Affirmative Practice and Alternative Sexual Orientations: Helping Clients Navigate the Coming Out Process

Those who differ from the dominant heterosexual ideal of exclusively other-sex attraction and intimacy encounter unique challenges, such as the coming out process, during which individuals with alternative sexual orientations must explore, define, and disclose their orientations in a way straight individuals need not. This article focuses on how clinicians can aid clients throughout the coming out process in a way that affirms the full range of sexual orientations. Following an overview of alternative sexual orientations and models of the coming out process, a case example is used to illustrate how clinicians can help clients address three challenges of coming out: overcoming internalized biases; clarifying their sexual orientation and identity; and making decisions about disclosure.     

The Marriage and Family Therapy Practice Research Network (MFT‐PRN): Creating a More Perfect Union Between Practice and Research

This article describes the Marriage and Family Therapy Practice Research Network (MFT‐PRN). The MFT‐PRN is designed to build a professional community based on practice‐informed research and research‐informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT‐PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical‐research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article .     

Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs

The physical health of substance abuse clients significantly deteriorates because of the client’s prolonged abuse of alcohol and other drugs and accompanying behaviors. The purposes of this study are (a) to understand how substance abuse clinicians think about the health needs of their clients, (b) to identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients, and (c) to identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients. A qualitative study was conducted using in-depth, semistructured interviews with substance abuse clinicians (N = 16) from 4 substance abuse treatment centers. Using the theory of planned behavior as a framework for understanding the promotion of health-conscious behaviors in substance abuse treatment, the findings suggest that substance abuse clinicians are capable of enhancing health-conscious behaviors among clients in substance abuse programs.     

Screening for depression and suicide: self-report instruments that work

Self-report instruments for depression and suicide risk can help busy clinicians identify adult clients who may be at risk for depressive disorders. These instruments provide a baseline measure of clients' behavioral status, reflect response to treatment, and improve clinical decision making. Such scales can also detect symptoms of depression regardless of whether they are reported or observed. Clinicians' recognition of depression is improved when self-report screening tools are used. When it is not feasible to conduct a thorough psychiatric evaluation, screening instruments can identify at-risk clients who need further evaluation.     

Moving Up the Continuum of Hope: Developing a Theory of Hope and Understanding its Influence in Couples Therapy

For years therapists have suggested that hope is an important catalyst in the process of change. This study takes a grounded theory approach to address the need for a clearer conceptualization of hope, and to place interventions that increase hope within a therapeutic context so that therapists know how and when to use those interventions. Fifteen active and experienced marriage and family therapists from across the United States participated in hour-long phone interviews about hope in couples therapy. Moving Up the Continuum of Hope emerged as the core category from the grounded theory analysis of the data. This category represents a process, with general and specific conditions and consequences that increase a couple’s level of hope. This study serves as a foundation for future process research on couples therapy, as well as research on hope in other contexts (e.g., individual and family therapy) and with other perspectives (e.g., clients).     

‘Somebody Watching You’: Impact of Reflecting Teams on Hope in Couple Relationships

Reflecting teams (RTs) represent both an epistemological stance and a therapeutic technique. Most commonly associated with narrative and systemic approaches to therapy, RTs offer an outsider perspective that can bring hope and alternative narratives and perspectives for therapists and clients to explore. Relational hope is a little researched concept in the field of couple therapy research. This study explores the experience of RTs in couple relationships and the aspects of the experience that couples describe as connected to a sense of hope for their relationship. The study also considers whether difference in attachment style shows any relationship with hope in couple relationships before and after the clients’ session with a reflecting team. Couples completed questionnaires about their attachment style, demographics, and relational hope and were given the option to complete an interview about their experience with the reflecting team within 1 month of their therapy session. Our findings suggest that RTs contribute positively to hope in couple relationships particularly for clients who present with an anxious attachment style. This direction for research is important because there is very little research about hope in couple relationships despite its importance (Merolla, 2014; Snyder, 2002) and there is no research about what aspects of a reflecting team contribute to hope in couple relationships. Analysis of interviews indicates a number of features of the reflecting team feedback that were valued by clients.     

