Creating Dialogic Contexts for Multidisciplinary Clinical Reviews: The Reflecting Team Process

When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.     

Multidisciplinary Team Perspectives on Older Adult Hoarding and Mental Illness

This qualitative study examined multidisciplinary team members' perspectives of their involvement in older adult hoarding cases. Fifteen informants, as representatives of four hoarding teams, described cases in which teams did or did not work well together. Specifically, informants described their (a) team characteristics, (b) awareness of hoarding as a mental health illness, (c) barriers to providing mental health services for older adults who hoard, and (d) components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.     

Psychologists and psychiatrists who violate the Goldwater Rule are guilty of malpractice

ABSTRACT

A number of psychiatrists and psychologists declared in the past year that the newly elected president was unfit to hold office due to mental illness, or being dangerous. Such declarations were made even though the subject had not been personally interviewed or tested and, consequently, they are guilty of malpractice. This has aggravated the already toxic milieu, wherein various prominent individuals have called for a coup d’etat to take place and families have broken up over election choices. Historical precedents for the current actions of these psychiatrists are presented, both in the United States and overseas. Dissenting psychiatrists brought up the Goldwater Rule that was created after the 1964 presidential election, which states that a psychiatrist may not make pronouncements of mental health on an individual that they have not personally examined. It is urged that the American Psychological Association and the Association for Psychological Science adopt the ethical Goldwater Rule.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

Recovery From Mental Health Problems: Scratching The Surface Without Ethnography

This article examines a central plank of mental health policy (‘recovery’) in societies which have attempted to reverse the long-term warehousing of those with a diagnosis of mental disorder (de-institutionalisation). The emergence of the concept is traced in relation to the shift from an institutional to a more dispersed and community-based form of service organisation. Different usages of the term ‘recovery’, each with distinct implications for practice are considered on the part of three main interest groups (traditional bio-medical psychiatrists; social psychiatrists emphasising social skills training; and dissenting service users). These different usages suggest that ‘recovery’ is a polyvalent concept that creates an uneasy consensus point to define the management philosophies of local services enacting mental health policy. Also mental health work is about more than the group of patients mainly considered in relation to recovery (those with ‘severe and enduring mental health problems’). Practice-near research strategies are now required to investigate the varied practical scenarios these contradictions generate and ethnographic research is therefore indicated. Without multiple ethnographies, we will be left with competing rhetoric about recovery and its meaning or meanings may be rendered worthless.     

The team as a secure base: Promoting resilience and competence in child and family social work

This paper outlines research findings on the relevance of the Secure Base model (Schofield & Beek, 2014) for developing supportive teams in child and family social work. When the social work team functions as a secure base, this can help workers cope with the emotional demands of the role. The concept of the secure base comes from attachment theory (Bowlby, 1969) in which our relationships with significant others, who are available, sensitive to our needs and reliable, provide us with a secure base to return to when life is stressful and provide us with comforting internal mental models when we are physically away from them. This ‘secure base for exploration’ reduces anxiety and enables us to engage with the world, consider the internal world of others (empathy) and remain resilient when life is stressful. Using data from 52 phone interviews with child and family social workers across eight local authorities in the UK, we show how the Secure Base model has relevance for emotion regulation and resilience for child and family social workers. Data were analysed using Theoretical Thematic Analysis (Braun & Clarke, 2006). In the context of the emotional demands of social work, our data indicate that the supervisors and teams provide a work related secure base across five dimensions by behaving in ways which instil these beliefs: Availability -‘People are there for me’; Sensitivity - ‘My feelings are manageable’; Acceptance - I don't always have to be strong’; Cooperation - ‘I can work with others to find a solution’; Team belonging - ‘I am valued and I belong’. Implications for practice are proposed to help supervisors and team members reflect on beliefs and behaviours which can help provide a secure base for their teams.     

Suicidal Ideation in the Palliative Care Patient: Considerations for Health Care Practice

In the present study, I outline how four social workers, with experience in working with women who self-starve, commonly known as anorexia nervosa, conceptualise this phenomenon. I conducted single, in-depth interviews with each worker and feminist discourse analysis was chosen as the method of text interpretation. Alternative (non-psychiatric) ways of understanding women's self-starvation were explicitly privileged. Hence, the alternative discourses of feminist and poststructural theories were used to design the research and analyse the data. The literature review outlines the historical ‘discovery’ of ‘anorexia nervosa’ as a discrete illness category. Contemporary and dominant ‘pathological’ perspectives and marginalised ‘cultural’ perspectives are presented. Three dominant themes emerged from the interviews. They were ‘control and perfection’, ‘femininity’ and ‘self-destruction/self-preservation’. These themes are presented, as are their critical implications for social work.     

