Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Collaboration and conflict between agencies and clients

Public relations agencies are an important part of the public relations industry, but their relations with client organizations are rarely studied. There is more literature and studies in agency-client relations in advertising than in public relations. This paper reviews literature and reports results of an empirical study into perceptions of public relations agencies and their clients on the reasons for their cooperation and sources of conflict between them. Results show that agencies misperceive reasons for which they are hired and the sources of conflict in the relationship. The paper offers several suggestions about how to tackle the problem: notwithstanding rebranding into consultancies and firms, public relations agencies-client relations should be studied as a particular example of a broader family of agency-client relations. Also agencies should study and strategically manage relations with their clients, while being realistic about client organization’s needs – sometimes they just need additional arms and legs.     

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID-19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem-Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.     

Clinical application of anxiety management and relaxation training: A multi-referral workshop

Anxiety may be so significant a block to problem-solving and the treatment process that clinicians, regardless of their treatment orientation, often find it useful to have tranquilizing medications prescribed for their clients as a concomitant to therapy. This paper reports on the practical application of group relaxation training as an anxiety management tool for clients at mental health centers. Besides teaching relaxation, this training, for which there are no contraindications listed in thePhysicians Desk Reference, teaches body awareness and self-regulation, specificity and clarifying thoughts, and is a useful model for the rational, problem-solving process.     

Effect of Brief Staff‐Assisted Career Service Delivery on Drop‐In Clients

Brief staff‐assisted career counseling services based on cognitive information processing theory were evaluated using 138 drop‐in clients who completed pre‐ and postintervention self‐report measures of knowledge about next steps, confidence in making next steps, and anxiety about career concerns. Significant changes occurred in each dimension and were significantly associated with the quality of career adviser interaction. Participants rated the experience as highly positive. Decreases in anxiety about career concerns were unrelated to the intervention. Implications include that a brief service delivery model yields positive outcomes for many clients but requires adjustments in organizational culture, physical environment, practitioner approaches, and client expectations. Future research should examine relational variables related to decreased anxiety with a brief service delivery model, the degree to which this approach works with specific career needs, and client attributes leading to successful versus unsuccessful outcomes with this model.     

Coping and Psychological Distress Among Genderqueer Individuals: The Moderating Effect of Social Support

This study examined the relationships between social support, coping, depression, and anxiety in a sample of genderqueer individuals (n = 64). Genderqueer is a label used within the broader transgender community and is defined as a gender identity that is outside the binary construct of male and female. Findings indicate that 53% (n = 34) of participants reported clinical levels of depression and 39% (n = 25) reported clinical levels of anxiety. There was a direct relationship between social support and depression and anxiety, indicating that more social support is associated with less depression and anxiety when statistically excluding coping factors. In addition, more facilitative coping (e.g., seeking help) was related to less anxiety, whereas more avoidant coping (e.g., avoiding emotions) was related to more anxiety and depression. There was a significant interaction between social support and coping factors when predicting anxiety, such that individuals who reported higher social support used more facilitative coping which was associated with less anxiety and those who reported less social support used more avoidant coping which was associated with more anxiety. Clinical implications for working with genderqueer-identified clients are discussed.     

Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers

The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost.     

Clients as Teachers: Reciprocal Influences in Therapy Relationships

The value of the continuing education industry for therapists is questioned, as is the usefulness of therapy books and journal articles, as a means of engaging therapists in life‐long learning. Instead, it is argued that our clients are our best teachers and that therapists learn most effectively from their clients. Drawing on research studies with prominent theoreticians and therapists, and on case studies from clinical work, a number of important themes are identified as ways in which therapists are influenced by their therapeutic encounters with their clients. The themes explored in this article include: (1) intimacy and high emotional arousal with clients as we witness profound change; (2) being challenged by clients; and (3) allowing for boundary ‘crossings’ in order to develop more flexible ways of working with clients. The implications for professional development are discussed.     

Decision-Making and Evidence in Direct Practice

This article presents the results of research designed to explore decision-making by direct practitioners in selected non-profit human service settings. Forty interviews were conducted with workers at front-line, supervisory and higher-management levels. The research questions included; what sources of information are used in decision-making, what variables enhance or impede utilization of evidence-based knowledge in decision-making and what would be important resources for improving availability, access and utilization of evidence-based knowledge in decision-making? Our results indicate that respondents relied most heavily on experience; on their professional values and beliefs, and on an empathic understanding of their clients’ uniqueness. Compared to these sources of information use of research and the professional literature were less enthusiastically endorsed.     

Listening to Words,Hearing Feelings: Links Between Eating Disorders and Alexithymia

Research suggests that eating disorders often involve difficulty with affect regulation and processing of emotions. Studies also show that many individuals with these difficulties suffer from alexithymia, or an impaired ability to use language to tolerate or process emotions. Many clients with eating disorders are highly verbal, able to talk about feelings and even have good insight into the causes of their behaviors. Yet their verbal and cognitive strengths may disguise their inability to use thoughts to manage their emotions. Such clients often have a lifelong experience of appearing more capable and competent than they feel. Self-criticism and negative self-image concretized in a negative body image are part of their eating disorder. Therapeutic exploration can increase anxiety and self-criticism, aggravating feelings of inadequacy and the concomitant need for self-soothing. Techniques that focus on affect regulation have been shown to be effective, yet a psychodynamic approach can be an important tool in such an integrative practice. In this article, clinical material and theory will illustrate some of the ways that incorporating an understanding of alexithymia into the work can enhance the use of both psychodynamic exploration of meaning and also tools to manage affect and change behavior.     

