Client Narratives Research Articles

The coproduction of a multilevel personal narrative intervention for people with aphasia in a community communication support group—A pilot study

IntroductionPeople with aphasia (PWA) face challenges in sharing personal stories due to communication difficulties. Discourse treatment in aphasia focusing on personal narrative macrostructure has yet to receive the attention this warrants of researchers and clinicians. Emerging person-centered approaches involve coproduction and codesign with PWA for meaningful discourse treatments. Few studies explore discourse treatment's impact on functional communication. This pilot study aims to explore whether the use of the coproduction approach in the development of a multilevel personal narrative intervention at the group level increased the production of macrostructure elements in trained and untrained narrative discourse contexts, improved aphasia severity and functional communication skills, and advanced quality of life of the participants with aphasia.MethodsAn ABA design was followed featuring a pre-treatment baseline assessment phase, a treatment phase, and a post-treatment assessment phase immediately after treatment was completed. Three people with chronic stroke-induced aphasia, three communication partners, and a moderator took part in the study. All participants were members of a university-led community aphasia communication group. The research protocol consisted of eleven, two-hour, weekly sessions over an 11-week block. Nine treatment sessions were carried out following codesign and coproduction methods that focused on participants with aphasia producing words, sentences, and total communication strategies to express macrostructure elements in their personal stories. Assessment measures were collected at baseline and post-treatment to evaluate improvements in trained and untrained narrative abilities, aphasia severity, functional communication, and the impact of aphasia on quality of life.ResultsMultilevel personal narrative therapy improved the narrative skills of the participants with aphasia at the macrostructural level of narrative discourse. Improvements were also observed in functional communication and quality of life post-treatment.DiscussionThe involvement of participants with aphasia in the codesign and coproduction of the treatment content for the group intervention facilitated improvement in narrative skills, functional communication, and overall quality of life with aphasia. It is recommended that researchers and clinicians consider using content from the personal narratives of clients with aphasia to build discourse treatment and adopt codesign and coproduction approaches, when designing interventions for people with chronic aphasia, to improve communication outcomes in everyday life.

Using Narratives of Immigrant Clients to Confront Grief: Supporting Autonomy in Vocational Rehabilitation

Narrative counseling, narrative interviewing, or storytelling is a therapeutic approach to treating individuals with mental health conditions that is client-led. The approach can also employ the power of recall to reconstruct one’s story and oneself through reframing. In this article, we explore the possibility of employing narrative counseling in vocational rehabilitation settings, with immigrants with disabilities experiencing grief through loss and migration. Autonomy, cultural relevance, and trauma-informed care present the rationale for consideration and further exploration of narrative counseling in vocational rehabilitation research, teaching, and practice.

Do Client Narratives Belong in Attorney Ethics Hearings?

Do Client Narratives Belong in Attorney Ethics Hearings?

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

BackgroundSince the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic.MethodsBetween April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software.ResultsQualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses.ConclusionParticipant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

Using Client Narratives to Identify Predictors of Outcome in Written Exposure Therapy and Cognitive Processing Therapy

Written exposure therapy (WET) is a brief, five-session treatment for posttraumatic stress disorder (PTSD) that aims to improve access to care. WET has been demonstrated to be an efficacious PTSD treatment with lower rates of dropout and noninferior PTSD symptom outcome compared to cognitive processing therapy (CPT), a 12-session, gold-standard treatment. To identify predictors of treatment outcome in both WET and CPT, the current study examined the content of participants’ written narratives. Participants were 123 adults with PTSD who were randomly assigned to receive WET (n = 61) or CPT (n = 62). The Change and Growth Experiences Scale (CHANGE) coding system was used to code all available narratives in both treatment conditions for variables hypothesized to be relevant to therapeutic change. Linear regression analyses revealed that in WET, higher average levels of accommodated (healthy, balanced) beliefs and an increase in accommodated beliefs from the first to the final impact statement predicted better PTSD symptom outcome at 12 weeks postrandomization. In CPT, higher average levels of overgeneralized and accommodated beliefs and lower levels of avoidance expressed in the narratives predicted better PTSD outcome. There were no significant predictors of outcome in analyses of change from the first to final impact statement in CPT. These findings add to research identifying predictors of change in WET and CPT by highlighting the importance of low avoidance in CPT and of trauma-related cognitions in both CPT and WET, even though WET is a brief written intervention that does not explicitly target cognitive change.

