Client Reports Research Articles

The Forensic Assessment for Immigration Relief (FAIR) clinic: A faculty-led, pediatric clinic model

Since 2019, the number of children apprehended by the United States Custom and Border Patrol at the southern border continues to increase. Many of these children are fleeing violence and extreme poverty and qualify for several forms of humanitarian relief. Trained pediatric health professionals have an essential role to play in documenting evidence to support their petitions. The goal of a forensic medical and psychological evaluation is to establish the facts related to the reported incident(s), provide forensic evidence to support these claims, and provide an expert opinion on the degree to which a finding correlates with the client's reports through a written affidavit. Research studies have demonstrated a significant increase in asylum grant rate for cases that include an evaluation. As demand for forensic evaluations has grown, multiple clinic models have emerged, including volunteer networks, student-led clinics, and faculty-led clinics. The Forensic Assessment for Immigration Relief (FAIR) Clinic offers a sustainable infrastructure while emphasizing the training of pediatric healthcare professionals on the conduct of trauma-informed, culturally attuned, and developmentally appropriate forensic evaluations. This paper outlines the year-long process of developing and launching a clinic specializing in pediatric forensic medical and psychological evaluations as a blueprint for replication.

Responding to self-criticism in psychotherapy

Objective: We explored the interactive process in which therapists respond to client self-critical positions. Methods: Drawing from the resources of conversation analysis (CA), we examined a corpus of in-session self-critical sequences of talk occurring in different kinds of treatments: Client Centered Therapy, (CCT), Emotion Focused Therapy (EFT), Psychoanalytic Psychotherapy (PP) and in different cultural contexts. Results: It was found that client self-critical talk performed various functions pertaining to diminished control, accountability (e.g., failed obligations leading to self-blame) and disparaging evaluations of self (contempt or disgust). Further, therapists were found to respond in ways that targeted the client's report of having diminished control or of being accountable for their negative attributes by providing a more optimistic reading of the client's experience, one that is more open to positive outcomes and the possibility of change. Our sequential analysis not only shows how clients may resist these optimistic readings, but also how therapists work towards successfully achieving moments of re-affiliation. Conclusion: We anticipate that the fine-grained sequential analysis of therapy interaction can provide therapists with a more detailed understanding of the options and challenges therapists face when working with clinical challenges of clients’ self-critical positions.

Socially-Optimal Design of Service Exchange Platforms with Imperfect Monitoring

We study the design of service exchange platforms in which long-lived anonymous users exchange services with each other. The users are randomly and repeatedly matched into pairs of clients and servers, and each server can choose to provide high-quality or low-quality services to the client with whom it is matched. Since the users are anonymous and incur high costs (e.g., exert high effort) in providing high-quality services, it is crucial that the platform incentivizes users to provide high-quality services. Rating mechanisms have been shown to work effectively as incentive schemes in such platforms. A rating mechanism labels each user by a rating, which summarizes the user's past behaviors, recommends a desirable behavior to each server (e.g., provide higher-quality services for clients with higher ratings), and updates each server's rating based on the recommendation and its client's report on the service quality. Based on this recommendation, a low-rating user is less likely to obtain high-quality services, thereby providing users with incentives to obtain high ratings by providing high-quality services. However, if monitoring or reporting is imperfect—clients do not perfectly assess the quality or the reports are lost—a user's rating may not be updated correctly. In the presence of such errors, existing rating mechanisms cannot achieve the social optimum. In this article, we propose the first rating mechanism that does achieve the social optimum, even in the presence of monitoring or reporting errors. On one hand, the socially-optimal rating mechanism needs to be complicated enough, because the optimal recommended behavior depends not only on the current rating distribution, but also (necessarily) on the history of past rating distributions in the platform. On the other hand, we prove that the social optimum can be achieved by “simple” rating mechanisms that use binary rating labels and a small set of (three) recommended behaviors. We provide design guidelines of socially-optimal rating mechanisms and a low-complexity online algorithm for the rating mechanism to determine the optimal recommended behavior.

