes greatly to a mental health client’s achievement of intervention goals. Practitioners who work with clients who have schizophrenia sometimes face challenges in developing positive relationships with them when the cognitive impairments characteristic of that disorder make verbal communication difficult. The purpose of this article is to review the indications for using humor with clients in general and then consider the potential for practitioners to use humor as one means of developing constructive working relationships with clients who have schizophrenia. This article does not address the use of specific humor techniques, but considers whether practitioners with a natural sense of humor can use it to their advantage in working with members of this population. Seven principles for the use of humor, and seven client examples, are included.     

Discretionary approaches to social workers’ personalisation of activation services for long-term welfare recipients

Contemporary social policies emphasise labour market inclusion of vulnerable groups through personalisation of activation services. This article investigates social workers’ decision-making when personalising activation measures to suit each client. Data consist of case files for 16 clients participating in a Norwegian activation scheme, and interviews with the clients’ designated social workers. Using Bakhtin’s theory of dialogism, the article examines what the social workers consider in their decision-making process and the pivotal factors in their conclusions. Findings show that social workers employ two distinct approaches to personalisation, which have significantly different implications for clients’ pathways towards labour market inclusion. The first approach concentrates on clients’ personal challenges, while the second focuses on feasible short-term employment strategies. The study demonstrates how institutional and political frameworks may lead to social workers’ posing activation requirements inconsistent with clients’ needs and capabilities. It suggests further research into these interrelations to improve social workers’ ability to adapt services to individual clients.     

Worker skill and client outcome in child protection

The research in child protection and in work with other involuntary clients suggests that the use of certain skills by child protection workers is likely to be related to positive client outcomes. In particular, effective practice involves: helping clients and client families to understand the role of the child protection worker; working through a problem‐solving process which focuses on the client's rather than the worker's definitions of problems; reinforcing the client's pro‐social expression and actions; making appropriate use of confrontation; and using these skills within a collaborative client/worker relationship. This study attempts to identify the extent to which child protection workers make use of these skills and how these skills relate to client outcomes. Data were sought through 50 interviews with child protection workers and 282 interviews with family members. The child protection workers provided information about 247 client families. It was clear that when workers used the skills, their clients had better outcomes—the workers believed their clients showed better progress, the clients were more satisfied with the outcomes and the cases were more likely to have been closed 16 months later. Copyright © 2002 John Wiley & Sons, Ltd.     

Beyond the Self: External Influences in the Career Development Process

The purpose of this article is to explore the wide spectrum of external influences that affect career decision making across the life span and, in particular, how these factors may directly or indirectly alter one's career trajectory and the extent of one's work volition. Career development practitioners are encouraged to respect externally oriented frameworks, explore the social influence of career choice alternatives faced by clients, encourage clients to voice their emotional responses to external constraints, and use career decision‐making strategies that seek an optimal balance of internal and external influences.     

The Therapist's Imagination of Self in Relation to Clients: Beginning Ideas on the Flexibility of Empathic Imagination

The therapist's capacity to imagine is one specific part of the endeavour of empathy which lies at the heart of the processes of the therapeutic relationship. This article offers beginning ideas about the significance of therapist's imagination of self in relation to her/his clients in the task of trying to understand their experience. In seeking to ‘understand’ the experience of others, the therapist is able to move between an imagination of sameness/identification with the client/s, and an imagination of difference/‘foreignness’. The family therapy orientation of curiosity and ‘not‐knowing’ relies on the imagination of self as different to our clients; more traditional understandings of empathic connection rely more heavily on the imagination of sameness/identification with clients. This article argues that flexibility in the therapist's use of self in moving between these positions allows an expanded capacity for therapeutic connectedness. These ideas have special valence in the practice territories of impasse and intercultural therapy.     

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.     

