Client Practitioner Research Articles

“If you don’t have rapport, you haven’t got anything really”: affective intensities, relationality and rapport building in the work of CVE Intervention Practitioners

ABSTRACT Countering Violent Extremism (CVE) continues to be a topic of national and international concern; however, within the field of research, there has been limited engagement with the daily work of CVE intervention. The article presents findings from a study which aimed to better understand the strategies CVE Intervention Practitioners employ, specifically rapport building and the fostering of mutual trust. Drawing upon the accounts of 12 practitioners currently working in Australia, we focus on the complex affective negotiations underpinning the client–practitioner relationship. Our analysis foregrounds relationality, a sense of connectedness and explores the affective labour involved in this work. In theorizing the work of CVE intervention, as a form of affective labour, the paper presents three key themes present in the data 1) rapport building to leverage; 2) transparency to build trust and change mindset; 3) versatility/adaptability.

The role of BACP in maximising the potential of counselling and psychological therapies research in the UK: Benefitting clients, communities, and societies

AbstractThe British Association for Counselling and Psychotherapy (BACP) is the largest professional membership body within the field of counselling and psychological therapies in the UK, but there is a mismatch between its membership of >65,000 and its research impact. This article sets out a potential strategic direction as considered by an informal grouping of researchers and teachers in the field. Actionable research plans are outlined at three levels: client–practitioner, local communities, and societies. At the client–practitioner level, data‐informed practice can be readily implemented as a therapeutic aid akin to supervision, providing the potential for integrating research into everyday practice. At the community level, interdisciplinary collaborations together with a focus on equality, diversity, and inclusiveness are paths to building a community of researchers and citizens that includes marginalised populations. The importance of social justice extends to the societal level, connecting with politics at a micro and macro level, and engaging internationally to respond to actual threats (e.g., climate change). Across these three levels, high value is placed on data with its potential for informing and improving practice, but also enhancing the lives of people in communities and societies. Overall, research strategies need to be collaborative (i.e., collegial) and less singular (i.e., individually project‐based), developing cumulative knowledge around specific topics via a ‘capture and build’ strategy for small projects with strategic oversight by BACP. Clarity of research strategy combined with collaborative and collective action from BACP and leaders in the field can help realise the full potential of BACP's research capacity.

The Effectiveness of Transactional Analysis Treatments and Their Predictors: A Systematic Literature Review and Explorative Meta-Analysis

Objectives: Despite many studies on transactional analysis (TA) psychotherapy, there are no comprehensive reviews or meta-analyses on its effectiveness. We conducted a systematic literature review and meta-analysis on TA psychotherapeutic treatments to examine the extent of psychological and psychosocial change in pre-post studies, the effects compared with other treatments in randomized clinical trials, and factors explaining these effects and differences. Method: We conducted a systematic literature review and meta-analysis according to Meta-Analysis of Observational Studies in Epidemiolog (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in Pubmed, Medline, PsycInfo, Web-of-Knowledge, and scholar.google.com . Results: Overall, 41 clinical trials of TA treatments had moderate to large effects on psychopathology (Hedges’s g = .66), social functioning ( g = .62), self-efficacy ( g = .80), ego-state functioning ( g = .69), well-being ( g = .33), and behavior ( g = .56). Compared with control conditions, TA had moderate to large effects on psychopathology ( g = .61), social functioning ( g = .69), self-efficacy ( g = .88), ego-states ( g = .70), well-being ( g = .85), and behavior ( g = .46). TA was more effective on most outcomes in individuals, groups, and families than in schools or prisons. Psychopathology changes were significantly predicted by improvements in ego-states, self-efficacy, social functioning, and client–practitioner relationship ( r² range = .27–.43). Treatments were more effective if they included systematic assessment, treatment stages, psycho-education, TA-unique techniques, and an experiential focus ( r² range = .03–.31). Conclusions: TA may be considered an effective treatment for many clients.

Managing stress during the coronavirus disease 2019 pandemic and beyond: Reappraisal and mindset approaches.

