Client Families Research Articles

Race, racism and systemic supervision

The idea of ‘race’ and the social reality of racism have gained increasing attention in family and systemic psychotherapy. This article seeks to extend this attention by focusing upon the influence of race and racism in the supervision of family and systemic psychotherapy. The way in which the idea of race might be conceptualized is discussed, before looking at how race and racism have been addressed in the field. Attention is then turned to systemic supervision, focusing upon the ideas generated about how supervisors might position themselves in relation to these issues, the implications this might have for the supervisory relationship and the relationships between supervisees and client families. It is proposed that by virtue of the supervisor's position of power over the supervisee, it is the supervisor's responsibility to initiate conversations about race and racism. A proposal for this task is outlined, which recognizes that these conversations are ongoing. A concluding assertion is made that such conversations should form part of the evaluative process for trainee supervisors.

Supporting Families With Parents With Intellectual Disability: Views and Experiences of Professionals in the Field

Professionals and parents with intellectual disability often disagree on what support is needed and how it should be provided. Parents report having little say in the matter, feeling coerced into accepting services that they do not find useful. Professionals may describe the parents as difficult to engage and not open to receiving help. The aim of this article was to capture the views and experiences of professionals working with parents with intellectual disabilities. A qualitative analysis of focus group discussions was undertaken. Study participants described their work with client families as fraught with difficulty. Their accounts differed depending on whether the child was living with the parents or the child had been placed in out-of-home care. In the first situation, parental limitations and inability to meet the needs of their children were emphasized, with parents failing to recognize their own high support needs. In the second situation, the parental role was seen as important, and it was considered vital to continue to provide proper support to enable the parents' ongoing contact with their child and maintaining their parenting. The difference could be explained by lack of appropriate support and knowledge provided through the organizations at which the study participants worked, along with job stress. The author notes that study participants doubted the capacity of the parents to care for their children and were uncertain about how to best support them. Gaps were revealed in the way in which knowledge about families with a parent with an intellectual disability is produced and used by professionals.

Different levels of psychotherapeutic competence

In this article, I argue for a both – and position in regard to manuals. I suggest that manuals are appropriate when describing therapeutic strategizing and technical competence. However, I also argue that they are an inappropriate tool for understanding the contribution of the client's family in family therapy. This argument fuels a further view that manuals cannot capture the dance that occurs between therapist and family. For this type of knowledge, a relational type of competence needs to be developed.We encourage you to listen to the JFT Editor, Mark Rivett, as he interviews the author on Manuals in the Practice and Research of Family Therapy. Available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1467-6427/homepage/jft_podcast_series.htm.

Client Relationships and Family Dynamics: Competencies and Services Necessary for Truly Integrated Wealth Management

Financial firms and family offices are increasingly affected by and involved with the personal and relationship issues of <i>client family</i>. This reality challenges a firm to help families in a way that is very different from providing financial services. For most relationship managers (RMs) who are the interface between the client and the firm, this is a new area in which they are neither trained nor comfortable. This article outlines the ways that family-dynamics issues impact multigenerational family decisions and how the RM becomes involved in these decisions. The authors present a typography of the competencies needed by RMs to serve families in this way. Next, they explore how the RM can develop these client relationship skills and define the key elements needed so that an RM is competent in handling these issues as they arise. Finally, the authors look at the challenges that arise within the financial firms and family offices as they support their client families with these services. We suggest some ways that RMs and their firms can effectively combine family-dynamics services with their financial advising. <b>TOPIC:</b>Wealth management

Client Family-Member Participation Is Associated with Improved Residential Treatment Program Completion at an International Drug and Alcohol Treatment Center

Prior research at Crossroads Centre Antigua has shown a 15% increase in long-term abstinence rates of clients if a family member attended the family program. This study examines the association of family program participation on client residential treatment completion. A retrospective review of records of all clients admitted from January 2004 to June 2007 was performed. Participation of client family members in the family program (a 4-day program including didactic material, workshops, group and individual counseling sessions for interested family members) was recorded. Information obtained from a limited client database, in addition to family program participation, included age, gender, country of residence, drug of choice, and 29-day treatment program completion. Data from clients having family members participate in the family program were compared with clients not having family members participate. There were 1,014 clients admitted, 681/1,014 (67%) men, mean age 41years, 733/1,014 (72%) from the Unit...

