Therapeutic Communication with Psychotic Clients

With the current emphasis on evidence-based practice, the significance of the social worker–client relationship as a prerequisite to client goal attainment has been de-emphasized. This is particularly problematic with regard to practice with psychotic clients, with whom practitioners often have difficulty establishing therapeutic relationships. The purposes of this article are to examine the communication deficits of persons with psychotic disorders and, with an extended example, to describe five intervention guidelines for social workers toward the goal of developing positive working relationships with them.     

Technology as a Weapon in Domestic Violence: Responding to Digital Coercive Control

ABSTRACT

Technology-facilitated domestic violence is an emerging issue for social workers and other service providers. The concept of Digital Coercive Control (DCC) is introduced to highlight the particular nature and impacts of technology-facilitated abuse in the context of domestic violence. While practitioners have become more adept at working with women experiencing DCC, there is still little known about its dynamics and whether this violence requires a change in current service responses. This article explores findings from survey research conducted with 546 Australian domestic violence practitioners about the ways perpetrators use technology as part of their abuse tactics. The findings demonstrate that DV practitioners believe perpetrator use of technology is extensive and has significant impacts on the safety of clients. A major dilemma faced by practitioners is how to promote and facilitate client safety from DCC while still enabling safe use of technology so clients can remain connected to family, friends, and community.

IMPLICATIONS

• The use of digital technology in domestic violence creates a significant practice issue for Australian domestic violence practitioners.

• The development of a practice framework for responding to digital coercive control may assist practitioners to highlight the risks posed by this abuse, while still enabling women and children the freedom to participate in the digital realm.

     

Six Step Therapeutic Process to Facilitate Forgiveness of Self and Others

This theoretical article postulates a six step therapeutic process to facilitate forgiveness of self and others. The purpose of this article is to provide therapists with the therapeutic process that can be used to assist clients who are working through forgiveness and self-forgiveness. The combination of several therapeutic methods in a specific order might be effective in assisting clients to work through the forgiveness process in a systematic way. A case example that chronicles a client’s experience while working through forgiveness is provided. Lastly, a discussion of implications for practice and further research questions are presented.     

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.     

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.     

Ethical Dilemmas of Working with Individuals Who Have HIV Disease

This article presents the results of a survey of 99 practitioners that explored their attitudes related to the conflicting priorities of maintaining the principles of confidentiality, versus exercising one's duty to warn someone of danger. Social work practitioners face this dilemma in working with individuals who have HIV disease. When clients let workers know that they are engaging in unsafe sexual practices, and have not warned their partner of their HIV+ status, Practitioners are in a bind. Results show deep ambivalence in attitudes and actions. Discussion focuses on the dilemmas involved, and presents recommendations for practice.     

Therapeutic Applications of Online Gaming

ABSTRACT

This article discusses online gaming in the twenty-first century, describes online gaming, considers negative and positive aspects of gaming, and proposes several possible research, practice, and educational strategies for subsequent development of this genre into a useful tool for human service interventions. Positive characteristics of online gaming environments such as high levels of social interaction and the potential for transformative experiences strongly suggest that many clients will be utilizing such environments. In addition, practitioners must not only learn to assess client use of gaming but also develop the necessary knowledge and skills to utilize online games as therapeutic tools.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Client-led Spiritual Interventions: Faith-integrated Professionalism in the Context of a Christian Faith-based Organisation

Focused on the professional practice habits of Christian social workers and counsellors, this article explores the question of good practice when working therapeutically with clients asking to discuss spirituality and faith. Interviews with 10 senior practitioners who are practising Christians as part of a qualitative study revealed several common experiences when working with clients actively seeking to explore faith and spirituality: (1) using flexibility, discernment, and a client-led approach; (2) trust in God and spiritual receptiveness; and (3) managing tensions between professional, personal, and organisational values. The implications of the study highlight the requirement for professional integrity, to include practising within one’s range of competence, and the value of ongoing professional development to support good practices when working with religious clients.     

Toward a Better Understanding of the Use of Psychodynamically-Informed Treatment with Latinos: Findings from Clinician Experience

Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. Therefore, the question of what types of mental health treatment approaches are useful in working with this population is of increasing concern. A strong sentiment against the use of psychodynamic treatment with Latinos persists in the literature in the absence of rigorous data that would support such a stance. Thus, it is important to examine systematically the use of psychodynamically-informed treatment with Latinos in order to address the question of its potential relevance and utility with this population. This article presents the results of a qualitative study of Latino therapists who employ psychodynamic approaches with Latino clients. Findings suggest that the clinicians interviewed have expanded the psychodynamic framework to include a flexible focus on the relationship, consideration of each client as an individual, and an acknowledgment and understanding of external reality and its impact on the client. Modifications these clinicians have made in technique, such as increased self-disclosure, support and maximize this expansion of the frame. Simultaneously, such modifications enhance the cultural sensitivity of these clinicians' work and are congruent with contemporary psychodynamically-informed relational theories.     

Enhancing Family Therapy's Relationships With Research

The contention of this article is that systemic family therapy has much to gain from a realistic appraisal of its research base, which is as positive as possible. And that through such an appraisal we can find ways of developing the scope of family therapy to the benefit of the profession and thereby, of our clients. Family therapy will benefit if practitioners can present an informed view of research. As a preliminary approach to this objective, I review reasons why perceptions of family therapy underestimate its research base, and why therapists might resist involvement with research. The article then explores the reasons for regarding randomised controlled trials as a ‘gold standard’, and why they are not well fitted for the purpose of evaluating or developing a relational therapy. Next is a consideration of alternative approaches to research, including a consideration of what clients actually want from their therapy, then a brief review of the positive findings of outcome research. Greater emphasis on researching processes in therapy is proposed, and consideration of the ‘common factors’ debate is shown to support priorities that are specific to systemic therapies. The article concludes with suggestions for increasing the involvement of family therapists with research, both as consumers and as research practitioners.     

