Attitudes of Disabled Individuals Enrolled in a Workstation Center and a Community College Program

This study measured the attitudes of disabled individuals toward the staff who gave them rehabilitation services. The attitudes of two groups of clients at a rehabilitation hospital were evaluated: (a) clients from a vocational rehabilitation workshop and (b) clients from a community college satellite program. Testing was performed at three-week intervals. It was found that clients in the community college program perceived their staff as having more concern than the workshop group. No relationship was found between attitudes and the length of time in the respective program. Clients who entered programs appeared to have attitudes that did not change to any great extent while they were in the rehabilitation programs.     

Assessment,Treatment, and Rehabilitation for Interpersonal Violence Victims

Abstract

Psychotherapists who have received minimal training in neuropsychology do not consider cognitive rehabilitation among the treatment options for their clients who have mild traumatic brain injury (mTBI). Historical perspectives on mTBI did not acknowledge brain plasticity and/or rehabilitation, yet rehabilitation might provide a necessary foundation for a client to be able to benefit from traditional feminist psychotherapy. This article provides an overview of two treatment modalities, biofeedback and neuropsychologically-informed feminist psychotherapy, for women with mTBI who sought relief from interstitial cystitis and headaches. Assessment for neuropsychological treatment planning and monitoring is illustrated with employment of the Ackerman-Banks Neuropsychological Rehabilitation Battery. Clinical examples are provided to demonstrate a variety of manifestations of mTBI and responses to treatment.     

Therapeutic Assessment "on the Front Lines": comment on articles from WestCoast Children's Clinic

I comment on the articles by Mercer (2011/this issue); Guerrero, Lipkind, and Rosenberg (2011/this issue); and Haydel, Mercer, and Rosenblatt (2011/this issue), which describe their practice of collaborative and therapeutic psychological assessment in a community mental health setting. These articles demonstrate that collaborative and Therapeutic Assessment can be used successfully with clients from underprivileged, high-risk backgrounds. Such assessments are rigorous for both clients and assessors, and their success depends on the ability of clinicians to form trusting relationships with clients. In fact, empathic disruptions by assessors are almost inevitable during the collaborative assessment process, especially if assessors' backgrounds and contexts are quite different from those of their clients. However, if assessors receive enough support to "take off their white coats" and reach into their clients' worlds, such disruptions can be repaired, leading to positive changes in both clients and assessors. This kind of assessment work is not for the faint of heart, but it is immensely rewarding.     

Freiwilligkeit oder Zwang

Within Quasi-Compulsory Treatment (QCT) measures for drug dependent offenders, a variety of treatment measures is offered in place of punishment. The present study examines if coerced clients differ from voluntary clients regarding drug history, criminal behaviour, psychological and medical problems as well as their treatment motivation. The data of the present study have been collected in six different treatment institutions in Austria within the framework of the European research project ?QCT-Europe“. A total of 150 clients, who began treatment either ‘voluntarily’ or as a QCT-measure, has been interviewed using standardized questionnaires. The comparison between ‘voluntary’ and QCT-clients suggests that ‘voluntary’ clients seem to suffer more from medical problems and also show more hazardous drug use behaviour.     

Results of intensive stuttering therapy with adults who clutter and stutter

The purpose of this investigation was to report on the identification of adult clients who clutter and stutter, evaluate their response to a stuttering therapy program, and determine if speech measures typically used in evaluating therapy outcome are sufficiently sensitive indicators of change for clients who clutter and stutter. Results suggest that cluttering-stuttering subjects had a very positive response to stuttering therapy, but greater improvements may have been achieved with additional therapy time and expanded therapy goals. Results also indicate that pretreatment and posttreatment measures of articulatory rate may be a more sensitive measure of change for cluttering-stuttering clients.     

Need for approval and counseling outcomes

The intent of this study was to determine the effects of a clients' need for approval on the outcomes of counseling. The expectation was that clients who have a high need for approval by others would cooperate more with the counseling process and would more often be successful in the sense of being rehabilitated. The Marlowe-Crowne Social Desirability Scale was administered to 167 applicants at a state rehabilitation agency immediately after the initial interview. It was hypothesized that successfully rehabilitated clients would obtain significantly higher social desirability scores than those clients who were not successful. The results confirmed the hypothesis at the .01 level of significance.     

Fostering the therapeutic alliance: Recognizing autonomy’s dialogical antecedents

ABSTRACT

This paper presents a reconceptualization of autonomy as the iterative realization of one’s capacity for “effective self-definition,” that is, possessing a sense of clarity and coherence in “who I am,” and exercising the decisional and volitional ownership over my life that this engenders. This process is “Relational,” wherein people’s interpersonal interactions have a deep and pervasive influence on their ability to recognize and exercise their autonomous capacities. This Relational understanding of autonomy is contextualized within the field of addiction rehabilitative practice. Addiction is a pathology that progressively and insidiously undermines autonomy – producing a number of negative consequences that present themselves along a “continuum of pervasiveness.” In order to most fully foster rehabilitation, therapeutic alliances should to be attentive to facilitating autonomy’s dialogical antecedents. Here, interpersonal recognition can help clients to more fully recognize their own autonomous resources – enabling them to embark on their rehabilitative journey and achieve broader autonomous living. This paper concludes by proposing ways that practitioners can manifest their recognition of their clients’ autonomy within the therapeutic encounter.     

