Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.
BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor. (+info
The broken mirror. A self psychological treatment perspective for relationship violence.
Clinicians face formidable challenges in working with male perpetrators of domestic violence. Many treatment programs use a confrontational approach that emphasizes male entitlement and patriarchal societal attitudes, without honoring the genuine psychological pain of the abusive male. Although some men with strong psychopathic tendencies are almost impossible to treat, the majority of spouse-abusing males respond best to an empathic, client-centered, self psychological approach that also includes education about sociocultural issues and specific skill building. Understanding the deprivations in mirroring selfobject functions from which these men typically suffer facilitates clinical treatment response. While insisting that men take full responsibility for their abusive behavior, treatment approaches can still be most effective by addressing inherent psychological issues. Group leaders who can offer respect for perpetrators' history, their experience of powerlessness, and their emotional injuries in primary relationships are more likely to make an impact. (+info
Physician characteristics and the physician-patient relationship. Impact of sex, year of graduation, and specialty.
OBJECTIVE: To examine the association of physician sex, medical specialty, and year of graduation from medical school with attitudes and behaviours that define physician-patient relationships. Hypotheses tested are that women physicians, family physicians, and recent graduates spend more time discussing lifestyle and general health issues during patients' first visits; are more likely to report behaviours that are empathetic and that encourage communication with patients; are less likely to view their role as directive and problem-oriented; and are more supportive of patients' rights to information and participation in decision making. DESIGN: A survey was mailed to a stratified random sample of physicians between February and June 1996. SETTING: Physician practices in Ontario. PARTICIPANTS: Of 714 practising Ontario physicians, 405 (57%) responded. MAIN OUTCOME MEASURES: Proportion of time and actual time spent discussing a patient's lifestyle during a first visit, communication style, attitudes regarding a directive approach to care, and attitudes regarding patients' rights. RESULTS: Women physicians and family physicians spent significantly more time discussing lifestyle during a first visit. Women, family physicians, and recent graduates were significantly more likely to report an empathetic communication style. Women and recent graduates were significantly less likely to have a directive, problem-oriented approach to care. Family physicians were significantly less supportive of patients' rights than medical and surgical specialists were. CONCLUSIONS: Physicians in this study reported empathetic communication styles and attitudes that support information sharing and patients' rights. (+info
The importance of intuition in the occupational medicine clinical consultation.
Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined. (+info
Threats to global health and survival: the growing crises of tropical infectious diseases--our "unfinished agenda".
Health, one of our most unassailable human values, transcends all geographic, political, and cultural boundaries. The health problems of the rapidly growing 80% of the world's population that live in the tropical developing countries of Asia, Africa, and Latin America pose major threats to industrialized as well as developing regions. These threats can be divided into three areas, or three "E"s: (1) emerging, reemerging, and antimicrobial-resistant infections; (2) exploding populations without improved health; and (3) erosion of our humanity or leadership if we ignore the growing health problems of the poor. Our assessment of current trends in global population distribution and resource consumption; DALY calculations, causes, and distribution of global mortality and morbidity; and the misperceptions about and maldistribution of resources for health point to the critical importance of addressing tropical infectious diseases and global health for preservation of democracy and civilization as we know it. (+info
Changing attitudes about schizophrenia.
Research on the effectiveness of short-term education programs in changing societal attitudes about mental illness has been mixed. Education efforts seem to be mediated by characteristics of the program participants. This study determines whether the effects of a specially prepared, semester-long course on severe mental illness are mediated by pre-education knowledge about and contact with severe mental illness. Eighty-three participants who were enrolled in either a course on severe mental illness or general psychology completed the Opinions about Mental Illness Questionnaire before beginning the course and at completion. Research participants also completed a pre-and posttest of knowledge about mental illness and a pretest on their contact with people who have severe mental illness. The education program had positive effects on some attitudes about mental illness. Interestingly, the effects of education group interacted with pre-education knowledge and contact and varied depending on attitude. Participants with more pre-education knowledge and contact were less likely to endorse benevolence attitudes after completing the education program. Participants with more intimate contact showed less improvement in attitudes about social restrictiveness. Implications of these augmentation and ceiling effects are discussed. (+info
Countertransference and empathic problems in therapists/helpers working with psychotraumatized persons.
Countertransference in therapists working with patients with posttraumatic stress disorder (PTSD) differs from countertransference in other psychotherapeutical settings. In this article we discuss the specificities of counter- transference in treating PTSD patients and its relation to empathy. The most difficult countertransference problems occur in treating multiply traumatized patients. Countertransference may occur towards an event (e.g., war), patients who have killed people, as well as to colleagues who avoid treating PTSD patients, or towards a supervisor who avoids, either directly or indirectly, supervision of therapists working with PTSD patients. Our recommendation for the prevention of problems in treating PTSD patients include : 1) careful selection of the therapist or helper, both in the personality structure and training; 2) prevention by debriefing and team work and peer supervision; and 3) education - theoretical, practical, and therapeutical. (+info
Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire.
PURPOSE: To develop a psychometrically sound patient-satisfaction-with-physician questionnaire that can be used in an outpatient oncology setting. PATIENTS AND METHODS: The questionnaire was developed by a four-step process involving a total of 277 cancer patients. The item-generation process utilized input from 95 oncology outpatients, three medical researchers, and the relevant literature. Items were tested by 70 of the above patients. Initial item reduction was achieved by input from another eight patients. Factor analysis and validity testing used data derived from a different group of 174 oncology outpatients. Convergent validity was tested by correlating the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD) with Rubin et al's Physician subscale of the Patient's Viewpoint Questionnaire (PS-PVQ) and Smith et al's Patient-Doctor Interaction Scale (PDIS). Divergent validity was tested by comparing these questionnaires with Spitzer's quality of life (QOL) questionnaire. RESULTS: The final PMH/PSQ-MD is a 29-item self-administered questionnaire with four response categories and a "does not apply" category. Four domains were confirmed by factor analysis: (1) information exchange, (2) interpersonal skills, (3) empathy, and (4) quality of time. The questionnaire has an overall Cronbach's alpha of 0.97; the values for each domain are, respectively, 0.92, 0.90, 0. 88, and 0.88. The PMH/PSQ-MD correlated well with both the PDIS and the PS-PVQ (P <.001 for both). Divergent validity was confirmed with Spitzer's QOL questionnaire. CONCLUSION: The PMH/PSQ-MD is an outpatient satisfaction questionnaire specific to the patient-physician interaction that has shown excellent internal consistency, is feasible, and has strong support for validity in this oncology population. (+info