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.     

IMPROVEMENT OF THE QUALITY OF RESPONSES TO FACTUAL SURVEY QUESTIONS BY INTERVIEWER TRAINING

In this study we analyze the effects of interviewer trainingon the quality of responses. Data from a field experiment reveala number of significant differences between trained and untrainedinterviewers in terms of nonresponse and the amount of informationobtained. For some questions, an interaction effect occurredbetween interviewer training, the use of tape recorders, andthe kind of responses. The effects of training appear to bedependent on the structure of the questions. Since such effectsoccur primarily with questions that assume a great deal of intervieweractivity, it is suggested that they are indeed due to the applicationof the techniques acquired by training, namely giving instructions,probing, and feedback. A brief analysis of the interviewer-respondentinteraction supports this interpretation.     

The object relations implications of taping individual therapy sessions

The Bogolob paper on Tape Recorders in Clinical Sessions (this volume) contains valuable perspectives on the use of tape recording in psychotherapy, but it fails to adequately develop the concept of client reaction to taping when it classifies negative transference reactions as psychopathology. This paper offers a variation on Bogolob's themes by suggesting that object relations theory offers a more useful framework for interpretation of therapist and patient behaviors following introduction of tape recording in psychotherapy sessions.     

Content validity and utility of the Assessment of Work Performance (AWP)

In the area of work rehabilitation, many decisions about future interventions for the client are based on the results of various kinds of assessments. Therefore, it is important that the assessment instruments used are adequate, useful, and reliable. The purpose of this study was to investigate the content validity and utility of the instrument Assessment of Work Performance (AWP) which is used to assess an individual's observable (working) skills during work performance, i.e. how efficient and appropriate a client performs a work activity. A questionnaire was answered by 67 respondents who used the AWP in various work rehabilitation settings in Sweden. The result indicates content validity and utility for the AWP that supports further testing of the instrument.     

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.     

The multi-disciplinary nature of low vision rehabilitation--a case report

This paper presents the case of a 47-year-old female with low vision secondary to high myopic macular degeneration who remains active in the work force as a spiritual and religious care coordinator for a large institution. An ophthalmologist with a specialty in low vision rehabilitation initially assessed the client. The ophthalmologist prescribed optical devices which used residual retinal vision available at preferred retinal loci. This availed better vision for viewing targets located at far, near and intermediate distances from the client. An optician provided and dispensed the devices prescribed to the client. Additionally, the ophthalmologist made a referral to an occupational therapist. The occupational therapist conducted a series of sessions to further enhance reading and writing skills and a work place assessment aimed at optimizing workplace conditions in order to achieve optimal functional vision. This case illustrates and emphasizes the multi-disciplinary nature of low vision rehabilitation, which involved in this case co-operation between ophthalmology, occupational therapy and opticianry.     

Acknowledgement of client diversity and oppression in social work student supervision

An enduring theme of social work literature and education has been the need for workers to recognise and challenge oppressive structures and develop competence in working with diverse client groups. This paper reports the findings of a qualitative research project where student and field educator supervision sessions were recorded, with the view to examining how oppression and diversity were addressed in these sessions. The authors have used the term 'difference' to describe the breach between the student and client experiences. Examples of anti-discriminatory practice were identified in the recordings, however on occasions supervisors had difficulty in assisting students to acknowledge diversity and oppression in supervision. Four factors that related to addressing diversity emerged from the supervision material. These were: the struggle to unmask subtle themes of oppression; the use of questioning to raise student awareness and development of self-knowledge; using student biography to facilitate learning on 'difference'; and field educator use of self-disclosure during discussions on diversity. Successful approaches to anti-oppressive practice and responding to diversity are outlined.     

Teaching Note—Social Work Serial: Using Video-Recorded Simulated Client Sessions to Teach Social Work Practice

Simulation, the use of trained actors as simulated clients, has gained empirical support as an effective teaching and assessment method in social work education. The associated costs involving the use of live simulation, however, often pose a barrier and prevent less resourced schools from implementing this pedagogical approach in the classroom. Social Work Serial is a pedagogical project that used video-recorded simulated client sessions as an alternative to live simulation. In this teaching note, we will describe step-by-step production and implementation processes involving the project and discuss the implications of video-based simulation for social work education.     

