Clinical Writing of a Therapy in Progress: Ethical Questions and Therapeutic Challenges

Clinical implications and ethical dilemmas of the use of confidential case material in clinical writing are examined, including a review of the discourse among professionals who publish clinical work. This literature is applied to a clinical illustration of psychotherapy with a client who gave consent for publication and read the clinical write-up of her case material. It is suggested that clinical writing may increase client “self-reflection” if there is a “secure base” of attachment between therapist/author and the client. The impact on the client’s treatment process is examined, in addition to a discussion of ethical questions and professional recommendations. ²Dr. Susanne Bennett is an Assistant Professor, National School of Social Service of the Catholic University of America. Dr. Bennett is also a psychotherapist in private practice in Falls Church, VA.     

Leaving Home Early: Passing from Girlhood to Womanhood

This paper presents a case study of a young woman’s narrative of leaving home and her transition to adulthood. The case study is part of a larger research project about young women with an experience of an early break-up from home, through running away or being thrown out. Empirical material underlying this paper consists of a qualitative study of 12 young women that have been interviewed. The aim of the study is to understand how events like running away/being thrown out of home influences their transition to adulthood. The particular narrative demonstrates how a young woman presents and accounts for such a dramatic event as running away or being thrown out from home, and how that is understood in relation to her adulthood. A further aim is to illustrate how social services efforts are reflected in her narrative.     

The humorous construction of disability: 'stand-up' comedians in the United States

We examine how stand-up [sic] comedy constructs, circulates, perpetuates and/or disrupts stereotypical images of disabled persons in the United States. We use disabled people, rather than people-first language, to remind readers that disability is an ill-defined, culturally imposed attribute. Although humor is culturally specific, we draw on works of an international cadre of humanities scholars and social scientists to ground our analyses. We conclude that disability humor constitutes an emerging, liberatory art form. Disabled and non-disabled comedians elicit thought-provoking laughter and present disability as an interesting way to live. However, disabling humor still perpetuates stereotyping and isolation.     

Liability in child welfare

Child welfare workers and agencies are vulnerable to lawsuits. Recent court rulings have more clearly defined the liability of workers. The distinguishing variable is custody. Children injured while in the custody of the state are entitled to sue for damages. Children injured by their parent, even if under the supervision of a child welfare agency, are not entitled to claim a violation of their 14th Amendment rights. These cases are reviewed and strategies designed to minimize vulnerability are offered.     

An uncertain future: children of mentally ill parents.

Research reports the uncertain outcome of variables affecting the life of a child of an MI parent. Nurses must avoid stereotyping children before assessment; they are to be in the forefront in assessing self-care skills and deficits to guide planning individual interventions for children and MI parents. Long-term research theory-based interventions will enhance mental health in high-risk children and families.     

Diagnosis and therapy of male gamblers in a university psychiatric hospital

From 1980 to mid-1990 fifty-one gamblers were evaluated and treated at the psychiatric university hospital of Homburg/Saar in Germany. All were men with a mean age of 33.7 years. Gambling had lasted 5.2 years on average. Most patients were motivated to undergo therapy by members of their family. The majority of them had been in psychotherapeutic treatment before. Thirty-six of the 51 patients had committed punishable acts including fraud and embezzlement and, in 7 cases, robbery. The sample could be divided into three clinical subgroups. The first group consisted of patients with severe psychiatric diseases such as schizophrenia, manic-depressive illness or organic brain disorder. Patients of the second group suffered from serious personality disorders. Those of the third group showed deep-rooted problems in their current relationships.This article is an extension of the special issue on Gambling in Europe edited by Iver Hand, M.D.     

Rates of pathological gambling in publicly funded outpatient substance abuse treatment

Rates of problem or probable pathological gambling were assessed in substance abusers seeking outpatient treatment in a publicly funded outpatient substance abuse treatment program. The South Oaks Gambling Screen (SOGS) was administered to 467 consecutive admissions at three different sites. Problem gamblers comprised 6.2 percent of the total (n=29), and 4.5 percent scored as probable pathological gamblers (n=21). These rates are two and one-half times greater than would be expected according to a recent state survey using the SOGS. Implications for assessment and treatment of problem gambling are discussed.The author expresses his appreciation to John Ramsay and the staff of Epoch Counseling Center for data collection; to Les Franklin for computational analysis; and Dr. Rachel Volberg for providing supplemental data from her Maryland State Gambling Survey.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.