Cognitive and behavioural assessment of people with traumatic brain injury in the work place: occupational therapists' perceptions

Cognitive and behavioural impairments, in the absence of severe physical disability, are commonly related to poor return to work outcomes for people with traumatic brain injury (TBI). Along with other health professionals, occupational therapists make judgements about cognitive and behavioural dimensions of work capacity of clients with TBI during the return to work process. Unlike many physical functional capacity evaluations, there is no standard method that therapists use to assess the ability of people with TBI to perform cognitive operations required for work. Little is known about what information occupational therapists use in their assessment of cognitive and behavioural aspects of client performance within the work place. This study employed qualitative research methods to determine what information is utilised by 20 therapists who assess the work capacity of people with TBI in the workplace. Results indicated that the process of making judgements about cognitive and behavioural competence within the work place is a multifaceted process. Therapists triangulate client information from multiple sources and types of data to produce an accurate view of client work capacity. Central to this process is the relationship between the client, the job and the work environment.     

Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

Culture,Context, or Religion: What Really Gets Single Mothers down the Aisle

Abstract

This article examines whether the relationship between religious participation and marriage behaviors for low-income single mothers is influenced by social norms and structural factors that promote the formation of traditional families. Specifically, we test whether religious participation encourages marriage generally or whether a specific type of marriage is encouraged (e.g., marriage to the baby's biological father). Using data from the Fragile Families and Child Wellbeing Study (N = 1,491), we examine the likelihood that religious participation increases marriage in single mothers. We find that the likelihood of marriage within four years after an unwed birth is not only related to church attendance but that the influence of church attendance seems to encourage the creation of biological families rather than simply two-parent households. Further, religious participation differentially influences the likelihood of marriage and a marriage partner based upon the mother's race and employment history. These findings highlight the importance of social context when analyzing marriage behaviors in single mothers.     

A Program Evaluation of Los Angeles ACORN's Welfare Case Advocacy

SUMMARY

Bureaucratic confusion and client dissatisfaction since the 1996 changes in welfare policy opened opportunities for third party advocacy on behalf of welfare clients. This paper evaluates Los Angeles ACORN's case advocacy program for welfare clients. Outcomes analyzed include client satisfaction with ACORN's advocacy and effects of the program on welfare clients who later became ACORN members. Ninety-one percent of clients surveyed (N = 99) stated they were satisfied with the resolution of their welfare case complaint. Eighty-eight percent of respondents stated ACORN did a better job resolving their problem compared to the welfare department. Unique aspects of the program include peer advocacy and opportunities for welfare recipients to join ACORN and work on welfare policy changes among other issues.     

Applying marketing management and communication management theories to increase client retention in the short-term insurance industry

Businesses must retain their clients to remain profitable. The academic field of marketing management considers customer relationship management (CRM) as most appropriate to achieve this, while communication management focuses instead on public relations (PR). The purpose of this research was to analyse theories in these two disciplines and derive an integrated theoretical framework of CRM and PR client retention. The framework was then tested through in-depth interviews with short-term insurance clients and short-term insurance providers (brokers and direct insurers) in South Africa to gain perspectives from both sides. The importance of some fundamental elements found in literature were affirmed, two elements’ importance were questioned and it was established that three inconsistencies existed between what providers regard as essential to retain clients and what clients regard necessary for them to stay in a relationship with an insurance provider. This may explain the many unsuccessful client retention efforts of South African brokers and direct insurers. Six new CRM and/or PR elements, not found in literature, are presented in the article for exploration in future research. In order to assist client retention in the very competitive short-term insurance industry, results were applied to the core tenets of Niemann's (2005) SA model for the implementation of strategic integrated communication (IC). Finally, the authors present an integrated approach to client retention strategies in the South African short-term insurance industry, incorporating both marketing and communication theories.     

Assumptions Regarding Vocational Counseling

Vocational counseling interviews involve the client and counselor in viewing each other, as the term inter-view indicates. As counseling begins, counselor and client view each other's assumptions about the nature of counseling processes and outcomes. Clients have assumptions about the kind of help they need to make occupational choices, what they can expect of counselors, what they can expect from any tests used, what they may be asked to do, and what will occur in the total process. Counselors need to understand the kinds of results clients expect from vocational counseling. Many assumptions, when held by either clients or counselors, lead to client (and possibly counselor) dissatisfaction with counseling because the assumptions build false anticipations for the client. Essentially, both clients and counselors often expect more definite outcomes and less effort from each party than is reasonable. This paper is written to promote counselors' reflections on their own and their clients' vocational counseling assumptions.     

