The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Using Therapeutic Metaphor to Provide a Holding Environment: The Inner Edge of Possibility

The basic thesis of this paper is that effective use of therapeutic metaphor can provide a holding environment within which the client can both address and recontextualize clinical issues. The use of therapeutic metaphor can serve to bolster the empathic connection between therapist and client, providing the client with a new feeling of being understood, in part through a new use of language. Therapeutic metaphor is also particularly well-suited to promoting dialectical understanding and analysis of everyday problems in living. The inner edge of possibility is a construct that illustrates the link between the clinical efficacy and structure of therapeutic metaphor.     

DIFFERENT AND SAME: FAMILY THERAPY WITH ASIAN-AMERICAN FAILIES

This paper is written for non-Asian family therapists who must deal with an increasing number of Asian-American client families. Unlike some writers in fthe field who advocate that client and therapist have the same ethnic background, the authors belive that cultural sensitivity can be learned. Several culturally important values are described, and suggestions on how to orient treatment to fit this client population are offered. A Detailed case example illustrates the treatment issues involued.     

An Integrated Human Behavior Theory

Abstract

In this article, the behavioral exchange model as derived from the work of Emerson, is presented to help the practitioner more adequately conceptualize the interaction between the clinician and the client. This model can help the clinician develop and further his/her understanding of how power differentials between the clinician and the client affect the therapeutic relationship. This model describes how clients use a cost-benefit framework to determine if treatment is worthwhile-meaning that if the client perceives the rewards of an interaction as not outweighing the costs, then the client may terminate treatment. Finally, this model can assist the clinician in constructing an integrative framework for the diverse variables reviewed in the text, and with this framework will be better equipped to influence them.     

Integrating three approaches to counter resistance in a noncompliant elderly client

1. The term "resistance' has been defined primarily in the psychoanalytic literature and is a significant issue in the treatment of mentally ill people. This issue needs to be addressed for the change process to begin. 2. An understanding of resistance from psychoanalytic, cognitive, and behavioral perspectives will enable the nurse to assist the client in achieving mental health. 3. Countertransferance can be used to understand the client's motives, hence becoming aware of therapeutic goals, or it can hinder the therapeutic process. 4. The psychiatric-geriatric population is complex. With the acceptance that an elderly client can benefit from psychotherapy and with an understanding of different approaches, the client may experience symptom relief.     

Agency and clientship in public encounters: co‐constructing ‘neediness’ and ‘worthiness’ in shelter placement meetings

This article seeks to develop our understanding of the agency of vulnerable groups who at first sight may not seem to have much agency in their lives. It explores the co‐constructed nature of agency in three Danish homeless shelters. Unlike earlier interview‐based studies, our research is based on naturalistic data drawn from 23 video‐recorded placement meetings. Using concepts from Goffman, we examine how versions of the neediness and worthiness of homeless people are negotiated verbally and bodily between staff and clients. We find that homeless people have to juggle two partly contradictory roles when they are given or take the roles of either a (active) citizen or a (passive) client. Clientship is actively negotiated by both parties and demonstrates the agency of homeless people: they can collaborate with (as clients) or challenge (as citizens) the staff’s attempts to formulate solutions to their troubles. We further examine how the professional ideology of client centredness affects the meeting between the two parties. However, we show that, like any discourse, client centredness has no intrinsic meaning and is played out by actors in very different ways. In work with the homeless, the discourse of client centredness is related to discourses of ‘neediness’, ‘worthiness’ and ‘value for money’ that define agency in different ways and make three different client positions available: the resolute client, the acquiescent client and the passive client.     

Job coaching for persons with mental disabilities

The effectiveness of job coaching for persons with mental challenges at the Yokohama City Comprehensive Care Continuum is examined through case records. The immediate intervention with the client, as well as improved working conditions through consultation with the company are recognized as crucial for the client's optimum adjustment at the work site. On the other hand, in a case where the client quit the job, we can see that the inadequacy is in the assessment of the client and of the working conditions. Improved assessments are needed. Using the principle and the strategies of supported employment developed in America, the goal of job coaching at Y.C.C.C. is to form an adequate support system for the client, both at the workplace and in other living and social situation which influence the client in the workplace.     

