Trauma and the Clinician: Therapeutic Implications in Clinical Work with Clients

This article explores clinical issues related to self-disclosure to clients following a traumatic event in clinicians' lives. In particular, special attention is paid to the role of self-disclosure in clinical work when clinicians are conflicted about whether or not to share personal information or how to communicate it to clients due to the nature of the trauma. Therapeutic implications, both short and long term, associated with such self-disclosure are discussed.     

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.     

Impossible Clients

Abstract

This paper is concerned with a group of clients, whom I have identified in terms of their capacity to evoke strong dislike amongst Social Workers. These clients approach us in a manner which suggests a lack of the most basic social skills. I shall try to describe some of their characteristic attitudes, and the ways these are demonstrated in their contact with the workers they meet, with particular reference to the hostility that typifies their dealings with us, and can paralyse us into an ineffective response. There follow some guidelines I have evolved from my own attempts to work with some of these clients.     

Beginning Practice with Preoperative Male-to-Female Transgender Clients

Abstract

Preoperative male-to-female transgender clients often present with specific and unique psychological and social issues distinct from gay male and lesbian clients. Therapists must be ready to assess and help diagnose these in preparation for work with gender queer clients. Therapists must also be prepared to face and resolve the various counter-transference dynamics inherent in therapeutic relationships with transgendered individuals. This Practice Note focuses on the author's beginning clinical and social case management experience working with two preoperative male-to-female transgender individuals.     

Supervision of Therapy with Patients Diagnosed as Psychotic

Psychodynamic therapy with psychotics has been reviewed and studied by different analysts such as Searles (1965), Rosenfeld (1988), and others. Nevertheless, there are almost no updated articles on supervision of this therapy. The article addresses this issue and the different aspects of supervision of psychodynamic therapy of psychotics. Therapy-related issues, such as holding, communications and interpretations, differentiation, boundaries, psychotic transference, and countertransference are discussed extensively. We also explore some of the difficulties involved in these processes and the implications for the supervision process.     

Listening to Clients

Abstract

Qualitative research can be used to influence policy development, implementation, and evaluation. Three focus group studies dealing with implementation of a county's welfare reform programs are presented to illustrate the ways that qualitative research can be used. The paper discusses results of the studies and presents strategies for exertinginfluence. Processes used to develop and change policy are explicated.     

Shame in the Clinical Process with LGBTQ Clients

This commentary integrates the literature on the social and psychological dynamics of shame and discusses its relevance to the clinical process, especially with lesbian, gay, bisexual, and transgender and queer clients. It is argued that engagements with shame, especially where sexual desire, sexual orientation, or gender identity is a foremost consideration or conflict, may be the most important factor in producing and maintaining the therapeutic alliance. Shame, a social emotion, is considered in the light of work done in sociology, psychology, neuroscience, and psychoanalysis. Future directions for clinical research are suggested.     

Adapting Social Work in Working with Muslim Clients

Current social work education programmes and textbooks often underestimate the hypothesis that providing effective services to different cultural groups requires cultural understanding. One approach that has been recommended is the localization of social work: using a fundamentally different social work knowledge base and approach with different cultural groups. To date, however, little scholarship considers how to localize social work in working with Muslim communities. On the basis of interviews with over 50 social service providers in Canada who work with Muslim clients, the present article provides insight into strategies and methods that involve localizing social work in Muslim communities, focusing on possible client characteristics, challenges, and needs from the perspective of the practising social worker. Issues of racism, spirituality, acculturation, help seeking, and client expectations of service are particularly relevant. Properly responding to these factors ultimately involves the coordinated efforts of educational institutions, agencies, and social workers, but none of this will be possible without a thorough understanding of cultural values meaningful to Muslim clients.     

A Network Therapy Clinic for Clients with Intellectual Disability

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability and behaviours of concern. This paper describes a model that draws on systemic family therapy and network therapy as well as the use of a reflective team. A single session intervention was provided for families of people with intellectual disability. A systemic consultation was used as a pre‐session meeting for professionals working with the family. The systemic consultation and single session therapy allowed the family and the professional network to gain insight. Involving the professionals in the therapy session also enhanced the alliance between professionals and family. This approach assists everyone involved in the case to find a way to progress.     

The Emergency Service Clients

Several housing risk clients identified in Chapter 3 are profiled here in detail regarding their housing circumstances and how they have been coping with these problems. Individuals are described for whom disloaction was brief; for whom homelessness was long term, repeated or habitual; or who have never been without a home. Most persons in the latter category are subsisting in this state at substantial personal risk. The unique coping abilities of each type are highlighted.     

Understanding Asian American Clients

Abstract

Asian Americans are the fastest growing ethnic minority in the United States today. Therefore, the Asian American population greatly needs the services of qualified cross-cultural counselors. An ethnic match between an Asian American client and his/her counselor is generally recommended. However, due to the limited number of qualified Asian American counselors and problems sometimes encountered with an ethnic match, an ethnic match between the counselor and client is very often not realistic nor always preferred. However, Western counselors who work with Asian Americans need to understand their clients' acculturation problems. They also need to understand the preventable mistakes often made in counseling Asian American clients.     

An Ethical Assessment of Structured Intervention with Chemically Dependent Clients

ABSTRACT

Structured intervention is a widely accepted approach to helping the chemically dependent client get treatment. Because this method departs from the tradition of the client directly seeking help, it raises unique ethical diletnmas-for both client and practitioner-including issues of self-determination, secrecy, coercion, environmental manipulation, and “fair exchange.” Analysis of these issues using a model for ethical decision-making is followed by discussion of four ethical options for the practitioner. The authors identify a preferred emical position based on theoretical and practice knowledge plus professional and personal values.