The novel coronavirus disease 2019 (COVID‐19) pandemic is a global public health crisis of a scale not previously experienced in modern times (Kickbusch et al., 2020). Governmental ‘lockdown’ measures aimed at minimizing virus transmission including ‘stay at home’ orders, closure of businesses and places of congregation, and travel restrictions have had a substantive societal impact that permeates almost every facet of daily life (Gostin & Wiley, 2020; Shanafelt, Ripp, & Trockel, 2020). These widespread changes represent considerable sources of stress in the population and will have deleterious effects on mental and physical health going forward. As nations begin to emerge from ‘lockdown’, the collateral damage to human health caused by these restrictions has taken centre stage, and mental health issues, particularly stress‐related conditions and outcomes, are prominent among them. The imperative for strategies to assist in managing stress and minimizing concomitant health problems has become a priority. In this commentary, we outline how stress reappraisal interventions, which have come to the fore in recent years, may be a potentially efficacious, cost‐effective way to manage stress during and post‐pandemic, and minimize the health consequences.

A Cayman Islands update on wills and trusts

Abstract This article looks at the principal provisions of two pieces of recent Cayman Islands legislation that are now in force and that are likely to be of interest generally to international private client practitioners: the Formal Validity of Wills (Persons Dying Abroad) Law, 2018 and the Trusts (Amendment) Law, 2019.

Exploring the use of Vibroacoustic treatment for managing chronic pain and comorbid mood disorders: A mixed methods study

ABSTRACTIntroduction: Chronic pain is a worldwide issue with common comorbidities of depression and anxiety, altogether inhibiting one’s personal relationships and capability to work. Music has long been used as a means to improve pain and mood, and the tactile application of music has shown promising and beneficial results for the treatment of both psychological and physical symptoms. VA treatment uses low-frequency sinusoidal sound vibration (20–120 Hz) supported by client-preferred music listening and therapeutic interaction.Methods: Using mixed methods, this study addresses the addition of a self-care VA intervention to maintain the effects of practitioner-led VA treatments and to increase patients’ independence in managing their symptoms. After baseline measurements, VA treatment was delivered to five patients at a rehabilitation unit by a trained VA practitioner, followed by self-care at home and a washout phase with no treatments. Quantitative outcome measures included Visual Analogue Scales for pain and mood, and Beck’s Depression Inventory and the anxiety subscale of Hospital Anxiety and Depression Scale. Qualitative data comprised practitioner clinical notes and participant evaluation forms.Results: Quantitative outcomes suggest VA treatment is beneficial for pain and mood relief and that a self-care intervention has the potential to prolong positive outcomes. Qualitative findings suggest that patients found the sessions at the hospital useful and empowering but the self-care treatments comparatively weak.Discussion: Future studies may address the difficulty in conducting self-care and the importance of the client–practitioner relationship in supporting this activity for those suffering from chronic pain and comorbid mood disorders.

From Dyad to Triad: Mediatization and Emerging Risks for Professional Autonomy

With the emergence and spread of digital media, more business models foster and empower client participation in medical professions. With services and products ranging from rating platforms to apps targeting self-diagnosis, these businesses transform the client–practitioner relationship yet risk undermining a central pillar of professions—autonomy. Practitioners have to take legal actions against these business models, making visible the frictional interplay among the involved actors. This development calls for an analytical understanding of how this technology-induced cultural change affects professions and discourses on professionalism. We argue that a perspective on how practitioners deal with these challenges in various situations can be beneficial. Hence, we conceptualize professionals as engaged in identifying, assessing and managing risks for themselves and their clients. The emerging risk-management practices lead to an understanding of how this apparent cultural change plays an increasingly meaningful role for research on how professionalism regarding legitimation of authority is negotiated.

The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge, comfort, experience, and ethical decision-making: a longitudinal randomized controlled trial

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client–practitioner boundary dilemmas.Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman’s two-way analysis of variance was used to examine the trajectories over time.Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ2 = 10.673, p = 0.014) and comfort (χ2 = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ2 = 3.609, p = 0.307) or control group (χ2 = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ2 = 13.188, p = 0.004) following training, however remained unchanged in the experimental group.Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated.Implications for RehabilitationEthical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting.In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making.Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting.Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

Community Elder Mistreatment Intervention With Capable Older Adults: Toward a Conceptual Practice Model.