The evolution of narrative identity in a "returning home" man: The psychological and cultural place of farming in the Chinese psyche.

This study attempts to illustrate the process of reconstructing adaptive self-identity by tracking the development of imagery in Mr. Z's dreams and sandtrays. The authors adopted amplification and Narrative Identity Process Analysismethods, and developed an Imagery NPCS tool to analyze the farming images in therapy sessions. It provided insights into Chinese culture from an applied, non-Western lens on identity theory. The subject of the study was a Chinese man who had lost his social identity due to stressful events, the results of which were reflected in the interplay between his personal narrative related to farming images and their cultural narrative framework. The authors propose a practical mode of developing narrative identity based on the dynamic organizing principle of opposites which are united in a persona-shadow personality system. Development of an integrated narrative identity can be facilitated by the dialectic between the cultural narrative offered by the psychotherapist and the client's personal narrative.

Assessments of Digital Client Representations: How Frontline Workers Reconstruct Client Narratives from Fragmented Information

Abstract Street-level bureaucrats assess increasing amounts of digital, often text-based, client representations. These representations have been criticized for oversimplification. However, frontline workers have also been known to develop simplified perceptions, or “shortcuts,” in their work. This study explores frontline workers’ assessments of digital client representations using observations of 15 needs assessments and 7 follow-up interviews from the Norwegian Labor and Welfare Administration (NAV). Based on simple information garnered from an online registration, workers decide how much assistance clients need from NAV to find work. Findings show that the online registration deconstructs client narratives into separate pieces of information, which the workers attempt to reconstruct back into coherent narratives. Using a street-level perspective, this article argues that the reconstructions are coping responses to fragmented information. Unlike traditional simplification responses, the workers complicate their perceptions of clients in the assessments. That is, street-level bureaucrats take “detours” to provide responsive services and manage the limitations of electronic government. Thus, this article provides an empirical contribution that also forms the basis for abductive theorization and suggests that the conceptual boundaries of coping strategies should be expanded to include “complication responses.” In contrast to the emphasis on face-to-face meetings in street-level literature, this article highlights the importance of texts.

Listening for bridges: Developing a culturally responsive, transdiagnostic approach to psychotherapy for Bhutan.

The increasing global need for mental health care has led to a search for efficient, effective treatments that are based on both local cultural healing traditions and scientific evidence. In this article, I describe the development of a brief, culturally responsive, transdiagnostic approach to psychotherapy for common mental disorders in Bhutan, a rapidly changing culture firmly grounded in Vajrayana Buddhism. Buddhist-Informed Therapy for Bhutan (BT-B) supports Bhutan's goals of preserving traditional culture, improving psychological well-being for its citizens, and integrating Buddhism into solutions for contemporary social issues. More broadly, BT-B extends the range of culturally responsive treatment approaches in several ways. First, BT-B is innovative in its identification and therapeutic use of conceptual links between specific Western evidence-based principles of therapeutic change and core Buddhist principles. Listening empathically to the client's narrative, the therapist identifies an evidence-based principle to address and uses conceptually linked deeply rooted Buddhist beliefs to guide the client in applying their own cultural wisdom to resolve problems. Second, the model illustrates the value of an ecological approach to culturally responsive treatment development that takes into account local cultural beliefs, practices, and institutions, including those that shape health care delivery and use. Third, evidence from case examples adds to the growing body of literature that supports the utility of transdiagnostic therapeutic approaches across cultures and in settings where resources are limited.

Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization.

