Partners in the Spiritual Dance: Learning Clients’ Steps While Minding All Our Toes

We present four case illustrations highlighting the complex interplay of therapists’ and clients’ spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients’ and therapists’ spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist’s and the client’s spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

Lesbian Therapists and Lesbian Clients

Abstract

The authors, on the basis of their own experience, explore issues specific to therapists working openly as lesbians with lesbian clients. Their discussion covers the structure of a private practice, the therapeutic relationship between lesbian therapist and lesbian client, and personal challenges for the lesbian therapist. Questions are raised and direction given with the aim of facilitating congruence among the therapist's personal capacities, the therapeutic setting, and the psychological intention of the therapeutic work. The authors note the therapist's need to tolerate the exposure of her personal life and the pressure toward fusion that are both entailed in work with lesbian clients, and they suggest that these special challenges, when the lesbian therapist's engagement with them is conscious, offer rich material that can deepen the therapeutic relationship and the therapeutic work.     

Negative attitudes,nonverbal behavior and self-fulfilling prophecy in simulated therapy interviews

This research investigated if interpersonal expectancies in a psychotherapeutic context were mediated through nonverbal behavior. Beginning (male) therapists served as interviewers and interacted with (male) subjects who were introduced as clients (who were treated for psychological problems) or normal students. It was hypothesized that the therapists would have a more negative attitude toward the supposed clients than toward the nonclients and show more arm position symmetry and less forward lean toward the supposed clients. The interviewees were predicted to show more ah-filled pauses, speech disturbances, and less looking at the interviewers in the client condition than in the nonclient condition. The results demonstrated that therapists had more negative expectancies toward supposed clients than toward nonclients. Support was shown for the hypothesis that more arm position symmetry would be shown in the client condition than in the nonclient condition. The results also indicated that supposed clients used more ah-filled pauses and speech disturbances than nonclients. The therapists used this information when they attributed more discomfort to the supposed clients. It is suggested that the findings of this study have implications for understanding the process of self-fulfilling prophecy in a therapeutic context.     

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.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Vaccine Preventable Disease on Campus

Abstract

Vaccine preventable diseases (VPD) have declined as a cause of morbidity and mortality in the United States. From more than 500,000 cases of measles reported annually in the prevaccine era, there were only 1,436 cases reported in 1983 (38% on college campuses); from more than 12.5 million reported cases of acquired rubella and 20,000 cases of congenital rubella syndrome (CRS) reported in 1964, there were only 954 reported cases of rubella (an unknown number occurred on campuses) and 4 cases of CRS reported in 1983. Only 6 cases of diphtheria (1 occurred on a campus), 8 cases of paralytic polio, and 75 cases of tetanus were reported in 1983 in the United States.

While these declines have been dramatic, significant morbidity from these VPDs persist. Up to 25% of college age adults remain susceptible to measles and rubella. Most students would be eligible for their first booster (10 years after preschool dose) at the time of college entrance, 62% of young adults (18–39 years of age) are estimated to be susceptible to diphtheria, and 11% are estimated to be susceptible to tetanus. Fewer than 5% of young adults are believed to be susceptible to polio.

Measles and rubella continue to be associated with college outbreaks. All cases of measles and rubella should be reported to local health departments. College and universities have the opportunity to ensure the protection of their students, faculty, and employees by establishing and enforcing immunization requirements for measles, rubella, diphtheria, tetanus, and polio as a condition of matriculation, registration, or unemployment.     

Recognising Strategy and Tactics in Constructing and Working with Involuntary Social Work Clients

ABSTRACT

This paper reports on the author’s academic work on working with involuntary clients, which began with a knowledge exchange project in Scotland. I reflect back on this work and use it as a way to explore subsequent reflections on the field. These move beyond consideration of the skills required to undertake such work through locating the category of involuntary clients within wider, yet contradictory, governmental discourses on client engagement. These are identified as the strategy that sets the context for such work. But the strategy is enacted through the day-to-day tactics of social workers on the ground; such tactics, enacted in everyday encounters, are constitutive of effective but also ineffective engagement with clients. The discussion goes on to problematise the distinction between voluntary and involuntary clients and to suggest that effective social work practice, whatever the nature of that involvement, requires that clients are recognised at an ethical and relational level.

IMPLICATIONS

• The term involuntary client(s) cannot be taken for granted but is constructed and needs to be understood in particular and often contradictory policy and professional contexts.

• Effective but also ineffective ways of working with involuntary clients go beyond the acquisition or demonstration of particular skills but are embodied in the everyday relational practices of social workers.

• Ethical engagement with involuntary clients proceeds from a sense of mutual recognition.