Gendering the Eye of the Norm: Exploring Gendered Concertive Control Processes in Two Self‐Managing Teams

This article is the result of an ethnographic research project exploring the workplace interactions of two self‐managed teams of recruitment consultants. I use data from participant observation and recorded interviews to show the gendered nature of what Barker terms concertive control: the social processes by which team members regulate each others' conduct in line with negotiated team values. My analysis examines how team members negotiate core team values, translate these into specific actions and regulate these actions through concertive control interactions. I then set out three ways in which gender acts as a resource for these concertive control processes. These are: team members' assumptions about men's and women's relative skills and capacities, the ‘tough’ masculinity of the haulage industry in which one of the teams operates and the regulation of performances of heterosexuality during customer interactions. Building on research by others, I show gender to be not only embedded in the values and managerial style associated with teamwork but also integrated into the collaborative process of team‐working itself. I emphasize that social categories like gender become resources in the regulation of conduct at work and can reify hierarchies even in so‐called participative practices like self‐managed teamwork.     

Mental Illness and Criminal Behavior

The tragic events in Aurora, CO and Newtown, CT have renewed public perception of mentally persons as ‘dangerous’ and ‘criminal.’ Unfortunately, this perception is based more on conjecture and fear than research. The following essay takes stock of the empirical research on mental illness and criminal behavior. Three noteworthy trends emerge from this literature. First, the prevalence of mental illness is substantially higher among individuals who have come in contact with the criminal justice system relative to the general population. Second, individuals with psychotic and externalizing behavioral disorders, particularly those who also abuse drugs and alcohol, tend to engage in higher levels of violence than individuals with other forms of mental illness. Third, mental illness does not determine whether someone will break the law; rather, it is but one of many criminogenic risk factors that interact in complex ways to influence individual behavior.     

Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.     

Leadership,Gender and Sense‐making

This article examines the nature of sense‐making processes in teams and considers the extent to which leadership as a sense‐making process is impacted by gender. We conducted an in‐depth inquiry into the decision‐making behaviour of two single‐gender teams and a third, mixed gender team, as they worked together to produce gender‐specific leadership schema in an experimental setting. Our research question was, ‘To what extent is leadership as a sense‐making process impacted by gender?’ The article reports on the design, conduct and outcomes of this research project. We found that using a meeting as part of the research method created a specific instance of a gendered organizational context exerting a dominant and directive influence on individual and collective behaviour. The current trend toward team‐based leadership is likely to involve more meetings with increasing numbers of women in senior positions. This suggests to us that men and women need to be alert to the possibility that the gendered nature of meetings may be acting as a barrier to the expression of feminine forms of leadership.     

Expert views of children's knowledge needs regarding parental mental illness

Children of parents with a mental illness are at significant risk of developing a mental illness. This risk may be reduced if appropriate interventions are provided that include information and knowledge about mental illness. While there are some interventions for children of parents with a mental illness, research is lacking about the type of mental health information children need and why they need that knowledge. This study presents the perspectives of a purposive sample of international research experts in the field of parental mental illness about the kind of mental health literacy information children with parents with a mental illness need. Twenty-three participants completed a self-constructed short answer questionnaire about the knowledge needs of children of parents with a mental illness. The qualitative data indicates that ‘identifying information’, ‘making sense of parents behaviour’, ‘coping better’ and ‘respecting safety’ are key knowledge needs of children. Given the views presented, these findings suggest that health care professionals should advocate for policies that support individual-, peer-, and family-focused programs driven by strong evaluation and rigorous research. If this is done, children of parents with mental illness may experience ‘myth busting’ of incorrect information about mental illness.     

Talking about culture in social work encounters: immigrant families and child welfare in Finland

This article aims at analysing the ways in which people talk about ‘culture’ in social work encounters involving child welfare in immigrant families. The empirical material includes conversations between immigrant clients, their social workers and co-operating professionals at six Finnish social service offices, as well as interviews with the persons participating in these meetings. The theoretical and methodological frames of reference are social constructionism and discourse analysis. The study suggests three ways in which the concept of ‘culture’ is used by social workers and their clients: firstly, as a means of explaining ‘the ordinary and normal ways’ of raising children; secondly, as ‘a difficulty’ in the interaction between social workers and clients; and thirdly, as ‘a methodical tool’ in creating dialogue with clients. As far as the practical implications for social work are concerned, it is emphasized that in order to avoid ethnocentric practice or ‘culturalization’ of problems, it is important for social workers to be conscious of the various meanings of ‘culture’ both in their own practice and in the ways their clients employ cultural symbolism.     

