Composite Vignettes Research Articles

A healing journey of the bilingual self: In search of the language of the heart

ABSTRACTThis article examines the clinical challenges that occur in the treatment of the bilingual Latino/immigrant client with a bilingual therapist who speaks both Spanish and English. Language plays a crucial role in the therapeutic process, especially when therapy takes place in the client’s second language with a bilingual therapist. Several theorists established a firm view that the mother tongue was the language of emotions and the second, the language of distance and detachment. A case composite vignette will introduce language switching as a defensive function for the bilingual client and as a therapeutic tool for the clinician. The work of Winnicott, who provides a framework in which to think about language from an object relations perspective, is discussed. The concepts and dilemmas described are applicable to other bilingual clients and clinicians.

‘School, family and then hockey!’ Coaches’ views on dual career in ice hockey

Despite the extensive research into coaches’ roles in supporting athletic development and motivation for sport, few studies have examined coaches’ attitudes and practices towards athletes’ dual careers. The present study extends European research into athletes’ dual careers by examining Finnish ice hockey coaches’ attitudes and practices surrounding players’ education. Ten male coaches aged 27–52 participated in semi-structured interviews. The data were analysed with an existential-narrative theoretical framework and with thematic and structural narrative analysis. Three composite vignettes were created entitled ‘supporting athletic development and players in reaching their own goals’, ‘enjoyment and physically active lifestyle’ and ‘developing good persons’. The analysis revealed that although all coaches embraced the official rhetoric where school is a priority over ice hockey, most of them had few practical examples of how this view had informed their coaching practice. It is concluded that young players may be easily lured into dreams of professionalism, whereas coaches’ dominant narrative of education as a back-up may be ineffective to spark athletes’ interest and engagement with education.

Coping rarely takes place in a social vacuum: Exploring antecedents and outcomes of dyadic coping in coach-athlete relationships

ObjectivesDespite widespread acceptance that coping is an interpersonal phenomenon, sport psychology research has focused largely on athletes' and coaches’ ways of coping individually. The aim of this study was to qualitatively explore coping from an interpersonal perspective (i.e., dyadic coping) in coach-athlete relationships. Methodology and methodsAntecedents and outcomes of dyadic coping were discussed with five coach-athlete dyads. We conducted individual interviews with athletes and coaches and then one interview with each coach-athlete dyad. Interviews were analyzed using dyadic analysis and composite vignettes were created to present the data. Methodological rigor was enhanced by focusing on credibility, resonance, rich rigor, significant contribution, and meaningful coherence. ResultsFive themes were identified. These represented the essence of dyadic coping (theme: the essence of dyadic coping), antecedents of dyadic coping (themes: lock and key fit, friendship and trust, communication of the stressor), and outcomes of dyadic coping (theme: protection and support). The first theme captures coaches' and athletes’ understanding of dyadic coping. The antecedent themes represent the factors that were necessary for dyadic coping to occur. Protection and support relates to the positive nurturing environment that was discussed as an outcome of dyadic coping. ConclusionThe results extend published research by exploring antecedents and outcomes of dyadic coping in sport. The findings highlight that dyadic coping was prevalent in coach-athlete relationships when various antecedents (lock and key fit, friendship and trust, communication of the stressor) existed. Protection and support were pertinent outcomes of dyadic coping that contributed to personal and relationship growth.

A Composite Vignette on Striving to Become “Someone” in My New Sport System: The Critical Acculturation of Immigrant Athletes

This study explores a composite vignette of athletes acculturating in a national sport system. The research questions were: What acculturation narratives did the athletes’ construct when they considered the notion of their receiving culture’s national sport system? And within these, what are the key challenges in relation to support that the athletes storied about their receiving culture’s national sport system as they sought to acculturate? The research was framed in critical acculturation (see Chirkov, 2009a, 2009b). The fluid process of acculturation is illustrated using creative nonfiction presenting one unifying voice presented within a composite vignettes (see Spalding & Phillips, 2007). The three themes in the acculturation vignette were as follows: (a) nothing but love—a nationalistic romance, (b) losing my romance with nationalism, and (c) dollars in exchange for newcomer results. This project reveals how immigrant elite athletes can move between distinct narratives that can contradict one another.

