Negativity in psychotherapists' evaluations of clients and personal acquaintances

Forty-seven psychotherapists were studied to determine if they construed their clients more negatively than personal acquaintances. The sample included personal construct therapists, psychoanalytic candidates, and therapists from a community mental health center; they varied in terms of sex, age, years of experience, and clinical discipline. Subjects chose six personal acquaintances and six nonpsychotic individual-therapy clients who were then used as elements in a repertory grid. Constructs were elicited by comparing pairs of elements; all elements were rated on the constructs. Elements were also directly rated on several dimensions, including liking and similarity to self. Results indicated that therapists selectively focused on clients' negative characteristics and acquaintances' positive characteristics. Clients were liked less than acquaintances and were judged to be less like the self. The correlations between valuative variables tended to be higher in the construing of clients than in the construing of acquaintances, whereas expected improvement with therapy was not related to affective evaluation. There were no gender differences in these effects. Although there were no differences in degree of negative construal of clients among the therapist subgroups, the psychoanalytic candidates construed acquaintances less positively than did other therapists. The results suggest that deviancy may be a major dimension distinguishing therapists' construal of clients from their construal of acquaintances. This dimension may result from both therapeutic ideology and the fact that clients selectively present negative aspects of themselves in therapy, producing a bias in the information therapists receive. Possible negative implications for the therapeutic relationship are discussed.     

The New Orleans Forensic Aftercare Clinic: a seven year review of hospital discharged and jail diverted clients

This paper provides a review of the Forensic Aftercare Clinic Conditional Release Program (FAC), which has been operating since December, 1995, in New Orleans, LA. The FAC is a community based program that provides clinical, rehabilitative, and supervisory services to individuals who have been found not guilty by reason of insanity or unrestorably incompetent to proceed and who have been discharged from inpatient settings or diverted from jail settings and placed on conditional release by district court orders. 119 clients participated in FAC over a 7 year period. Forty-one (34.4%) had their conditional release revoked. Of the total population, 12 (10.1%) were re-arrested on at least one charge, 3 (2.4%) were arrested on felony charges, and 9 (7.6%) on misdemeanors. Only two of these charges were violent, resulting in no significant harm to victims. Twenty (16.8%) were hospitalized at least once due to relapse. Clients diverted from jail to community settings did not differ significantly on most variables from clients who were discharged from long-term hospitalization. Data related to public safety and client diversion demonstrate that clients, when appropriate, can be safely diverted to the community in lieu of hospitalization. The number of statewide clients who have been discharged from the forensic hospital into the community has increased steadily from 13 in 1995 to 29 in 2002, and statewide diversion clients have steadily increased from 0 in 1992 to 20 in 2002. The increase in statewide diversion clients and forensic discharges over this 7 year period indicates that stakeholders see the viability of the program as an alternative to as well as a step-down from long-term forensic hospitalization.     

Comorbidity and Related Factors Among Ethnically Diverse Substance Using Pregnant Women

Studies have established that comorbidity needs to be considered when assessing and treating substance-using clients. This study explores course of treatment, risk factors, and drug-related issues among 192 ethnically diverse pregnant women who were actively using drugs at admission to a residential treatment program. Findings revealed that course of treatment is more difficult for comorbid clients who perceived more treatment barriers than noncomorbid clients. Comorbid clients were more likely to have a history of attempting suicide but no more likely to have been reported for child abuse or charged with a crime. Comorbid clients reported greater severity of alcohol use but did not differ from noncomorbid clients regarding drug of choice. Comorbid clients were no more likely to leave against treatment advice, and noncomorbid clients were no more likely to complete treatment. Findings suggest that sensitivity to comorbidity issues is crucial to retaining comorbid clients in treatment.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

A Mind-Body Approach to Domestic Violence Perpetrator Treatment: Program Overview and Preliminary Outcomes

Conventional interventions with perpetrators of domestic violence are marginally effective. Given these results, researchers and practitioners are beginning to focus on identifying ways to improve domestic violence treatment outcomes. This article describes how a rural state-sponsored domestic violence offender program utilizes a treatment approach known as Mind-Body Bridging to help its clients overcome their abusive behaviors. Preliminary findings from an ongoing outcome study are also reported. According to these findings, the program has a high completion rate coupled with a low recidivism rate. Ninety-three percent (82 of 88) of the clients who have participated in this program completed the program, and just 7%?(6 of 82) of those who completed the program reoffended during the follow-up period, which ranged from 9 to 27 months.     

