Close encounters: Exclusion and marginalization as an intersubjective experience

The following paper will review current writings in intersubjective literature in order to examine how the issues of race and ethnicity color the therapeutic encounter in relation to paradigms of power and authority, transference, and countertransference and the “ethnic third.” It will then use two case vignettes to illustrate that therapists and clients coming from different cultural and ethnic groups can find ways to bridge their differences around race and culture through mutual experiences of exclusion and marginalization. The vignettes will illustrate some of the intersubjective interplays that are possible through the use of cultural rituals and symbols, both in order to form an empathie connection and in order to examine how race and culture shape the therapeutic relationship.     

Bilingual Social Workers in Mental Health Service Provision: Cultural Competence,Language, and Work Experience

Many agencies actively recruit bilingual social workers. This study presents the reactions of 10 Chinese bilingual social workers to the expectations and demands of their agencies. The study employed a qualitative design with a phenomenological approach. The participants’ responses provide insight into how they manage ethnic and cultural mental health issues in Chinese populations. This study aims to improve social service delivery for clients with limited English proficiency by identifying effective, culturally competent services. The findings suggest that when hiring bilingual social workers, it is just as important for them to be culturally competent as it is for them to be an ethnic or language match with the client base. Having all of these qualities will result in staff members who can provide more effective services by making accurate diagnoses and identifying appropriate treatment plans. In addition to employing bilingual social workers, it is important to maintain good supervision as this will allow supervisees to have a unique perspective on what is involved in providing effective delivery of services to clients with limited English proficiency. Implications for research, practice, and policy are discussed.     

Culturally Competent Approaches for Counseling Urban Appalachian Clients: An Exploratory Case Study

ABSTRACT

The authors examine the application of a strengths-based empowerment approach to working with an urban Appalachian woman and her family. The purpose of this article is to start the research process by utilizing the lessons learned to assist health and human service practitioners. Key points are identified in developing awareness and intervention skills when working with clients who have an Appalachian cultural heritage. This case study utilizes a culturally competent framework for assessing and intervening with Appalachian clients that emphasizes the strengths and empowerment literature. As the foundation for further research, this case study provides a rationale for starting evidence-based practice incorporating a strengths-based empowerment theme. Case study research is limited by its focus on one individual within a specific span of time and cultural context; findings cannot always be generalized to a similar population. Suggestions for further research in this area are provided.     

Auspicious Experience in Social Work

Abstract

This personal narrative recounts the experiences of one psychodynamic practitioner as she grew over the course of her social work career. It follows the development of her therapeutic awareness as she first worked with adolescents in a wilderness therapy program, and later with low-income clients in several large urban areas. While discussing the role of her Masters and Doctoral education, it explores particularly the role supervision played in developing her therapeutic awareness and skills. Overall, it is directed toward explaining her professional growth as a psychodynamic practitioner and the components involved in that growth.     

Helping families when child sexual abuse is suspected but not proven

This paper reports from a project investigating reactions within families when intra‐familial child sexual abuse was suspected, and family members’ responses to a therapeutic approach. Data were obtained from therapeutic sessions and follow‐up interviews with mothers, children and alleged perpetrators. Before treatment the mothers felt uncertain as to how to interpret the children’s unclear signs. The children had severe symptoms, but had seldom disclosed abuse. The alleged perpetrators were often not informed about the suspicions. The families were in a state of crisis and shock, and communication within the family was characterized by uncertainty about what to talk about and whether the suspicions should be shared. In most cases after treatment the conflicts had been reduced, the children had few symptoms, supervised contact had been established, and the clients were satisfied with the treatment. One conclusion is that therapeutic sessions, where family members share information about concerns and take part in the decisions of how to protect children, seem relevant and helpful to the clients in unclear abuse cases.     

现代公民意识与和谐社会建设

公民意识作为现代民主法治中的民众意识,是对传统的臣民意识的超越。它的存在是社会主义市场经济、社会主义民主法治及实现人的全面发展的必然选择,对构建社会主义和谐社会具有重要的价值功能。但沉重的传统承袭时时都在试图摧毁人们心中的公民意识的萌芽。因此,培育良好的现代公民意识,无疑会对经济、政治、社会、文化全面发展的和谐社会产生重要的影响。     

To disclose or not to disclose: Political conflicts in the countertransference

Self‐disclosure is a frequent topic in the relational psychotherapy literature. However, there are few psychoanalytic writings or empirical studies that concern self‐disclosure in the context of cross‐cultural treatment; specifically treatment between Israeli therapists and Palestinian clients. This particular subject broadens the investigation of cross‐cultural treatment beyond race and color into the domain of religious and political differences between client and clinician. An Israeli‐American therapist's counter‐transference reflections around self‐disclosure and its impact on her Palestinian client will be the subject of investigation in the following paper.

Self‐disclosure has been increasingly examined in the relational literature over the past ten years in the context of the therapist's subjectivity within the therapeutic encounter (Aron, 1991; Renik, 1995). Few psychoanalytic writings, however, have focused on self‐disclosure as embedded within race and culture, and fewer still address the impact of religious and political differences between client and therapist, differences that, in the case of a Palestinian client and an Israeli therapist, reflect larger social and political conflicts. The transference‐countertransference dynamics around self‐disclosure and the way these shape the therapeutic encounter between a Palestinian client and an Israeli therapist will be the subject of investigation in this paper.     

