Culturally responsive social work practice with D/deaf clients

ABSTRACT

D/deaf individuals are often marginalized in our society. A lack of cultural understanding among social workers serving this population, coupled with communication barriers, inconsistent access to interpreters, or misperceptions of culture, adds to the potential for further marginalization. D/deaf individuals seeking mental health and social services live in a unique cultural context with which social workers may not be familiar and experience persistent issues surrounding access to mental health and social services. This article reviews some useful best practices, cultural points to be aware of, and suggests some strategies for providing culturally responsive social work when working D/deaf clients.     

Subjective distress from trauma in older clients with severe mental illness

There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.     

Counseling clients with genital herpes

The epidemic of genital herpes requires nurses to diagnose and treat human responses to this health problem (American Nurses' Association, 1980). It also creates many opportunities for nurses, particularly in the realm of counseling and education. Given the changing epidemiology of genital herpes and the psychosocial consequences, nurses need to keep abreast of new information so that they may assist people to live with the disease and teach the prevention of transmission of the disease. Recent information about mild and asymptomatic cases of herpes infections has serious implications for counseling and education of persons with genital herpes. The emergence of this "silent" dimension of herpes infections means more difficulty in diagnosis and treatment. All persons with genital herpes should be assessed for their physical and psychological responses to the disease and information should be given to combat misconceptions, to alleviate fear, and aid in preventing transmission. The most significant implication of mild or asymptomatic herpes is the greater risk of transmission. The public needs to be informed about the practice of "safer sex" as a routine measure to prevent herpes, as well as AIDS and other STDs. Given the widespread and epidemic proportions of herpes, persons should be counseled to use condoms whenever they engage in sexual activity with a partner. In addition, correct use of condoms must be taught. Nurses have an important role to play in counseling clients with genital herpes and in preventing the disease.     

Psychotherapy with Lesbian and Gay Clients from an Adult Life Course Perspective

Abstract

A life course perspective of gay and lesbian adulthood enriches our understanding of clinical presentations and modifies our conception of psychotherapy. The author describes shifts in his psychotherapeutic orientation characterized by an increasing recognition of the importance of social, cultural, and historical forces that shape gay and lesbian mental health. Given the uncharted nature of many gay and lesbian lives across adulthood, existential questions about the meaning of life choices are often present in the consulting room. Therapists working with gay and lesbian clients embark on an empathic journey informed by treatment skills as well as our joint participation in a world of significant social change.     

Psychotherapy with Traumatized Southeast Asian Refugees

Southeast Asian refugees have suffered severe traumas, and face the challenges of adapting to a new and unfamiliar land. The paper identifies techniques for time-limited mental health treatment with this group. These include the initial task of establishing clinician credibility (by focusing on symptom reduction), assisting resettlement, and working through the traumas they suffered. In addition, the special challenges of working with refugees are addressed.     

Psychotherapy with the Father-Absent Military Family

Defense department regulation changes concerning military dependents have had a marked impact on a large number of service families. One outcome is a specific fractured family—father-absent military family—which has unique characteristics and distinctive problems. In addition to explicit features of military families in general, dynamics of the father-absent fragment are discussed. A psychotherapy strategy is also presented which has been shown to be of value in promoting continued growth in the father-absent military family     

Legal issues surrounding psychotherapy with minor clients

This article discusses several legal issues of concern to psychotherapists working with minor clients such as informed consent to treatment, confidentiality, and the minor's legal capacity to enter the psychotherapist-client relationship. Suggestions are offered to assist the clinician in dealing with these legal issues.     

Phase Oriented Psychotherapy for Gay Men Recovering from Trauma

Summary

Gay men live in a culture of trauma in the United States. Phase Oriented Psychotherapy offers an integrative treatment model for helping gay men overcome the helplessness and disconnections that result from trauma. Successful recovery in this model yields a basic cognitive shift from indiscriminately attributing traumatic significance to present events to accurately differentiating discomfort from danger and responding to situations with aware choice. The model is a synthesis of the phase-oriented model of recovery with the principles of gay-affirmative psychotherapy. Recovery occurs over stages: (a) Stabilization of symptoms and the development of coping skills; followed by (b) Integration of dissociated or fragmented aspects of experience (including affects, sensations, beliefs, memories, identity); leading to (c) New Self and Relational development. This type of work will present distinct challenges to both therapist and client. Specific techniques are offered to aid the therapist both to assist the client and protect him/herself.     

