Volunteer Clients Research Articles

Effects of training in dream recall and dream interpretation skills on dream recall, attitudes, and dream interpretation outcome.

Forty-two volunteer clients with below-average dream recall and attitudes toward dreams participated in training sessions focusing on either improving dream recall and attitudes toward dreams, building dream interpretation skills, or educating about counseling. After training, individual dream interpretation sessions were conducted. No significant differences were found among the 3 conditions in regard to dream recall, attitudes toward dreams, or client- or therapist-reported session outcome, but effect sizes suggested that participants in the skills condition gained more from sessions than did participants in the dream recall-attitudes condition. Session outcome for all volunteer clients was equivalent to those in previous studies of volunteer clients with no training, suggesting that training was not necessary and that these participants were able to benefit from single-session dream interpretation.

Factors Influencing Nutrition Education for Patients with Low Literacy Skills

Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center–based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients’ social networks; appear in a visually based, interactive format; and be culturally appropriate. J Am Diet Assoc. 1998; 98:559–564.

The effects of description, association, or combined description/association in exploring dream images.

During single 20-40 minute sessions, 51 volunteer clients were given instructions to either describe their dream images in rich detail, to provide associations to the dream images, or to combine these descriptive and associative activities. Volunteer clients in the association condition reported significantly more exploration/insight gains (e.g., becoming involved while working on the dream, making previously unobserved connections between the dream and waking life) than did volunteer clients in the description condition. No differences were found among conditions on clients' ratings of session depth (e.g., valuable, powerful), judges' ratings of the cognitive complexity of client's dialogue during the session (e.g., clear, elaborative), judges' ratings of how insightful clients were in their written dream interpretations, and judges' ratings of the quality of clients' written action plans. Implications for dream interpretation are discussed.

A comparison of therapist-facilitated and self-guided dream interpretation sessions.

Twenty-five volunteer clients participated in both a therapist-facilitated and a self-guided dream interpretation session; sessions were randomly ordered and separated by approximately I week. Observer and therapist ratings indicated that therapists adhered to the C.E. Hill (1996) model during therapist-facilitated sessions. Clients reported achieving greater depth, mastery, and insight, as well as more dream exploration-insight gains and more action-related gains, from therapist-facilitated sessions than from self-guided sessions. In addition, 88% of the clients preferred therapist-facilitated over self-guided sessions. Implications for using both types of sessions are presented.

Interviewing skills: self-evaluation by medical students.

In an independent learning project, 52 third-year medical students carried out a structured self-assessment of two videotaped psycho-social interviews they had conducted with volunteer clients 1 year earlier, as part of a previous course. The interviews had been conducted in small tutorials with feedback from their clients, fellow students and tutors, facilitated by videotape playback. During the sequence of 16 tutorials each student had carried out an early and a late interview and had observed and participated in the discussion of the interviews of 14 peers. Students were asked to tally the frequencies of various interview behaviours, to evaluate the quality of their behaviours, and to establish priorities for future learning. The videotapes were also reliably rated by an independent observer. Students' overall self-assessments correlated 0.46 with those of the independent observer. This correlation was higher than is typically reported in studies of the validity of self-assessment. In absolute terms, the students' mean rating of interviewing performance was 3.2 (adequate plus) which was significantly lower than the observer's mean of 3.6 (adequate to good). Results are discussed in terms of Gordon's (1992) two recommendations for improving the validity of self-assessments and two further suggestions, for paired comparisons and low-threat learning environments, are added.

Videotaped interviewing of non-English speakers: training for medical students with volunteer clients.

In a multicultural society such as Australia, with over 20% of its population born overseas, interpreters are often required to facilitate medical interviews. However, where a patient has some proficiency in English, medical interviews are sometimes conducted across the boundaries of culture and language. This is a report of an educational innovation to teach interviewing skills to pre-clinical medical students with the assistance of volunteers of non-English-speaking backgrounds. Pre-clinical students interviewed community volunteers on topics of general life history in a sequence of 16 tutorials. Each student conducted two interviews. Teaching methods included feedback from the volunteers, tutorial discussion facilitated by playback of videotapes, and modelling of skills by the teachers. Evaluations by volunteers and students indicated high satisfaction with the teaching methods and outcomes. Students gained confidence in interviewing people from different cultures. Evaluation of students' pairs of videotapes by an independent rater achieved satisfactory reliabilities and indicated significant gains in inquiry skills and the communication of positive attitudes. Skills in communicating empathy and in using simple language did not improve measurably.