Auditor's going‐concern modification decision in the post‐Enron era

AbstractThe decision to modify a client's report for “going‐concern” reasons is one of the most difficult decisions an auditor faces. The American Institute of Certified Public Accountants' (AICPA) guidance, in SAS No. 59, requires the auditor to evaluate whether there is “substantial doubt about the entity's ability to continue as a going concern.” But although the term going concern is widely used in the profession, curiously it is not defined authoritatively in accounting standards.Many auditors also point out that the going‐concern modification fails to predict bankruptcy. And to further confuse matters, SAS 59 does not use the word bankruptcy anywhere in the text. The standard charges the auditor only with the responsibility to evaluate whether or not there is substantial doubt (another vague term) about the entity's ability to continue as a going concern for a period of one year beyond the date of the audit.So with all this uncertainty, what is the state of the going‐concern decision in today's post‐Enron era? © 2012 Wiley Periodicals, Inc.

Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work.

What does the first exchange tell? Dialogical sequence analysis and assimilation in very brief therapy

Abstract The authors applied dialogical sequence analysis, a microanalytic method for tracing recurring maladaptive patterns, to study assimilation in the psychotherapy of a woman treated for mild depression in two weekly sessions plus a 3-month follow-up session. The very first exchange (four speaking turns each by client and therapist) enacted a pattern in which the client responded to her own potential vulnerability by adopting a controlling caretaker position. Subsequent therapeutic work delineated component positions in this pattern, which was recurrent and maladaptive, leading to an insight reached midway through the second session. From the client's reports, it appeared that she used her new understanding to assimilate her problematic controlling side, giving her greater flexibility in her relationships and greater scope for meeting her own needs for care. She seemed to progress across three of the eight developmental stages postulated by the assimilation model: problem statement–clarification, und...

Beyond Both Traditional Scientist/Humanists and Humanist/Scientists

This article compares traditional science and the “new science of possibilities” for counseling based on humanistic principles. The information age impels counselors to shift to the new paradigm because the exponential increase of cultural change is generating a climate in which control‐oriented procedures are inconsistent with events and debilitating to clients.

Solving the ideological dilemmas of peer social support: Microanalysis of provider strategies on a warm line

It is commonly assumed that supportive communication consists of multiple goals and that there are difficulties tied to accomplishing these multiple goals in interaction. Building upon a description of three contrary themes that typify the goals of social support on a peer‐run warm line for clients within community mental health, this study explores how support providers address the contrary themes of connectedness, problem solving, and nondirectiveness in actual phone calls. Support providers share their own similar experiences with clients in order to help solve client problems, too. Support providers put forth advice within queries in order to meet dual goals: solve client problems yet support client autonomy. Additionally, paraphrasing client's reports, if done well, both supports client autonomy and helps build stronger peer relationships. Future studies should detail other actual strategies that address dilemmas inherent to social support.

Interaction of Programming and Design: The First Unitarian Congregation of Rochester and Louis I. Kahn

This essay investigates the relationship between programming and design. It exposes and criticizes those views that characterize programming and design as separate and their relationship as linear. Instead, we propose that the relationship is interactive and that the clarification of programmatic and design issues goes hand in hand. During this interactive process both client and architect take significant responsibilities. The design process of the First Unitarian Church of Louis Kahn is an illustrative example. Investigation of the client's reports, of Kahn's and the client's letters, and of Kahn's design proposals exposes the client's contribution and the interaction between programming and design. Our study suggests that clients have the potential to play crucial roles in design and deserve credit.