Institutionalized strategies in face-to-face encounters: focus on immigrant clients

The aim of this article is to explore how officials' institutionalized patterns of acting can be useful for understanding encounters between immigrant clients and representatives of a welfare organization. The data indicate that there are two fundamental social mechanisms at work: the materialization of the organizational ideology, and the cultural filter. Both have an impact on the type of action strategy chosen by an official in handling client problems. An analysis of the strategy outcomes according to the social mechanisms shows that: 1) The outcome will depend on the client's consent to the organizational ideology. Immigrant clients more often than other clients are assumed to have different views on, for example, sickness, work capability and retirement age; 2) Comparing clients to the image of an ideal-typical long-term sick person can lead to the definition of clients with different cultural backgrounds or those of immigrant status as deviant, and therefore problematic to deal with; 3) The cultural filter through which the officials interpret their clients' situation can be an important obstacle in understanding the responses of immigrant clients.
The study was conducted at a local social insurance office in a suburban area of a major Swedish city. Immigrants represented approximately 60% of the long-term sick people. The empirical material consists of observations of encounters and interviews with the officials working with rehabilitation of the long-term sick.     

Early Cultural Dialogues in Cross-Cultural Clinical Practice

This article examines the quality of cultural dialogues between clients and therapists when they initiate and integrate verbal references to culture in the beginning process of therapy. Six cross-cultural dyads in short-term–oriented community mental health services participated in the study. The initial three sessions of actual clinical encounters were taped, and conversation analysis was used for an intensive analysis of the treatment sessions. Despite the presence of a wide range of affectively charged cultural content raised by the clients, the therapists showed only minimal responses to these topics. The potential of therapeutically germane cultural dialogue was lost, and the discussion of material involving cultural differences regressed to monologues expressed by clients. In this sample, there was little talk that focused on cultural differences or similarities between clients and therapists. Implications and limitations of the study in cross-cultural clinical practice are discussed.     

道德自觉的内涵及其实现路径的选择

当今世界正处在重大调整时期，各种思想道德文化交流交融交锋更加频繁，道德自觉在增强国家文化软实力，提高国家综合国力中的地位和作用更加凸显。党的十七届六中全会明确提出，要培养全体人民的高度文化自觉，以增强国家文化软实力。而文化自觉的核心和关键在于道德自觉，因此，弄清道德自觉的内涵及其路径选择，就成为当代德育必须解决的重大问题，具有极强的现实性和紧迫性。     

Caring for the Child Welfare Client: Am I Good Enough?

ABSTRACT

Given the demographics of youth served by the child welfare system, culturally responsive approaches are critical to effective social work practice and desperately needed. Like many adolescents who grow up in the child welfare system, Paul, a White adolescent male in foster care, was beset by a lack of adequate environmental resources and multiple stressors and had little hope or motivation to work on improving his situation. This article highlights the author's “use of self” as an African American male therapist who worked with Paul, using a Winnicottian and caring framework. Because child welfare workers are often overburdened by the demands of work, including large caseloads and clients with few to no resources, they find it difficult to consistently provide empathic and caring behaviors for their clients. The author highlights his therapeutic work and struggles with Paul and offers cultural insights and Winnicottian strategies when working with adolescents in the child welfare system who are ultimately in need of permanency and stability.     

It Is Called a Mother Tongue for a Reason: A Qualitative Study of Therapists' Perspectives on Bilingual Psychotherapy—Treatment Implications

This article is a qualitative study that explored therapists' understanding of the role of language in psychotherapy with bilingual clients. Among the findings were that it is typical for bilingual clients to switch back and forth between primary and secondary languages in psychotherapy, as their narratives are often expressed incompletely in a second language. Bilingual clients tend to return to their mother tongues when expressing strong affects, in their dreams, or when dealing with death or trauma. They may also use their first language as a defense against painful material. Interviewees concurred that bilingual clients express different values or even identities in different languages. Finally, language was reported to be a factor that influenced the therapeutic alliance, as, encoded in language, were issues of trust, idealization, and hostility toward the psychotherapist.     

Trial and error: attending to language barriers in child welfare service provision from the perspective of frontline workers

This paper reports on a qualitative study that used focus groups to gather data from the perspective of child protection workers on their experiences in providing services to clients with limited English proficiency (LEP). The goals of the study were to understand processes of relationship building and service provision that could contribute to improved practice. Focus groups are ideal in obtaining data on how a group deals with particular situations and for understanding their decision‐making processes. Measures to ensure rigour and trustworthiness were taken throughout the study. Findings provide rich and multilayered insights into the complexity of providing services for families with LEP showing that agencies use bilingual workers as well as interpreters for services. Participants noted, however, that services continued to be inconsistent with unclear guidelines and training about how and when to access interpreters. Lack of training for bilingual workers was also identified. Confidentiality issues, barriers to engaging with clients, problems with the quality of interpretation and role confusion together with benefits including interpreters being cultural and language ‘conduits’ and links to culturally specific services; enhanced communication decreasing the possibility of inaccurate assessments and lessening power differentials; and help with workload were noted.     

