Spiritual Transformations in Clinical Relationships Between Social Workers and Individuals Living with Disabilities

Abstract

Some individuals living with disabilities have expressed a need to have spirituality recognized within clinical relationships. Social workers and other professionals have not responded to this need and therefore, there is a growing difference between what individuals with disabilities need and what clinicians, including social workers, are providing. Jean Vanier is a Canadian who has spiritual wisdom gained from over 40 years of living with people who have disabilities. Applying insights from both Vanier and transformational learning theory, this paper demonstrates that Vanier's approach is an important resource as social workers integrate spirituality into the clinical relationship with disabled individuals.     

Designing Computerized Clinical Information Systems to Monitor Interventions on the Agency Level

The aim of this paper is to suggest an approach to the design of computerized clinical information systems to help meet the information needs of practitioners in social service agencies. Further, the interest is in data that can and should be collected as integral part of practice and not as part of one-shot research endeavors. This paper presents a brief analysis of what outputs a clinical information system should produce in order to meet information needs of clinicians, and suggests guidelines for the design of such systems. Two applications of information systems based on these guidelines are presented and discussed. In the discussion, the paper identifies the need for programming tools which would faciliate the interface between practitioners and data base programs. Finally, the implications of the availability of this information technology for clinical judgment and for individualized interventions are briefly discussed.     

What White Mental Health Professionals Need to Understand About Whiteness: A Delphi Study

This Delphi study surveyed an interdisciplinary panel of diversity expert trainers (N=20) about what white mental health professionals need to understand about whiteness. The panel endorsed 162 items that included what white mental health professionals need to understand about historical and contemporary whiteness within the mental health fields and larger social systems, self of the therapist work for white therapists, as well as challenges to understanding whiteness in clinical training and practice. More specifically, the panel provided guidance on the cognitive and emotional transformations necessary for white mental health professionals to address whiteness, as well as the challenges to those transformations. The researchers provide clinical training implications for marriage and family therapists (MFTs) and other clinicians based on the results.     

What Do We Need To Do To Keep People Safer?

This paper explores what it might take to narrow the implementation gap between the evidence base and advice about what keeps people safe and the actual practice close to the patient and client. We describe what we have learnt about facilitating conversations with clinicians about times when their practice ‘fell short’ and how attention to the framing assumptions embedded in these stories can tell us more about what it takes to keep people safer.     

Adoption Competent Clinical Practice: Defining Its Meaning and Development

The need for adoption competent mental health services has been well documented. However, the term “adoption-competent” has lacked a standardized, broadly accepted definition. This article reports findings from two related studies. The first examines how adoption competencies are demonstrated in practice by clinicians participating in an evidence-informed adoption competency training program. The second is an online survey designed to determine whether members of adoption kinship networks agree with a definition of an adoption competent mental health professional developed by experts. Both studies contribute to our understanding of what constitutes “adoption competent” clinical practice.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

A Response to Commentary on Faust,Bridges, and Ahern's (2009) “Methods for the Identification of Sexually Abused Children”

With every Diagnostic and Statistical Manual of Mental Disorders that has been published, there has been controversy within controversy; however, what appears to be lacking is the importance of truly understanding what, why, and how the changes impact the community at large. Issues such as homosexuality, the five axial diagnostic system, and transitioning from a medical model to a biopsychosocial model have been hot topics that have led clinicians to challenge the reliability and validity of the manual throughout history. As clinicians and medical professionals, it is important to objectively look at the manual and become educated on how and why these changes exist. With that being said, this commentary aims to challenge the article “Commentary: Problems with the Sexual Disorders Sections of DSM-5” by Colin A. Ross (2015). The structure of this commentary purposefully mirrors the structure of the commentary that it is challenging.     

How people with schizophrenia build their hope

1. Both clinicians and consumers identified the importance of maintaining relationships and experiencing success as helpful in building and nurturing hope for consumers. 2. To provide holistic care, clinicians need to discuss spirituality and meaning with clients. 3. Because being hopeful is an active process, clinicians need to talk to clients about hope, openly, realistically, and strategically.     

Multiple Risks,Multiple Worries,and Adolescent Coping

Summary

To describe the process that clinicians use to engage vulnerable urban adolescents in mental health counseling, the authors propose a tri-partite model of clinical engagement that takes into account: (1) consumer preference; (2) risk and worry; and (3) youth development (YD) perspectives. These conceptual lenses embody what adolescents want to talk about, their exposure to behavioral and environmental risks, and their coping and strengths. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this paper uses this tripartite model to summarize patterns of risk that service applicants experience, what they worry about, and how they cope. It explores the substructure of adolescent risk and vulnerability, through factor analysis of relevant items across a broad range of Adquest life areas, to develop a typology of adolescents by risk and worry. Patterns of coping and desire to talk across a range of life areas within this typology are described, as are the practice implications. The authors conclude that even those adolescents who most concern clinicians—because they have high environmental and behavioral risk and low worry-present many different opportunities for engagement.     

An overview of evidence-based program registers (EBPRs) for behavioral health

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices meet this need to a degree. However, much needs to be done to improve the ability of the registers to fully realize their purpose.     

Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Developing a Syllabus for a Mixed‐Methods Research Course

In this paper, the author shares with readers his journey towards creating and evaluating a mixed‐methods research course in education using a course design framework to guide the discussion. He discusses important questions such as what goes into a mixed‐methods syllabus, what resources are available to instructors and students, what learning goals we might set for our students and how we might assess whether students achieve these goals in the context of teaching his own course for the first time. There is a need for dialogue among the ‘first generation’ of instructors of mixed‐methods research courses about how we teach these courses – readers are encouraged to continue this dialogue about teaching mixed‐methods research courses by following up on and extending the ideas in this paper.     

Kids' experience of post-modern stress: New tools for clinicians

A recent qualitative inquiry into the question of what it's like being a kid' provides clinicians who treat children with useful tools. It is very important that clinicians be effective in a world where the context of kids' lives is increasingly stressful and where clinicians are accused of contributing to the stress. This article describes the stresses on kids and accusations leveled at therapists. It then discusses the research methodology, findings relevant to stress, and implications for clinicians who work with children.Mrs. Ellis has a private practice and is a School Social Worker in Wilmette School District #39.     

A witness for the defense of need assessment

Need assessment, a frail and weak offspring of evaluation and planning is in both vogue and a struggle for survival. A prevailing requirement for social and health programs, need assessment has become the “in thing.” Still, ten references to need assessment, once probed, are likely to mean ten different things. It is possible, that premature push for poorly understood technology and concepts resulted in the evolvement of need assessment into multimeaning and multi-method activities. This paper presents a view of what need assessment is, frequent misunderstanding and criticism of need assessment, and suggested changes for need assessment activities. The purpose of this paper is to address relevant issues and hopefully reduce the likelihood that need assessment will go the way of the “new math,” that is, the way of an activity of merit, poorly explained, poorly prepared for, implemented, and then dismissed.     

Mandatory Reporting and Child Exposure to Domestic Violence: Issues Regarding the Therapeutic Alliance with Couples

Some child welfare legislation have recently expanded the definition of ‘a child in need of protection’ to include child exposure to intimate partner violence. Such legislation places clinicians in the challenging position of determining whether a situation falls under their duty to report. The current paper examines a case example in which there was child exposed to intimate partner violence, the clinician made a report to child welfare authorities and attempted to maintain the therapeutic alliance with the couple in treatment. The couple viewed contacting child welfare authorities as a crisis situation both in their marriage and in their family. Practice principles for clinicians are suggested.     

‘Miss mum’: mind and affective experience of Korean learners identified with autism spectrum and cognitive difficulties

Responding to the call for culturally informed research on autism spectrum (AS) to allow for the provision of appropriate services, this paper qualitatively explores the affective experience of five Korean learners identified with AS and cognitive difficulties by listening to their voices. The learners, supported by the use of visual aids and a choice of their preferred mode of communication, expressed the complexity of their inner experience that encompassed abilities as well as difficulties. The findings highlight the commonalities of experience between Korean and non-Korean individuals with AS, along with some aspects specific to the Korean cultural context.     

Establishing self and meaning in low back pain narratives

Pain narratives encounter the problem of verbalising private and internalised experiences. Words appear to fall short of giving meaning to the feelings and impact of pain. In this paper we report on how people describe their low back pain and the way in which they claim to present this to clinicians. In the research interviews they need to establish themselves as believable narrators and provide accounts of how they legitimise their pain in clinical encounters. As a result, the interviews provide complex and layered narratives of pain and its representation.     

Ethics Anxiety

This case report, drawn from an American hospital, explores a phenomenon best described as ethics anxiety, a feeling of uncertainty as to what is ethically required or permitted, leading to clinical delay and confused decisions. In the specific clinical situation presented, the clinicians find themselves confronting, under severe time constraints, a complex, multidimensional problem with ethical and legal implications. The situation deteriorates as the clinicians find themselves unable to find what they perceive as the expert advice, either clinical or ethical, that would enable them to resolve the problem presented. In the discussion section of the case report, some attention is given to the role that the bioethics movement itself has had in creating these situations and undermining clinical decision‐making.     

Hospitality in Family Therapy Practice: A Further Engagement with Jacques Derrida

Derrida's concept of hospitality has been proposed by some authors working from a collaborative perspective as an interesting tool to reflect on the therapeutic relationship as an ethical relationship in which the therapist develops a welcoming openness to the client. In this paper, we engage with this recent emphasis on the therapist's ethical position of welcoming the client's otherness and turn to Jacques Derrida's original texts with the aim of developing an in‐depth understanding of what exactly is at stake in this therapeutic position of hospitality. This reading evolves into an understanding of how Derrida's notion of hospitality invites clinicians to identify how the therapeutic position intricately intertwines healing and violence. The concept of hospitality calls on therapists to accept the complexity of therapeutic responsibility as a form of supportive presence that necessarily and simultaneously involves the violence of appropriation and power difference.     

Narrative Methods for Differential Diagnosis in a Case of Autism

Diagnosis is rarely a straightforward process. This is especially so in psychiatry, where diagnoses are not based on organic biomarkers (e.g., blood tests). Diagnosis can be particularly complicated for children, whose symptoms must be disentangled from typical developmental processes. In this paper, we examine how clinicians use narrative as a method for differentiating a child's autism from a possible co‐morbid seizure disorder. Our approach is conversation analysis, and we show that narrative is a pervasive and endogenous practice for producing warrantable diagnostic knowledge about patients and, as such, forms part of what we term “the practical epistemology of clinical work.”