Enrollment in the Home-Based Mental Health Evaluation (HOME) Program is associated with higher rates of treatment engagement following psychiatric hospitalization discharge, as compared to enhanced care as usual. We aim to describe feasibility and acceptability data related to implementation of the HOME Program at two Department of Veterans Affairs Medical Centers (VAMCs) to inform future program refinement and implementation. Process evaluation data regarding feasibility and acceptability were collected in the context of an interventional multi-site trial. Data regarding enrollment in the study and the intervention were collected by study staff. Additional acceptability and feasibility data were obtained via the Client Satisfaction Questionnaire-8 (CSQ-8) and Narrative Evaluation of Intervention Interview(NEII). Between 82 and 91% of enrolled Veterans participated in at least one post-discharge telephone contact. Site differences existed with respect to completion of home visits. CSQ-8 results suggested high levels of satisfaction with the HOME Program. Themes identified via the NEII reflect that as a result of participation in the HOME Program, Veterans felt hopeful and cared for and learned how to keep themselves safe following hospital discharge. Process evaluation data from a clinical trial of the HOME Program demonstrated that the intervention was feasible to implement at two VAMCs and was acceptable to participants. These data inform considerations for future research and implementation efforts.Trial Registration ClinicalTrials.gov Identifier: NCT03347552.

The torchlight model of mapping in cognitive analytic therapy (CAT) reformulation: A qualitative investigation.

Despite the central role of formulation in psychological therapy, there is limited research on how formulations are constructed in clinical practice. In Cognitive Analytic Therapy (CAT), a formulation diagram (or CAT map) is used in transforming the client's narrative into a psychological understanding of the difficulties. The objective was to build a theoretical model of the processes involved in the early stages of CAT mapping. A qualitative research design using constructivist Grounded Theory Methodology (GTM) incorporating Interpersonal Process Recall (IPR) methods. CAT therapists participated in a role-play therapy session with an actor (the 'client') and made an initial attempt at formulation by mapping. A video recording then formed the basis for a semi-structured therapist interview. Following data analysis, a conceptual model and visual metaphor of the early process of CAT mapping was generated. The Torchlight model conceptualizes the mapping process as a coming together of unique factors brought by client and therapist, alongside the conceptual apparatus of CAT. Each factor brings a unique light to the unfolding process of mapping and intermixes through a dialogical, collaborative process, analogous to coloured lights mixing to form new colours. The model outlines the mapping process itself as an iterative sequence of tasks, achieved through collaboration, within a growing therapeutic relationship. The model offers an empirical underpinning to existing accounts of CAT mapping, and a potential tool for training. The process by which individual CAT reformulation diagrams are started appears to be as unique to the therapist-client dyad as the contents of the map, on the basis of the findings. Mapping faithfully enacts the dialogical and developmental theoretical principles underpinning the CAT approach. The Torchlight model is the first empirically based model of the processes taking place in the creation of CAT reformulation diagrams, in the early stages.

A Review of Empirical Studies Investigating Narrative, Emotion and Meaning-Making Modes and Client Process Markers in Psychotherapy

Despite the importance of narrative, emotional and meaning-making processes in psychotherapy, there has been no review of studies using the main instruments developed to address these processes. The objective is to review the studies about client narrative and narrative-emotional processes in psychotherapy that used the Narrative Process Coding System or the Narrative-Emotion Process Coding System (1.0 and 2.0). To identify the studies, we searched The Book Collection, PsycINFO, PsycARTICLES, PsycBOOKS, PEP Archive, Psychology and Behavioral Sciences Collection, Academic Search Complete and the Web of Knowledge databases. We found 27 empirical studies using one of the three coding systems. The studies applied the Narrative Process Coding System and the Narrative-Emotion Process Coding System to different therapeutic modalities and patients with various clinical disorders. In some studies, early, middle and late phases of therapy were compared, while other studies conducted intensive case analyses of Narrative Process Coding System and Narrative-Emotion Process Coding System patterns comparing recovered vs unchanged clients. The review supports the importance to look for the contribution of narrative, emotion, meaning-making patterns or narrative-emotion markers, to treatment outcomes and encourages the application of these instruments in process-outcome research in psychotherapy.