A Preliminary Study of the Role of Attunement in Adult Psychotherapy

This paper presents the results of a preliminarystudy on the recognition of affect attunement in adultpsychotherapy. Brief extracts from six videotapedtherapy sessions were shown to experienced clinicians, who were asked to judge whether the therapistwas attuned to the client/patient or not. Clear examplesof attunement and non-attunement were obtained and thesewere then shown to a sample of postgraduate social work trainees. The trainee resultsshowed none of the consistency of the cliniciansjudgments: 67% (n = 21) were undecided about the exampleof attunement, with only 19.3% (n = 6) giving responses which corresponded with those of theclinicians. For the non-attuned extract, just over athird gave a response which coincided with theclinicians, with 42% (n = 13) undecided. The resultswere used to develop a model for future research on affectattunement, which should provide the basis for thedevelopment of strategies for teaching the attunementskills which may be required by therapists.     

Intervening with Couples Experiencing Domestic Violence: Development of a Systemic Framework

Current gendered interventions for couples experiencing intimate partner violence often do not address the complex systemic issues, nor allow for couple therapy. Experience of working in men's behaviour change group programs (or batterer programs) and with heterosexual couples, indicates this is not enough. Change options for men perpetrating domestic violence and support for partners are generally provided by individual services or gendered groups, located in separate agencies. This article initially poses some of the inadequacies of this gendered, ‘one size fits all’ ideology, which may compromise safety when couples stay together or there is shared parenting. It then explores further questions and possibilities raised by utilising a systemic lens in working with partners and families. It is possible to work systemically with a couple without compromising safety and accountability, where there is flexibility at intake, a both/and approach, ongoing assessment of risk, collaboration between professionals, and good transitions between individual and conjoint work. This article describes a systemic practice framework for working with partners, utilising individual, group, and conjoint sessions in a recursive four phase approach.     

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.     

Faith and Religious Delusions in First-Episode Schizophrenia

ABSTRACT

Empirical research has not adequately examined whether social workers and clients discuss sociocultural issues when addressing mental health problems, nor the quality of the interaction when such discussion occurs. This exploratory mixed-method study examined the interactional process associated with discussion of sociocultural issues in the first three counseling sessions with four white social worker/client of color dyads. Findings showed that productive cross-cultural interactions were associated neither with specific sociocultural content nor client-worker composition, but rather with the social worker's perception and skill. Analysis differentiated one worker/client dialogue from the others, highlighting the importance of training practitioners to apply social work knowledge and skills in a synthesized manner.     

Examining the Incidence and Clients’ Experiences of Single Session Therapy in Italy: A Feasibility Study

Single session therapy (SST) postulates that one session can be sufficient for a client to take charge of the process and work toward their own solutions. Research has been conducted worldwide corroborating SST assumptions with several mental health conditions, but not in Italy. For the first time in Italy, this paper aims to explore: (1) if the most frequent number of sessions in traditional psychotherapy (not SST) is one (Study 1); and (2) the satisfaction of clients who attend SST services and the number who consider one session sufficient to address their presenting problem (Study 2). In Study 1, the records of 476 voluntary clients referred to three different traditional (not SST) psychological services in the west-central region of Latium, Italy, were retrospectively screened, and the number of sessions attended by each client recorded. In Study 2, 85 consecutive clients who voluntarily asked for SST with seven mental health professionals across Italy received a link to an online ad hoc survey, 1–3 weeks after the consultation, evaluating their experience. Study 1 found that the most frequent number of traditional psychotherapeutic (not intentionally SST) sessions was one (124 out of 476 clients (26%). Study 2 found that 44 out of 85 clients (52%) considered one session to be enough, as they felt better or much better and chose not to attend further sessions. Of those who asked for a second session (41 clients), 33 clients (80.5%) indicated that the first session was not enough and 8 clients (19.5%) wanted to address a new problem. These results converge with previous international studies and provide encouragement for the use of SST in both private and public psychological services to address the demand for timely mental health services in Italy. Further research is needed to support the efficacy of SST and to evaluate its cost-effectiveness.     

Unique Learning Needs of Physically Handicapped Social Work Students

Recognition of physically handicapped social work students' unique learning needs and utilization of their “rehabilitation” experiences and perspectives enhances class learning. Role play and simulations can be structured to help them assess whether their handicap enters into the client-worker relationship and practice ways of dealing with possible client system responses. Diversity in term paper topics and agency placements conveys a variety of career options and allows them to develop confidence in working with nonhandicapped client systems. The instructor should respect students' independent efforts to develop coping skills in dealing with classroom and agency logistics.     

