Social Work with Clients Contemplating Suicide: Complexity and Ambiguity in the Clinical, Ethical, and Legal Considerations

Social workers in agency and private practice settings often work with clients grappling with suicide, either as an acute or chronic situation. Probably more than any other clinical condition, suicide forces the practitioner to confront complex ethical, legal, and psychological questions while managing an urgent circumstance. This article attempts to illuminate the ethical and legal considerations that may arise when a client contemplates suicide. Rather than advancing one answer, we stress that in training and the workplace social workers must fully consider the complexities and ambiguities of a client's experiences as well as their own clinical, ethical, and legal obligations.     

Clients' relational conceptions of conjoint couple and family therapy quality: a grounded formal theory

Based upon a qualitative metasynthesis of 49 articles centered on clients' experiences of their conjoint couple and family therapy, the investigators constructed a grounded formal theory of Clients' Relational Conceptions of Conjoint Couple and Family Therapy Quality. The theory suggests from pretherapy conceptions to posttherapy reflections, clients' perceptions of conjoint couple and family therapy quality appear to consist of clients' constructed meanings regarding a series of interrelated relationships between clients and their therapists and therapy environments, between clients and themselves, between clients and other family members, and between process and outcome both inside and outside therapy. Within and across these relationships, clients appear to focus on expectations, connections, balance, and change when evaluating the quality of their clinical experiences. Based upon this theory, the investigators recommend that researchers continue to explore this clinical phenomenon and that therapists regularly seek clients' conceptions of quality in therapy.     

Training issues for supervisors of marriage and family therapists working with persons living with HIV

The purpose of this article is to address the special issues and considerations Martial and Family Therapy (MFT) supervisors might face with the increasing HIV/AIDS epidemic. Three primary issues will be addressed in this article. First, the importance of educating therapists regarding various aspects of the disease process and its transmission will be discussed, followed by educational strategies programs might adopt. Second, we will discuss the ethical and legal considerations that may need monitoring by supervisors and trainees. Third, special therapeutic considerations will be provided to supervisors of therapists working with stigmatized populations.     

A GENOGRAM WITH AN ATTITUDE

The approach described in this paper is predicated on the fundamental belief that in order to become competent and ethical practitioners, students must understand themselves and how they see others. They must be given tools and skills that facilitate examinations of their own assumptions and beliefs about themselves, other, and how the world works. It is also essential that students examine how these assumptions and beliefs will influence the way they choose to conduct therapy. Once they are aware of their biases, they must learn to choose to consciously influence themselves in a way that permits their clients the largest room for change within the clients' own contexts of belief, understanding, experience, and possibility. In this paper I describe the use of the genogram as a tool to facilitate the process of gaining self knowledge. This tool has been used in a multicultural counseling course, as well as in professional development workshops for psychologists, mental health counselors, and marriage and family therapists.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

When Social Workers Are Stalked: Risks,Strategies, and Legal Protections

By virtue of their work, social workers are at risk of becoming victims of stalking. This is because social workers assist individuals who suffer from major mental health problems that may cause them to develop delusional beliefs about their therapists, and because social workers may need to exercise authority against individuals with personality disturbances that present a risk to others. Surveys suggest that 16% of social workers have been stalked at one point in their career by a client. Stalking of social workers by clients has far-reaching personal and professional implications, potentially affecting all aspects of an individual’s life. This paper reviews the nature and incidence of stalking of social workers, the legal remedies available to social workers who are victims of stalking, and strategies for protection.     

Opening Up: Therapist Self-Disclosure in Theory, Research, and Practice

While most therapists report that they do disclose some information about themselves to their clients, therapist self-disclosure continues to be both controversial and nebulous in clinical theory, research, and practice. This article considers what makes therapist self-disclosure so challenging to define and study and provides an overview of the empirical and theoretical literature. It then concludes with a consideration of therapist self-disclosure in contemporary legal, ethical, and technological contexts of clinical work.     

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.     

Understanding the experience of Black clients in marriage and family therapy

Past research on Black clients' utilization of therapy focused on the barriers that prevent Black clients from attending therapy and the reasons for these barriers. However, few studies have been conducted that focus on how Black clients attending therapy actually experience these barriers. This study utilized both Likert and open-ended questions to examine the obstacles 16 Black clients face in their attempts to attend family therapy. The most frequently identified obstacles were related to concerns over family member response and cultural barriers to therapy. Participants also reported concerns about racial and/or cultural differences and a lack of understanding by non-Black therapists. The implications of this study addressed how to effectively meet the therapeutic needs of Black clients.     

Clients' views of live supervision and satisfaction with therapy

In this study we examined clients' perceptions of live supervision and their satisfaction with therapy in a university-based training clinic for marriage and family therapists. A total of 108 clients completed the Client Satisfaction Questionnaire-8 and a modified version of the Purdue Live Observation Satisfaction Scale. Clients' comments on the advantages and disadvantages of live supervision were also solicited through short-answer questions. Results indicated that clients were generally satisfied with therapy and found the live-supervision process satisfactory as long as the perceived helpfulness of live supervision outweighed its perceived intrusiveness. The challenge for training clinics is striking a balance between helpfulness and intrusiveness in an effort to both train competent therapists and provide quality treatment.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Boundary Issues in Gay and Lesbian Psychotherapy Relationships

Abstract

Gay and lesbian psychotherapists face unique challenges when working with clients who also identify as gay or lesbian. Of particular importance are the roles professional boundaries play in working with sexual minorities. For example, clinicians must decide whether it is in the client's best interests to know the therapist is gay. Issues of contact outside of the therapy hour also become important, particularly when the therapist lives in a small community, or otherwise risks the possibility of seeing the client in the community. This chapter addresses some of these issues, and poses options for therapists on how to minimize professional boundary or ethical violations.     

The impact of therapist pregnancy on the treatment process

Therapist pregnancy is a powerful emotional stimulus and a real-life event that affects clients and the treatment process. In the present paper, previous literature is reviewed and clinical experiences of the author in a university counseling center are reported to address how therapist pregnancy influences clinical treatment. Although therapists often hesitate in emphasizing their pregnancy, evidence suggests that it is easy to underestimate the importance of the pregnancy for clients. Case examples are presented which demonstrate client responses and the significance of the pregnancy for four female clients. Gender differences in client reactions are not fully understood, and it may be particularly difficult to facilitate male clients in dealing with issues stimulated by the pregnancy. These clinical findings suggest that in a variety of settings, understanding and working with clients' reactions to the therapist's pregnancy can enhance treatment.     

Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.     

Essential components of curricula for preparing therapists to work effectively with lesbian, gay, and bisexual clients: a Delphi study

The purpose of this study was to determine the knowledge, experiences, and values that therapists should possess to provide quality therapy services to lesbian, gay, and bisexual (LGB) persons and their families. Using the Delphi method, consensus from a panel of experts on LGB topics was obtained on the components that training curricula should ideally include to prepare therapists adequately to work with this population. Panelists provide suggestions for important therapist values and qualities, key theoretical orientations, common issues of LGB clients and their support persons, key components of assessment and interventions, ethical and legal issues, and recommended materials. The panelists stress self-of-the-therapist work and development of a systemic perspective as critical aspects of training. The role of sexuality was deemphasized. Recommendations to training programs based on these findings are provided.     

Emotional Abuse in Therapy

This paper presents the experiences of clients who have been emotionally abused in therapy. By this I mean the intentional and unintentional conduct they experienced from therapists towards them that was not in their best interests. By sharing these experiences, I will explore emotional abuse in therapy, how it can be defined, the effects of such on clients and the methods of healing these traumatic experiences. Recommendations will be discussed in the light of this information for practising therapists, professional training and development, standards and ethical committees.     

Photo‐documenting the needle exchange: methods and ethics

When research subjects are people with stigmatized identities, then special consideration must be given to their desire for privacy and anonymity. This is especially true when photographs constitute the recorded data. This paper discusses some challenges in conducting research in a needle exchange located in a small city. Within the needle exchange, the camera posed a threat to drug users who preferred to remain anonymous, if not invisible. Ethical considerations and emotional frustration, stemming from the need and desire to get photographs of clients while respecting their obvious desire for privacy, are discussed. The practical difficulties associated with getting photographs and some methods for facilitating interaction with clients are also presented.     

Motivational,ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.