Religious Clients, Strong Religious Beliefs

Their personal or family con?icts have become too great; and the answers, cures, or solutions within their religious framework have failed.
Because religion represents both culture and personal choice, differences between counselor and client, though not visible, can still be pronounced and unsettling . You might be directly asked about your religious beliefs in an initial interview. We recommend a balanced response:
  • First, as a professional, it is your job to explore both the cause for concern and the
concerns themselves as they relate to the client’s problems and needs.
  • Second, have a truthful and carefully considered answer ready. Refusing to share
a brief summary of your own religious or spiritual orientation only exacerbates the concerns in most situations. After your summary, return the topic to how it feels for the client to work with you. Do not debate matters of faith.
One of our colleagues, a psychologist who is also an ordained minister, often provides religious clients with the following commentary about the relationship between religious and psychological well being: I understand it can be hard for a person with strong religious beliefs to consult a professional about personal problems. One way I look at it is like this: I know some people who are doing very well psychologically and very poorly when it comes to their religious adjustment. On the other hand, I know some people who are doing ?ne with their religious life, but they have some psychological or emotional work to do. Although many times religious and psychological well being are highly connected, being well in one area doesn’t necessarily mean you are feeling well in the other. I guess what I’m saying is that, if you want, I think we can work on the emotional and psychological concerns here, without violating issues of faith.
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Exercise Prescription, Strong Evidence

The exercise leader and team need to combine the art and science of exercise prescription and behavioural change to enhance exercise compliance and promote long term adherence. The ACSM acknowledge this: unfortunately exercise testing and exercise prescription are often overemphasised in relation to behavioural components of the programme.Effective behaviour change, which optimises secondary prevention, involves engaging people in a commitment to an active lifestyle and generalising the exercise habit beyond the rehabilitation session. Some strategies include integrating personal contracts and one to one motivational interviewing into the exercise programme.Although there are many factors that contribute to exercise adherence, there is strong evidence that the qualities of the exercise leader can have an enormous in?uence on cardiac patient participation .
A CR exercise leader should be:
  • professional, credible, con?dent and enthusiastic;
?a respected advocate and role model for CR; ?a skilled listener, communicator, facilitator and educator; ?a decision maker, with autocratic or democratic style, as required;164 Exercise Leadership in Cardiac Rehabilitation ?a motivator with persuasive skills who sets realistic and achievable aims;
  • tactful, organised, with a planned, systematic approach, directive as
appropriate;
  • an excellent manager of time, people and documentation;
  • empathic and sincere, an optimist with a strong personality;
  • in control of situation creates atmosphere and promotes fun
.
Many of the leadership characteristics demonstrated in management of the patient groups are also common and equally important to the professional responsibilities and relationship between the exercise leader and the rest of the CR team.
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Exertion Scale, Strong Sense

The RPE is advised in CR because it is moderate submaximal exercise, where muscle and breathing sensations respond in an almost parallel fashion to the exercise stimulus, unlike exercising at higher intensities.
PERCEIVED EXERTION IS MORE THAN USING AN RPE SCALE Many clinicians will discharge patients based on the rating of perceived exertion scale. However, there is another step to be achieved, and that is for patients to be knowledgeable and experienced with the physical sensations, without the rating scale, of the appropriate intensity. The ultimate example of using perceived exertion to control exercise intensity is found in elite endurance athletes who, through their continuous training, have developed a strong sense for pacing. They are able to endure exercise on a very ?ne line between sustaining their pace and becoming fatigued; physiologists studying bicycle performance have termed this point the

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Strong Borg Cr10 Scale, Light Light <

It took over twenty years for Borg to formulate what was felt to be a 6

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Strong Emotional Reactions, Disproportionate Emotional Reactions

If you take your clients’ emotional reactions to you too personally, you will probably experience strong emotional reactions. Strong or disproportionate emotional reactions to clients constitute countertransference.

Countertransference

Countertransference is similar to transference, except it happens to interviewers rather than clients. Countertransference, like transference, stems from con?icts, attitudes, and motives not consciously experienced. Countertransference also consists of emotional, attitudinal, and behavioral responses that are inappropriate in terms of their intensity, frequency, and duration. It is important and helpful for professional interviewers to become aware of their own countertransference patterns .