     

Transforming Into Men Who Matter: Increasing Empathy in Domestic Abuse Treatment

ABSTRACT

Men referred to domestic abuse treatment are typically involuntary clients, ranging from being legally mandated to being under significant pressure from others to attend. Such treatment programs have mixed results in achieving change in abusive behaviours. Most programs emphasise taking responsibility for abusive behaviour by examining the precursor thinking beliefs and values, with less attention paid to learning new interpersonal skills that replace antisocial behaviours with prosocial alternatives. Empathy provides a measurable moderator of moving beyond simply acknowledging responsibility for past abuse into learning and applying prosocial relationship enhancement skills with their treatment cohort, families, and significant others. This paper describes a program that builds empathy skills through a series of program and mentalisation tasks that include routine client feedback using the Partners for Change Outcome Management System (PCOMS). Evidence of increased retention and statistically significant changes in empathy using the Social Empathy Index are provided from a previous study examining the same program. The practice and research implications for domestic abuse clients and other involuntary populations are discussed.

IMPLICATIONS

• Involuntary clients continue to have high dropout rates across a range of client populations and are a challenge to engage in the change process. With the application of the client feedback tools and relationship enhancement skills described in this paper professionals can more effectively engage other types of involuntary clients in their change efforts.

• The focus on empathy and relationship enhancement skills can lead to reduced treatment dropout across involuntary client populations referred for substance use, domestic violence, or other offender behaviours.

     

A Program Evaluation of Los Angeles ACORN's Welfare Case Advocacy

SUMMARY

Bureaucratic confusion and client dissatisfaction since the 1996 changes in welfare policy opened opportunities for third party advocacy on behalf of welfare clients. This paper evaluates Los Angeles ACORN's case advocacy program for welfare clients. Outcomes analyzed include client satisfaction with ACORN's advocacy and effects of the program on welfare clients who later became ACORN members. Ninety-one percent of clients surveyed (N = 99) stated they were satisfied with the resolution of their welfare case complaint. Eighty-eight percent of respondents stated ACORN did a better job resolving their problem compared to the welfare department. Unique aspects of the program include peer advocacy and opportunities for welfare recipients to join ACORN and work on welfare policy changes among other issues.     

Practices of psychotherapists: cultural mutuality,ideologies, and work settings*

Quand on mit en comparaison la culture et l'idéologie professionnelle des psychothérapeutes d'une région métropolitaine avec les affiliations religieuses de leurs clients, on constata que l'affinité culturelle entre thérapeute et client était plus grande dans les clientèles privées que dans les clientèles d'hôpital, ce qui suggère que le thérapeute et le client privé se choisissent plus souvent selon leurs formations religieuses. L'affinité culturelle est la plus grande parmi les protestants, moins grande parmi les catholiques, et encore moins parmi les juifs. Il y a aussi un rapport important entre l'affiliation religieuse du client et l'idéologie professionnelle du thérapeute, surtout dans deux cas: les clients catholiques sont le plus souvent en thérapie chez des thérapeutes de l'analyse existentielle de Rogers, et les clients juifs le plus souvent chez des thérapeutes psychanalytiques. Dans une comparaison entre la culture et l'idéologie professionnelle du thérapeute et la religion du client, on trouva dans les clientèles privées moins d'affinité culturelle parmi les protestants et les juifs, et plus d'affinité culturelle parmi les catholiques; dans les clientèles d'hôpital, il y a une diminution d'affinité culturelle et une augmentation concomitante de l'importance de l'idéologie professionnelle. En général, on constate que l'affinité culturelle entre le thérapeute et ses clients explique la dynamique des rapports mieux que le font les relations entre l'idéologie professionnelle du thérapeute et les affiliations religieuses de ses clients. When the attributes of cultural affinity and ideology of psychotherapists were related to the religious affiliations of their patients in a metropolitan area, it was found that there was higher cultural mutuality (shared culture) of therapists and patients in private practices than in organizational practices, which indicates that therapists in private practice and their patients more often mutually select each other on the basis of religious backgrounds. Cultural mutuality is highest for Protestants, followed by Catholics and then by Jews. Treatment ideologies of therapists are also importantly related to religious affiliations of patients, especially in two cases: Catholic patients are more often in therapy with Rogers-existential practitioners and Jewish patients in therapy with psychoanalytic practitioners. When cultural affinity and ideology of therapists are simultaneously considered in their relation to their patients' religions, private practices exhibit reduced cultural mutuality of Protestants and Jews and increased cultural mutuality of Catholics; in organizational practices, there is a reduction of cultural mutuality for Jews, with a concomitant increase in the importance of the ideologies. In general, it was found that cultural mutuality of therapists and their patients more importantly explains the structural patterns of the practices than the relation of the mental health ideologies of therapists and the proportions of patients' religious affiliations in the practices.     

Counselor Trainees' Assessment and Diagnosis of Lesbian Clients with Dysthymic Disorder

SUMMARY

Graduate-level counselor trainees completed an Assessment and Diagnostic Inventory consisting of clinical vignettes and a series of questions pertaining to conceptualization of client problem, diagnosis, and assessment of overall level of psychopathology.We hypothesized that participants would assign different diagnoses to clients with lesbian versus heterosexual sexual orientation. Participants responded to vignettes in which clients were identified as either a lesbian or a heterosexual female, with all other content identical. Participants were significantly more likely to perceive lesbian clients' problems to be related to sexual orientation for the vignette corresponding to dysthymic disorder. However, they were not more likely to assign personality disorder diagnoses, nor did they attribute a greater degree of psychopathology to lesbian clients with dysthymic disorder.     