Adjusting to the Receiving Country Outside the Sport Environment: A Composite Vignette of Canadian Immigrant Amateur Elite Athlete Acculturation

This qualitative project is focused on the challenges that newcomer athletes revealed when they considered their earliest encounters with a receiving culture during general daily life. Conversational interviews with 24 national and international amateur newcomer athletes were subjected to interpretive thematic analysis and developed into a composite vignette. This vignette unearths three themes revealing hope (theme: opportunities abound); uncertainty and fear (theme: weighing the risks for the journey ahead); and anger, humiliation, and hardening (theme: public stonings). Understanding the fluidities within the vignette will permit practitioners to explore the uncertainties of acculturation and find entry points to support athlete acculturation.

Trauma Informed Clinical Social Work Practice: Case Composite with Court-Involved Adolescent

ABSTRACTAccording to the Office of Juvenile Justice and Delinquency Prevention (Puzzachera, 2013), there were approximately 1.47 million arrests of juveniles in the United States reported in 2011, including 68,150 serious violent crimes and 190,000 simple assaults. These data demonstrate that violent crimes are a significant national issue. Past studies have indicated that court-involved and delinquent adolescents frequently report a history of trauma symptoms and exposure to violence. The goal of this article is to present a framework for practice with court-involved youth that reflects the intersection of literature on adolescent development, trauma, and court-involved youth. Improving our understanding of the influence that trauma has on court-involved adolescents will support our ability to better understand the needs of this population in terms of treatment and crime prevention. This article presents a trauma-specific context for addressing the needs of court-involved youth from developmental, neurobiological, and trauma informed perspectives. One of the central components of this article is the inclusion of the TARGET model, a research-informed exemplar for the treatment of adjudicated adolescents who have histories of trauma. A review of the literature is followed by the presentation of a case composite vignette that exemplifies the need for a trauma-informed approach to working with court-involved adolescents.

Finding one's footing on foreign soil: A composite vignette of elite athlete acculturation

ObjectivesThe focus of this manuscript is the challenges associated with newcomer athlete acculturation within a sport system. The research question was as follows: What acculturation challenges do immigrant athletes have to work through as they attempt to integrate into new sport environments and facilitate their athletic careers within shifting cultural dynamics? DesignThe research was framed as a critical acculturation project (see Chirkov, 2009a, 2009b). The project aligns with broader calls in sport research for innovative qualitative approaches that reveal the complexity and multifaceted aspects of acculturation. Using creative non-fiction (e.g., a composite vignette), this project sought to illustrate the fluidity of acculturation, based on athletes' stories. MethodsConversational interviews were gathered and an interpretive thematic analysis was performed. The data were then developed into a composite vignette to illustrate the fluidity of the athletes' acculturation experiences. ResultsThe acculturation vignette revealed four major themes: (a) navigating the Canadian Sport System without local support, (b) adjusting to new sport programs and training approaches, (c) dealing with cultural differences in Canadian athletes' mindsets, and (d) searching for balance. ConclusionsThis project reveals how immigrant elite athletes experience continuous acculturation. These fluidities are best captured through emerging methodological approaches, where acculturation can be storied as non-linear.

An Interdisciplinary Response to a Tobacco Cessation Case Vignette

Introduction:Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.Aims:The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.Methods:ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.Results/Findings:While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.Conclusions:Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services.

A cloud and a box: an embodied triangle of imagery work in relational body PTSD psychotherapy supervision

This paper considers the place of imagery in supervision and their relational and corporeal resonances in the supervisory relationship. Drawing on Keleman's (1985) formative psychology concepts in order to explore clinical material through a composite case vignette from her supervision practice, the author considers her parallel process and describes the role of her countertransference in the embodied triangle of supervisor, supervisee and client.

Nurses negotiating professional-familial care boundaries: striving for balance within double duty caregiving.

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional-Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC.

Substitute consent in women with psychosis.

