Dislike of one’s clients is a problem many clinicians encounter and it can have a drastic negative impact on client-clinician rapport, as well as the intervention outcome. Reasons for dislike can be varied and are not clearly known, as little research has been done on the topic. The purpose of this pilot study was to begin to understand how clinicians experience and navigate dislike for clients in practice. The study yielded critical information regarding the factors that influence dislike and the coping skills utilized by practitioners to counter or ameliorate such feelings. Recommendations for practitioners are provided, including a better understanding of feelings of dislike for one’s client outside of the countertransference framework of understanding.
Background
In the context of the current U.S. injection drug use epidemic, targeted public health harm reduction strategies have traditionally focused on overdose prevention and reducing transmission of blood-borne viral infections. Severe bacterial infections (SBI) associated with intravenous drug use have been increasing in frequency in the U.S. over the last decade. This qualitative study aims to identify the risk factors associated with SBI in hospitalized individuals with recent injection drug use.
Methods
Qualitative analysis (n = 15) was performed using an in-depth, semi-structured interview of participants admitted to Bellevue Hospital, NYC, with SBI and recent history of injection drug use. Participants were identified through a referral from either the Infectious Diseases or Addition Medicine consultative services. Interviews were transcribed, descriptively coded, and analyzed for key themes.
Results
Participants reported a basic understanding of prevention of blood-borne viral transmission but limited understanding of SBI risk. Participants described engagement in high risk injection behaviors prior to hospitalization with SBI. These practices included polysubstance use, repetitive tissue damage, nonsterile drug diluting water and multipurpose use of water container, lack of hand and skin hygiene, re-use of injection equipment, network sharing, and structural factors leading to an unstable drug injection environment. Qualitative analysis led to the proposal of an Ecosocial understanding of SBI risk, detailing the multi-level interplay between individuals and their social and physical environments in producing risk for negative health outcomes.
Conclusions
Structural factors and injection drug use networks directly impact drug use, injection drug use practices, and harm reduction knowledge, ultimately resulting in tissue damage and inoculation of bacteria into the host and subsequent development of SBI. Effective healthcare and community prevention efforts targeted toward reducing risk of bacterial infections could prevent long-term hospitalizations, decrease health care expenditures, and reduce morbidity and mortality.
A t the time of this writing, severe acute respiratory syndrome coronavirus 2 has caused over 7.6 million cases and over 423,000 deaths worldwide. 1 New York City confirmed its first positive case on March 1, 2020, and quickly became the center of the pandemic, with over 214,000 confirmed cases to date. 2 To provide support to overwhelmed New York City hospitals, the Department of Defense (DOD) was deployed to provide medical care for patients at the Javits Center Field Hospital (Javits) and United States Naval Ship Comfort (USNS Comfort) in April 2020. Due to low patient populations at Javits and USNS Comfort, many DOD personnel redeployed to the city's public healthcare system, New York City Health and Hospitals (NYC H+H), to provide frontline care within emergency departments, intensive care units, and medical/ surgical wards. 3 Additionally, Javits changed its admission criteria to include patients who tested positive for COVID-19, which ultimately led to the acceptance and treatment of over 1,000 patients with COVID-19. From this experience, DOD healthcare workers reported to their
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