Facilitating Narrative Change in Career Construction Counseling

Career Construction Counseling fosters client change by evoking and elaborating innovative moments in client narratives. In this article, we describe four types of dialogues that counselors may use to prompt narrative novelty and foster client change: (a) identify and evaluate the effects of innovative moments, (b) highlight contrasting self-positions, (c) ask about changes achieved, (d) promote a meta-perspective on change. Vignettes from a case are used to illustrate how to use IM markers as a heuristic guide for when to engage in these four types of dialogues.

Acceptability of Internet-based interventions for problem gambling: a qualitative study of focus groups with clients and clinicians

BackgroundAlthough Internet-based interventions (IBIs) have been around for two decades, uptake has been slow. Increasing the acceptability of IBIs among end users may increase uptake. In this study, we explored the factors that shape acceptability of IBIs for problem gambling from the perspective of clients and clinicians. Findings from this qualitative study of focus groups informed the design and implementation of an IBI for problem gambling.MethodsUsing a semi-structured interview guide, we conducted three focus groups with clients experiencing gambling problems (total n = 13) and two with clinicians providing problem gambling treatment (total n = 21). Focus groups were audio recorded, transcribed verbatim, and analyzed using a two-part inductive-deductive approach to thematic analysis.ResultsAlthough both user groups reported similar experiences, each group also had unique concerns. Clinician perspectives were more homogeneous reflective of healthcare professionals sharing the same practice and values. Clinicians were more concerned about issues relating to the dissemination of IBIs into clinical settings, including the development of policies and protocols and the implications of IBIs on the therapeutic relationship. In comparison, client narratives were more heterogeneous descriptive of diverse experiences and individual preferences, such as the availability of services on a 24-h basis. There was consensus among clients and clinicians on common factors influencing acceptability: access, usability, high quality technology, privacy and security, and the value of professional guidance.ConclusionsAcceptability is an important factor in the overall effectiveness of IBIs. Gaining an understanding of how end users perceive IBIs and why they choose to use IBIs can be instrumental in the successful and meaningful design, implementation, and evaluation of IBIs.

Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program

Background: Obsessive–Compulsive Disorder (OCD) is a psychiatric illness that can result in debilitating symptoms and functional impairment. Until recently, individuals with severe OCD symptoms have not received appropriate services within the Canadian healthcare system. The Frederick W. Thompson Anxiety Disorders Centre launched an Intensive Services Residential treatment programme for OCD in July 2017 to meet the needs of the Canadian population. This paper sets out to demonstrate the effectiveness of this programme.Methods: This study incorporated quantitative and qualitative data collection. Quantitative data were analysed using paired sample t-tests while qualitative data was transcribed and coded for emerging themes.Results: Beneficial changes in symptomatology were found. Client narrative emphasised the importance of exposure response prevention (ERP), creation of an OCD community as well as enhanced functionality in clients’ lives. Clients also commented on why they believed the treatment worked and points of potential improvement for discharge planning and programme organisation.Conclusions: This study adds to the growing body of evidence regarding the importance of intensive services for individuals experiencing severe symptoms of OCD. Enhancing accessibility to services and ensuring ongoing maintenance of gains will be important next steps in ensuring long-term recovery for individuals with severe symptoms of OCD.Key pointsIntensive services treatment for OCD has been found to be beneficial for clients and this paper demonstrates the first time this has been seen within a Canadian programme.Treatment provided decreased OCD severity and increased functionality and quality of life.Clients cited exposure and response prevention work as a key ingredient in their recovery.Our programme is always in an ongoing state of quality improvement, ensuring client engagement and satisfaction.

Asserting Our Competence and Affirming the Value of Occupation With Confidence.