Current treatment of generalized anxiety disorder

Generalized anxiety disorder is the most common anxiety disorder and is second only to depression as the most common disorder diagnosed in primary care. Because it is potentially disabling due to its high comorbidity with other psychiatric conditions, psychiatric nurses must accurately diagnose GAD and formulate individualized treatment plans that promote positive outcomes for clients with this disorder.     

A National Study of Involuntary Protective Services to Adult Protective Services Clients

ABSTRACT

A questionnaire was sent to state administrators of Adult Protective Services Programs (APS) to learn about involuntary protective services provided by APS to vulnerable adults at risk of abuse, neglect, or exploitation. Data were obtained on criteria used to assess the need for involuntary services, types of services provided, sources of authority for involuntary intervention, the nature and extent of public concern about involuntary services, and the protection of the rights of incapacitated clients. Based on responses from 43 states, less than 10 percent of APS recipients receive services without their consent; and all states providing services involuntarily take steps to ensure the protection of rights. Available information from the study does not support the general belief that adults who self-neglect are more likely than other APS clients to have protective services imposed.     

Marriage and family therapists and psychotropic medications: practice patterns from a national study

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.     

Living on the edge? Professional anxieties at work in academia and veterinary practice

ABSTRACT

Through empirical research on academics and veterinary surgeons, this article focuses on identity and how it is reflected in, and reproduced by, anxiety and insecurity at work. Three analytical themes – perfection, performativity and commodified service – each of which generates anxiety indicates a loss of autonomy as academics and vets are subjected to competitive market forces as well as an intensification of masculine managerial controls of assessment, audit and accountability. We see these pressures and their effects as reflecting a commodification of service provision where the consumer (student or client) begins to redefine the relationship between those offering some expertise and those who are its recipients, partly achieved through the performative gaze of constant and visible rating mechanisms. Our empirical research also identifies sources of anxiety concerns in their attempts to achieve perfection against this background of uncertain knowledge and precarious contexts of the performative nature of professional expertise.     

Equine-assisted social work counteracts self-stigmatisation in self-harming adolescents and facilitates a moment of silence

The purpose of this study was to determine whether equine-assisted social work (EASW) could affect self-stigmatisation and thereby counteract false identities in self-harming adolescents. Data were collected via interviews with nine female self-harming clients aged 15–21 years and eight staff members. Interviews and video-recorded human–horse interactions with three staff members and four clients were analysed. The interviews were followed by further dialogue with participants while they viewed videos of their own EASW sessions. The analysis indicated that the horse had a calming effect on the clients; enabled them to free themselves of their preoccupations; provided real-time, non-verbal and non-judgmental feedback on their emotions; and increased feelings of trust, patience and empathy. The presence of a horse provided a ‘moment of silence’ for the clients, silencing their inner critic, and made them feel more authentic and better able to regulate their emotions. However, staff could counteract this ‘safe’ healing by being too focused on goals, making interpretations and lecturing and encouraging clients, thus making clients feel judged anyhow. EASW seemed to give clients the opportunity to break free from self-stigmatisation, which seemed to lower the barrier to change.     

A Person‐Centered Perspective to Welfare‐to‐Work Services: In Pursuit of the Elusive and the Unattainable

Because of changes in legislation regarding the U.S. welfare system, there is an urgency now that has never before existed, except perhaps during the Great Depression, for career counselors to advocate for those of their clients who are on welfare and for their minor dependents. E. B. Lent (2001) has revitalized the debate over the role Rogers's person‐centered perspective should play in career development with welfare‐to‐work (WTW) clients. The usefulness of such an approach with today's clients was explored within the context of inherent limitations of Rogers's person‐centered perspective. Potential ethical conflicts for career counselors working with WTW clients were identified.     

Does Affirmative Training Matter? Assessing CFT Students’ Beliefs About Sexual Orientation and Their Level of Affirmative Training

This study examined couple and family therapy (CFT) students’ beliefs about sexual orientation, their self-reported competency working with lesbian, gay, and bisexual (LGB) clients, and the level of affirmative training students received in their CFT programs. One hundred and ninety students from accredited CFT programs completed the study. While participants reported feeling only somewhat competent to work with LGB clients and less than half reported receiving any training on affirmative therapy, the majority of the participants did appear to hold positive attitudes toward LGB clients. The results support the literature arguing for CFT programs to include specific training on affirmative therapy practices, as the level of affirmative training was directly related to participants’ self-reported clinical competency working with LGB clients.     

Dietetics majors' weight-reduction beliefs, behaviors, and information sources

One hundred twenty-eight female dietetics majors aspiring to be registered dietitians were surveyed to identify and assess their reasons for wanting to lose weight and the weight-loss techniques and information sources they used and would recommend to clients. Fisher's exact tests were used to analyze behavioral data, and binomial tests to determine whether proportions of students achieving their desired weight-loss outcomes were significantly greater than 50%. Most dieters wanted to lose weight to improve their appearance and increase their self-esteem. Sound weight-loss techniques that were used and recommended include increased exercise, low-fat foods and snacks, and portion control. Accurate information sources used and recommended included food labels and college nutrition courses. Unsound weight-loss techniques and potentially inaccurate information sources were also used and would be recommended by a few students. Findings suggest a need for more learning opportunities focusing on enhancement of self-esteem and weight management.     

Financial Planners and Philanthropic Planning

This article reports findings from a survey of Canadian financial planners. The focus of the study is learning more about the depth and breadth of philanthropic planning that is included in their advising services to their high-net worth clients. The findings indicate that a minority of financial planners (1) regularly broach the topic of philanthropy in their counseling, (2) believe their clients are interested in philanthropy, and (3) feel sufficiently knowledgeable to assist their clients with philanthropic planning. The implications of these findings and recommendations for improvement are discussed.