Perceived effectiveness and implementation of public relations measurement and evaluation tools among European providers and consumers of PR services

While the need for and lack of implementation of more sophisticated methods for measuring the impact of public relations efforts has been well documented in the U.S. and some other world regions, relatively little information exist about this practice in the European Union. Results from a survey of both consumers and providers of public relations in the EU shows that perceptions of effectiveness and actual use are not related for most advanced techniques of measurement and evaluation. These results demonstrate some potentially important differences between the perceptions of providers and consumers that may support practitioner observations regarding a lack of interest among clients in more accurate assessment of results from public relations activities.     

Walking our talk in Social Work Education: partnering with consumers of Mental Health Services

Social work education emphasizes the importance of partnership and collaboration with clients, defining clients as experts in their lives and needs. However, academic departments of social work do not usually model this concept of partnership by fully collaborating with clients in the process of educating social work students. Clients are seldom partners with academic educators in curriculum development, information dissemination, or student evaluation. The authors developed and implemented a facilitated dialogue process between consumers of mental health services and social work students as a way to begin to address this issue. Areas of discussion included consumer views on helpful social worker actions and interventions, as well as ways consumers could be, and wished to be, included in social work education. This paper reports on the strategies and recommendations generated by consumers during the dialogue, and discusses implications for social work education.     

You’re Deaf? Breaking through Myths for Effective Therapeutic Practice

ABSTRACT

Most mental health practitioners provide services to hearing clients and might be unprepared when a deaf individual requests services. The purpose of this article is to explore commonly held stereotypes and myths about deaf people and to provide guidance to clinicians who encounter deaf clients in their practices. Myths and stereotypes can affect the way clinicians perceive their clients’ needs. This can lead to miscommunication, misunderstanding, and misinformation, which can harm the therapeutic relationship, thus making effective therapy unattainable. Clinicians should reframe these beliefs and overcome barriers to make way for the therapeutic process to begin.     

Preparing social workers for practice with LGBT populations affected by substance use: perceptions from students,alumni, and service providers

Trends in the field of service among those with alcohol and other drug addictions highlight the urgent need for schools of social work to effectively train students to serve clients with substance use disorders, and have cultural humility to effectively serve disproportionately affected LGBT consumers. Online surveys and interviews examined perceptions of graduate social work students and alumni in a certified alcohol and drug counselor program, along with several service providers within an urban setting in the US. Results indicated that students and alumni did not feel adequately prepared through coursework to practice with LGBT populations affected by substance use, while feeling more clinically competent to practice with LGB individuals, than with transgender consumers. Similar findings related to unique differences associated with perceptions of faculty support, along with field preparedness to practice with LGB individuals when compared to transgender individuals. Service providers noted an overall commitment and to serve LGBT consumers as well as positive perceptions of students and alumni to do the same. Implications examine the role of faculty in addressing challenges related to preparation of social work students to practice with LGBT consumers affected by substance use disorders, along with suggestions for curricular changes, and ongoing field trainings.     

Exploratory study of the use of community treatment orders with clients of an Ontario ACT team

ABSTRACT

Community Treatment Orders (CTOs) have raised questions about coercion, lack of autonomy, and effectiveness in reducing hospitalizations and improving service users’ quality of life. This study examined the experiences of clients and clinicians when CTOs are used in combination with Assertive Community Treatment (ACT) in a recovery oriented approach. Eleven clients who were or had previously been on a CTO and eight ACT clinicians were interviewed. Although most clients had negative feelings about CTOs, some acknowledged their lives had improved. Clinicians reported that the decision to employ a CTO is sometimes debated within the team but they agreed that combining CTOs and ACT resulted in regular access to mental health supports, fewer hospitalizations and overall improvement of quality of life for their clients.     

What every nurse needs to know about nocturnal sleep-related eating disorder

This article provides information about a bizarre pattern of eating while asleep called nocturnal sleep-related eating disorder. People with this disorder, which has begun to be studied only recently, demonstrate features of both a sleep disorder and an eating disorder. Many clients are reluctant to initiate discussions regarding this condition because of feelings of powerlessness and shame. Other clients do not discuss their symptoms because nurses and other clinicians fail to gather accurate assessment data due to lack of knowledge within the professional community regarding the disorder. This review includes the historical background, definition of terms, and clinical manifestations of nocturnal sleep-related eating. In addition, emphasis on assessment and clinical management are included. Safety issues, the need to educate health care providers, and the role of the nurse in advocating for appropriate diagnosis, treatment, and referral are addressed.     

