Shruti Singh Poulsen

Patient-centered communication and prognosis discussions with cancer patients

OBJECTIVE To examine physician communication associated with prognosis discussion with cancer patients. METHODS We conducted a study of physician-patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk. RESULTS Actor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (beta=.40, C.I.=0.11-0.68) attentiveness (beta=.32, C.I.=0.06-0.58) and being an oncologist vs. a family physician (beta=.33, C.I.=0.33-1.36) accounted for 46% of the variance in prognosis communication. CONCLUSION Eliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty. PRACTICE IMPLICATIONS Eliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.

Open Relationships: A Culturally and Clinically Sensitive Approach

Romantic and sexual relationships that challenge the notion of monogamy are more common and visible in American society than earlier years, yet there is very little literature focusing on therapy with clients in open relationships. Concepts from the literature on open relationships that could be used in couple and family therapy are discussed in addition to specific ethical considerations for therapists who work with this population. A case description that illustrates a clinical approach that draws upon constructionist and narrative elements is provided. A discussion of how therapists can assist with the negotiation of non-monogamy, and suggestions for ways to create secure therapeutic space for clients in open relationships also are provided.

Addressing Heterosexist Privilege During Orientation: One Program's Experience

New counseling students often have strong reactions when confronted with the concept of heterosexist privilege, and when expected to address issues of multiculturalism and diversity, personally and professionally. In this program evaluation article, the authors describe a model of new student orientation that focuses on inviting masters-level counseling students to embrace difference, especially regarding sexual orientation and gender identity/expression. Aggregate data regarding students’ evaluation of the program are included.

Narrative Therapy for Adoption Issues in Families, Couples, and Individuals: Rationale and Approach

This article explores the application of narrative therapy to clinical work with clients’ adoption-related issues. The importance of therapist competency in addressing adoption-related issues is the primary focus for exploring the application of narrative therapy with individual, couple, and family clients experiencing adoption issues. The narrative method can be effective in exploring and understanding the diversity of experience and meanings adoption triad members report in regard to their adoption experiences (Baden & Wiley, 2007; Daniluk & Hurtig-Mitchell, 2003). Multiple realities and meanings emerge as a theme in the adoption literature and as core concepts in the narrative framework.

Cultural Responsiveness in Family Therapy: Integrative and Common Factors Lens

While integrative approaches have had an impact on family therapy practice, how these approaches to therapy may be particularly suited to enhancing cultural responsiveness in family therapy has not been explored extensively. In this chapter, I will illustrate how I use the common factors lens (Sprenkle et al. (2009). Common factors in couple & family therapy: The overlooked foundation for effective practice. New York, NY: Guilford Press) and foundational therapeutic approaches such as the basic genogram and the cultural genogram (Hardy et al. (1995) Journal of Marital & Family Therapy 21:227–237, 1995; McGoldrick et al. (2008). Genograms: Assessment & intervention. New York, NY: W. W. Norton) integratively, to enhance cultural responsiveness in systemic and family therapy. Attunement to two factors, client and therapist factors, are considered important components of effective therapy models. Understanding the dynamic nature of clients’ lives and their cultural realities is critical to the therapy process. I will provide examples of how to utilize in family therapy the clinical tools that infuse cultural responsiveness and awareness of culture systemic work.

The Future of MFT: Clinical Implications of Cross-Cultural Responsiveness and Social Justice Lens to the Field

In our final chapter of this volume, we summarize the information from our contributors’ chapters and provide an overview of the future of the field of marriage and family therapy (MFT) and the continued need for attention to cross-cultural responsiveness and social justice. We bring together the overall themes of the book and how each of the authors has contributed to these themes as well as to the larger implications and conclusions we can draw regarding the future of systemic therapies and multiculturalism.

Expanding Conversations About Cultural Responsiveness in Supervision

Understanding the dynamic nature of therapists’ and clients’ lives and their cultural realities is important to the supervision process. As a systemic clinical supervisor, I aim to use clinical tools that support and overtly address clients and supervisees’ complex and diverse contexts to enhance cultural responsiveness in supervision. In this chapter, I will illustrate the common factors lens (Sprenkle et al., New York: Guilford Press, 2009) combined with foundational couple and family therapy techniques such as the genogram and cultural genogram (Hardy & Laszloffy, Journal of Marital & Family Therapy, 21, 227-237, 1995) and the MECA model (Falicov, Family Process, 34, 373-388, 1995; Family Process, 46, 157-171, 2007) as a framework for cultivating and expanding the conversation on cultural responsiveness in supervision.