Dream interpretation sessions: Who volunteers, who benefits, and what volunteer clients view as most and least helpful.

Undergraduate students (N = 336) completed measures of personality, cognitive functioning, and attitudes toward dreams; reported average hours of sleep and estimated dream recall; and kept a 2-week dream diary. A subset of 109 students volunteered to participate in, and 65 students actually participated in, a dream interpretation session. The students who volunteered for dream interpretation had more positive attitudes toward dreams, recalled dreams more frequently, were more open, were higher in absorption (capacity for restructuring one's phenomenal field), and were more often female than nonvolunteers. The volunteer clients who gained the most from dream interpretation reported fewer dreams in a 2-week dream diary. Clients reported that the most helpful aspects of dream interpretation were insight, links to waking life, and receiving another person's input.

Dream interpretation sessions: Who volunteers, who benefits, and what volunteer clients view as most and least helpful.

Dream interpretation sessions: Who volunteers, who benefits, and what volunteer clients view as most and least helpful.

The Relationship Between In‐Session Significant Events and Session Outcome for Prepracticum Counselor Trainees and Their Volunteer Clients

The relationship between the number of task, interpersonal, and hindering events and session outcome was examined for prepracticum trainees. Implications for counselor training are discussed.

Clinical Practice and Heuristic Reasoning

An understanding of heuristic reasoning has long been seen as important by researchers in human decision making (Newall & Simon, 1972). Recently, attention to this phenomenon has also arisen in social work (Heineman Pieper, 1989; Tyson, 1992). The decision strategies incorporated in heuristic reasoning have been viewed as both essential (Braunstein, 1976) and dangerously misleading (Kahneman, Slovic, & Iversky, 1982). However, despite possible drawbacks, this form of reasoning continues to generate interest because decision makers are often forced to rely on such informal methods to render decisions in pressured work environments (Cohen & March, 1986). Until recently, discussions of heuristic reasoning in social work have been confined to issues of research methodology. Lately, this theme has begun to emerge in discussions of clinical practice (Goldstein, 1990; Imre, 1991; Nurius & Gibson, 1990). What is Heuristic Reasoning? Heuristics are basically rules for decision -- or what Wildavsky (1974) termed aids to calculation. Both formal and informal clinical decision rules have been identified (Arocha, Vimla, & Vimla, 1993; Holtgrave, Lawler, & Schweibert, 1993); informal heuristics are discussed in this article. Such heuristics can be defined as rough rules of thumb used to solve problems (Haugeland, 1989). These rules have been identified as integral components in clinical judgment (Schon, 1983). Such heuristics do not always give the correct answer but are generally adequate or good enough for everyday behavior. The following are some common examples of informal heuristic rules: * Red sky in the morning, sailors take warning. * First come, first served. * The shortest waiting line is the fastest. * If it ain't broke, don't fix it. To better understand the use of such informal rules, the following description by Wiest (1975) is helpful: We all use heuristics in our daily living, drawing them from our knowledge and experience.... We devise simple rules of thumb that free us from the task of solving the same or similar problems over and over again. For example, consider the rule, when the day is cloudy, take an umbrella to work. The problem at hand is how to defend oneself against the potential discomforts of the weather.... For many problems of this kind, we lack the time or inclination to employ more thorough problem-solving procedures. A simple ... rule serves us best. (p. 382) Informal Heuristics as Decision Strategies The idea that heuristic reasoning in practice situations is made up of various decision strategies has generated various attempts to identify the strategies most often used by decision makers. Werner, Rose, and Yesavage (1983), for example, studied the informal decision strategies used by hospitals in making predictions about the imminent dangerousness of psychiatric inpatients. Other research has included studies of screening decisions in psychiatric emergency rooms (Segal, Watson, & Nelson, 1985), decision making in psychiatric emergencies (Murdach, 1987), social workers' decision making about violent clients (Werner, Rose, Murdach, & Yesavage, 1989), strategies for involving volunteer clients in treatment (Rooney, 1988), and decision making in the welfare bureaucracy (Schmidt, 1990). Of particular interest are the investigations of clinical decision making conducted by Rennels, Shortliffe, and Miller (1987). Drawing on research done on multiattribute decision making and other work in artificial intelligence, Rennels et al. proposed four decision strategies for management of patient care: 1. lexicographic ordering -- Solutions are ranked according to acceptability and the most preferred is selected. 2. …

Factors affecting satisfaction among community-based hospice volunteer visitors.

