Reflective Supervision for Child Protection Practice – Reaching Beneath the Surface

This paper describes a model of reflective supervision for child protection practice that is informed by psychoanalytic theory. Eileen Munro promotes the idea of depth in practice, referring to the skills and knowledge required to undertake the work. Her reports highlight the importance of supervision to provide a thinking space for practitioners where reflection can take place. This paper will explore the importance of supervision in more depth and describe how psychoanalytic ideas can help us understand the complexities of our work with families, anchoring us to a solid theoretical base and helping to make sense of the maelstrom of feelings that are stirred in us as well as in our colleagues and clients.     

Innovative Moments in Career Construction Counseling: Proposal for an Integrative Model

This article advances understanding of career construction counseling (CCC) by viewing it through the lens of the innovative moments model (IMM) of how clients construct change. The IMM conceives clients’ narrative transformations as resulting from counselors prompting and clients reflecting on exceptions to a problematic self‐narrative (i.e., innovative moments; IMs) that emerges in counseling dialogues. On the basis of intensive IMM analysis of CCC case studies, the authors propose an integration of the 2 models that describes the sequence of client change in IMs across the 3 phases of CCC. This proposal provides both conceptual and assessment tools that make it possible to describe and analyze the process of client change through life‐designing dialogues. The authors illustrate the integrated framework with vignettes from case studies and conclude by suggesting research to examine the validity and usefulness of the client change sequence and interventions for using this pattern of change to foster client transformation.     

Australian Workers’ Narratives about Emergency Relief and Employment Service Clients: Complex Issues,Simple Solutions

This paper illuminates two under-investigated, and often intersecting, frontline services accessed by unemployed people. It reports on the narratives of 32 Australian service providers working in emergency relief or employment services during 2012, including perceptions of clients’ presenting issues and problems, and rationale for intervention. Workers tended to use reductionist and individualistic terms to describe complex client issues suggesting self-motivation and personal responsibility were key to gaining employment or alleviating poverty. Clients were often viewed as having the power to change their circumstances, while workers appeared unaware of their positional power and drew from dominant conservative discourse about welfarism and unemployment to fortify their compliance requirements. The findings are discussed in relation to service delivery and reform.     

How Can I Become More Secure?: A Grounded Theory of Earning Secure Attachment

The purpose of this study was to develop a grounded theory of earning secure attachment. This study included 15 women and 5 men who met the criteria of having a self-reported history of attachment insecurity and demonstrated evidence of earned security. The grand tour research question, How do adults with a history of insecure attachment earn security?, was explored using constructivist grounded theory and semi-structured interviews emphasizing processes of positive attachment change. The results describe a process model of change hinging on three interrelated categories: meta-conditions of positive attachment change, making intrapsychic changes, and making interpersonal changes. Clinical implications include the importance of clients committing to the process, clients working with a clinician trained in trauma-focused therapy, and clinicians being surrogate attachment figures for clients.     

Working with African American clients: considering the "homeplace" in marriage and family therapy practices

In this article, we discuss perspectives on the "homeplace" that are important to consider in marriage and family therapy involving African American clients. The homeplace comprises individual and family processes that are anchored in a defined physical space that elicits feelings of empowerment, rootedness, ownership, safety, and renewal. Critical elements of the homeplace include social relationships that shape individuals' and families' sense of social and cultural identity. We draw on our ethnographic and clinical research with African American families in urban and rural settings to describe typical schisms between therapists and African American clients when communicating about the homeplace. We also explore the impact of homeplace disruptions on experiences of "yearning." Recommendations for integrating a homeplace perspective into therapy practices are provided.     

Touch: its use in psychotherapy

The use of touch as a therapeutic intervention is a matter of controversy. While the literature reflects the healing potential of touch, it also identifies concern that touch can be harmful to our clients. This article reports the results of an exploratory research project on how social work therapists are touching their clients, as well as their reasons for using touch or not using touch. The results of the study show that the therapists sampled use touch with their clients, but have received little education, training or supervision on the use of touch. The authors encourage further dialogue and research about this potentially powerful but complex intervention.     

A Study of Clinical Change in Individual Career Counseling

This study examined the clinical significance of career counseling effects. Participants were 111 university students (83% women) who participated in individual career counseling sessions at their university. All participants completed the French version of the Outcome Questionnaire–30.2 (OQ‐30.2; Lambert, Finch, Okiishi, & Burlingame, 2005) immediately before the 1st session (pretest) and at the beginning of the last session (posttest). The OQ‐30.2 assesses 3 client life domains: subjective discomfort, problems in interpersonal relationships, and problems in social role satisfaction. Using Jacobson and Truax’s (1991) statistical approach to assessing clinical change, the authors compared clients’ pretest OQ‐30.2 scores with their posttest scores. Among clients with a “dysfunctional” score (n = 59) at the study’s inception, 34% recovered and 14% improved, whereas 41% of clients with functional scores (n = 52) at the study’s inception improved. The results suggest that individual career counseling can make a difference in the lives of many clients; they also highlight the importance of further outcome research that accounts for possible variability in clients’ responses to career counseling.     

Physical health problems of the psychiatric client

The psychiatric nurse can make significant contributions to the client's overall state of health by attending to the physical health care needs of clients in psychiatric settings. Psychiatric clients die at a younger age than the general population and their incidence of physical health problems tends to be higher. As major providers of psychiatric care, especially to the chronically mentally ill, nursing skills are crucial to the physical and mental health of vulnerable clients. The case reports provide examples of how the interaction between physical and psychological states influence care.     

When therapists do not want their clients to be homosexual: a response to Rosik's article

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.     