Methodological aspects used in the scientific production about nursing consultation: an integrative review

&nbsp;Nursing consultation is the method by which the nurse can have complete autonomy to develop comprehensive care strategies for the client's health, family or community. The study aimed to verify the methodological aspects used in the scientific literature about the nursing consultation. It is an integrative review of literature that used the not controlled descriptors nursing and consultation and the translation into English of words together (nursing consultation) and Spanish (consulta de enfermer&iacute;a) in the following databases: LILACS, PubMed, CINAHL and Cochrane databases. The search took place from December 2009 to February 2010, being selected 31 articles that met the following criteria: be available in its entirety, be available in Portuguese, English and Spanish addressing the nursing consultation. Data analysis was based on literature relevant to the topic. Was obtained as results the predominance of descriptive studies with qualitative approach. The South East was the region with the largest number of published studies, mostly performed in adults in primary care units. In the last decade there has been an increase in productions made. Thus, it is clear that in the nursing consultation the nurses actions are very diverse, but still it is necessary to carry out more studies on the subject to prove the effectiveness of nursing consultation.&nbsp;

Using Family Paradigms to Improve Evidence-Based Practice

Evidence-based practice (EBP) describes clinical decision making using research, clinical experience, and client values. For family-centered practices, the client's family is integral to this process. This article proposes that using family paradigms, a family science framework, may help elicit and understand client/family values within family-centered EBP. This article describes the family paradigms framework: 4 classic paradigms of "closed," "random," "open," and "synchronous." Its applicability to family-centered EBP is proposed using augmentative and alternative communication examples. A family-centered approach to EBP requires families to be an integral part of clinical decision making, but some families may need assistance in enumerating their views and values. Family paradigms (which consider how a family uses its resources of time, space, energy, and material in the pursuit of its goals of control, affect, meaning, and content) may be a way to elicit family values and preferences relevant to clinical decisions. Family and client values can be incorporated throughout the EBP steps. Considering family paradigms may increase awareness and understanding of how families' views of their goals and resources affect clinical decisions. Further research is needed into both the processes and effectiveness of using family paradigms to conduct family-centered EBP.

A Systemic Approach to the Treatment of Dissociative Identity Disorder

Although dissociative identity disorder (DID) continues to be questioned by some clinicians, those who work with this population understand the complexity of this disorder. Most often DID clients undergo predominantly individual psychotherapy to help them integrate their fragmented parts or personalities usually taking an average of 5 to 7 years. Although there is limited literature on the use of systemic therapy with DID clients, family therapy approaches can be used to conceptualize the treatment of the DID client and their family members. This article discusses how individual psychotherapy from a systemic perspective can be applied to treat DID while family systems therapy can be used to help educate the client's family about DID, the process of treatment, as well as how to recognize and become prepared for any symptoms of recurrence. The internal family systems model of therapy with a DID client is discussed through a case example.

A Fine Line to Walk: Case Managers' Perspectives on Sharing Information With Families

In the United States, sharing information with families in health care involves competing demands between clients' rights to confidentiality and families' wishes to know. In this article, I explore how community mental health providers share information with families of clients with severe mental illness. I interviewed 24 case managers in assertive community treatment programs. Results show that case managers share information with families to attain treatment goals rather than to support families in providing care. Case managers respect clients' confidentiality and do not release information without client consent. However, the absence of client consent posts an ethical dilemma when families provide helpful information for clients' treatment. Case managers find themselves walking a fine line between adhering to confidentiality guidelines and working for the clients' best interests. The findings suggest the need to expand confidentiality laws to the exchange of information and to develop guidelines for working with families in community settings.