Trained volunteers are an essential component in the delivery of care to clients and families facing a terminal and/or life-threatening illness. As the need for hospice care increases, so does the need to increase the number of volunteers available for visiting. Hospice of London, which is a community based hospice, proposed that volunteers who felt satisfied would remain with the organization longer, thereby, decreasing the costs associated with training new volunteers and enhancing the ability of the agency to provide high-quality volunteer client matches. Accordingly, a survey was conducted in August 1992 to determine which factors were related to hospice volunteer satisfaction. One hundred and five volunteer were surveyed over the telephone. Results demonstrated a positive correlation between satisfaction and feeling like a team member, receiving feedback from staff, feeling valuable and having the volunteer's expectations match the position. Differences in the factors related to satisfaction were noted when the groups were divided by age and gender.

A client-computer interface for questionnaire data

Our purpose was to assess efficiency and patient acceptance of a simple, inexpensive method of direct client-computer interface. A computerized version of the Sickness Impact Profile (SIP) was developed with the standard keyboard replaced by a numeric keypad. Forty-eight volunteer clients of an occupational rehabilitation center completed both the paper format and the computer format in randomized order, then were asked to compare the two methods in four areas. The majority of subjects rated the computer as easier to use and as the preferred method. Most subjects rated the computer and paper formats as equivalent in comfort and understanding. A summary score established that significantly more individuals preferred the computer format over the paper format (p = .02). Efficiency was determined by the mean time to score the test and produce a report (computer 39s, paper 309s). The correlation coefficients for the physical, psychosocial, and overall scores were very acceptable being greater than 0.90. These data indicate that a simple client-computer interface for the SIP is preferred by clients and is more efficient compared to the paper and pencil format.

Client Perceptions of Therapist Competence

We explored how volunteer clients evaluated therapist competence and how these evaluations of competence were related to session outcome, treatment outcome, and client satisfaction. The 24 clients who were interviewed after the third of six sessions rated their graduate student therapists as competent. Open-ended responses of what led to competence ratings were coded by judges into 27 categories, which were grouped into seven supercategories: Facilitating Style, Facilitating Intervention, Facilitating Effect, Detracting Style, Detracting Intervention, Detracting Effect, and Client Minimization. Therapist competence was most often attributed to Facilitating Style. When clients perceived their therapists as facilitative, they rated session outcome and satisfaction positively; when they perceived therapists as detracting, they rated satisfaction and treatment outcome negatively.

The Impact of Therapist Ability to Perceive Displayed and Hidden Client Reactions on Immediate Outcome in First Sessions of Brief Therapy

In this replication/extension of Thompson and Hill (1991), we examined therapist ability to perceive displayed and hidden client reactions. During videotape reviews of 29 first sessions of six-session therapy with graduate student therapists and volunteer clients, clients reported displayed and hidden reactions to therapist interventions while therapists reported reactions they thought clients were displaying, hiding, or unaware of. If therapists identified the same reaction cluster as clients did for a given therapist intervention, a match was counted. Results indicated that: (1) Therapists were better than chance at matching supported reactions, no better than chance at matching challenged and no reaction, and worse than chance at matching on therapeutic work and negative reactions; (2) Clients hid more negative reactions than any other type of reactions; (3) Therapists were aware that clients were hiding and unaware of negative reactions, but they were not as accurate at identifying hidden reactions as...

Therapist Perceptions of Client Reactions

This study examined therapist ability to identify client‐reported reactions. Sixteen therapists each saw two volunteer clients for single counseling sessions. In postsession reviews, clients rated the helpfulness of, and indicated their reactions to, each therapist intervention. Therapists also rated the helpfulness of, and indicated their perceptions of client reactions to, each therapist intervention. In 50% of the instances therapists matched clients, that is, reported the same reaction cluster as the clients did. There were higher match rates on the reaction clusters of therapeutic work (62%), supported (54%), and no reaction (46%) than negative reaction (27%) and challenged (14%). When therapists matched on therapeutic work, helpfulness ratings for the following intervention were higher than when therapists did not match. In contrast, when therapists matched on negative reactions and no reaction, helpfulness ratings for the following intervention were lower than when they had not matched. Thus, therapists' ability to match client reactions was related to their ability to generate helpful interventions. Implications for practice and future research are discussed.