Narrative interaction and the development of client autonomy in clinical practice

Data from a psychoanalytic case are used to explore the development of client autonomy in clinical treatment. The client's narratives and the talk about them in which narrative meaning is formulated and reformulated are selected as one series of interactions in which the development of client autonomy can be studied. Discourse analysis methods are adapted to document and describe specific shifts in the structure of client narratives and talk about them which reflect the development of client autonomy over the course of treatment. Implications for casework treatment are discussed.     

Tape recorders in clinical sessions: Deliberate and fortuitous effects

Literature indicates that tape recorders have five purposes in clinical work: observation of sessions; teaching, research, recording, and treatment adjunct. Experience indicates that when a tape recorder is used for any of these purposes, client responses to the tape recorder can express transference or psychopathology. Such client responses can be used to deepen sessions. Experience also indicates that therapist responses to the tape recorder occasionally impede practice. However, therapists using tape recorders typically work at peak levels, because the tape recorder symbolizes recognition by others.     

Abstinence-Only: Are You Not Working the Program or Is the Program Not Working for You?

Low retention rates are common in substance use treatment programs. The dominant model of service delivery in the United States is abstinence-only, a high-threshold service delivery model requiring abstinence. What “doesn’t work” for the client—from the client point of view—is an overlooked source of insight about client engagement and disengagement. We report client counter-narratives about the choice to disengage from abstinence-based services, shifting from a story of “dropouts” to one of self-respect. Understanding why clients choose to disengage from treatment can help us as practitioners to “meet clients where they are” and enhance engagement in substance abuse treatment.     

What does client satisfaction tell us about effectiveness?

It is common in child protection research to undertake studies of client satisfaction with services. Although these studies have their own intrinsic value, it has been argued that they tell us little if anything about effectiveness—high levels of client satisfaction mean little if child abuse continues to occur. This study, undertaken in a statutory child protection service in Australia, considers the relationship between client satisfaction and other outcome measures, including worker estimates of client progress, further notifications of abuse and whether or not children have been removed. The results show strong correlations between different measures of client satisfaction and strong correlations between different measures of worker estimates of client progress. They show weaker but statistically significant correlations between client satisfaction and worker estimates of client progress, and between client satisfaction and further notifications. There is also a significant relationship between client satisfaction and children remaining at home. However, this applies only to parents, relatives and carers, not to the primary clients themselves. It is concluded that client satisfaction studies may have value beyond simply measuring client satisfaction. However, the study also supports an argument for using more than one outcome measure if the aim is to measure effectiveness. Copyright © 2008 John Wiley & Sons, Ltd.     

Integrating Art Therapy Methodology in Brief Inpatient Substance Abuse Treatment for Adults

ABSTRACT

Decades of drug addiction research and clinical work have underscored the need for multifaceted and comprehensive treatment responses in order to sufficiently address the varied needs of individuals struggling with addiction. One valuable treatment component that can be incorporated into traditional treatment protocols to expand the comprehensive nature of treatment response is art therapy. A conceptual framework is presented, detailing the integrative opportunities and benefits of including an art therapy component to short-term hospital-based inpatient substance abuse treatment programs. A creative arts component can be particularly beneficial for brief inpatient programs, where the client population is diverse, in crisis, and at high-risk for relapse; and where clinicians need to obtain comprehensive client information from multiple sources in a short amount of time. Art therapy methodology can provide a mechanism for collecting such collateral information for assessment purposes, can be employed to facilitate therapeutic change, and is used to track and document client progress and clinical change over time. Practice guidelines and specific treatment techniques are presented through short case examples.     

Die Rolle von Vertrag, Macht und Sozialer Einbettung für wirtschaftliche Transaktionen

This paper focuses on the conditions that enhance punctual payments of clients in economic transactions. Within such exchange relations the actors face a problem of trust: the contractor delivers goods or services ex ante and has to trust the client that he will pay punctually. Three possible solutions are discussed: institutional mechanisms like enforceable contracts, market mechanisms, and mechanisms based on the social embeddedness of the transaction. It can be shown, that the trust problem concerning proper payment behavior cannot be solved by the market or bilateral contracts. Due to this fact, the embeddedness of economic transactions in social networks and long-term relationships becomes an important mechanism to reduce problems of trust between client and contractor. Based on a general theoretical framework, hypotheses are tested using regional restricted data of handicraft enterprises. It can be shown, that due to unbalanced power relations and insufficient institutional regulations the actors are not able to solve the problem of trust. Although the social embeddedness fosters cooperative behavior, opportunism by the client cannot be avoided completely.     

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.     