When “Best I Can” is Not Enough: Welfare Managers’ Appraisal of Clients’ Mothering Practices

The “mommy wars” are a cultural narrative of conflict between mothers that amplifies the scrutiny placed on mothering practices. While mothers at all social locations face criticisms for their choices surrounding parenting, mothers in poverty lack the resources to enact many socially mandated parenting practices and contend with additional scrutiny through participation in programs like welfare-to-work. In this project, I examine the parenting expectations mothers on welfare must navigate. I use 69 semi-structured interviews with welfare-to-work program managers in Ohio from 2010-2011 to examine which mothering ideologies they encourage and discourage clients to adopt. I find that managers are highly critical of clients’ (perceived) parenting practices and instead promote a combination of intensive mothering and economic nurturing. Managers promote intensive mothering and meeting children's needs—so long as it does not interfere with the work requirements of the program. Economic nurturing simultaneously allows managers to express concern for children and promote clients participating in the work requirements of OWF, implying that work and family needs are aligned and can be met via work.     

Women's Spirituality: A Proposed Practice Model

SUMMARY

The values and spirituality of clients are an important area for social workers, counselors, and other mental, health professionals to consider in their work. This article addresses the need for professionals to be sensitive to this aspect of growth and development for all clients. Noting that until recently, religious writings have tended to reflect a male-centered bias and patriarchal values, issues related to women's spirituality are identified, implications for therapeutic interventions are discussed, and a model for understanding and facilitating women's spirituality is proposed.     

Enhancing Student Awareness of the Importance of Full and Accurate Documentation in Social Work Practice

The paper describes a classroom assignment that was used to raise social work students' awareness of the importance of timely, clear, and thorough documentation. The assignment was devised in view of the great importance of quality documentation in social work, coupled with the reluctance of social workers to invest the necessary time and effort to produce it. The core of the assignment was for the students to examine and report on the documentation in two client files at their fieldwork agency. The findings obtained from the students' reports show that about a fifth of the 190 files that were examined did not contain various pieces of basic information about the clients and intervention outcomes, and that much of the information that was provided was unclear and unorganized. The students' written reflections following the completion of the assignment indicate that the assignment achieved its aim of elevating their awareness of the importance of quality documentation. The paper ends with a discussion of issues to consider in repeating the assignment in the future, based on the reflections of the students and their classroom instructors.     

Social Work Assessment of Adaptive Functioning Using the Vineland Adaptive Behavior Scales

Abstract

The assessment of client adaptive functioning is often an important component of a comprehensive social work evaluation. The Vineland Adaptive Behavior Scales (VABS) are the most commonly used quantitative measures of adaptive functioning for clients meeting the criteria for a wide range of disorders. We review the development of the VABS and current knowledge pertaining to the instrument's reliability and validity. We conclude that the ability to administer and interpret the VABS is an important skill for clinical social workers to acquire.     

Peer Discussion and Client Motivation in Men's Domestic Violence Programs: An Australian Qualitative Interview Study

Abstract

Relationships Australia NSW and Baptist Community Services NSW & ACT, through its BCS LifeCare Counselling & Family Services program, collaborated to explore client perceptions of men's domestic violence programs. Recruitment targeted male clients and their female partners, across six locations in New South Wales, Australia. In total, 63 qualitative interviews were gathered from 28 participants, between 2007 and 2009, at program intake, program completion and 6-month follow-up. The focus of this article is on the 20 male interviews conducted with 14 participants at program completion (10) and at 6-month follow-up (10). Recurring themes from these interviews indicate the potentially disruptive effect of client dialogue on group dynamics. While positive group discussion has the potential to enhance client motivation, negative peer discussions, external to group sessions, can diminish group functioning and client motivation for these participants. The paradoxical nature of the group-intervention experience is explored in light of these accounts. Suggestions for men's domestic violence program facilitation and research are outlined.