A survey of psychological assessment feedback practices

There have been no previous studies on how often psychologists conduct feedback and whether they view this practice as a useful component of assessment. To explore psychologists' feedback practices and their perception of the effects of feedback on their clients, the authors examined survey data from 719 psychologist members of the International Neuropsychological Society, the National Academy of Neuropsychology, and the Society for Personality Assessment who regularly conducted assessments as part of their professional activities. The results indicated that the majority of respondents (71%) frequently provided in-person assessment feedback to their clients and/or their clients' families. Furthermore, most respondents (72%) indicated that clients found this information to be helpful and positive. Factors contributing to perceived positive feedback effects, including graduate training and feedback session length, were also examined. Last, differences in the feedback practices of psychologists predominantly practicing neuropsychology versus those predominantly practicing personality assessment were sampled and discussed.     

The Self-Concept of Welfare Recipients

Do persons receiving welfare feel differently about themselves and others than persons who are not welfare recipients? Does duration of time on welfare have any bearing on these feelings? To answer these questions the writer compared 2 groups of clients who were receiving services from the Division of Vocational Rehabilitation, using a number of scales that reflected attitudes regarding self and others. One group consisted of clients who were on welfare at the time of application for rehabilitation services and the other group consisted of those who were not. The welfare group was further broken down into 3 groups on the basis of the duration of time that they had been on welfare. No differences were found between any of the groups on self-concept, self-acceptance, ideal-self or concept of others. Some variables that might be masking the hypothesized differences, thus accounting for the present findings, are discussed.     

Structural Determinants of Boredom Among the Clients of Psychosocial and Vocational Rehabilitation Centers

In psychosocial rehabilitation programs, clients are encouraged to counter boredom by occupying their time in more structured, meaningful, and enjoyable ways. Several means by which the structure of service organizations reduces feelings of boredom were explored. Hypotheses were tested using data from a sample of clients of Flemish rehabilitation centers for people with chronic mental health problems. Results show that in larger, more heterogeneous centers, boredom is reduced by offering clients a wider range of more routinized activities; in small homogeneous centers, the same effect is obtained by enhancing the intrinsic value of the tasks and by providing more opportunities for task communication. Rehabilitation centers seem to adapt their rehabilitation technology according to their organizational structure.     

And the Winner is… Awards for the Integration of Science and Practice in Psychology

Psychotherapists from all fields perform difficult and challenging work, trying to help their clients gain insight into their problems and make lasting changes in their thoughts and behaviors. Unfortunately, too often the work of a psychotherapist is minimized, neglected, or disregarded. Where departmental or conference awards may be presented regularly, public recognition for evidence-based and clinically-relevant published work is lacking. The present paper aims to acknowledge the most valuable recent accomplishments in the field of mental health assessment and treatment. Nominations were accepted for works published during 2017, papers of enduring value, and most valuable psychologist, and votes were cast by a panel of judges. These valuable contributions are recommended for all psychotherapists who hope to improve their work with clients.     

Preferences Regarding Targeted Education and Risk Assessment in People with a Family History of Major Depressive Disorder

Genetic testing for susceptibility to major depressive disorder (MDD) is not available for clinical use at present. Given this, family history remains the best predictor for development of MDD, and family-history-based risk assessment and information about familial aspects of MDD may be useful to clients at increased risk for MDD attending for genetic counseling. This study uses a mixed-methods design to assess the information needs and preferences of people at increased familial risk for MDD. Telephone interviews were conducted with 23 individuals, who had at least one first-degree relative with MDD and were recruited through advertisements placed on depression education websites. The most preferred way to access depression information was via the internet (87 % of participants), although this preference may have been due to the internet-based recruitment method. The second most preferred dissemination strategy (56 %) was face-to-face delivery through a health professional, including genetic counselors. Individuals reported a need for information about etiology and development of MDD, reproductive decision-making, early detection of symptoms and risk-reducing strategies. Nearly all participants expressed an interest in risk assessment. The present study found evidence of a high level of interest for information targeted to people at increased familial risk for MDD. Genetic counselors are likely to be called upon increasingly to provide supportive counseling to assist clients at increased familial risk in interpreting and contextualizing such information once it becomes available.     

Assessing risk: confrontation or avoidance—what is taught on counsellor training courses

Recent mental health policy development has focused on the assessment and management of risk in vulnerable clients. Counsellors have a significant role to play in delivering mental health care in a range of settings, with clients sometimes presenting with suicidal ideation, self-injury and a risk of violence. The aim of this research was to explore the profile of risk assessment teaching within BACP accredited courses. A total of 49 BACP accredited courses were contacted and 24 responded. This response rate is discussed with particular reference to those courses that did not respond to the questionnaire. Risk assessment was viewed as an important consideration for counsellor training whilst suicide and self-harm seemed to have a higher profile than violence to others. Supervision was cited by the majority of respondents to have an important role in developing trainees' skills in assessing risk. The implications of the findings of this study for how counsellors are prepared by their training experiences to work with clients at risk are discussed and some recommendations made for future training developments.     

