A Survey of Online Practitioners: Implications for Education and Practice

In the last decade the helping professions have seen a growing interest in the provision of online counseling and therapeutic services for individuals. Like most fields of work, social work also has experienced a growth in the creative use of technology in various areas of professional work. Based on this growing interest and the need for such services and research on its efficacy, a study was conducted to learn from e-therapists across the United States on their experiences with this mode of service delivery. This paper elicits results from the online survey and provides recommendations to better serve our clients in the tech savvy world and future research endeavors. The main findings of this preliminary study include: (a) Many theoretical perspectives and models are being used to ground online practice, (b) e-therapists are beginning to use videoconferencing for online practice supplementing their face-to-face sessions, and (c) e-therapists believe that online interventions benefit their clients.     

Online Peer Support Programs for Young People with a Parent Who has a Mental Illness: Service Providers’ Perspectives

Young people with a parent or parents who have mental illness are at a higher-than-average risk of experiencing emotional and behavioural difficulties. Notwithstanding the difficulties experienced by these young people, opportunities to interact with and obtain support from peers living in similar families can be beneficial. While young people face several barriers to participating in face-to-face peer support programs, online approaches potentially provide a different way of obtaining peer support. This paper aims to explore service providers’ perspectives on current Victorian peer support programs, as well as the strengths and weaknesses of online approaches to peer support. Semistructured interviews were conducted with 17 mental health professionals who work with families affected by parental mental illness. Participants recognised that many young people miss out on face-to-face peer support programs, and were highly supportive of the idea of online programs. This study suggests that online peer support programs for young people could occupy an important position in the evolving suite of services for Australian families affected by mental illness.     

A Re-Conceptualization of the Working Alliance in Cross-Cultural Practice with Non-Western Clients: Integrating Relational Perspectives and Multicultural Theories

This article will addresses a gap in the literature regarding the working alliance in cross-cultural treatment. The paper draws on references from current relational theories and multicultural conceptual and empirical sources to re-conceptualize the definition of the working alliance to include cross-cultural dynamics between Asian clients and European-American therapists as a case in point. The paper includes an overview of the working alliance, and a proposal for the inclusion of specific relational domains that this author has found to be important for the definition of the working alliance. These domains are empathy, mutuality, the dynamics of power and authority, the use of self, and the process of communication. A case vignette is included to illustrate these discrete domains. The paper opens new directions for clinical practice and research in the area of the working alliance in cross-cultural counseling.     

Cultural Competency and Achieving Styles in Clinical Social Work

Abstract

This paper attempts to build a cultural competency framework by reviewing the literature and laying a conceptual foundation for professional standards in clinical social work. It also explores the implications of cultural competency by relating some important factors to clinical decisions, alliance, and outcome in the mental health field. The pathways and directions of the relationships as well as the potential factors affecting cross-cultural clinical alliance are illuminated in a general model to guide hypothesis formulation in further research. Empirical data are presented on clinical social work practice with Asian American clients in light of a key factor in shaping cultural competency, i.e., clinicians' personal achieving styles. The findings suggest that such styles are culturally bound.     

Research Note—A Pilot Cyber Counseling Course in a Graduate Social Work Program

Cyber counseling is a new and growing medium for offering mental health services to children and youth. However, there is a lack of identification of the core competencies required to provide effective online counseling. A school of social work, in partnership with a national service agency providing online counseling to children and youth, developed and offered a 13-week course to participating MSW social work students and agency staff. The development of online counseling competencies was assessed through individual interviews with participants and a content analysis of online posts. Participants scored well in areas of assessment and intervention. Challenges were identified in relationship building within an online environment.     

Counseling with Muslim Refugees: Building Rapport

Recent social work literature has stressed the importance of considering culture when working with individuals with mental health problems. This paper presents my personal experience, journaling, reflections, and research as a mental health social work practitioner and researcher working with refugee clients with mental health problems from a Muslim background. It also draws on my research experience in cross-cultural mental health. The paper emphasizes the significance of building rapport especially in the earlier stages of the professional relationship.     

