Burn-out

At first the concept of burnout will be critically reflected in the context of the discussion in a position paper of the German Society for Psychiatry Psychotherapy and Neurology. An investigation of preventive stress management interventions at the workplace will be reported. The treatment concept of the day clinic of the Department for Psychosomatic Medicine and Psychotherapy of the Munich-Harlaching hospital for occupational stress-related disorders will be presented. An empirical study of the effectiveness of this treatment will be reported comparing patients with occupational stress-related disorders (n?=?95) to other patients treated in the day clinic during the same time interval (n?=?154). Furthermore, a qualitative analysis of 102 patient charts with occupational stress-related disorders will be described. Two case histories typical for mental health disease with burnout syndrome are presented to illustrate the conclusions.     

Evaluating Occupational Therapy Psychiatric Care Through Medical Documentation

Recent JCAH survey results have reported serious deficiencies in quality assurance efforts of support departments, especially Rehabilitation Services. Because occupational therapy is grouped under Rehabilitation Services, occupational therapists should closely monitor quality assurance efforts. Quality assurance activity becomes somewhat more complex when dealing with psychiatric patients where treatment modalities lack unanimity. However, those quality assurance efforts can be more productive through better medical documentation. Medical documentation essentials are reviewed and described with an emphasis on problem oriented methods. It is proposed that adhering to these essentials will enhance professional performance as well as improve the outcome of quality assurance activities.     

Occupational Therapy Intervention in the Treatment of Alcoholics

The first section of this article will provide the rationale for all occupational therapists to learn extensively about the isease of alcoholism regardless of area of practice or type of agency where employed. It will offer su estions on how this learning can take place. The second section will take an historic look at occupational therapy literature documenting the use of occupational therapy in alcoholism rehabilitation from 1941 to the present. It will describe modalities currently being used by occupational therapists in alcoholism rehabilitation and discuss expansion of occupational therapy in this practice area.     

Is Seasonal Stress a Career Choice of Professional Accountants?

Workload compression during the first quarter of each year (January-March) is hypothesized to involve additional job demands on auditors and tax professionals causing job strain (occupational stress). Using canonical correlation analysis to analyze the survey data, this study found that the strongest stressor-strain relationship was for the group surveyed in January, indicating that workload compression contributes to seasonal occupational stress. Seasonal stress will remain a very strong barrier to qualified individuals in making an accounting career their vocational choice and will put additional demands on Employee Assistance Program (EAP) counseling for accounting practitioners.     

Chapter 6. Greater Satisfaction with Post-Injury Male Gender Roles

ABSTRACT

Shaken Baby Syndrome is a serious form of child abuse, involving infants under the age of six months. Deliberately shaking an infant is often associated with frustration or anger, particularly when an infant will not stop crying. The shaking results in numerous initial and long-term consequences for the developing infant. In its most severe form Shaken Baby Syndrome results in the death of the infant. A case study detailing the clinical findings and treatment of a six-month-old infant with Shaken Baby Syndrome who received inpatient occupational therapy services is presented.     

Occupational Therapy Treatment

This paper describes borderline phenomenon as it relates to occupational therapy treatment groups. The author discusses the genesis of the syndrome from the separation-individuation phase, its relation to adult functioning, subsequent treatment design and recommended therapeutic interventions. A case illustration will highlight these elements.     

Clinical Application of the Model of Human Occupation in Dementia of the Alzheimer's Type

Dementia of the Alzheimer's type (DAT), termed the disease of the century (Braly, 1986), has affected over two million Americans (Katzman, 1986). As the population ages, this figure will rise, presenting a continued challenge to health care systems and to occupational therapists who will increasingly confront people with DAT In their various clinical settines. The Model of Human occupation is suggested as a framework Kr guiding assessment and treatment for the person with DAT. A brief review of the symptoms and potential disturbances affecting occu ational function within the framework of the model is presented, followed by a case study illustrating clinical application bf the model.     

The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties

In this paper, it is argued that the new occupational therapy paradigm includes a core of psychosocial skills, consistent with the profession's historical roots in mental health. It is proposed that contrary to the declining presence of occupational therapy in mental health, psychosocial interventions should be explicitly integrated in all professional practice, such that occupational therapy will become the profession of choice in addressing psychosocial issues of all clients irrespective of clinical specialty. A case study is presented as an example to demonstrate how this explicit integration may be achieved in physical rehabilitation.     

Safety climate as a mediator between foundation climates and occupational accidents: a group-level investigation

Building on recent work in occupational safety and climate, the authors examined 2 organizational foundation climates thought to be antecedents of specific safety climate and the relationships among these climates and occupational accidents. It is believed that both foundation climates (i.e., management-employee relations and organizational support) will predict safety climate, which will in turn mediate the relationship between occupational accidents and these 2 distal foundation climates. Using a sample of 9,429 transportation workers in 253 work groups, the authors tested the proposed relationships at the group level. Results supported all hypotheses. Overall it appears that different climates have direct and indirect effects on occupational accidents.     

Psychology doctoral training in work and health

Psychology as a profession has an opportunity and obligation to advocate for and develop healthy work environments. This will require the design and conduct of doctoral-level training in occupational health psychology. A model for training might well be based on the assumptions that there is a viable role for occupational health psychologists trained at the doctoral level for both academic and applied work settings, and that doctoral training would be based on the integration of health psychology and public health. Issues remaining to be addressed in the development of doctoral training programs include appropriate predoctoral training, academic standards, the interdisciplinary nature of faculties, and appropriate settings for training. Future directions in establishing doctoral training in occupational health psychology will best be taken in dialogue with several other professions and institutions that share a common interest in reducing leading work-related diseases and injuries and promoting public health in the workplace.     