When treating patients with schizophrenia, substitute consent for treatment is often needed because of the patient's decisional incapacity. The goal of this article is to illustrate the potential problems involved in surrogate decision-making in a mental health service for women. A composite case vignette that highlights these issues is presented. The vignette was developed based on files from a women's clinic for psychosis and a selective literature review. The quality of the relationship between marriage partners and the possibility of pregnancy, motherhood, and child custody disputes all complicate the ethics of next- of-kin surrogate decision-making. The concept of "best interests" (the mother's or the child's) is not straightforward. A related ethical issue is whether/when to disclose psychiatric information to spouses. It is hoped that this paper will engender further discussion in medicine, cultural studies, ethics, and the law.

Building positive relationships with Indigenous children, families and communities: learning at the cultural interface

Drawing on the work of Martin Nakata, this paper brings into focus the everyday complexities involved in the cultural interfaces that educators, both Indigenous and non-Indigenous, negotiate in order to promote children’s engagement with formal education processes. Analysis of emergent data from a recent evaluation of a preschool education programme operating in 35 rural and remote Indigenous communities in Queensland, Australia, revealed that educators struggle to situate their own knowledge and experiences in relation to the knowledge and experiences of others in both the educational and cultural contexts in which they work. A series of composite vignettes reporting the experiences of early childhood educators across these communities is used to examine the pedagogical opportunities available to educators when they are able to recognise the value of the knowledge and experience of all those involved in a child’s educational success.

“Working the system”: The experience of being a primary care patient

Health care providers and system administrators are in the midst of a paradigm shift; moving from paternalism toward an egalitarian approach. For patient centred care to occur, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences and expectations into account. While there is literature regarding patient centredness, there is less information from the patient perspective about the experience of being a patient and the influence on behaviour. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, this study addressed the questions, a) what is the essence of being a primary health care patient, and b) what influence do beliefs, attitudes, and experience have on people’s behaviour as a patient? Nineteen individuals participated. Seven shared elements of being a primary health care patient were identified and contributed to the development of a composite vignette. The patient experience was a socially oriented, governed and reinforced cyclical process. Patients described themselves as actively engaged in their health care – “working the system” to get what they needed, when they needed it. Patients changed their beliefs, attitudes and behaviour as a result of experiences with their physicians, and their perceived success or failure in acquiring the best health care possible. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at the specific goal of getting the best healthcare possible. The theory of planned behaviour was unsuitable for understanding patients’ beliefs, attitudes and behaviour.

Stop, Look, and Listen: Being a Child Psychotherapist

Therapeutic stance, attention to process, and empathic connection represent crucial dimensions of effective child psychotherapy. These concepts are explored with illustrative composite case vignettes, drawn from clinical practice in child psychotherapy and classroom consultation. When clinical treatment adequately integrates stance, process, and connection, patients engage forward development with enhanced capacities to play, work, and relate.

The effects of physical activity vignettes on physical activity-related social cognitions among people with spinal cord injury

Purpose: The purpose of this study was to explore the effectiveness of informational portrait vignettes for enhancing physical activity-related psychosocial cognitions in adults with spinal cord injury (n = 90). Methods: Using the Health Action Process Approach (HAPA), participants were classified as being in the motivational or volitional phase of behavior change. Half of the participants were randomly allocated to read an experimental vignette, which described the physical activity behaviours, thoughts, and feelings of a character demographically similar to the reader. The remainder read a control vignette. Social cognitions were measured one-week before, and immediately after reading the vignette. Results: Analyses revealed no significant effects of the vignettes on social cognitions (p > 0.05). Conclusions: Informational portrait vignettes describing a physically active person with SCI and targeting multiple HAPA-based social cognitions are not recommended as a physical activity promotional strategy for people with SCI. The effectiveness of other types of vignettes should be examined.Implications for RehabilitationUntil further research is completed to determine whether social comparison strategies play a meditational role in accounting for the impact of a tailored informational portrait vignette to alter leisure time physical activity among those with spinal cord injury, these types of informational intervention should not be utilized in a rehabilitation, or real-world, setting.Although informational portrait vignettes may not be effective in altering leisure time physical activity social cognitions among those with spinal cord injury, different types of vignettes, such as composite vignettes, should be explored.