Working with families in Assertive Community Treatment (ACT): The case manager's perspective.

In response to research findings of insufficient family involvement in mental health services for people with severe mental illness, this grounded theory study examines case managers' interactions with families of clients in Assertive Community Treatment (ACT). Findings suggest that case managers conceptualize families as sources of social connections, rather than sources of care, for clients. This conceptualization is influenced by case managers' goals, which also guide their assessments of families for involvement in treatment in terms of the extent to which families help attain treatment goals. In developing strategies to work with families, case managers engage in ongoing assessments and consider client permission for family involvement in treatment, family availability to clients, and family wishes for involvement in treatment. Three case examples illustrate the relationships among case managers' goals, assessments of families, and selections of work strategies. The potential role of the ACT model in shaping this particular view on families is also discussed.

Home Care as a Complex Experience: A Chronological Case Study

ABSTRACT This case study of an older woman with macular degeneration describes her experience of dispensing daily medications over a 3-year period, during which a home care nurse began and continued visits. Using a phenomenological method, I analyzed data of 9 interviews, discerning the structure of her experience and depicting it in 7 diagrams. The home care experience can have unintended outcomes influenced by family and provider perceptions of clients' abilities, especially when family members and practitioners assume tasks that older women have managed alone. Minimizing intergenerational ambivalence about the need for home care and maximizing client agency should be preeminent foci of home care providers.

Survey of Community-Based Programs Serving U.S. Families With Huntington’s Disease: Perceived Barriers and Facilitators in the Residential Placement Process

This article describes the contours of the residential care placement experience for social service staff health care providers, and their client families of patients with Huntington's disease. The purpose of this study was to determine the factors, conditions, and barriers encountered by outpatient clinical staff and families in the transition to skilled nursing care. A Long-Term Care Contact Survey was developed to (a) gather information about long-term care referral sites; (b) determine the factors considered in choosing a facility; (c) describe the factors that hindered the transition to long-term care; (d) describe conditions prior to institutionalization; and (e) determine research interest. The study found that large cohorts of patients with Huntington's disease in residential care are scarce. A lack of confidence in the available options suggests the need for increased support for educational and social services to facility staff Speech/swallowing therapy and physical therapy as placement facilitators reflect salient issues of latter stages of the disease, implicating funding support needs. Families facing this transition require long-term guidance for financiail, caregiving, and psychosocial issues.

The Therapist's Notebook for Integrating Spirituality in Counseling, Volumes 1 and 2

The Therapist's Notebook for Integrating Spirituality in Counseling, Volumes 1 and 2

Health Care Aides' Struggle to Build and Maintain Relationships with Families in Complex Continuing Care Settings

Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA-family relationships in complex continuing care (CCC). In-depth individual interviews with eight HCAs and a follow-up focus group with HCAs from three CCC facilities were analysed. Building relationships with families entailed "being there for them and their relatives", while maintaining relationships involved "dealing with disappointments". Factors influencing building and maintaining HCA-family relationships included "having supportive team members", "having resources available", and "functioning within care-team hierarchies". The findings highlight the importance of minimizing the unit and organizational factors that disrupt HCA-family relationships.

Older Case Management Clients With Younger Family Members in Need of Care: Interdependencies and Well-Being

This exploratory study investigated caregiving and interdependencies in families of frail older case management clients who coreside with younger individuals in need of care. Analyses were based on interviews with 78 older adults recruited from a large urban case management program. To be eligible for the study, the older adult had to coreside with an individual under age 60 who had disabilities or chronic health problems and/or with minors. Results indicated that the majority of older adults were primary caregivers for at least one younger individual In a substantial number of families, the older adult depended on a younger adult with disabilities for primary care. Older adults who lived with both younger adults with disabilities and minors experienced more negative affect than those who lived with only one of these two kinds of younger individuals. Positive affect among elders living with younger adults with disabilities was positively related to the number of formal services received by the younger adults. The implications of these findings for service delivery to families with complex needs for care are discussed.

