No abstract

In this analysis particular emphasis is given to the question of blame in meaningful relationships, such as those occurring within families and between practitioners and their clients. The authors suggest there is a potential in these contexts for the subjective experience of being blamed to challenge, perhaps even disturb, an individual's sense of personhood and for interpersonal boundaries to therefore become de‐regulated. A general implication for practice is then raised: if blame can be so powerful in its effects, practitioners may benefit from talking explicitly to their clients about blame in order to access intrapsychic and interactional material, for its relevance to the immediacy of the client's lived experience, for its ability to contribute to engagement, and perhaps most importantly, because feeling blamed and being blaming reduces the self‐agency available to clients and hence potential for change.

Acquired Brain Damage (ABD) causes immense difficulties for individuals and families and is increasingly recognised as a serious community issue. This paper focuses on the burden placed on family members with a head injured relative. The authors propose that when working with families with a member with a neuropsychological condition, the family therapist may be required to embrace a more flexible role. Depending on the developmental needs of the family, the family therapist may at times: provide educational information about brain damage and its effects arrange family support groups or wider network meetings be the family's advocate in the context of complex legal and financial bureaucracies or undertake marital, sexual or family therapy when required. Whatever the role played, a ‘family sensitive practice’ approach by family therapists is advocated. It is also deemed useful to develop a theoretical assessment model which helps the therapist locate where individual family members are in their negotiation of the tasks of grieving, restructuring, identity reformation and achieving a sense of growth after head injury. Further implications for clinical practice are outlined.

This study presents findings from a 21-month study situated at a large PSR agency (Thresholds). Comparisons of vocational outcomes are reported for two groups of people who are members of an Assertive Community Treatment [ACT] program. A comparison group (n = 144) received routine ACT services. The intervention group (n = 139) received ACT and vocational services through a "blended vocational model," combining elements of the agency's extant Diversified Placement Approach with elements of the Individual Placement and Support model. The positive outcomes demonstrate that combining elements of both models is a valuable option for psychiatric rehabilitation agencies to consider.

Rather than assuming that confidentiality is an intransient problem, the authors conclude that dealing with the question of confidentiality sensitively presents clinicians with an opportunity to develop quality relationships with both clients and their families.