Giving Good Sermons in Therapy

SUMMARY

Social workers and other therapists often deliver “sermons” which are not heard by their clients. Like some preachers who lose their congregations with dull monologues, therapists can lose their audiences through ineffective preparation or poor delivery. The effective preparation and delivery of messages are addressed in the body of literature known as homiletics. This article begins a conversation between practitioners of homiletics and of family therapy. A discussion of the vital elements of an effective sermon as well as its preparation and delivery that makes sense to clients is offered. Vignettes to illustrate various uses of sermons in therapy are included.     

Producing Family Problems: Organization and Uses of the Family Perspective and Rhetoric in Family Therapy

This article applies and extends literature on the micropolitics of trouble and family rhetoric perspectives by analyzing how therapists in a family therapy agency practicing the brief model used family rhetoric in defining and responding to client problems. Family rhetoric is the use of images of family (the family perspective) to (1) persuade others to one's preferred orientation to issues of mutual concern and (2) attribute identities to one's self and others. The article focuses on how the therapists rhetorically enacted and applied the family perspective in interactions with colleagues and clients to define and remedy client troubles. In general, troubles were defined and remedied by treating them as products of clients' family systems, defined as enduring roles, relationships, and perspectives. The therapists sought to remedy client troubles by initiating changes assessed as appropriate for their troubles and family systems. The article concludes by considering some of the implications of the findings and analysis for the sociological study of human service work.     

Impact of Computerized Rapid Assessment Instruments on Counselors and Client Outcome

Abstract

The effect of the availability of Rapid Assessment Instrument (RAI) (1) computer scoring, and (2) computer administration on: (3) counselor behavior, and (4) client outcome was inspected. Counselors without computer assistance employed fewest RAIs with their clients; those with computer scoring available employed more RAIs, and those with computer administration available employed RAIs most frequently. When more RAis were employed, clients improved more in counseling, terminated against medical advice less frequently, and were also more satisfied with their counseling experience.     

HIV and family therapists' duty to warn: a legal and ethical analysis

In the absence of definitive legal precedents, family therapists must decide whether to warn sexual partners of HIV-positive clients when clients themselves refuse to do so. Deciding whether to break confidentiality reaises both legal and ethical issues. Legally, the Tarasoff ruling requires therapists to warn potential victims of illegal dangers posed by clients but does not require therapists to warn potential victims of dangers posed by their clients' legally permissible actions. unless the behavior of the seropositive client is proscribed by state law, warning the clients' partners does not fall within the scope of the Tarasoff ruling. Ethically, therapists must negotiate and adhere to a disclosure policy that balances considerations of respecting autonomy, maintaining integrity (avoiding fraud and betrayal), benefiting clients, and fostering responsibility. Some therapeutic and ethical aspects of these considerations are discussed.     

Diversity in Diversity: Changing the Paradigm

SUMMARY

This essay discusses the growing complex diversity in client populations, emphasizes the need to support all legal statuses of clients, and advocates for a paradigm shift in culturally competent social work practice.     

Counselors as Social Advocates

ABSTRACT

The authors discuss the importance of social advocacy and empowerment models in working with lesbian clients. They also explore the multiple contexts that impact lesbian clients and their families. A case illustration involving a lesbian client facing issues of internalized homophobia, heterosexism, sexism, and legal issues is presented. Suggestions for applying a feminist and social advocacy approach are offered.     

‘Bad Therapy’ as a Training Technique: An Empirical Analysis

The purpose of the present study was to gather empirical data to examine the usefulness of an intriguing training technique called “bad therapy”. The technique, developed by Lang (1980, 1982), is utilized in a role-play setting for experienced therapists who are having difficulty with specific clients showing little improvement. The therapist is instructed to disregard his or her usual style of treatment, and instead, within a role-play format with a colleague who plays the part of a client, to try an alternative style of treatment. This new treatment, termed “bad therapy”, instructs the therapist to try to make the client worse rather than better. Interestingly, reports from both the role-play therapist and client indicate that the “bad therapy” session was considered more beneficial than the therapist's usual mode of treatment. As well as empirically investigating Lang's assertion, the present study also attempted to look at different perspectives of bad therapy. Is “bad therapy” a directive to be harmful and destructive, or is it a suggestion to be more daring and to take more risks? Subjects were 56 therapists who formed twenty eight pairs of therapist-client dyads. First, each pair conducted a “session” where the therapist performed his or her typical therapy. Then, therapists in one group (N= 11) were given directives to try to make their clients worse rather than better (“destructive” set), while therapists in another group (N=11) were told to say and do things that they wished to, but never dared (“daring” set). Finally, six therapists were told to simply repeat their usual type of therapy (“control” set). Results indicated that clients perceived the destructive and daring groups differently with the daring group being perceived more favourably, yet more authoritarian. Similarly, therapists perceived the daring and control groups more positively than the destructive group. The results are discussed in terms of training techniques and current trends in psychotherapy.