Rebel colours: 'framing' in global social movements

This paper presents data gathered during and since the protests against the IMF and World Bank meetings in Prague in September 2000. It describes the interactional and deliberative processes that were undertaken by activists involved in framing the protests and the manifestation of this ‘frame‐work’ in three separate marches denoted by different colours, which took place on September 26^th during a ‘global day of action’. The paper utilises ethnographic detail to develop a critically engaged model of social movement frame analysis that focuses upon the genesis of these ‘action frames’, including the elaborate negotiation of conflicting ideological and tactical dispositions that lay behind them, and the variety of democratic decision making forums which were instrumental in their design.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

Narrative and Frame Alignment in Social Movements: Labor Problem Novels and the 1929 Gastonia Strike

Research on social movements and frame alignment has shed light on how activists draw new participants to social movements through meaning making. However, the ‘framing perspective’ has failed to interrogate how the form or genre in which frames are deployed affects the communication of meaning. The burgeoning literature on social movements and narrative would seem to point to one discursive form of importance to meaning making in social movements, but scholars have failed to connect their insights with the literature on framing. In this article, I analyze five novels published in response to a 1929 communist-led strike in Gastonia, North Carolina. I argue that labor movement activists deployed these long-form narratives for the purposes of ‘frame alignment,’ specifically ‘frame amplification’ and ‘frame transformation,’ and I show how these narratives conveyed frames in ways that other discursive forms could not. The study raises new questions about the selection and reception of discursive forms in social movements.     

Culture instead of politics: negotiating ‘Otherness’ in intercultural educational activity

Programmes based on intercultural encounters with the ‘Other’ place culture and cultural difference at their centre. ‘Cultural discourse’ has even been defined as a new epistemology and praxis that plays a key role in the process of recognition. In the light of these assumptions, this study used ethnographic field work to examine the ways culture was employed by Palestinian and Jewish students who took part in an intercultural programme in a large academic institution in Israel (2006–2010). The findings reveal two major discursive practices that were used during the meetings: individuation and collectivisation of culture. Individuation was used mostly by the Jewish group and served to emphasise the particularity of the participants. Collectivisation was used mostly by the Palestinian group and served to emphasise the particularity of the group. The different ways both practices used culture served to position majority–minority rhetoric outside national political contexts. Thus, by revealing the way power relations were discursively re-produced by the use of culture, these findings problematise the role and authority given to culture in encounters with the ‘Other’.     

Virtual Teams — Support for Technical Communication?

Abstract

To work together in virtual teams has increasingly become a natural change in how organizations work. Due to demands from the environment, organizations have had to transform from traditional ways of working to becoming more flexible and adaptive. The aim of this article is to identify obstacles, problems, and presumptions in order to enable the virtual team to be successful. A project — The TIC-project — is described, and results from a study concerning collaboration and networking among companies within Technical Communication are presented. Results show that, to a great extent, experiences from networking are lacking. Furthermore, trust must be embedded in the teams, meaning that personal meetings must precede virtual meetings. Most interviewees declared a wish to collaborate despite being competitors. Finally, questions and topics for further research are presented.     

Racialisation and the afterlife of colonial divide and rule: a response to Avtar Brah

In this response to Avtar Brah’s review of Race Otherwise (2017) I briefly clarify the relationship between the concepts ‘racism’, ‘race’ and ‘racialisation’. I expand my framing of the book as less about racism and more about specific processes of racialisation. To this end I draw on material from and beyond the book to illustrate the value of the concept ‘racialisation’ for understanding the afterlife of colonial divide and rule in South Africa and other former British colonies in Africa. I show the ways in which re-articulations of the ‘signification-action complex’ at the heart of processes of racialisation in post-1994 South Africa produce a politics of evasion as well as tensions between struggles for recognition on the one hand and on the other, struggles for justice and freedom. With these re-articulations come varying convergences - of claims of culture, belonging and victimhood, genomic science, jurisprudence and global discourse on indigenous rights – that reify notions of ‘race’ and ‘tribe’.