Suchergebnisse

Despite awareness in social work and related literatures that sociocultural power dynamics are reproduced in practice, there is little research on how whiteness manifests as an oppressive discourse in clinical settings. This article analyzes audio-recorded therapy sessions between white therapists and racialized immigrant clients from an urban community mental health center in Canada to explore the ways in which whiteness shapes clinical encounters. Using poststructural theories of discourse and conversation analysis, the authors examine how discursive strategies that therapists and clients use in therapy sessions produce and reify whiteness as a prominent feature of cross-cultural communication. The findings illustrate how therapists maintain whiteness as an unmarked norm in their assessment of individual development and the family life cycle and how clients respond to, negotiate with, and resist whiteness, which positions them as subordinate others in Canada. The authors conclude with a discussion of implications for practice and future research.

Bodily phenomena that are difficult to identify, localize, explain and cure with the aid of modern biomedical knowledge and technology leave ample room for cultural influence. That makes them a perfect case for studying the cultural dimension of medical knowledge and practice. Building on this assumption we qualitatively explore the communication between neurologists and women with seizure disorders of uncertain etiology, often labeled psychogenic non-epileptic seizures (PNES), in a specialist clinic in England. Based on an interpretation of film-recordings of eight naturally-occurring clinical consultations we discuss the following questions: How do neurologists explain the name, the cause and the treatment options to these patients? How do patients and their companions respond to these explanations? And finally, what makes these interactions so difficult? Our interpretation of the data is inspired by critical discourse analysis, and framed within a social constructionist perspective on medical knowledge and practice. We found that the neurologists presented the diagnosis and its cause -inappropriate stress management -through objective language that conveyed a high degree of certainty. Patient-parties often disagreed, and found it hard to believe that these physical symptoms had a psychological origin. Companions often acted as advocates for the patients in negotiations with the doctors. The polarized debate between psychogenic and somatic understandings of the seizures that emerged illuminates how the Cartesian dualism between body and mind complicates clinical encounters - a dualism doctors explicitly reject, but presumably accept. We argue that it is impossible to overcome this polarization without acknowledging the cultural dimension of medical knowledge and practice. (author's abstract)

Purpose Characterize factors associated with smoking-cessation counseling in clinical encounters. Design Cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) 2000 data. Setting U.S. households. Subjects 10,582 smokers (aged ≥ 18 years) reporting one or more clinical encounters during the prior year. Measures Multivariate-adjusted odds ratios (OR) and 95 % confidence intervals (CI) for quit advice associated with respondent and encounter variables. Results Almost 55 % of respondents were advised to quit smoking. Young men were advised to quit least often. Increasing age (18–24, 25–39, 40–64, ≥65 years) was associated with increasing odds of receiving quit advice (OR = 1.33, CI 1.10–1.61) for men. Other positive associations with quit advice included patient education, BMI, diagnosis of asthma, and private health insurance. Patients seeing physicians had greater odds of being advised to quit smoking (OR = 3.29, CI 2.13–5.06) than those seeing dentists. There was a 4% to 23% chance of receiving quit advice at any given nondental clinical encounter; the odds of such counseling did not rise significantly with the number of visits. Conclusion Smoking cessation counseling may be provided preferentially on the basis of patient demographics, and often is not provided at all. In a given year, just over half of smoking patients are advised to quit, and such counseling is provided at less than a quarter of clinical encounters.

Catholic social teaching (CST), a branch of moral theology, addresses contemporary issues within the political, economic, and cultural structures of society. The threefold cornerstone of CST contains the principles of human dignity, solidarity, and subsidiarity. It is the foundation on which to form our conscience in order to evaluate the framework of society and is the Catholic criteria for prudential judgment and direction in developing current policy-making. With knowledge of these social principles, in combination with our faith, we will be more armed and informed as to articulate the Catholic vision of reality, the truthful nature of the human person and society, to apply and integrate the social teachings in our everyday administrative and clinical encounters, and through the virtue of charity take action within the social, political, and economic spheres in which we have influence.

Objectives: Women's healthcare is a potential source of cross-cultural conflicts. Diverging values between healthcare providers and patients challenges the provision of culturally sensitive care and meeting migrant women's needs. The aim is to investigate healthcare providers' values in relation to sexual and reproductive rights, gender equality, migration and religion in Swedish sexual and reproductive healthcare. Methods: A national cross-sectional study was carried out. The questionnaire was distributed through a non-probability sample to midwives or other nurses, gynaecologists and obstetricians, and hospital social workers (n = 1,041). Through descriptive statistics, we mapped their values, comparing healthcare provider data to external representative population survey data. Results: Healthcare providers in sexual and reproductive healthcare displayed homogeneous liberal social values, being permissive towards sexual and reproductive rights and restrictive against gender-based violence. They were for gender equality, expressed low anti-immigrant sentiments, and had even more liberal values than the Swedish population and a demographically comparative sub-population. Conclusion: Individuals with very liberal values are selected to work in Swedish sexual and reproductive healthcare. Healthcare providers need self-reflexivity to avoid conflicts in clinical encounters in a diversified society.

Describes how issues of class and politics, and the intense emotions they engender, emerge in the clinical setting and how psychotherapists can address them rather than deny their significance. This book demonstrates how clinicians need to take into account the complex convergences between psychic and social reality to help their patients.