Adolescents Seeking Mental Health Services

Summary

Inner-city adolescents receiving mental health services often get inadequate medical care. However, when those who seek counseling are asked about their health concerns, they say they want to discuss them with their therapists. Based on responses to a clinical self-assessment questionnaire (Adquest), adolescent mental health clients reported sleep difficulties, weight and eating concerns, and frequent headaches and stomachaches. Age and gender differences in patterns of vulnerability and willingness to talk were explored.     

Client Psychological Distress: An Important Factor in Career Counseling

The authors explored client psychological distress as a variable in career counseling. Forty‐two clients in a naturalistic setting were seen for a total of 290 sessions by 21 counselors‐in‐training. The results indicated that (a) 60% of the clients were psychologically distressed, (b) clients' scores decreased significantly from pretest to posttest on psychological distress variables, (c) significant linear growth occurred in the clients' perception of the working alliance across sessions, and (d) the psychological distress outcome variables were significantly related to both the first session level of the working alliance and its linear growth.     

The working alliance between homeless young adults and workers: A dyadic approach

The development of a strong working alliance between homeless young adults and their social workers is seen as a critical component in the recovery process. The purpose of this study was to examine the composition of the working alliance between homeless young adults and their social workers, and its association with self-determination, resilience and quality of life. A sample of 102 homeless young adults and 32 social workers from ten Dutch shelter facilities participated. Homeless young adults were interviewed twice: when entering the facility (baseline) and sixth months after baseline or when care ended earlier. Social workers were questioned about the working alliance at follow-up. Data were analyzed by using a one-with-many design. Results showed that homeless young adults who generally reported strong alliances with their social worker, do not have a social worker who generally reported strong alliances (generalized reciprocity). In addition, if a young adult reported to have an especially strong alliance with his worker, this worker did not necessarily reported to have a strong alliance in return (dyadic reciprocity). Homeless young adults who perceived a stronger working alliance with their social worker than other young adults, who were supported by the same social worker, improved more on self-determination than young adults who reported to have a weaker alliance. Our results indicate that the working alliance is important in achieving outcomes. A dialogical approach should be encouraged in which young adults feel valued and safe enough to express their expectations and to build a strong working alliance.     

The Therapeutic Use of Humor With Clients Who Have Schizophrenia

A positive worker/client relationship contributes greatly to a mental health client’s achievement of intervention goals. Practitioners who work with clients who have schizophrenia sometimes face challenges in developing positive relationships with them when the cognitive impairments characteristic of that disorder make verbal communication difficult. The purpose of this article is to review the indications for using humor with clients in general and then consider the potential for practitioners to use humor as one means of developing constructive working relationships with clients who have schizophrenia. This article does not address the use of specific humor techniques, but considers whether practitioners with a natural sense of humor can use it to their advantage in working with members of this population. Seven principles for the use of humor, and seven client examples, are included.     

Walking a Tightrope: Case Management Services and Outpatient Commitment

Effective case managers in community mental health are successful at forging a working alliance with recipients. This article explores one key aspect of case management practice, serving involuntary clients, specifically those on outpatient commitment orders. In 19 intensive interviews, a subset of a larger study, case managers shared their perceptions of the utility of outpatient commitment with a focus on how such orders impacted the professional relationship. We argue that the use of advance psychiatric directives and shared decision-making processes can reduce the need for coercive practice.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.     

Contributions of the Working Alliance in the Practice of Career Counseling

We see the working alliance, a construct well articulated in the psychoanalytic counseling literature, as a key element in enhancing the counseling of those with career concerns. This article describes the working alliance as that sector of the overall experience of counseling participants characterized by their collaboration, mutuality and cooperation with regard to the work of counseling. The dimensions of the working alliance, the counselor and client contributions to it, and the perspectives of others about it are discussed. This study reviews obstacles to building and sustaining the alliance, such as resistance in the form of fear of counseling, and confusion related to counseling goals, tasks, and bonds. Finally, mention is made of the possible research and policy implications of emphasizing the working alliance in career counseling practice.     