Integrating self-care into clinical practice with trauma clients

ABSTRACT

Self-care is recognized as an important aspect of social work practice. Beginning in educational settings, developing social workers are encouraged to learn about and practice self-care. However, self-care is typically promoted through strategies and approaches outside of the practice context. Social workers are oftentimes encouraged to use individualized self-care plans, which often feature a variety of relaxation and secondary techniques; focus on self-awareness and self-reflection; and have proper use of supervision. Although these strategies are invaluable, they do little to directly benefit the social worker during direct practice or while in session with a client which is a time period when clinicians are particularly vulnerable to distress or burnout. The importance of real-time self-care strategies is particularly critical for clinicians, especially those who engage in trauma work, given the sensitivity of topics that clients may have endured or benefit from assistance in processing. Further, little information has been published on the use of self-care techniques during a session with a client or in a clinical context. The purpose of the present paper is to discuss self-care strategies that can be useful both outside of and within a clinical setting and present a model of such strategies that focus on integrating self-care in clinical practice particularly for those engaging in trauma work. The paper will conclude by discussing the relevancy of the developed model in practice.     

Countertransference with adolescent clients of the same ethnicity

This article addresses countertransference in therapeutic relationships involving therapist and client from the same ethnicity. A case illustration of a Japanese adolescent and a Japanese therapist is used to develop the thesis that obvious similarities in race, or culture may lead to invalid assumptions about shared beliefs and values and subtle countertransference manifestations which have the potential to disrupt or prevent the development of a working relationship.in private practice.     

One or Two Session Psychotherapy with University Students

Abstract

One or two session psychotherapy has a long history, and well-known practitioners have made use of it. Favorable results have been reasonably well documented. Often it has been done out of necessity, less frequently because all were satisfied that it sufficed. Problems that lend themselves to one or two sessions are: psychological work which has already been done but for which affirmation is sought, requests for diagnostic evaluation, and less often but more challenging, intrapsychic conflict requiring uncovering work. Patient characteristics and therapist attitudes are discussed. For one or two sessions of treatment to occur the therapist must be alert to the possibility, must assess quickly when a case is in hand, set the process in motion, and determine a satisfactory stopping point. It is suggested that the college population lends itself especially well to one or two sessions of psychotherapy, not only from the standpoint of the limited resources of many student health services but also for the ego strengthening potential it provides.     

Integrating Dream Analysis with Intersubjectivity in Group Psychotherapy

The author discusses her application of Daniel Stern's theories of intersubjectivity to group psychotherapy. The group members were women presenting with issues regarding childhood molestation and/or abuse. From her case notes, she examines the dreams the women discussed in the group treatment setting and illustrates how the group members mutually constructed life narratives, which ultimately created new meanings regarding their lives. Through mutual construction of these narratives, her clients ultimately organized new senses of self, affecting them both interpersonally and intrapsychically.     

Psychotherapy with older adults: benefits and barriers

Psychotherapeutic treatments are known to be effective in older adults with mental illnesses. Depression, anxiety, and complicated bereavement must be considered psychiatric illnesses, rather than normal consequences of aging. To improve the rate of psychotherapy use among older adults, stigma surrounding psychiatric treatment, as well as misconceptions that older adults are incapable of change, must be unlearned and eliminated.     

Psychotherapy with Deaf and Hard of Hearing Individuals

ABSTRACT

This qualitative study explored the subjective experiences of deaf and hard-of-hearing individuals in psychotherapy. Which culturally syntonic considerations are necessary for effective psychotherapy with deaf and hard-of-hearing individuals? The findings support the literature on multiculturalism and deafness that entail effective communication, empowerment processes, cultural sensitivity, therapist role flexibility, the imparting of information, and the development of a positive therapeutic relationship. The data focuses on the experience of communicating rather than focusing solely on the acquisition of content as well as the understanding the clinical dynamics of the transcultural relationship in order to make effective use of the social work relationship in treatment. The findings of this study add richness and depth to the existing literature on psychotherapy, with emphasis on the experiential processes of treatment.     

Embedded counselling in advisory work with clients in debt

This article addresses the potential for embedded counselling in social work with clients in debt. It is based on experiences from Sweden where budget and debt advisors employed by the municipalities give assistance to clients in financial difficulties. A distinction is made between advice and guidance on the one hand and counselling on the other. As the financial problems often have been long lasting, it is not enough with one-time advice that the client hopefully then follows. The purpose of the article, thus, is to explore the possibilities of incorporating counselling in the role of the advisor.     

Extended mutual imagery in work with anxious and phobic clients

Imagery and metaphor have a long history as tools for helping and healing. This article traces that history to the present and defines and explains the author's variation of using imagery called Extended Mutual Imagery (EMI). The emphasis on mutuality is, from the social work perspective, an essential ingredient for the effectiveness of EMI. EMI has been found to be effective with anxious and phobic clients who use metaphoric and imaging language. A case example using EMI with a 47 year old anxious female client is provided followed by discussion.