Managing care in the community: Analysis of a training workshop

Summary

Managing mental illness in the community is an anxiety provoking business. Yet the legislative emphasis on business management and rapid re-structuring both creates anxiety in workers and carers and appears to devalue those traditional psychotherapeutic skills which facilitate the containment of anxiety. Anxieties that are put out of mind (not contained) have damaging and dangerous consequences for carers, users and members of the public.

This paper is about a ten-week workshop with the task of providing a safe, constructive setting where the anxieties generated by community care of the adult mentally ill could be identified, addressed and thought about. The developments within the workshop are analysed as the process shifts back and forth between paranoid-schizoid and depressive position modes of functioning gradually progressing towards the latter. Members gradually found the ability to combine therapeutic and business management skills so that they could regain their authority in relation to the work while retaining an openness to mental disturbance in others and in themselves. This emerged through a greater appreciation of the complex relationships that exist within communities. In this way the workshop also offered members a model of containment that could be internalised.     

Integrative module-based family therapy: application and training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.     

Howard Becker's summer workshop in visual sociology: A personal view

We social scientists fumble with the forms of social life—from mating pair to extended family; from friendship clique to community; from work team to corporation. We think of a group—say the Daughters of the American Revolution or the Mothers of Invention—and nothing much comes to mind, only a dull uncomprehending blankness. What IS a group exactly? We find even our most vital areas of social science hobbled for want of clear conceptions to fix understandings of key terms such as group, family, organization, and culture. This article reports my halting progress with the question of how to study human groups. My answer comes in images such as those of Plate 1. Here we have, first, children dancing arm in arm in a graveyard. Their joined circle is a living form—bounded in space and time, full of tension, rhythm, harmony, growth and possibility. Counter‐posed to the dancing children is the graveyard, which is likewise a form bound in space and time and animated by rhythms and growth. It is a remarkable fact that even in death, when there is no reason for it, we remain together with others, united in groups. Such images as these, I argue, are key to a scientific study of groups. In them we find the group.     

Symbols,anxiety, and ritual: A functional interpretation

This article deals with the relationship between symbols and ritual. The thesis is advanced that the human capacity for symbol production creates disruptive problems as well as adaptive advantages and that ritual serves as one major mechanism for controlling these disruptive aspects. Symbolic awareness greatly expands an organism's psychological field, and it is argued here that this expansion in turn generates problems of information organization, extended awareness of threat and amplification of appetitive drives. These extensions of consciousness are potentially disruptive and anxiety producing to the individual and may threaten group coherence as well. We maintain that by structuring symbolic expression, ritual behavior serves the important function of delimiting the proliferative tendencies inherent in symbol production and thereby helps to control this disruptive potential.     

The application of financial management in enterprise management

Nowadays,financial management plays a vital role in the process of enterprise operation.To improve the level and ability of financial management of enterprises is of great significance to the realization of the modernization of enterprises and the sustainable development of science.In this paper,the financial management status would be first proposed,and suggestions would be made to improve the financial management in enterprises.     

Future anxiety: Clinical issues of children in the latter phases of foster care

Children in foster placement are often considered clinically in terms of the issues that led to their being separated from their families. Placement has been recognized as a powerful intervention in the lives of children and families, with ramifications of its own extending through time. Despite the movement towards permanency planning, children continue to be exposed to periods of uncertainty, ambivalence, and ambiguity about the resolution of placement. This uncertainty, along with the intrinsic transience and marginal identity connected with the role of foster child, reduces the child's sense of stability, attachment, and predictability. Children in foster care often feel powerless, and may resort to disruptive behavior in an attempt to influence decisions about their future. Other responses include depression, withdrawal, and passivity. Future anxiety is a system issue, which needs to be addressed by the adult caregivers in the child's life. The reality is that children in foster placement often face chronic loss, and caregivers may resist sharing in the child's experience. This dynamic makes the development of a support system to help the caregiver manage feelings about the child and his or her role in the child's life a necessity. Four case examples are discussed, illustrating interventions in working with issues of future anxiety.He is also a consulting psychologist for the Family Life Center at the Massachusetts Department of Social Service.     

Professional morale and social work training: A study

This article presents the results of an empirical study that was designed to ascertain the state of professional morale of the membership of the Connecticut Society for Clinical Social Work. The data suggest a dissatisfaction with career choice. Reassessment of the character and quality of social work supervision emerges as one of the study's implications.This article is adapted from the author's Masters thesis,Social Workers, Social Work, and Professional Self-Perceptions (1978), for the Smith College School for Social Work. The author wishes to thank Professor Roger Miller of Smith for his helpful comments.     

Clinical aspects of the training of foster parents

This paper recognizes that training programs for foster parents are as good as their implementation for which the author emphasizes the need for clinical expertise. It is important to help foster parents emphasize and understand issues of grief over loss and separation and the child's expressions through behavior. Techniques to help foster parents with these issues are identified.     

A model for assertive training: Integration of feelings and behavior

The current emphasis in assertive training is based on behavioral and cognitive approaches. In this paper the authors present an approach which explores the interconnectedness of feelings and behavior in the learning of assertive skills. Creatively designed structured exercises are presented as tools used to bring people into contract with themselves, to highlight nonfunctional behavior, and to provide the means to try out and practice new assertive behaviors. The impact of the exercises as a learning vehicle in assertive training is described and discussed.     

Effectiveness of a stress management program in reducing anxiety and depression in nursing students.

This study sought to develop a stress management program based on the arousal-attribution stress model and to evaluate the effectiveness of the program in reducing anxiety and depression experienced by nursing students. Forty-two sophomore and 34 senior nursing students in a private, sectarian, liberal arts college were randomly assigned to experimental and control groups. All subjects were given pre- and posttests consisting of the State form of the State-Trait Anxiety Inventory and the Institute for Personality and Ability Testing Depression Scale. Posttest analysis indicated that the experimental group had significantly lower anxiety and depression than the control group (p less than .05). These results support the use of the arousal-attribution stress model as a theoretical framework for stress management training.