Mental health practitioners’ strategies in equine-assisted psychotherapy: implications for social work

Equine-assisted psychotherapy (EAP), in this study, which included a mental health practitioner, an equine specialist, at least one horse, and a client in therapy sessions, is emerging in social work practice, education, and research. The purpose of this paper was to explore experienced EAP mental health practitioners’ cognitive activities and strategies to inform the social work profession.

Utilizing a constructive narrative approach, eight experienced EAP mental health practitioners participated. Two semi-structured, face-to face, individual interviews were used to gain their perspectives. Qualitative software assisted thematic analysis. The findings included a main theme identified as participants’ concrete strategies used in EAP with two subthemes. The second main theme identified abstract strategies with six subthemes.

EAP provides a holistic framework as social workers incorporate horses and natural environments in practice, which is consistent with systems theory. The findings inform experienced mental health practitioners to be effective therapists and educators, as well as to instill confidence in novices. Recommendations for the application of the findings in social work practice, education, and research are explained.     

Managerial audit and community mental health: a study of rationalising practices in Finnish psychiatric outpatient clinics

In many European welfare states the reform of mental health services has been accompanied by the implementation of new forms of governance, including the introduction of managerial audit systems. While such systems have been developed for ‘good causes’, such as quality assurance, financial management and monitoring staff performance, they may simultaneously produce diverse and contradictory effects on practice. The aim of this article is to examine the role of one managerial audit system, introduced in psychiatric outpatient clinics in central Finland, and assess its impact on practice. Reference is made to modernising mental health policy in the UK as that has producedsimilar practics outcomes. The research was an empirical study of practice using a mixed-method case study design involving documentary research and semi-structured interviews. Insights from Mitchell Dean's notion of governmentalisation of government were utilised in the analysis. It was found that, although the audit system primarily served administrative needs, it began to reshape practice by reinforcing certain modes of working and excluding others. The analysis of community mental health work in Finland, with similar trends in the UK, highlights the connection between documentation, resource allocation and managerial priorities that reinforce particular styles of practice. In community mental health services it would appear that the problems of professional practice have become the problems of administration.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Psychotherapy and Schizophrenia: The Mirror of Countertransference

The relationship between psychotherapy and schizophrenia has undergone pronounced changes over the last several decades. The advent of psychiatric medication led to remarkable breakthroughs that obscured the existential issues inseparably tied to the lived experience of illness and overshadowed the role of psychotherapy in the treatment of schizophrenia. Recent years have brought renewed scrutiny of the place of psychotherapy in the treatment of persons with major mental illness but much less attention has been shown to matters of countertransference. The complex legacy of loss and grief assumes a special dimension in the therapeutic relationship and touches the lives of client and clinician alike. Both travel a common path and share privileged moments. It is the intersection of these life experiences, and how their confluence shapes the course of therapy that is the focus of this essay.     

KNOWING THE CHILD: AN ECOLOGICAL APPROACH TO THE TREATMENT OF CHILDREN IN FOSTER CARE

Social workers in agencies and school settings often deal with high risk, multi problem children such as those in foster care. Increasingly, there is widespread recognition that a coordinated, multifaceted approach is required to address the range of cognitive, social, and mental health problems with which they present. This article recommends utilization of an ecological treatment intervention that is specifically tailored to the needs of the child based on a formulation of the child’s experience and developmental deficits. A case example comprising the treatment of an eight-year-old boy in foster care with comorbid diagnoses of alcohol related neurodevelpomental disorder, failure to thrive, and attachment disorder, illustrates this approach. The article concludes with implications for social work practice.     

神秘文化与精神疗法:评徐小斌小说的救赎意识

在当代女作家徐小斌的小说中,逃离是女主人公在现实社会受挫后最重要的行为方式,而那些蒙着神秘文化面纱的宗教神话世界、未被现代文明污染的"化外之境"和摆脱了历史束缚的自然爱欲世界,则成为对主人公进行精神救赎的皈依之地。从心理学的意义看,这种奇特的逃离方式具有对病态现代人进行精神疗救的形而上色彩。然而,拨去神秘的面纱后我们发现,现代人始终无法抵达真正的灵魂栖息地,获得心的归属与庇护。     

Recovery Lessons Learned from Individuals with Psychiatric Disabilities

ABSTRACT

Over a long career in the public mental health system, the author has seen the progress in the service delivery that has given consumers more independence and ownership of their recovery. Until another breakthrough in brain science improves the outlook for prevention and treatment of brain disorders, the push to improve expectations with supports to manage their recovery needs to continue. The author describes Harbor City Services, Inc, a market-based social enterprise that creates jobs offering security against losing a job because of reappearing symptoms, including some jobs with the potential for growth beyond entry level. The growth of this business over 25 years shows the highs and lows of moving from public funding and charity to a self-supporting business. The author encourages the use of business strategies to improve the vocational opportunities that help sustain recovery and offers tips on employment and business.     

心理咨询师的自我表露在心理咨询与治疗中的运用

在心理咨询与治疗过程中,咨询师的自我表露与来访者的自我表露具有等价的重要性。对于心理咨询师来说,最大的挑战不是咨询师是否进行自我表露,而是能否系统地利用自我表露使之发挥积极的作用。文章结合临床实践经验,从自我表露的定义、咨询师自我表露的功效以及咨询师自我表露的技巧三方面进行阐述。     

Employment status, psychiatric disability and quality of life: comparison of men and women with schizophrenia in Malaysia

This study explores the association between employment opportunities, psychiatric disability and quality of life of male and female patients with schizophrenia. The data were collected from 100 male and 100 female patients and their primary caregivers through personal interviews. The Disability Assessment Schedule and the Quality of Life Interview were used to collect the data. The results of the present study indicate that a large number of both the men and women were unemployed, although they suffered from only mild psychotic symptoms and had no or only minimum psychiatric disability. However, in almost all areas and levels of psychiatric disability, a significantly higher number of men than women were employed. However, the subjective Quality of Life of the employed men was significantly lower than that of the unemployed. Keeping in mind these two results, the present study argues that there is minimal community recognition in Malaysia for the employment potential of people with schizophrenia. The study also argues that policy makers must legislate to create more appropriate workplaces for the mentally ill. People with schizophrenia are entitled to just and fair treatment, and workplaces should be made attractive to them.     

Delusional themes of penetration and loss of boundaries and their relation to early sexual trauma in psychotic disorder

This paper explores how the psychotic experience of the penetration of destructive objects and a loss of boundaries appears in the delusions experienced by a woman who reported early sexual trauma. Through a close analysis of these psychotic experiences, this research seeks to illustrate how a psychotic personality organization, coupled with repeated early attacks on the integrity and boundaries of the self, can create a pervasive sense of being relentlessly pursued and penetrated by destructive objects. These delusions may serve multiple functions, as will be discussed. It is suggested that working through these experiences within the therapeutic relationship involves a gradual process of separating the inner from the outer, the destructive from the benevolent, so that a less fragmented, more integrated sense of self can emerge.