A Cross-Sectional Examination of the Association Between Dyspnea and Distress as Experienced by Palliative Home Care Clients and Their Informal Caregivers

This study examined the association between dyspnea and distress as experienced by both palliative home care clients and their informal caregivers as a unit of care. Cross-sectional analysis was conducted using the interRAI Palliative Care Assessment database. Responses from 6,655 individual palliative home care clients across six regional jurisdictions in Ontario, Canada were included. This study found that clients experiencing dyspnea were more likely to show overall signs of distress; report one or more signs of self-reported distress; and be at risk for depression when compared to clients who do not experience dyspnea. Caregivers of clients experiencing dyspnea were more likely to exhibit distress than caregivers of clients not reporting dyspnea. When indicators of caregiver distress and client distress were combined, 53% of the caregiver-client units exhibited distress. Social work practitioners should include a focus on distress within the care unit as a priority when care planning to meet the needs of persons nearing the end of life. Members of the care team should consider available treatment and management options tailored to meet both the client and their informal caregiver’s needs.     

文化自觉与人格独立微探

当前，我国大力深化文化体制改革，以促进文化的大发展大繁荣，以高度的文化自觉和文化自信，着眼于提高民族素质和塑造高尚人格。当今的中国社会，亟待以文化体制的深入改革，文化事业的健康发展校正经济的发展动向，引导经济沿着以人为本的轨道前行，以文化自觉引领经济自律，引导经济行为的伦理化，让市场经济活动的主体去传承文化的血脉，充满着道德的血液。以文化的发展繁荣促进人的全面发展，以文化体制改革的不断深化驱除青少年人生修养中的拜物不拜人现象。     

Drug abuse, paradigms and social work

Two different treatment practices for the inpatient treatment of drug abusers are described: the pedagogical and the therapeutic. The treatment practices are analyzed from the perspective of sociological theories of human action and from a cultural perspective. The control of the client is of crucial importance but it is exercised in different ways. In the pedagogical treatment practice, the control is manifested in the development of social skills and internalization of conventional roles and norms. In the therapeutic practice, the client's emotions and awareness of ontological facts as freedom and responsibility are objects of control.     

The will to sanction: How sensitive are caseworkers to recipients’ responsibility when imposing sanctions on non-compliance in a welfare-to-work programme?

The activation trend in social policy entails that caseworkers on the frontlines of the welfare state are expected to decide ‘reasonable’ activation requirements for clients and when and how non-compliance should be sanctioned. This study investigates how caseworkers form judgements about their clients’ personal responsibility when activation requirements are violated and how their judgements about responsibility matter for the sanctions they impose. We find that caseworkers are sensitive to personal responsibility, varying the motivation for not fulfilling the activation requirement from a case where the client has less control (circumstances) to one with more control (choice) more than doubles sanctions.     

Evaluating the Roles of Professional Geriatric Care Managers in Maintaining the Quality of Life for Older Americans

This study examined the roles of Professional Geriatric Care Managers (PGCMs). In-depth telephone surveys were completed with 19 PGCMs. Qualitative data were coded independently by two researchers. PGCMs reported that most clients and/or families seek services in response to a health crisis or because a family member was providing care at a distance. Most emphasized the importance of treating clients as autonomous decision-makers. Services described as most useful were supporting families and caregivers, being an advocate for clients, conducting initial assessments and ongoing follow up, and educating families about community resources and the financing of long term care. Regarding maintaining the quality of life for their older clients, a number of care managers described assisting clients to live independently at home, arranging for transfer to an appropriate level of care, and helping clients die peacefully with dignity. Major challenges PGCMs encountered were family conflicts and obtaining needed services. Recommendations to improve PGCM practice include increasing awareness of services, and establishing minimum professional standards through certification.     

Self-determination: Lessons to be Learned from Social Work Practice in India

Correspondence to Dr F. K. Ejaz Research Associate Applied Research Institute Menorah Park Center for the Aging 27100 Cedar Road, Beachwood, OH 44122 USA. Summary Self-determination is a controversial principle in social workpractice. On the one hand it is accepted as being central tosocial work and stems from the broader philosophical issuesof autonomy and respect for the individual. On the other hand,there are many doubts about its implications for practice. Thisarticle examines how the Western social work principle of self-determinationis influenced by cultural beliefs and expectations in India. Twenty-six social workers participated in a qualitative studyon the influence of culture on casework practice in Bombay,India. Open-ended questions and case studies were used to examinehow culture specific problems were handled and how workers interpretedand used some of the principles of social work practice. Social workers believed that Indian clients expected to be guidedin a therapeutic relationship. Further, clients were generallyapathetic and fatalistic about circumstances in their lives.Indian social workers came across as being maestros at bridgingeast-west differences. They subtly fulfilled social and culturalexpectations and at the same time enabled clients to assumeenough autonomy to handle their own problems.