Social networks: A village of support for single mothers

The purpose of this study was to expand the literature by investigating the perception of social support by single mothers who sought online support through social media. This study explored sources of social support in single mothers using the Multidimensional Scale of Perceived Social Support (MSPSS) to examine if income, education level, or type of marital status is related to sources of social support among single mothers who utilized online support. The study also investigated statements regarding support from family, friends, and significant others that were ranked highest by single mothers who utilized online support. Results revealed that participants received sufficient amounts of social support from family, friends, and significant others, with income accounting for 12% of the variance in social support subscale scores and no significant differences with regards to education level or type of marital status. Results also indicated that three of the four most strongly rated items on the MSPSS related to social support from friends. This study invites mental health providers and researchers to consider the value and utilization of social media networks for single mothers.     

Social and Health Service Use and Treatment Outcomes for Sexual Minorities in a National Sample of Substance Abuse Treatment Programs

This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.     

Mental Health Professionals' Exposure to Clients with Problematic Internet Experiences

ABSTRACT

This paper examines clients' exposure to problematic Internet experiences among a national sample of 2,098 social workers, psychologists, marriage and family therapists, and other mental health professionals. This analysis finds that mental health professionals are working with clients experiencing a range of problems related to Internet use. However, these professionals have generally not been exposed to training or information in the professional literature on the topic of working with clients with problematic Internet experiences. We identify several areas in which additional training is needed and review practical implications for mental health professionals.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

The Relation of Negative Career Thoughts to Depression and Hopelessness

Although some research literature focuses on the integration of mental health and career counseling, there has been little that examines both areas in relation to depression and hopelessness. This study investigated the relationship among dysfunctional career thinking, depression, and hopelessness in a sample of 139 undergraduate and graduate students seeking drop‐in or individual career counseling services at a university career center. The authors found that two aspects of dysfunctional career thinking, decision‐making confusion and commitment anxiety, accounted for a significant amount of variance in depression. Decision‐making confusion also accounted for a significant amount of variance in hopelessness. Implications for counseling practice include the need for more careful screening of career clients who present with high levels of anxiety and negative thinking. Future research could involve more diverse client populations, such as unemployed adults, and explore the use of additional screening measures to assess the intersection of career and mental health issues.     

Health Care Providers' Experiences with Problem Gamblers

The purpose of this study was to document health care providers' awareness of problem gambling and frequency of recognition and treatment. An exploratory survey was designed to collect data on awareness and knowledge of problem gambling. A structured questionnaire was completed anonymously by 180 health care providers (nurses, physicians, social workers, and other allied health professionals). Almost all respondents (96%) reported knowledge of problem gambling, and 30% reported asking clients about gambling problems when they presented with stress related symptoms. A third of the respondents reported identifying and treating clients for a gambling problem. The most frequently reported intervention was referral to counseling and other gambling resources. Respondents were generally interested in learning more about gambling problems, particularly those providers who have had a client discuss gambling related concerns. There were no significant differences in findings between provider groups.     

DOES ACADEMIC TRAINING BACKGROUND MAKE A DIFFERENCE AMONG PRACTICING MARRIAGE AND FAMILY THERAPISTS?

Using a national sample of practicing marriage and family therapists (MFTs) and their clients, this study investigated whether academic training background is associated with differences in pracice patterns and client outcomes. Clinical members of the American Association for Marriage and Family Therapy with academic training in psychology, social work, counseling, and marriage and family therapy were compared on a wide range of clinical practice variables, and their clients were surveyed about thier satisfaction and outcomes. Results showed highly similar practice patterns and client outcomes across all four disciplinary groups. Although the findings showed little evidence for the uniqueness of academic marriage and family therapy training among experienced MFTs, they also refute the notion that therapists trained in MFT degree programs practice in unusual or inferior ways compared to MFTs trained originally in other mental health disciplines.