Addiction Treatment with Deaf and Hard of Hearing People: An Application of the CENAPS Model

ABSTRACT

Alcohol and drug addiction is a significant problem among deaf and hard of hearing people. Looking through a Deaf culture lens, treatment for alcohol and drug addiction is key for providing care for deaf and hard of hearing clients. Using the CENAPS model, an applied cognitive-behavioral therapy program is recommended for addiction treatment. The CENAPS model provides clinicians with tools for stabilizing deaf and hard of hearing clients, supporting their transition to early recovery. Educating the client about the stages of relapse and the stages of recovery, clinicians using this model can better treat and prepare deaf and hard of hearing clients for long-term recovery.     

Psychological implications of childhood meatotomies

This paper informs clinicians about the nature of childhood meatotomies, and presents two cases which suggest that the presence of a meatotomy in the developmental history of male clients should alert clinicians to the potential significance of particular body damage fears and body integrity issues in the client.     

Secondary Trauma: A Team Approach

Bearing witness to trauma stories can evoke in clinicians the confusion and emotional turmoil their clients experience, known as secondary trauma. Given the complexities of trauma work, practitioners need help to clarify issues and feel more effective. The terror attacks of September 11, 2001 further compound the task, as therapists may themselves be feeling the impact of those events. Presented here is a team model for structured case discussion which can help workers identify and deal with their reactions to both client trauma stories and their own experiences. The model is explained and illustrated with examples, and the process by which it was piloted and evaluated is discussed.     

A Content Analysis of Intake Paperwork: An Exploration of How Clinicians Ask About Gender,Sex, and Sexual/Affectual Orientation

In the United States, the transgender and gender nonconforming (TGNC) population has increased twofold since 2011. Although counseling professionals are called to provide competent services to TGNC clients, no empirical studies exist that examine one of the first points of contact: Intake paperwork. The authors conducted a content analysis (N = 128) of intake paperwork and assessed how and if clinicians asked for gender, sex, and sexual/affectual orientation, and whether they conflated these constructs. Findings indicate adjustments need to be made for intakes to be more inclusive of these constructs. The authors offer clinical implications and avenues for future research.     

Nature & prevalence of stalking among New Zealand mental health clinicians

Stalking involves recurrent and persistent unwanted communication or contact that generates fear for safety in the victims. This pilot study evaluated the nature and prevalence of stalking among New Zealand nurses and physicians working in mental health services. An anonymous questionnaire asking respondents to describe their experiences with 12 stalking behaviors was distributed to 895 clinicians. Results indicated that regardless of discipline, women were more likely than men to have experienced one or more stalking behaviors, including receiving unwanted telephone calls, letters, and approaches; receiving personal threats: and being followed, spied on, or subject to surveillance. Women also reported higher levels of fearfulness as a consequence of stalking behaviors. Nearly half of the stalkers were clients; the remaining were former partners, colleagues, or acquaintances. In client-related cases, the majority of respondents told their colleagues and supervisors first, and the majority found them to be the most helpful resource. The results of this pilot study indicate a need for further research focused on the stalking of mental health clinicians in New Zealand and for development of workplace policies for adequate response to the stalking of mental health clinicians.     

‘I Thought We Came for Therapy!’: Autobiography Sessions in Couple Work

Each family builds up its own culture which is partially invisible to each of its members, and so I invite my couple clients to write their own autobiography as part of a move towards self‐differentiation. By emphasising difference in this way, I hope to allow my clients to feel OK about their discomfort, if any, with my ethnicity. I include vignettes to illustrate the process and client response.     

A constructivist approach to the help-seeking process of clients: A response to cultural diversity

The issue of cultural diversity presents clinicians with both delemmas and opportunities. To deal with such a challenge, I have proposed a constructivist approach to the help-seeking process of clients from diverse ethnoracial backgrounds. A model of clients' help-seeking processes provides a useful and systematic frame for clinicians to understand clients' construction of their problem situations and possible solutions. It provides a useful key for clinicians non-presumptuously to understand clients' subjective experiences, and to enhance clients' ability to resolve problems.     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.