Counselling adults who were abused as children: Clients' perceptions of efficacy, client-counsellor communication, and dissatisfaction

Despite the amount of clinical material relating to adults who were abused as children, there is a dearth of research which has examined the effectiveness of counselling such clients. In order to examine the perceived efficacy of counselling with this client group, a total of 53 in-depth interviews were undertaken with a sample that included adults abused as children who had received counselling, counsellors working with this client group, and counselors-who-were-abused-as-children. The findings indicate that there are many similarities in what abused clients and the general client population judged to be helpful and unhelpful factors in counselling. However, certain aspects of the counsellor-client relationship appear to have specific impacts and meaning for an abused client group, especially when they have little prior knowledge or experience of counselling. Data are presented relating to clients' evaluations of counselling. These illustrate clinically relevant issues in relation to communication and experiences of dissatisfaction. One conclusion from the study is that in terms of their responses to counselling, it is simplistic for adults who were abused as children to be categorisied as a unitary group. Nevertheless, there are certain aspects of counselling with such clients which do merit particular attention if practitioners are to minimise the possibility of counselling being ineffective, unhelpful or, at worst, re-traumarising.     

Exercise and Movement as an Adjunct to Group Therapy for Women with Chronic Mental Illness

Abstract

Feminist therapists value the empowerment of clients and the appropriate sharing of the therapist's institutionalized power. As therapists who are also “mandated reporters,” we are obligated under certain circumstances to use our power to warn potential victims of harm, to prevent clients from harm to self or others, or make reports to institutions which have a great impact on clients' lives. Using four case examples, this paper will present clinical situations where the use of the therapist's power interfaces with homophobia, racism, and paternalism in the lives of low-income clients.     

Assessment and Development of Rehabilitation Plans for Counselors Who Have Sexually Exploited Their Clients

Counselors who have sexually exploited clients require rehabilitation if they are to return to practice. The authors present a model, derived from their clinical experience with more than 1,000 cases, for the assessment and development of rehabilitation plans for impaired practitioners who have sexual contact with their clients. They present a classification system for the perpetrator, an assessment process that leads to the development of a rehabilitation plan, and a method for deciding if rehabilitation has been successful.     

The integration of family therapy in a psychiatric day hospital

The clients, who present themselves at our psychiatric day hospital in Amsterdam, often have long-standing problems. These problems are usually of a complex nature, and the age of the clients plays an imporant role in this. Their age varies from seventeen to forty, with an average of twenty-eight.
Efforts were made over a long period to facilitate solutions to the clients' family conflicts. During this time an extensive range of problems within the family were presented of which the symptoms of the client represent just a part.
Working as a family therapist in a psychiatric day hospital, where clients are admitted individually, places the family therapist in a number of dilemmas, especially when many working in the hospital see the problems only as individual ones.     

Empowering high‐risk clients to attain a better quality of life: a career resiliency framework

Career counselors frequently encounter clients who are at high risk for career and life development difficulties. Research suggests there is a connection between resiliency and successful career development in high‐risk clients. Many high‐risk individuals have poor decision‐making skills and lack motivation to succeed in life and career development. This article describes a career resiliency framework in which career resiliency is best understood within the context of psychological resiliency. Specifically, this article explicates how career counseling from a resiliency theory perspective may promote successful career development for populations dealing with multiple barriers.     

When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level

The present article describes six strategies found useful when working with depressed clients who are struggling with severe financial limitations. First, it is important to help clients maintain an attitude of hope for a better future, so they remain as positive yet realistic about their current options and future goals. Second, empathy is considered to be a central component in all psychotherapy sessions, helping therapists to understand their clients’ life experiences and ongoing struggles. Third, clients can learn to develop more adaptive perspectives about life, family, and friends, trying to focus on the positive events they have experienced and the supportive bonds they have developed. Fourth, clients can develop new specific coping skills that may help them to manage the problems they encounter. Fifth, many clients can better utilize the social support that is often available, starting to ask family members and friends for assistance and support when help is needed. Sixth, an interdisciplinary treatment team is often optimal when the treatment plan integrates the potential benefits derived from psychotherapy, medications, and social service agencies. An effective psychotherapist respects the limits of psychology while consulting with colleagues from other health care professions. These six strategies can help guide therapists when working with clients who are struggling with persistent depression in the face of adversity.     