Psychosocial Occupational Therapy Interventions for Substance-Use Disorders: A Narrative Review

The review was conducted to explore psychosocial interventions for adults with substance-use disorders. A refined literature focus was placed on articles published by occupational therapists, or articles published by an allied health professional, that discussed occupational therapy performing the intervention. Ten articles met inclusion criteria, all focusing on aspects of life skills training. Study results support the professions’ ability to enhance functional independence and occupational performance for individuals recovering from substance use. Further, a more controlled investigation is warranted to further define occupational therapy’s scope within substance-use disorder treatment.     

Occupational therapy in neurology--results of 7 years' experience

Indications, mode of referral, therapeutic methods, and documentation of the functional occupational therapy practised in the field of neurology are presented and experiences hitherto existing discussed. For many of neurological diseases, the occupational therapy may be regarded as an equivalent method to the medication and to the physiotherapeutic treatment. When carrying-out as group therapy, it is an economical way of treatment, and most of the patients take this kind of therapy in a positive manner. In addition to this, the occupational therapy renders possible that the state of the rehabilitation can be sized up.     

Occupational Therapy Interventions for Adults at the End of Life: A Systematic Review of Dignity Therapy

The objectives of this study were to determine the effects of dignity therapy, a psychological intervention for individuals with terminal illness, and to explore whether this is an appropriate occupational therapy intervention. A literature search produced 10 dignity therapy studies for review. Four reported positive effects (decreased anxiety, depression, suffering), one reported negative effects (decreased quality of life, increased depression), and five reported no effects. With its client-centered and occupation-based approach, dignity therapy aligns with the values of occupational therapy. Practitioners should explore dignity therapy as an intervention and direct future research toward examining its efficacy as part of a holistic treatment plan.     

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.     

Occupational mobility in the world of prostitution: Becoming a madam

Prostitution may be viewed as a sexual service industry that includes various occupational sub‐categories, such as streetwalker, call girl, madam, pimp. These occupational sub‐categories differ in terms of work environment, financial rewards, work hazards, etc. Occupational mobility is possible within the prostitution business but is dependent upon factors similar to those found in more legitimate occupations (e.g., race, mental acumen, personal contacts, presentation of self, ambition).

This paper will attempt to show, principally through the case history technique, the manner in which a small group of prostitutes exercised occupational mobility and became madams. It is believed that the benefits of such an inquiry may be twofold. First, as Everett C. Hughes argued on more than one occasion, the study of deviant occupations and institutions can yield data of value to the study of legitimate occupations and institutions. Secondly, it is hoped that the continued utility of a sociology of work approach to the study of deviant behavior will be demonstrated. A basic orientation of this paper is that prostitution may be more fruitfully studied as an occupation than as a “social problem.”     

Playing Together: DIR and Child Psychodynamic Therapy

ABSTRACT

This article describes the integration of the developmental, individual difference, relationship model (DIR) and relational child psychodynamic therapy. DIR is an effective treatment for many children with uneven development, not only for those on the autistic spectrum. The importance for child psychodynamic therapists to understand individual differences, as delineated by occupational and speech/language therapists, and to include parents within the treatment will be discussed throughout this article and in a particular case. An understanding of individual differences makes psychoanalytic formulations, especially about the body, more accessible and actionable. Overlooking the contribution of individual differences to a child’s play and development has consequences for progress in treatment. Together, DIR and child psychodynamic therapy can most effectively integrate “psyche” and “soma” (Winnicott, 1949). The child psychodynamic therapist’s particular expertise, in such areas as countertransference enactments and unconscious meaning, crucially contributes to this integration.     

The Effectiveness of an Occupational Therapy Program for Chemically Dependent Adolescents

This research study, conducted at a residential treatment center for chemically dependent and emotionally disturbed youth, was designcd to answer the following questions: is occupational therapy effective in producing behavioral change in the adolescent chemically dependent population and, if so, what are the factors producing the change? An assessment tool was designed and used in conjunction with observations to determine each resident's behavioral status before and after involvement in occupational therapy groups. All residents admitted to James- town wcre involved in a Work Skills Group (focusing on pre- work skill development) and/or a Relationship Skills Group (fo-cusing on interpersonal skill development). The behavioral status was measured by the therapist using a defined rating scale in an interview format. The changc in ratings from pre- to post-treatment was used as the basis for the data analysis. Groups of residcnts were compared to each other on the, variables of age, sex, attendance, rate of goal completion, group membership, and completion and type of occupational therapy goals. The results of the study indicate that rcsidents who attended occupational therapy, were involved in both groups, completed their occupational thcrapy goals, and completed the occupational therapy program demonstrated significant behavioral change, especially in relationship skills. Age and sex variables alone did not produce significant behavioral change.     

An Aggregate Fieldwork Model: Cooperative Learning,Research, and Clinical Project Publication Components

An occupational therapy psychosocial level-two fieldwork model, which consists of cooperative learning, clinical project or research publication, and interdisciplinary collaboration and intervention, is herein outlined. An example of the model is presented using an acute inpatient psychiatric setting with a multidisciplinary staff and 50 occupational therapy interns. Data on the aggregate fieldwork model collected over a two-and-a-half-year period from: 1) logs; 2) supervision; 3) peer reviewed publications; 4) conference presentations; 5) verbal feedback from the occupational therapy educational institutes; and 6) the supervisor's comparisons with other fieldwork models is presented. The outcome of the aggregate fieldwork model is that students do well, seem to learn more than in 1:1 supervisory models, and manage to publish while on fieldwork. It is hoped that more academic programs will consider working with clinical educators to develop programs based on this model.