Community-based elder mistreatment response programs (EMRP), such as adult protective services, that are responsible for directly addressing elder abuse and neglect are under increasing pressure with greater reporting/referrals nationwide. Our knowledge and understanding of effective response interventions represents a major gap in the EM literature. At the center of this gap is a lack of theory or conceptual models to help guide EMRP research and practice. This article develops a conceptual practice model for community-based EMRPs that work directly with cognitively intact EM victims. Anchored by core EMRP values of voluntariness, self-determination, and least restrictive path, the practice model is guided by an overarching postmodern, constructivist, eco-systemic practice paradigm that accepts multiple, individually constructed mistreatment realities and solutions. Harm-reduction, client-centered, and multidisciplinary practice models are described toward a common EMRP goal to reduce the risk of continued mistreatment. Finally, the model focuses on client-practitioner relationship-oriented practice skills such as engagement and therapeutic alliance to elicit individual mistreatment realities and client-centered solutions. The practice model helps fill a conceptual gap in the EM intervention literature and carries implications for EMRP training, research, and practice.

Reproductive Coercion by an Intimate Partner: Occurrence, Associations, and Interference with Sexual Health Decision Making

Reproductive coercion is a form of intimate partner violence (IPV) in which a variety of tactics can be used to force pregnancy on an intimate partner. This study investigated the occurrence of male-perpetrated reproductive coercion, its relationship to other forms of IPV, and interference with women’s sexual health decision making. Two data sets were collected, by conducting client–practitioner screenings (n = 2,108) and anonymous surveys (n = 84), from women seeking reproductive health services in a southwestern state and analyzed separately. Prevalence and correlates of reproductive coercion varied according to data-collection method, indicating that behaviorally based screening tools and anonymous screening may increase disclosure rates. In the screening sample, reproductive coercion was associated with forced sex, threats of physical harm, and verbal abuse. In the survey sample, reproductive coercion was associated with being nonwhite, fear of asking one’s partner to use a condom, and fear of refusing sex. Social workers should be aware that reproductive coercion is a form of coercive control that may be associated with increased fear and IPV and may interfere with sexual health decision making; however, disclosure of reproductive coercion or IPV is not necessary for intervention. The article concludes with a discussion of screening and intervention strategies.

FACTORS CONTRIBUTING TO NON-ADOPTION OF VALUE ENGINEERING METHODOLOGY FOR BUILDING SERVICES

The procurement of building services (BS) constitutes a great challenge in the construction industries of both developed and developing countries. Adoption of value engineering (VE) methodology could aid BS components selection at design and installations stages. However, the methodology is not appropriately used by the project team during design and installation of BS. Leading to overdesign, poor quality specification, lack of team work and unreliable budget estimate. The main objective of this paper is to determine the factors preventing the adoption of VE in the procurement of BS projects. A questionnaire was design to collect information on 18 generic factors contributing to non-adoption of VE. The questionnaire was administered to randomly selected practitioners in clients’, contracting and consulting types of organisations in Malaysia. The result shows that lack of understanding of VE by clients organisations, lack of request for the services, and inadequate time to conduct the study are the most important factors deterring adoption of VE for building services. The factors analysis of result for the 18 variables produced a four (4) factors result as: Non-involvement of stakeholders; education and traditional practice; resistance to change, and lack of experience about VE. It is essentially important for industry clients to understand the importance of adopting VE so as to ensure that time required for the study are pre-planned and budgeted for at project inception

The Parolee–Parole Officer Relationship as a Mediator of Criminal Justice Outcomes

Although psychotherapy literature identifies the client–therapist relationship as a key factor contributing to client outcomes, few studies have examined whether relationship quality among corrections populations and supervising officers influences outcomes. This is surprising given that many criminal justice intervention models include quality of the client–practitioner relationship. Parolees enrolled in a six-site randomized clinical trial, where they were assigned to a parole officer–therapist–client collaborative intervention designed to improve relationship quality ( n = 253) or supervision as usual ( n = 227), were asked to rate relationship quality with their supervising officer. Results showed parolees assigned to the intervention endorsed significantly higher relationship ratings and demonstrated a lower violation rate than those assigned to the control group. Ratings of the parolee–parole officer relationship mediated the relationship between study condition and outcomes; better perceived relationship quality was associated with fewer drug use days and violations during the follow-up period, regardless of the study condition. Findings are discussed as they pertain to supervision relationships.