Embodiment and the supervisory task: The supervision of Dance Movement Psychotherapists in training

Supervision is an intimate act of creation and this article endeavours to understand the mercurial nature of this task, drawing on theoretical perspectives grounded in a Jungian framework. With a focus on training, supervisor and supervisee negotiate a labyrinth as they co-create a process within a triangular relationship, in which one key player, the client, is absent. The role of embodied knowing shapes a process involving the body as an active agent of change, whilst the wider matrix of the institution offers a multi-layered universe of parallel processes. The article offers composite vignettes to illustrate how unarticulated embodied wisdom transforms into a conceptualised understanding of clinical material through the transcendent function. The article illuminates the value of the body as radar for unconscious communication within the supervisory relationship.

Understanding Physical Activity through the Experiences of Adolescent Girls

Researchers have found that female youths are particularly vulnerable to withdrawing from sport and physical activity programs in early adolescence (see Active Healthy Kids Canada, 2010). However, there is an absence of a comprehensive, emic description of how female adolescents experience physical activity. Open-ended, semi-structured interviews were conducted individually with 15 early adolescent females (12–14 years old) and 20 middle and late adolescent females (15–18years old). Co-participants in the mid to late adolescent cohort provided retrospective accounts of their early adolescent experiences along with insight on how their experiences shaped their current participation. The girls’ voices were brought to the forefront through composite vignettes that highlight their physical activity experiences, integrating the words used by the co-participants. Results are discussed in relation to physical activity programming for adolescent females and why a qualitative approach is useful in contributing to gender-specific physical activity programming.

Stirring the depths: transference, countertransference and touch

The author explores transferential dynamics arising in the context of touch and tactile contact in the therapeutic relationship. The paper sets out with a brief review of transference phenomena and theory followed by considerations of the reciprocal nature of touch and of inter-personal dynamics evoked by touch. Relational perspectives of touch are used to contextualise some common challenges arising when we either consider or use touch in psychotherapy. Composite case vignettes from the author's practice provide clinical examples and evaluations to illustrate how psychodynamic and biodynamic aspects of the therapeutic relationship may interact with one another. The paper also highlights the crucial importance for therapists to remain anchored in their own bodies and personalities to navigate the depths stirred by touch safely.

‘Naadmaadmi’: reflections of Aboriginal community members engaged in sport psychology co‐researching activities with mainstream academics

When attempting to work with people from Indigenous cultures, mainstream researchers often encounter cultural differences, mistrust and a general resistance to community research. These challenges have emerged within the sport psychology domain as a consequence of mono‐cultural, Eurocentric research paradigms, which have marginalised Indigenous populations and disconnected community members from their traditional teachings and values. The current project was developed out of a partnership among mainstream academics and Aboriginal community members in northern Ontario, Canada, who have been engaged in sport psychology co‐researching activities for six years. The purpose of the current study was to elicit Aboriginal community members’ reflections of engaging in research with mainstream academics, based on past experiences as well as more recent efforts among the current bicultural team. The overarching intent was to encourage mainstream researchers interested in working within the Aboriginal community to adopt culturally reflexive practices that are meaningful from the local standpoint and to resist traditional mono‐cultural approaches. Conversational interviews were employed with nine Aboriginal community members who were also engaged as co‐researchers throughout the project. The community co‐researchers delineated negative and positive research experiences and outlined the specific strategies that contributed to each. A community composite vignette was developed as a narrative supplement to the data and reflects a unique and culturally relevant process within the study.

A portrait: Magdalena's dream.

A recent critical ethnographic study examined the effects of the health care system, historical exploitation, socioeconomic factors, and cultural values on retired migrant farm workers in northeastern Colorado. Combining ethnographic interviews, participant observation, photography, and critical analysis, study findings indicated a need to increase the cultural knowledge and collaborative efforts of health care providers. Emerging from the study, this article presents a creative composite vignette of retired migrant farm workers. The narrative and photograph offer testimony to the lived experience of these rural older Hispanic persons. The intent of the story is to provide the readers with deepened understanding of the hardships, social ostracism, economic challenges, personal hardiness, and cultural values that are characteristic of this special population.