Throughout the years, leaders in the profession have challenged us to affirm the value of occupational therapy and to substantiate what we do. Occupational therapy practitioners have always focused on what most matters to clients in what is now called client-centered or patient-centered practice. We have also focused on client function to enable participation in everyday life. In a welcome shift, society's views about health and meaning-making are becoming more congruent with the long-standing ideals of occupational therapy. Now, more than ever, we have a powerful opportunity to communicate our competence. But how do we assert our competence and the complexity of occupation with confidence? This lecture draws on the conceptual foundations of theories about competence and confidence and provides examples from the research literature, and a practitioner and client narrative to illustrate the factors that enable us to effectively demonstrate the value of occupational therapy.

“I Started to Feel Better now”: Qualitative Findings from Client Narratives on Early Recovery in Inpatient Substance Use Treatment

While a plethora of studies indicating substance use treatment reduced measurable, pathological symptoms, research is still needed to explore treatment-related recovery (i.e., therapeutic changes) derived from a lived experience from clients. The current study used semistructured interviews to query clients’ narratives on the process of early recovery in inpatient substance use treatment. The analysis of qualitative data revealed five themes: positive therapeutic changes pertaining to substance use (including substance-related problem recognition, a desire for drug cessation, and a continual need for treatment), emotion regulation, mindfulness and self-awareness, being positive for future outcomes, and changes in conceptualizing important relationships. The findings speak to the importance of promoting changes related to substance use and cultivating co-occurring positive psychological functioning in early recovery. Clinicians may consider integrating a variety of interventions into substance use treatment that help process and regulate emotions, reconnect with client sense of self and personal values, and understand traumatic experiences, which would ultimately facilitate recovery.

What's the Point of Spiritual Care? A Narrative Response.

This article assumes spiritual care is relevant for all people, regardless of their faith affiliation. Building on the author's work in narrative spirituality, the discussion demonstrates how spiritual care practitioners can engage clients in their lived narratives, with Narrative Empowerment being the end goal. Several therapeutic practices are thus revealed, as well as three traits by which a client's Narrative Empowerment can be described and assessed.

Career Counseling Interviewing: ThemeMapping a Client’s Story

Often, practitioners are reluctant to utilize client narratives due to a lack of training in detailed application concerning story construction and reconstruction and fear of moving into psychotherapy instead of career guidance or counselling (Lengelle & Meijers, 2012; Reid & West, 2011). In this article, wepresent a working process for organizing, mapping, and building viable co-constructions with clients.We offer theming strategies, schemes, and categories that practitioners can use during the career counselling process to help clients in gaining movement in their career trajectories.

Career Counseling Interviewing: ThemeMapping a Client’s Story

Often, practitioners are reluctant to utilize client narratives due to a lack of training in detailed application concerning story construction and reconstruction and fear of moving into psychotherapy instead of career guidance or counselling (Lengelle & Meijers, 2012; Reid & West, 2011). In this article, wepresent a working process for organizing, mapping, and building viable co-constructions with clients.We offer theming strategies, schemes, and categories that practitioners can use during the career counselling process to help clients in gaining movement in their career trajectories.

Exploration of Racial Enactments in an Interracial Therapeutic Dyad to Foster the Strengthening of Voice and Identity in African American Male Adolescents

ABSTRACTThe purpose of this paper is to examine the impact of systemic racism on an interracial therapeutic dyad between a white therapist and an African American adolescent male. Leary (2000) operationalized the term “racial enactments” and made the important point that its “most common” manifestation “has been our relative silence about racial issues” (p. 647). It is the premise of this paper that the youth of color’s subjective experience of racial microaggressions and assaults experienced on a daily basis must be validated and explored prior to a meaningful intersubjective exploration in the clinical encounter. The emphasis in this paper is on the racial enactment that precedes the clinical encounter. A treatment vignette is used to highlight the intersection of social and psychic spheres of human experience and how an awareness of unconscious bias in the therapist can facilitate a more meaningful dialogue in which priority is given to the emergence of a powerful client narrative voice.