(WITHDRAWN) Understanding Health Talk in Clinical Social Work Encounters: A Qualitative Analysis

Background: There has been growing awareness that physical and psychological health are inextricably intertwined and therefore, attending to the physical health and wellbeing of individuals can positively impact their behavioral health outcomes. Presently, in mental health settings interventions that address the physical health of clients are often delivered separately rather than being embed within routine therapeutic work, though it is likely that health issues are also being discussed within clinical sessions as well. Few studies have explored how health talk naturally occurs during therapy, and the implications of these conversations for traditional therapeutic approaches. This qualitative study examines the frequency and content of health talk in clinical social work sessions, and describes its impact on therapeutic sessions.

Methods: This study occurred within the behavioral health department of an integrated community health center. Data consisted of 51 therapy sessions between provider-client dyads that were transcribed verbatim. First, content analysis was used to determine the frequency with which physical health was brought up in sessions. Iterative coding guided by sensitizing concepts was completed, followed by thematic analysis was used to distil codes into meaningful patterns and themes that described how health talk impacted therapy sessions. This process was facilitated by memo writing, peer debriefing, and constant-comparative techniques.

Results: Health talk occurred in 92% (n=47) of sessions, and the majority of these discussions were initiated by clients. Discussions about sleep (40%, n=19), diet/exercise (35%, n=16), and chronic health conditions (28%, n=13) were the most common. Analysis suggests that health talk either complimented or conflicted with therapeutic work, depending on both the health topic discussed, and when it occurred during the course of the session. Health talk changed the scope of therapeutic work by integrating care coordination activities into routine clinical practice.

Conclusions: Findings suggest that physical health talk is pervasive in therapeutic sessions. These conversations are frequently initiated by the clients, signaling the relevance of physical health to service users’ own goals for psychological wellness, recovery, and wellbeing. While providers often leveraged heath talk to complement and enhance their therapeutic work, these strategies were not universally applied. Incorporating physical health talk into sessions inherently changed the traditional scope of the therapeutic work as clinicians engaged in routine care coordination activities. Practice and policy changes that can support a more interdisciplinary approach to clinical work are needed to prepare providers to respond to the full range of health issues that emerge during therapeutic sessions .