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.     

Becoming a Client: The Socialization of Novice Buyers of Sexual Services

Contributing to the growing body of research on the buyers of commercial sex services, this study explores the socialization of novice clients. Drawing on data from a popular Web-based discussion forum, the article identifies the central questions and concerns of individuals who are on the verge of purchasing sex for the first time. A second dimension of the study examines the ways in which more seasoned clients respond to novices who ask for advice in the forum. We find that the veterans’ responses, taken together, help to socialize new clients and reflect a set of conduct norms and best practices within this online subculture.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

Masculinity Ideology, Income Disparity, and Romantic Relationship Quality Among Men with Higher Earning Female Partners

This research assessed factors that may affect men’s heterosexual romantic relationships in which their partner earns a greater income. Forty-seven men from the United States completed measures that assessed masculinity ideology, the importance of the partner’s greater income, and romantic relationship quality. We examined whether the perceived importance of the income disparity mediated the relationship between men’s masculinity ideology and the quality of their romantic relationships. Using multiple regression analyses to test for mediation, results showed the relationship between masculinity ideology and romantic relationship quality was due in part to the importance one placed on the difference in income. Specifically, men who were more traditional in their masculinity ideology and have higher earning female partners were more likely to have poor quality romantic relationships in part because such men view the disparity in income as having importance. Conversely, results showed men who were more nontraditional in their masculinity were more likely to perceive the disparity in income as having little or no importance and have high romantic relationship quality.     

Using Visual Journaling in Individual Counseling: A Case Example

The purpose of this article is to describe and illustrate through a hypothetical case example how visual journaling, a form of expressive arts counseling, can be adapted for use in individual counseling. Counselors may consider using visual journaling as a counseling intervention when working with clients who may not have words for what they are feeling or experiencing, and for clients who tend to be very analytical. Visual journaling can be a way to bypass the intellect and give clients another way to access their experience.     

TARGET ARTICLE: Singles in Society and in Science

We suggest that single adults in contemporary American society are targets of stereotyping, prejudice, and discrimination, a phenomenon we will call singlism. Singlism is an outgrowth of a largely uncontested set of beliefs, the Ideology of Marriage and Family. Its premises include the assumptions that the sexual partnership is the one truly important peer relationship and that people who have such partnerships are happier and more fulfilled than those who do not. We use published claims about the greater happiness of married people to illustrate how the scientific enterprise seems to be influenced by the ideology. We propose that people who are single-particularly women who have always been single-fare better than the ideology would predict because they do have positive, enduring, and important interpersonal relationships. The persistence of singlism is especially puzzling considering that actual differences based on civil (marital) status seem to be qualified and small, the number of singles is growing, and sensitivity to other varieties of prejudice is acute. By way of explanation, we consider arguments from evolutionary psychology, attachment theory, a social problems perspective, the growth of the cult of the couple, and the appeal of an ideology that offers a simple and compelling worldview.     

Preventing Clients from Dropping Out of Treatment

A large proportion of clients drop out of treatment prematurely. Although not all of these clients fare oorly, most have poorer outcomes than clients who complete treatment. lased upon a thorough review of the literature, the author defines and describes the drop out phenomenon, and then suggests techni ues that social workers in independent practice can use to prevent clients from wishing to withdraw prematurely and to overcome impending drop out when it occurs.     

Best Practices for Counseling Clients Experiencing Poverty: A Grounded Theory

Poverty is a pressing sociopolitical issue in the United States and worldwide. Poverty experiences have a significant effect on one’s mental health and overall wellness. Therefore, the ability to effectively serve clients experiencing poverty is critically important to professional counselors. However, there are no empirical models for counseling clients experiencing poverty. The authors present the results of a constructivist grounded theory study in which 21 professional counselors who work with clients experiencing poverty were interviewed to identify best practices for working with this population. Five major best practices are identified: (a) awareness, (b) training, (c) knowledge, (d) skills, and (e) advocacy. Implications for professional counseling are included.