Rare Disease Research Roadmap: Navigating the bioinformatics and translational challenges for improved patient health outcomes

Rare disease registries have now been recognized as a global priority for progress both in monitoring and documenting the natural course, and preventing and treating rare diseases. However, a disease registry is only one element of rare disease translational research. Here, we outline what we believe are ten key components in comprehensive rare disease translational research and describe critical relationships between them. These components are: (i) client–practitioner partnerships; (ii) disease registries; (iii) biobanks; (iv) genomics and other -omics platforms; (v) community-based and population-wide studies; (vi) bioinformatics and high performance computing; (vii) interactions with pharma to facilitate drug discovery; (viii) personalized treatments based on genotype-phenotype correlations; (ix) eHealth and a whole of life record; and (x) regulatory frameworks, particularly with regard to specimen and data sharing, and the return of results. Each component has its own inherent complexity, but if effectively integrated they will provide a comprehensive approach to the future management of rare diseases, and aid health care providers in delivering services to individuals affected with rare diseases. We demonstrate that navigation through the roadmap can provide relevant health stakeholders with a blueprint to understand the challenges and barriers which need to be overcome within and across the constituent components. The rare disease roadmap will assist decision-making at all health stakeholder levels and enable the seamless integration of new knowledge, standard operating procedures and the implementation of best practice.

Client participation in mental health: shifting positions in decision-making

Individuals with severe mental illness have often been perceived by themselves and others as stigmatised and unable to make decisions about their lives. However, perceptions of mental illness and health care have experienced significant changes; as a result, community-, consumer- and recovery-based approaches have been developed. The aim of this article is to deepen our understanding about client participation as interactive and shifting positioning work. It examines how a client constructs him/herself as a decision-maker and how others support or hinder that position. The study is based on 25 mental health client interviews. Findings are reported in three sections that examine: (1) restricted participation; (2) supported participation; and (3) independent participation. It is argued that, when dealing with client participation in mental health, we need to focus on the subtle discursive practices by which clients perform positioning and are given positions. The findings provide a basis for discussing client participation as relational and interactive phenomena. Client participation is bound by client–practitioner interaction as well as by discursive practices. For the client to participate, he/she first needs to accomplish participant positioning, become an actor with a voice and be able to make decisions and choices. This is a crucial (but not easily accomplished) precondition of client participation.

Reported client–practitioner conversations as assessment in mental health practitioners' talk

The aim of the study is to show how reported client–practitioner conversations function as assessments. The setting of the study is a rehabilitation course targeted at young adults. The data consist of informal backstage meetings among the practitioners, which do not have an officially stated or recognized task of assessment making. However, the study demonstrates that the meeting talk is rich in reported client–practitioner conversations with a dimension of assessment. The located assessment functions of reported conversations and the accompanied meeting talk are (i) making negative and positive portraits of clients; (ii) treating clients' voices as selfevaluative and influential; and (iii) presenting practitioners' own past talk as problematic and creating selfadvice for future conversations. By making reported conversations visible as everyday assessment practices, the article challenges the onesided view of assessment as a separate and formal professional practice, which is conducted with standardized tools such as psychological and social ability tests.

John Dee: the patronage of a natural philosopher in Tudor England

For all of his failures to secure patronage, John Dee was successful compared with his contemporaries. We know more about his patronage relations than those of any other natural philosopher in Tudor England. Only by comparing him with other English client practitioners can we understand how unusual and even productive were Dee’s relations with his patrons. This article makes those comparisons and offers an overview of Dee’s patronage, but in the main it explores three of the unusual aspects.The first is Dee’s good relationship with female patrons and patronage brokers, notably Queen Elizabeth. The second is the kind of office that Dee sought. His greatest efforts were aimed at securing the headship of a collegiate institution such as Eton College or the Hospital of St Cross. Not only did they fit his aspiration to set up a research institute, but all were offices in the Queen’s direct gift, and so played to Dee’s strengths. Nevertheless, Dee was frustrated at nearly every turn. It is suggested that a major cause was the young Dee’s links with both Sir John Cheke’s network of Protestant humanists, who became Marian exiles, and with ‘Louvainist’ Catholic exiles opposed to Edward VI and Elizabeth. We see how Dee was consistently passed over in favour of other members of these circles. Notwithstanding this, it is concluded that Dee was relatively successful, given the English court’s refusal to patronise speculative natural philosophy, even that offered by Thomas Digges, William Gilbert or Francis Bacon. Finally, some of Dee’s supposed failings as a client, such as the sparseness of printed works, are shown to have been systemic.