Psychosocial moderators of substance use among middle school-aged adolescents.

Recent statistics show a decrease in the overall use of drugs and alcohol in the general population [1]. In sharp contrast to this trend is the indication that adolescents' use of drugs and alcohol is increasing [2]. Because the use of drugs and alcohol can have serious implications for adolescents' physical, emotional, and social development, it is important that human service practitioners working with them understand those factors that influence their substance use, in order to develop effective interventions to deal with this growing problem. This article reports the findings of a study of drug and alcohol use among a sample of 779 adolescents who attended middle schools in a large urban city in the southwest United States. The study examines the relationships between substance use, social support, and a variety of other psychosocial factors. The implications of those relationships for human service practice and research are discussed.     

USING SOCIAL NETWORK INTERVENTIONS TO IMPROVE MENTALLY ILL CLIENTS’ WELL-BEING

This paper reviews empirical evidence showing that the structures of the social networks of mentally ill clients influence both their well-being and their use of mental health services. Network interventions that might help clients better address network-related problems, and might help their families improve relationships and prevent caretaker’s burn-out are presented. A case illustration will demonstrate how practitioners can assess a client’s social network, involve the client’s family in treatment, evaluate that treatment, and select tailored interventions. This case will emphasize both how practitioners can help a client restructure her network, and the complementary roles of formal and informal networks. The author shows practitioners how to match clients’ initial network structures to interventions and desired outcomes. Practitioners can thus help clients modify their social networks, increase the use of preventive services, and improve their well-being. Dr. Pinto has been supported by a training grant from the National Institute of Mental Health (732MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator, Anke A. Ehrhardt, Ph.D.) at the HIV Center for Clinical Behavioral Studies for Clinical and Behavioral Studies.     

Stories of strangers: Writing donor acquisition letters in the human services

This study explores the choices fundraisers make in crafting letters to acquire new donors for a human services organization, and whether the type of client served affects those choices. We use an experiment to control for organizational differences, and code the resulting letters written for elements identified in theory and practice, then perform an exploratory factor analysis to find patterns of co‐occurring variables. Writers tended to focus either on the quality of the organization or the unmet need in the community, but not both. Two of the factors, Universalism and Security, describe distinct personal value constructs that may reflect the preferences of the writer or the presumed preferences of the reader. Compared to participants writing for an older adult client base, participants writing for clients with mental illness were less likely to use a negative frame, more likely to use statistical evidence, and used lower expectations in describing successful client outcomes. Within letters, clients were described using three patterns: by describing a stranger who is worth helping because of intrinsic attributes; by describing a stranger who is worth helping because of their relationships within the social order; by describing the client group using facts and statistics, rather than an emotionally compelling story narrative.     

Abstinence-Only: Are You Not Working the Program or Is the Program Not Working for You?

Low retention rates are common in substance use treatment programs. The dominant model of service delivery in the United States is abstinence-only, a high-threshold service delivery model requiring abstinence. What “doesn’t work” for the client—from the client point of view—is an overlooked source of insight about client engagement and disengagement. We report client counter-narratives about the choice to disengage from abstinence-based services, shifting from a story of “dropouts” to one of self-respect. Understanding why clients choose to disengage from treatment can help us as practitioners to “meet clients where they are” and enhance engagement in substance abuse treatment.     

Sexual behavior of resident street prostitutes with their clients in Camden,New Jersey

This paper describes a prospective study of the sexual behaviors of 20 resident street prostitutes and their clients. Prostitutes were long‐term residents of and practiced street prostitution in their community. They worked full‐time and reported averages of four clients per workday, four to five workdays per week, in an eight‐year career. Sexual behaviors with clients on five to eight workdays were recorded over a seven‐month period. Forty‐nine percent of contacts were with repeat clients. A regular client was defined by prostitutes as one who visited at least once a week. The results of the present study indicate that long‐term sexual relationships exist between some clients and prostitutes. Typically, a regular client had one to three sexual encounters per week with the prostitute, spent several hours with her at a motel (or one of their homes), and was more likely (than the occasional client) to engage in vaginal intercourse. Reported condom use was in the range of 39 to 74 percent.     

Disability and spirituality in social work practice

In working with social work clients, issues of religion and spirituality are sure to arise. Religious views on disability can have both positive and negative effects on the individual. In our increasingly pluralistic society, these issues must be approached with sensitivity and patience since it is common to work with adherents of minority or nontraditional religious groups or groups whose values conflict with the social work profession. The purpose of this article is to enhance and develop sensitivity to diverse religious views in order to respect the values and life beliefs of the client while enhancing the development of adaptive religious and spiritual views.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Can't Buy My Love: A Typology of Female Sex Workers' Commercial Relationships in the Mexico–U.S. Border Region

Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who “fell in love” with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.     

Aggression exhibited by older dementia clients toward staff in Japanese long-term care

This study examined the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analyzed. In the past year, 75.3% and 63.5% of staff members had experienced physical and verbal aggression, respectively. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Burnout, which is likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression.