Mutuality in Relationships with Health Care Providers

Abstract

I have had a mobility impairment for many years and have experienced repeated trauma at the hands of medical personnel. They have withheld anesthesia and postoperative pain medication, insisting that I had no pain. Physicians have also refused to believe that I have been physically active, and have minimized the degree of impairment that I described. They hold the same biases about people with disabilities as do most people: that we are lazy and weak, and that we do not try hard enough. Despite my ongoing attempts at self advocacy, my orthopedist has made unilateral decisions about my treatment goals and the management of my diseased joints. These have caused me to wear out other joints, until I am significantly impaired and can work only a few hours a week. He then began to treat me differently, since his preconceptions prevented him from seeing me as an individual with unique abilities facing attitudinal and physical barriers. Our relationship was the only tool available to me to attempt to break down his prejudices to stop the harm he was causing me. I will describe a series of oppressive medical provider relationships. I will then demonstrate my attempts to assert myself as an essential mutual partner in decisions about my goals, and show the limitations of this approach in the presence of a great power differential.     

The Search for Fuller Mutuality and Self Experiences in a Women's Psychotherapy Group

This article examines the reconnection experience of four women, mutually sharing their feelings, thoughts, and implicit relational knowing of each other within the group treatment setting. Initially, Carol, Marcia, Helen, and Nancy were in a six-month psychotherapy group, describing and recounting their histories and life narratives of rape, abuse, neglect, and generally traumatic childhoods. Four years later, they met again, just to see how everyone was doing. The social worker hired a camera-woman to film the five hours of this re-engaging group process. What emerged was a dynamic example of intersubjectivity, affect attunement, emotional regulation, and the power of mutuality and intrinsic responsiveness.     

Nonprofit agency dependence on direct service and indirect support volunteers: An empirical investigation

Thirty agency directors or volunteer coordinators were interviewed regarding the human resource techniques they use to attract and retain two types of volunteers: direct service and indirect support. Agencies that depend on direct (point‐of‐service) volunteers are more likely to bring volunteers on board and use the performance feedback process to guide any needed improvements. Role playing and mentoring are particularly effective training techniques for these volunteers. Despite the critical function of point‐of‐service volunteers, more sophisticated recruitment and screening techniques were not used, contrary to expectations. Agencies that depend on indirect support volunteers use the recruitment process to screen out those who would not be successful volunteers and terminate them quickly for lack of confidentiality and reliability, particularly if they have had on‐the‐job training. Agencies hesitate to terminate direct service volunteers even for lack of ability and violations of policies and procedures. Finally, agencies used nonmonetary rewards with indirect support, but not direct service, volunteers. Implications of these findings and others are discussed.     

Personal assistance—direct payments or alternative public service. Does it matter for the promotion of user control?

Personal assistance organised as direct payments is seen as an important means for securing user control and freeing disabled people from their reliance on welfare professionals and unpaid carers. The hypothesis put forward in the article is that just looking at whether personal assistance is organised as direct payments or as an alternative service represents an overly restricted approach to judge how the user’s preferences are taken care of. By comparing models of personal assistance in the US, the UK, Sweden and Norway it will show that several other factors influence user control. In the final part of the article the question is raised as to whether paternalism is always negative for welfare service users. Since the users constitute a broad group it might be questioned if the assumption of the service users as rational, well informed and competent to make the best choices is always valid.     

Transference,Countertransference, and Mutuality in Relational Social Work with College Students

The college experience represents a major life transition from adolescence to adulthood, which is often fraught with challenges in relationships, identity formation, and communal belonging. Steady generational changes in self and relational identity have led to younger generations that increasingly embody a more interpersonal and less individualistic conception of the human person, with less rigid norms and greater openness to diversity. These characteristics make college students an appropriate target population for interpersonal psychotherapies based on mutuality of process. Relational therapy is a particularly fitting treatment modality for college students, as it focuses on these very qualities. This article reviews the current literature on relational theory in psychological and social work practice, describing its principal tenets and concepts, and applying this theory to clinical work with college students to reveal applications for constructive practice with this population.     

(Imagining) Erotic Mutuality: Negotiating Difference in Sexual Orientation in an Analysis

This article explores the clinical limitations of an exclusive adherence to the oedipal paradigm for the understanding of erotic material in the transference/countertransference in analytic treatments where the participants identify with differing sexual orientations. Its central argument posits that possibilities for recognizing developmentally significant, evolved connections with patients of all genders and sexual orientations is subtly circumscribed when understanding of these phenomena is partitioned chiefly by the “either/or” of a positive or negative form of oedipal desire.

The argument goes on to query and challenge formulations of a universal bisexuality as a satisfactory resolution to this conundrum, again, particularly when the 2 analytic partners claim different sexual orientations. Part object relations as residue of an early and ubiquitous polymorphous perversity are proposed as useful theoretical and clinical alternatives. Case material is also provided.     

From Provocation and Combustibility Toward Mutuality: Once More with Less Rage,Please

This paper presents a summary and excerpts taken from the psychoanalytic treatment, spanning over 16 years, of a highly disturbed and provocative male patient. Prior to referral, the man had been unsuccessfully treated psychopharmacologically for a depressive illness with severe somatic and affective symptoms and behavioral disturbances. A highlight of the case is the emergence of a therapeutic impasse that developed around the patient's attempt to connect intensely with the analyst; the patient attempted to repair his own damaged phallic narcissism by demanding that the analyst participate in a ritualized sexual enactment, which threatened the destruction of the treatment process. The resolution of the impasse was accomplished through the analyst's reaffirming the frame and recovering his own disrupted composure and ref lectiveness, while maintaining a compassionate and caring attitude toward the patient.     

Leadership challenges for human service administrators

This study addresses the challenges that human service administrators face in maintaining and moving their organizations forward. Twelve leadership challenge dimensions are identified, variations in these challenges across agencies and administrators are explored, and the implications of these findings for leadership development programs targeted at human service administrators are discussed.     

Education and training for direct care workers

Approximately 80% of social care workers have no formal qualifications or training and efforts to encourage the take up of training for qualifications have only had limited success. This paper reports on the training needs and attitudes towards training of residential workers and home care workers who took part in a major study of statutory social services employees by the National Institute for Social Work (NISW). The paper describes a diverse workforce with a high level of interest in training to improve skills and the quality of the service, although not all workers were interested in obtaining qualifications. Factors associated with taking part in training are examined including gender, age, occupation, personal circumstances, information and access to training, and learning needs and preferred ways of learning. Government initiatives to improve levels of training and qualification, including a new regulatory framework for social care workers, make this an opportune time for employers in the statutory and independent sectors to encourage workers to develop their skills by creating a positive learning culture. The paper concludes that to do this training strategies will have to address the diverse training needs of the workers.     

Our perverse reliance on prescribed standardized processes as proxies for quality in Ontario Children's Aid Societies: Towards the establishment of direct service and outcomes standards

The Ontario child protection system has, over the past 13 years, gone through two waves of reform but a recent government audit has highlighted ongoing concerns with performance and cost. In response, the Ontario Government set up a “Commission to Promote Sustainable Child Welfare” to address these concerns. The Ontario reform strategy has introduced much standardization and a compliance regime to ensure service quality. In this article, the bona fides and costs of such a strategy are examined and the author proposes that continuous outcomes monitoring and a standard to safeguard direct service time to clients are essential if child protection services are to improve.     

Professional development for university faculty through service

The purpose of this article is to identify the contexts for service that are useful for the professional development of university faculty as well as to suggest a model for delivering the work that is part of this type of professional development. The article accomplishes this goal by examining contexts for service, related activities and transformable skills. The model suggested for developing and implementing service activities consists of three components: 1) an initiating force, 2) ways for testing and sharing ideas, and 3) proposed solutions.     

Clinic-based service programs for increasing responsible sexual behavior

Three general classes of clinic-based programs to increase responsible sexual behavior are considered: (a) clinic-based educational/counseling programs, (b) school clinic-based condom distribution programs, and (c) clinic-based STD/HIV screening programs. Consistent condom use may double in response to clinic-based counseling. However, consistent use seldom exceeds 50% of coital exposures. Extensive and personalized counseling interventions reduce incident sexually transmitted infections by 5% to 10%. Increases in responsible sexual behavior following school-based condom distribution programs is reported in some but not in all studies. Screening programs for sexually transmitted infections are associated with decreases in rates of some infections. STD/HIV screening should be considered an important aspect of healthy sexuality and an adjunct to other counseling efforts.     

Training for civil work in the probation service

Social work education is under constant pressure to give increased attention to various issues relating to practice. This is in large part a reflection of the nature of the social work task which is continuously evolving as it responds to shifts in social policy and changes in social work perspectives and practice. One such issue which is currently the focus of substantial change is the civil work role of the probation service. The author draws on the findings of a recent survey of probation officers which highlights a number of important questions about the adequacy of current training provision, both pre-entry and in-service, and which also raises fundamental issues about the relationship between theory and practice.     

Child maltreatment coordinating committees for effective service delivery

Previous research suggests the importance of multidisciplinary, interagency approaches in creating effective and efficient community service delivery systems for the prevention of child maltreatment. Despite both federal and state mandates for communitywide approaches to service coordination, however, multidisciplinary approaches have generally been untested or underutilized. This article reports a study of the most common mechanism--the community coordinating committee--and offers recommendations to help communities determine readiness for coordinating committee formation, most appropriate committee type and focus, and most effective operating conditions.