Cracks in the Seams: Durability of Child Care in JOBS Welfare-to-Work Programs

The success of recent welfare reforms will depend, in part, on the ability of local welfare programs to meet the child care needs of low-income parents. A key challenge is the integration of targeted child care subsidies into a seamless system for parents who are making transitions between welfare, training, and employment. This article uses data from a one-year panel study to describe program activities and child care use and transitions for participants in a welfare-to-work program. The results suggest that welfare clients were receiving significant child care assistance but services remained fragmented and poorly integrated. Adult clients engaged in multiple, often short-term job preparation and employment activities, and transitions between activities frequently resulted in disruptions in child care arrangements and loss of child care subsidies. Implications for welfare and child care policy are discussed.     

A group‐based module for adolescents to improve motivation to change sexually abusive behaviour

This article describes a group‐based intervention for adolescents specifically designed to improve motivation to change sexually abusive behaviour. The intervention is intended to be used as a single module within a comprehensive treatment programme based on cognitive behavioural and relapse prevention principles. It utilizes the Prochaska and DiClemente ( 1983 , 1986 ) model of the stages of change and Morrison's ( 1998 ) seven steps in contemplating change. We have combined these two models to produce ‘11 Steps of Motivation and Action in Changing Sexually Abusive Behaviour’. These 11 steps form the foundation of the intervention. In this paper we describe how we use the 11 steps, with accompanying illustrative vignettes and question cards describing juvenile sexual abusers at various points along the continuum of change, in order to promote the acceptance of responsibility for abusive behaviour and the development of skills to prevent reoffending. Examples of the vignettes are provided, along with a discussion of how they can be used to motivate change, develop healthy group norms in treatment and set individual goals for clients. Finally, we highlight the possibility of future applications of this intervention with male adult abusers, adolescent and adult female abusers, parents groups, significant other groups, individual clients and children with sexually aggressive behaviour. Copyright © 2001 John Wiley & Sons, Ltd.     

Impossible Clients

Abstract

This paper is concerned with a group of clients, whom I have identified in terms of their capacity to evoke strong dislike amongst Social Workers. These clients approach us in a manner which suggests a lack of the most basic social skills. I shall try to describe some of their characteristic attitudes, and the ways these are demonstrated in their contact with the workers they meet, with particular reference to the hostility that typifies their dealings with us, and can paralyse us into an ineffective response. There follow some guidelines I have evolved from my own attempts to work with some of these clients.     

Partners in the Spiritual Dance: Learning Clients’ Steps While Minding All Our Toes

We present four case illustrations highlighting the complex interplay of therapists’ and clients’ spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients’ and therapists’ spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist’s and the client’s spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.     

The Outposting Method of Community Services: A Multistaged Field Experience

Outposting is an interorganizational method of service delivery that requires an exchange relationship between an initiating agency and a host setting, for the benefit of third-party clients. This paper reports its experimental adoption as a graduate field training modality at a school of social work. Consideration is given to the contractual relationships among the parties, and to the learning objectives and outcomes. It focuses on problems of dual agency orientation and the integration of outposting with outreach and multiple advocacy. It confirms that outposting is a flexible service modality most appropriate in times of turbulence and social change.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

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.     

Child welfare clients and school satisfaction

Despite long-standing knowledge about child welfare clients' poor educational outcomes, we know less about these vulnerable young people's situation in school. This article addresses school satisfaction among upper secondary students who have been in contact with the child welfare services. These child welfare clients' school satisfaction is compared with their peers' satisfaction. The results from a survey indicated that the majority of child welfare clients were satisfied with school but that they were less satisfied with school than were their peers. The results showed that the association between school satisfaction and positive school experiences explains a large part of this difference. Among students who reported they were doing well in school, had supportive teachers and friends at school, the difference in school satisfaction between child welfare clients and others was small. Among students who did not report similar positive experiences in school, difference in school satisfaction between child welfare clients and their peers was more substantial. These results show that school can be a good place for child welfare clients, but that facilitating support from teachers, increasing opportunities for making friends at school, and working to develop the child welfare clients' academic performances are important as efforts to improve school satisfaction.     

Going beyond vocational rehabilitation as a training of skills: return-to-work as an identity issue

In western welfare states, labour participation is increasingly considered a vital aspect of taking part in society. Vocational rehabilitation programmes are intended to support people in the process of returning to work. These programmes pay much attention to the skills that clients need to develop in order to return to work. We argue, however, that vocational rehabilitation is more than the acquirement of skills, and that further attention should be paid to clients’ ‘identity work’ processes. Based on 45 life-stories, we present an analysis of the identity work expressed by people with a work disability in the Netherlands. We describe ‘separative’, ‘integrative’, and ‘pending’ processes of identity work. The presented typology can help vocational rehabilitation professionals become more sensitive to clients’ processes, and supports more inclusive vocational rehabilitation.     

We've Looked at Care from Both Sides Now: The Effects of Alternative Evaluation Strategies on Study Conclusions

This study uses two studies about the role of managed-care programs in serving Medicaid long-term care clients in Florida to illustrate how different research designs can reach divergent conclusions. Two reports from different groups using essentially the same database to assess the impact of managed care on a group of older Medicaid clients served by a Nursing Home Diversion Program reached different conclusions. The report from Florida's Office of Program Policy Analysis and Government Accountability concluded that the Diversion program saved money, whereas the report from the Florida Policy Exchange Center on Aging at the University of South Florida reached basically the opposite conclusion. Both agreed that the capitation rate was too high. How the policy questions are framed and analyzed can affect the conclusions reached. A variety of factors can influence the apparent effects of programmatic interventions. Evaluations must take relevant confounding variables into account.