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

of the program, and 1 month later. Results: Immediately following completion of the program, participants reported increased comfort when faced with client behaviors related to motivation and adherence, sexuality, and aggression and when interacting with other staff and client families. Changes in comfort level with sexual situations, aggression, and staff/staff interactions were maintained 1 month post training. Conclusions/Implications: These results suggest that crisis intervention training is effective in increasing levels of staff comfort with difficult situations commonly experienced in the rehabilitation setting and the changes are maintained following training.

Intensive Family Preservation Services: The Perceptions of Client Families

This qualitative study seeks to understand the correlation between intensive family preservation services and family functioning in those families who have participated in services. The focus is on the perceptions of client families with respect to the impact of services on family functioning including communication, family dynamics, and parenting skills. The discussion centers on the responses of client families to a narrowly constructed survey instrument designed to capture their perceptions with respect to the services provided by case workers.

The ‘ordinary’ family as a resource for single parents—on the Swedish contact family service

This article reports on some important results from a qualitative study, which mainly focused on the topics of family notions and notions of ‘good parenthood’, and their impact on the Swedish ‘contact family service’. The service is provided to help mostly single mothers—with scarce social networks that lack the ability to provide support—to get relief from constant care-giving for one or two weekends a month. The three parties—client families, contact families and the social workers that handled the cases—have been interviewed (a total of 54 interviews) about their experience of their own parenthood and family life as well as their notions in general, for example of a ‘normal’ and an ‘ideal’ family. The interaction and influence of these notions on shaping the contact family service were studied. The article comes to the conclusion that the design of the contact family service needs further consideration on the family ideals that are reproduced in the service. With the nuclear family as the norm, the burden of a lone parenthood will increase.

Treatment of Comorbidity in Families

SUMMARY Half or more of all people presenting for treatment for alcohol disorders will also have an additional current or past psychological disorder. The presence of a comorbid disorder makes design and implementation of a treatment plan more complicated, completion of treatment less likely, and the odds of relapse greater. In addition, the presence of a comorbid disorder creates added stress on the social support network of the client, in particular, the client's family. In many cases, the stress reaches a level that leads to a cutoff between the client and family. However, when the family is still actively involved in the client's life, the family members may be able to provide much needed assistance in diagnosis, treatment, and support for abstinence. Current studies indicate that, in order to increase the likelihood of successful treatment, most comorbid disorders should be treated concurrently with alcohol disorders.

Communication skills: A tool for interpersonal relationship in nursing care

Background: The interpersonal relationship between the nurse and other health care providers is poor. Moreover, the ineffective therapeutic communication skills within the health team are the bane to effective and efficient health care delivery system. Nurses, as members of the health team are supposed to communicate information about the client to other members of the team to enable them carry out a comprehensive plan of care, though this is found wanting. The lack of knowledge of the factors that influence or inhibit effective communication among health care providers contribute to the lopsided health care delivery system. Methods: A review of the process of communication in the nursing process utilizing relevant texts and papers obtained by manual/Medline search. Results: This paper reviews the process of communication, its skills in the nursing process which involves the client's family and other health care professionals in identifying the health care needs of the client. Factors that influence or inhibit effective communication is discussed. Effective communication establishes good working relationships between the nurse, client and other health care providers. Thus, this promotes client's well-being and reduction of death rates in our hospitals. Conclusion: Effective communication is necessary for the nurse's role in helping the client to adapt to the changes resulting from health alterations. Nursing is a communicative interaction and it is believed that the foundation of nursing lies in the communicative attitude. It is a fact that failure to communicate leads to serious problems that can threaten professional credibility. Keywords: Communication, Interpersonal, Relationship, Nursing care. Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 87-89