Dream analysis and casework technique

Conclusion Dreams are not an essential ingredient of casework treatment. When they are part of the reality of an individual client, they can be included as demonstrative of the process within the individual that is being studied by client and social worker together. They help reinforce interpretations, overcome resistances, and point up material that the client might otherwise withhold. In every instance, only that part of the dream which relates to the constant central focus of treatment is utilized by the caseworker. As long as the caseworker respects the boundaries of casework treatment and the limits set by diagnostically focussed treatment, he need not be fearful of including the interpretation of dreams among his skills.This article is from a chapter in a forthcoming book,The Practice of Clinical Casework to be published by Behavioral Publications, Inc. in 1974.     

Assumptions Regarding Vocational Counseling

Vocational counseling interviews involve the client and counselor in viewing each other, as the term inter-view indicates. As counseling begins, counselor and client view each other's assumptions about the nature of counseling processes and outcomes. Clients have assumptions about the kind of help they need to make occupational choices, what they can expect of counselors, what they can expect from any tests used, what they may be asked to do, and what will occur in the total process. Counselors need to understand the kinds of results clients expect from vocational counseling. Many assumptions, when held by either clients or counselors, lead to client (and possibly counselor) dissatisfaction with counseling because the assumptions build false anticipations for the client. Essentially, both clients and counselors often expect more definite outcomes and less effort from each party than is reasonable. This paper is written to promote counselors' reflections on their own and their clients' vocational counseling assumptions.     

Community care or therapeutic stalking: two sides of the same coin?

Although the government of the United Kingdom strives to address the needs of individuals engaged in mental health services, its policies must, by their nature, reflect a utilitarian approach. When a client chooses to disengage from services, mental health professionals can find themselves in an ethical dilemma in which adhering to policies can lead them to hyperactive conduct, whereby the client may experience what feels more like stalking behavior than therapeutic care.     

A review of Rankian will therapy and its relevance for social casework

Conclusion In this study I have postulated on teh basis of Rankian philosophy and my own personal and professional experience that 1) self-knowledge in and of itself rarely heals; 2) a client who is accepted by another, in his totality, is able to change; and 3) persons have an inherent need to become fate-determining beings.Engaging the other in a process of willing his own growth is the central aim and way of helping. Thus, the caseworker is not a foe, educator, or passive on-looker; rather, he lendshimself, to be used or not as the client chooses. There is in the caseworker a willingness to let the client fumble, flounder, and waver until his rigid Will can soften enough to encompass and use another. A caseworker who can permit this freedom offers his steadiness as a springboard against and with whom the patient finds his own strength. This process is characterized by a slow coming together, a period of union, and a separation when the newly-won self fears, yet seeks autonomy. Having discovered that he can unite with another without being destroyed, the client leaves, not cured, yet less restricted, more open to the promises of life.     

Collaborative evaluation of a high school prevention curriculum: How methods of collaborative evaluation enhanced a randomized control trial to inform program improvement

Blending high-quality and rigorous research with pure evaluation practice can often be best accomplished through thoughtful collaboration. The evaluation of a high school drug prevention program (All Stars Senior) is an example of how perceived competing purposes and methodologies can coexist to investigate formative and summative outcome variables that can be used for program improvement. Throughout this project there were many examples of client learning from evaluator and evaluator learning from client. This article presents convincing evidence that collaborative evaluation can improve the design, implementation, and findings of the randomized control trial. Throughout this paper, we discuss many examples of good science, good evaluation, and other practical benefits of practicing collaborative evaluation. Ultimately, the authors created the term pre-formative evaluation to describe the period prior to data collection and before program implementation, when collaborative evaluation can inform program improvement.     

Resolving Therapeutic Impasses by Using the Supervisor's Countertransference

The traditional role-set of the clinical social work supervisor has grown to be much more complex. From the exclusive position of teacher, administrator, and overseer she is now an integral part of a system wherein she is influenced not only by the therapist, client, and her own promptings but is a prime source of feedback to the client through the supervisee.As clinical social workers have shifted their conceptualization of therapy to a two-person psychology, this perspective has emerged as part of the supervisory process. Now the supervisor's countertransference responses to the supervisee, to his client, and to their interaction have assumed importance in supervisory work. This article is an attempt to demonstrate through case illustrations how the supervisor's disclosure of countertransference responses to the supervisee can strengthen the supervisory alliance which then enables the client and therapist to resolve therapeutic impasses.