DEVELOPMENT OF AN EXERCISE EXPERT SYSTEM FOR OLDER ADULTS

54 Mechanisms are needed to aid health professionals in developing appropriate exercise programs for their clients. This study developed a computerized exercise expert system (EES) that creates individual exercise plans for older adults. The EES focuses on determinants that influence exercise behavior and uses recommended strategies for improving exercise initiation/adherence for the elderly. First, a knowledge base containing all determinants related to initiation/adherence of exercise was compiled. A diagnostic questionnaire obtaining information on exercise habits and preferences was then created. Strategies to optimize exercise initiation/adherence were assembled. A national workshop was held to evaluate the EES and to establish reliability and validity. Both inter-rater reliability and criterion validity were found to be at acceptable levels (greater than .80) by all expert groups. The critique of the EES and its outcomes were also evaluated for user-friendliness. There was an 88% agreement between the experts that the expert system user interface for user-friendliness was excellent. The remaining raters rated it as good. The output of the EES includes both a client's report and a practitioner's report. The client's report consists of a customized exercise prescription, recommended strategies, and an exercise knowledge sheet. The practitioner's report consists of the client's exercise prescription, summary of determinants, and exercise preferences. Based on the individual's exercise determinants, the tailored exercise plan should increase the likelihood that older adults will initiate/adhere to exercise. Supported by Department of Veterans Affairs Project # E825-RA

Use of Time and Satisfaction with the Psychotherapeutic Relationship

Abstract The purpose of this inquiry is to determine how social position affects the quantity and quality of psychotherapeutic care received in outpatient mental health centers. It is posited that use of time in the therapeutic dyad is, in part, a manifestation of the therapist's desire to work with the patient and also a cause of the degree of satisfaction expressed by the patient with the psychotherapeutic relationship. Using data from a random sample of adult community mental health care recipients (N = 179), use of time is assessed by the client's report of waiting time and session length. The results indicate the importance of temporal factors for predicting satisfaction in the psychotherapeutic relationship. Although the sex and race of the respondent did not affect use of time or satisfaction with the psychotherapeutic relationship, socioeconomic status and age effects were observed. The broader implications of this study are that lower class clients express more positive attitudes toward medicine ...

Counselling, cognition and reality

In this paper I would like to explore what academic psychology has to offer for counselling. When a counsellor meets a client or a group of clients he enters the situation with a number of implicit and explicit assumptions. He assumes, for example, that a relationship exists between the client's report about his situation and his social and material environment. He assumes further that the client's descriptions of his environment have an influence on, or can even guide his actions in his environment. That these assumptions underlie the work of all therapists or counsellors can even be seen in the case of behavior therapists. They talk with their clients about their problems, they select problem areas according to the words of the clients (e.g. study difficulties, anxiety situations) and they instruct their clients how to do behavioral tasks. In viewing the theories of psychotherapy we find that they usually stress one of two aspects: the objective world outside or the subjective images of the individual. Behavior therapy in general sees the organism as being controlled by the environment and does not concern itself with intra-psychic structures. We find, on the other hand, theories such as psychoanalysis or the humanistic approaches to psychotherapy which stress that behavior is determined from within the organism. The exponents in these fields claim that fantasies, ideas, feelings, etc., control behavior and that these inner events may or may not correspond to outside situations. In extreme cases they state that there is no objective reality; it is only a construction of the individual. I think that the development of these two opposing positions has been possible because of the very special situation in which psychotherapy is normally practiced. The situation can be explained as one in which the therapist has enough power and time to concentrate on only one of the aspects mentioned above. As a behavior therapist you must have enough power to be

SIGNIFICANT CHANGES IN THE DIRECTION OF BEHAVIOR

The initial counseling interview provides an excellent opportunity to study significant changes in the direction of the client's behavior and his reactions to them. Such changes may occur in his family situation, relations to the opposite sex, job history, recreational pursuits, health experiences, religious affiliations, and academic achievements. The client's report of his reactions to such redirection points often throws light upon his typical response to frustration—whether it be task‐oriented or defense‐oriented, on his attitudes toward other people and himself, the rigidity or flexibility of his thought processes, his tendency to move into or away from challenging situations, his awareness of his own motivation, his ability to deal effectively with his feelings and emotions, changes in his basic life values and continuity, and change in his self‐concept.