Although countertransference is similar to transference, there are several important differences. Originally, S. Freud identi?ed countertransference as a reac116 Listening and Relationship Developmenttion to client transference. This is certainly the case sometimes. On occasion, clients treat their interviewers with such open hostility or admiration that interviewers ?nd themselves caught up in the transference and behave in ways that are very unusual for them. For example, at a psychiatric hospital, a patient once unleashed an unforgettable accusation against her therapist: “You are the coldest, most computer like person I’ve ever met. You’re like a robot! I talk and you just sit there, nodding your head like some machine. I bet if I cut open your arms, I’d ?nd wires, not veins!” Certainly, this accusation might be considered pure transference. Perhaps the client was responding to her therapist in this manner because, in the past, she experienced males as emotionally unavailable. On the other hand, as the saying goes, it takes two to tango. As interviewers, we need to look at our own contributions to the therapist client dance.
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Strong Feelings, Negative Feelings

Second, when clients do not know if they should talk about something, they should be encouraged to discuss it, at least so interviewer and client can collaboratively decide whether the information is important. Discussing issues together enhances the collaborative relationship.
Third, although the client is suggesting otherwise, his or her feelings may well be related to the interviewer-the client’s perceptions of the interviewer’s competence or because his or her appearance or personality style reminds the client of someone else. If so, the client needs to know that he or she can express concerns, whether those concerns are based on reality or imagination. These concerns may be signs of transference and should not be ignored .
Fourth, when clients attend their ?rst counseling sessions, they often feel worse because they are focusing on and discussing uncomfortable problems. Consequently, explaining to clients that they may feel hopeless, mixed up, or angry while discussing their problems can prevent premature therapy dropouts.
The following explanations might help if a client has strong negative feelings about being interviewed:
  • “If you’re unsure about whether you should talk about something in here, I want
you just to go right ahead and talk about it as much as you can. That way, at least we can decide together whether it’s important.”
  • “Sometimes, people develop strong feelings about their counselors or about counseling. Usually, these feelings are important to talk about, even if they’re negative.”
* “You know, it’s not all that unusual to have negative feelings during counseling.
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Strong Feelings, the Confrontation

  • To a socially anxious client: “When people don’t say hello to you, you think they’re
rejecting you, when it’s probably only because they’re having a bad day or have something else on their minds.” Reframes may be met initially with denial, but having clients view their interactions or problems in a new way can reduce anxiety, anger, or sadness. Reframes promote ?exibility in perceiving or interpreting actions.

Confrontation

The goal of confrontation is to help clients perceive themselves and reality more clearly.

Clients often have a distorted view of others, the world, and themselves. These distortions usually manifest themselves as incongruities or discrepancies. For example, imagine a client with clenched ?sts and a harsh, angry voice saying, “I wish you wouldn’t bring up my ex wife. I’ve told you before, that’s over! I don’t have any feelings toward her. It’s all just water under the bridge.” Obviously, this client still has strong feelings about his ex wife. Perhaps the relationship is over and the client wishes he could put it behind him, but his nonverbal behavior-voice tone, body posture, and facial expression-tells the interviewer that he’s still emotionally involved with his ex wife.
Confrontation works best when you have a working relationship with the client and ample evidence to demonstrate the client’s emotional or behavioral incongruity or discrepancy. In the preceding example, we wouldn’t recommend using confrontation unless there was additional evidence indicating the client’s unresolved feelings about his ex wife. If there was supporting evidence, the following confrontation might be appropriate: “You mentioned last week that every time you think of your ex wife and how the relationship ended, you want revenge. And yet today, you’re saying you don’t have any feelings about her. But judging by your clenched ?sts, voice tone, and what you said last week about her

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Strong Projections, the Posterior Thalamic Nucleus Arises

The entire trigeminal sensory nuclear complex projects to the thalamus . The trigeminothalamic tract projections are not uniform. Following unilateral horseradish peroxidase injections into the thalamus, Kemplay and Webster counted 8,683 retrogradely labeled neurons in the PTN, 524 cells in the STNo, 1, neurons in the STNi, and 260 labeled cells in the STNc. Generally, the projection toward the VPM and the posterior thalamic nucleus arises mainly in PTN and in STNi, while the nucl. submedius and the intralaminar nuclei are heavily innervated by the nociceptive STNc. The lamina I neurons send strong projections to the nucl. submedius, VPM, and Po. The deeper laminae moderately innervate VPM and Po, but project heavily to the ventral diencephalon . The smallest thalamic innervation arises in STNo. The TTT is bilateral but, especially for the STN, strongly crossed.
Projections to the Ventrobasal Thalamus in the Rat We examined the projections of the trigeminal sensory nuclei, DCN, and the SC to the thalamus by means of the retrograde axonal transport ?uorescent method of Kuypers et al. . We injected unilaterally in the thalamus of Wistar rats 2 ?l of 1%Fast Blue , 0.5 ?l per injectionfocus.Twoinjectionswereplaced6mm,andtwo5mmanteriorto the interaural line. The injection foci spread to all somatosensory thalamic nuclei on the side of the injection, including the ventrobasal complex ,Ascending Pathways of the Spinal Cord and of the STN posterior nucleus group, and the intralaminar nuclei. Animals were transcardially perfusion ?xed 5 days after injection. This ?uorescent dye labels the cytoplasm silver blue, and in heavily loaded cells extends also in the dendrites. The FB injection foci are sharply demarcated , and it is successfully transported over long distances. The present results are comparable with our previous data, obtained with a very effective retrograde tracer colloidal gold conjugated to the B subunit of cholera toxin .
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