Treatment of Drug Abuse

The major drug-treatment modalities-methadone maintenance, therapeutic communities, outpatient drug-free programs, and some criminal justice system-based treatments such as civil commitment-have all been shown to be successful by most outcome criteria. Programs with flexible policies, goals, and philosophies produce better results than inflexible programs, especially when they adopt combinations of treatment components that are suited to individual clients' problems and needs. Patients' lengths of time in treatment are highly correlated with positive outcomes, but dropout rates are high for most modalities. Clients entering treatment under legal coercion do as well by most outcome criteria as volunteer clients and may stay in treatment longer. The evidence on treatment effectiveness suggests a social policy of expanded treatment capacities and options and increased attention to adequate implementation of treatment programs.

Relation of nonverbal behavior to client reactions.

Sixteen therapists each saw a volunteer client for a single counseling session. During a videotape review the clients recorded their reactions and the therapists recorded their perceptions of client reactions to each therapist intervention. Client nonverbal behaviors (speech hesitancies, vertical and horizontal head movements, arm movements, leg movements, postural shifts, adaptors, illustrators, and smiles) were examined to determine whether they were consistently associated with client reactions

Relation between counselors' use of intentions and clients' perception of working alliance.

I examined the relation between counselor intention use and client-rated working alliance. Subjects were 42 volunteer clients paired with 42 counselor trainees for 4 counseling sessions. Ratings were obtained for client interpersonal attitudes, client-rated working alliance, and counselor intention use

Integrating diet therapy and dietary counseling: An alternative education technique

The purpose of this study was to examine the effects of a change in education methods on learning among students enrolled in a coordinated undergraduate program (CUP). An experimental process applying the principles of diet therapy and counseling in a situation involving volunteer clients was initiated, and the effects were measured. A pretest-post-test design was used for this investigation. Two psychometric instruments, the Myers-Briggs Type Indicator and the Affective Sensitivity Scale, were used to measure changes in attitudes, values, and aptitude. The curriculum of the treatment group (19 juniors in the CUP) was reorganized so that diet therapy and dietary counseling would be taught during the same semester. The laboratory sessions were combined the last 6 weeks of the semester to provide an opportunity for students to counsel clients recruited from the university campus. The comparison group (11 seniors in the CUP) had enrolled in diet therapy the first semester of the junior year and dietetic counseling the second semester; those students were tested during their senior year. The research indicated that the students in the treatment group learned effectively. They significantly increased their awareness, listening, and understanding during the treatment period. The post-test of the treatment group indicated that they had increased perception and more acute affective sensitivity in comparison with the control group.

Effect of empathic communication and use of paralanguage.

The conceptualization of empathic understanding and its role in effectiveness of counseling has been well established. Less certain are the behavioral components of empathy. Empathic understanding involves the ability of a helper to communicate understanding to the helpee, and so the means of communication is important in determining effectiveness in that communication. Whereas the components of verbal expression in empathic understanding have received considerable attention, the nonverbal communication channels have received less attention due, in part, to the difficulty of isolating such components. The purpose of this study was to examine parts of the nonverbal (paralanguage) channel and their role in effectiveness of empathic communication. Specifically, the role of vocal pitch, tempo, and loudness in communicating empathic understanding was examined. The participants were 36 students drawn from a counseling practicum. Recorded segments of counseling interactions with volunteer clients were rated by trained raters for level of effectiveness in communicating empathic understanding using Truax and Carkhuff's (1967) Empathic Understanding in Interpersonal Process Scale. This yielded segments representative of subtractive, minimal, and additive effectiveness of empathic communication. Inter-rater reliability for this was .95. These three groups were then rated using Markel's (1965) Paralinguistic Phenomena Scale to detetmine the level of match between helper and helpee on components of pitch, tempo, and loudness. Interrater reliability for this scale was .89. The isolation of the three paralanguage channels was made possible by the author's development and use of an electronic filter that removed the high frequency portions of the recorded segments. This process left the paralanguage channels intact while rendering the verbal portions unintelligible. Using one-way multivariate analysis of variance, the obtained F ratio of .75 (df = 6/62) was nonsignificant. The means and standard deviations for effectiveness level were: Subtractive--.OS and .70, Minimal-.16 and .GI, and Additive.07 and .58. The range of scores were for Subtractive 2.5 to 1.0, Minimal 3.0 to 2.6, and Additive 3.5 to 3.1. No systematic relationship was established between the helper's use of three paralanguage dimensions and three levels of effectiveness in empathic communication. This finding suggests a need for a continued search among the other nonverbal components to identify the major contributors to effective empathic communication.