Burnout during a long-term rehabilitation: comparing low burnout,high burnout – benefited,and high burnout – not benefited trajectories

Abstract

To focus rehabilitation activities among burnout clients more effectively, it is important to investigate who benefits from burnout interventions. This study (N=85) aimed at identifying burnout trajectories in terms of benefit, that is, subgroups of clients who share similar mean levels and changes in burnout during a one-year rehabilitation intervention (17 days in total) with a six-month follow-up. After identifying the burnout trajectories, the relations of the trajectories with factors describing the clients, antecedents, and consequences of burnout during the one-year intervention were examined. Three burnout trajectories were identified by growth mixture modeling: (a) low burnout (n=39), (b) high burnout – benefited (n=29), and (c) high burnout – not benefited (n=17). Positive changes were detected in antecedents and consequences among the clients in the low burnout and high burnout – benefited trajectories. Recovery from burnout was associated with increased job resources and decreased job demands, as well as with increased job satisfaction and decreased depression. It seems that more precise targeting of rehabilitation is needed since the trajectories revealed not only clients with mild symptoms, but also clients who probably received this treatment too late.     

An exploration of the experience of Christian counsellors in their work with both Christian and non‐Christian clients,with particular reference to aspects of cultural transition

Aim: This study explores the experience of Christian counsellors working in both Christian and secular settings, paying particular attention to the possibility of regarding their development as a form of cultural transition. Method: Heuristic methodology was used, interviewing 22 counsellors with varying churchmanship (i.e. Christian tradition/denomination) and counselling training. Findings/Discussion: A spectrum of experiences with both Christian and non‐Christian clients emerged. The level of overtness of the counsellors’ faith with these clients varied considerably. Parallels with the experience of these counsellors and that of immigrants in terms of cultural transition are discussed. Conclusions: The experience of Christian counsellors differs with respect to the level of Christian influence (i.e. Christian or secular input) in training, supervision and work context. Those with higher secular influence have less difficulty working with clients with different belief systems and values. Implications: Christian counsellors need to be more reflexive with respect to the effect of their own value systems when working with clients, particularly if they work mostly in a Christian context. Trainers need to be aware of cultural transition aspects in the development of counsellors who have a Christian faith.     

Client Aggression Towards Therapists: Is It More or Less Likely with Transgendered Clients?

ABSTRACT

It is well known that clients occasionally threaten or assault their therapists. No studies to date have attempted to systematically measure client aggression by transgender patients towards clinicians. One of the major questions of this study was to determine if clients with gender dysphoria have greater levels of aggression towards therapists than non-gender dysphoric clients. One hundred and fourteen professional therapists who are members of the Harry Benjamin International Gender Dysphoria Association responded to a questionnaire that addressed aggression by both transgender and non-transgender clients. Transgender clients were shown to commit significantly less acts of aggression than did non-transgendered clients (p = 0.0094). Within the relatively small subgroup of transgender clients that did commit acts of aggression, male-to-female transgender clients were significantly more likely to do so than female-to-male clients (p = 0.002). While the transgendered client undergoes significant suffering in violating inviolable gender boundaries, this suffering, in general, does not translate into acting out behaviors directed towards their therapists.     

Reinforcers and vocational maturity in occupational aspiration,expectation, and goal deflection

When vocational aspirations and expectations are not the same, this difference is termed occupational goal deflection. The present study was designed to investigate the notion that such aspirations, expectations, and goal deflection are related to an individual's vocational maturity, education, and job reinforcers. The subjects were 149 vocational rehabilitation clients and 51 graduate students. Analyses of variance yielded findings that more vocationally mature individuals tend to display greater vocational aspiration, greater vocational expectation, and less goal deflection. Similarily, subjects who value such job characteristics as “getting a feeling of accomplishment, fair company policies, trying out their own ideas, doing work without feeling it is morally wrong, making their own decisions, (and) planning work with little supervision” tend to have higher aspirations and expectations, but lower goal deflection.     

Book review

Voluntary or involuntary migration and international work patterns have made it necessary for many people to adopt a new country and with it, a new language. Some of these latter-acquisition proficient bilinguals may seek therapy in this country. A small scale qualitative study was conducted, informed by a constructionist epistemology, in order to explore the meanings that participants gave to their experience of working in English with a client or patient who used English, proficiently, as a second language. Interviews were conducted with 10 therapists who had been contacted through counselling and psychotherapy organizations, and professional networks. Results indicated that participants experienced varying degrees of separation and distance from their bilingual clients. They found it necessary to pay extra attention to their clients' communications on all levels in order to make a good connection. An awareness of the underlying psychodynamic implications of bilingualism is helpful for the assessment of bilingual clients, in supervision and training, and in the ongoing work.     

Counsellors' experiences of working with suicidal clients: An exploratory study

Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi‐structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self‐doubts about their professional competence. In addition, they identified the threat of litigation for negligent practice and the lack of confidence in appropriate risk assessment approaches as significant causes for concern. The implications for further research, and practice, are discussed.