Observing the Delivery of a Domiciliary Support Service

This paper describes a study of the work of domiciliary support services which have been developed under the All-Wales Strategy for services to people with learning difficulties. The study employed direct observation methodology to describe the pattern of activities of domiciliary support workers and their clients. Twenty-eight sessions were observed, with the work of the domiciliary support worker with each client being observed twice. The pattern of work observed broadly fell into four categories: physical care in the family home, sitting-in, support for skill development and support in community activities. The results revealed that while support workers worked with skill and sensitivity in the family home they require further guidance and support if they are to assist successfully in skill development and community integration activities.     

Single-Session One-At-A-Time Therapy: A Personal Approach

The terms ‘Single-Session Therapy’ (SST) and ‘One-At-A-Time’ (OAAT) therapy are both used to indicate a situation where the therapist and client set out with the expressed intention of helping the client in one session while acknowledging that additional sessions are available to the client. Both terms have their advantages and disadvantages and thus the author uses the blended term ‘Single-Session One-At-A-Time’ (SST/OAAT) therapy to highlight the advantages of both. It is a core feature of SST/OAAT therapy that it is client-centred especially where the session’s focus and goal are concerned. However, in an attempt to avoid SST/OAAT therapy being highjacked by therapists who operate from the ‘expert’ source of influence, the field has downplayed the contribution of the therapist’s expertise. In this paper, I make clear that the expertise of the therapist when allied to the expertise of the client can be a potent force for good in SST/OAAT therapy. My main task, however, is to outline my own approach to SST/OAAT therapy which is a blend of general principles that are likely to be held by the majority of SST/OAAT therapist and specific ideas that are derived from working alliance theory, pluralism and Rational Emotive Behaviour Therapy.     

More Than Protest: Further Explorations of Alternative Metaphors in Narrative Therapy

In the experience of non‐narratively trained therapists, as well as some narratively trained therapists, the ‘protest metaphor’ for framing externalising conversations retains signature status. Yet this metaphor does not adequately represent the breadth of narrative work. As therapist and client reflecting on our joint work, we explore what using a range of metaphors offers to narratively informed therapeutic work. The concept of ‘resistance practices’ from Stacey (1997) is revisited, alternative metaphors employed in externalising conversations are reviewed, and power is re‐examined. We then review the effects on practice that ensue from drawing on a range of alternative metaphors, illustrating our account with extracts from letters and comments on sessions.     

The Place of Single Session Family Consultations: Five Years’ Experience in Canberra

Open Day, in the form of two half day single session family clinics, has operated weekly in the ACT Child and Adolescent Mental Health Service since April 1993 and over a thousand families have been seen. Clinicians are often resistant to the concept of single sessions and frequently overestimate the amount of assistance that clients feel they require. However in an era of sharply increasing demand for services, selective use of single family sessions for milder problems, screened by a telephone intake process, has value to both families and workers. Telephone follow-ups of 100 families in 1994 and 70 families in 1996 found that single session family interviews were well accepted by the large majority of families seen. Clinicians see the program as reducing pressure from clients for early attention, enhancing client motivation when seen at crisis times, providing readily available consultation support from peers, increasing learning opportunities and building inter-disciplinary team work.     

Staying With The Client

Abstract

Since the early seventies there have been widespread assumptions in social work that: (a) effective therapy is necessarily brief-lasting, at most, eight to ten sessions, and (b) that we should only deal with the problems that the client wants help with.

The author challenges the universality of these assumptions, and their basis in research and considerations about supposed cost-effectiveness. He illustrates through a single case study of a depressed adolescent girl and her unhappy mother that although contact could have been terminated after ten sessions, when the identified patient was better, in fact it would probably have achieved very little, since intervention up to that point had had the effect of making the mother only too painfully aware of her life predicament and reducing her almost to despair.

At the mother's request, social work contact continued for a further eleven sessions, spread over five months. She appeared to use this to achieve a considerable degree of acceptance of her painful and deprived childhood, and adopt a very much more positive attitude to her future. Her depression lifted, and her anxiety diminished. Follow-up eighteen months later strongly suggested that the gains made had been maintained for both mother and daughter.