The ethics of forensic psychiatry: moving beyond principles to a relational ethics approach

Forensic psychiatry has been described as a ‘moral minefield’. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit ‘untrustworthiness’ of forensic patients shape practitioners' everyday reality. Suspicion colors client–practitioner relationship and fundamental care concepts, such as patient advocacy, take on different nuances in this milieu. Despite the complex ethical demands of this unique practice area, it has received little attention within mainstream bioethics. There is, however, a growing imperative to find a theory of ethics for the specialty. In this article, the ethics of forensic psychiatry is examined, and it is argued that relational ethics is a fitting framework for forensic practice and, further, that forensic settings are the very place to test the validity of such an ethic.

A Relational Goal-Oriented Model of Optimal Service Delivery to Children and Families

ABSTRACT.This article presents a Relational Goal-Oriented Model of Service Delivery to Children with physical or mental health difficulties and their families. This research-informed and practice-relevant model provides a broad understanding of what effective service provision entails and requires from practitioners and service organizations. The model provides a framework by which to improve the design and delivery of services. It highlights the importance of six major elements of quality care and management: overarching goals; desired outcomes; fundamental needs; relational processes; approaches, worldviews, and priorities; and strategies by which to bring about desired outcomes. The model emphasizes the fundamental role of client–practitioner and practitioner–organization relationships and goal-related aspects of practice. Implications for research to improve our understanding of the psychosocial aspects of human service delivery are discussed, as well as implications for managerial and clinical practice.

Integrating Asset-Liability Risk Management with Portfolio Optimization for Individual Investors

A majority of private client practitioners rely on mean-variance optimization (MVO), rules of thumb, or model portfolios for making asset allocation recommendations. Considerations for income levels and other constraints figure into the typical approach. However, not enough attention is given to the nature of an investor’s multiple time horizons and implications for cash flows. These are the future demands placed upon the portfolio. The risks that these demands will not be met need to be clearly understood in order to validate any asset allocation decision. This article presents an approach incorporating MVO within a multi-horizon asset-liability management risk model. This approach allows for cash-flow matching of a portion of an investor’s portfolio within the optimization framework. This combined approach allows an individual’s portfolio to provide short-term cash flow, as needed, while also considering the longer-term demands on the portfolio.

Developing the readiness to alter sun-protective behaviour questionnaire (RASP-B)

Background: Australia has the highest incidence of skin cancer of any country in the world, even though the risk of contracting the disease can be lowered considerably by engaging in appropriate sun-protective behaviours. We aimed to construct and validate a questionnaire to assess the readiness of a group of mostly young people to change their levels of sun-protective behaviour by assigning them to a stage of change based on the transtheoretical model of behaviour change. Method: A sample of 122 undergraduate students in Queensland, Australia completed the readiness to alter sun-protective behaviour questionnaire (the RASP-B, a 12-item questionnaire about their attitudes toward sun-protection), in addition to a short questionnaire about their current sun-protective behaviours. Results: A principal component analysis revealed a clear three-factor structure corresponding to the precontemplation, contemplation, and action stages of the transtheoretical model. Participants in the action stage reported engaging in significantly higher levels of sun-protective behaviour than participants in the earlier precontemplation and contemplation stages. These behaviours included avoiding exposure to direct sunlight by wearing long-sleeved clothing and remaining in the shade or indoors. Participants in the different stages reported no significant differences in the reported frequency of sunscreen use, although respondents across all three stages reported using sunscreen infrequently. Conclusion: The RASP-B requires approximately 5 min to complete, can be self-administered and has satisfactory psychometric properties, and thus has utility in primary health care settings where time and client–practitioner contact are often limited.