An assessment of the needs of mutual-help groups

Assessed the needs of mutual-help groups in relation to how self-help clearinghouses can best assist. Most important problems centered on member involvement, attendance and recruitment, lack of public awareness, and finances. Most important needs were for greater public education and more referrals to groups. Significant differences were found across different types of organizational affiliation for the problems of recruitment of members, lack of public awareness, and problem members. The dynamic nature of mutual-help groups may naturally produce many of the turnover, attendance, and involvement problems which in turn generates the ongoing need to recruit new members in part through greater public awareness. Many of the goals and needs of mutual-help groups, coupled with the large number of group members, may lead to significant social and policy change in health and mental health services.     

The Effect of Professional Partnership on the Development of a Mutual-help Organization

The effects of partnership between Schizophrenics Anonymous (SA, a mutual-help organization) and the Mental Health Association in Michigan (MHAM, a professionally staffed advocacy organization) on SA's growth and development were explored. Following the initiation of a formal partnership, SA groups were more available throughout the state, more likely to be associated with formal mental health settings, and less likely to have leaders who had been participants in other SA groups. Groups with consumer leaders had significantly greater longevity than groups with professional leaders. Changes in the organizational structure and process of SA were also identified. SA leaders reported that SA moved from a collective to a more bureaucratic structure. As a result, there was greater consistency, administrative capacity, and response capacity. This enhanced capacity came with costs reported by SA leaders. The leadership role of SA members became less defined. SA members expressed concerns about the more hierarchical structure of SA's organization, decreased consumer control, increased professional involvement in SA, and an excessive focus on group development as opposed to group maintenance. Mental Health Association in Michigan staff reported that MHAM was also impacted by the partnership, both with regard to internal functioning and external perception. Implications for effective partnerships between mutual-help and professional organizations are discussed.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

The Role of Referent and Expert Power in Mutual Help

This study explored the roles of referent power (i.e., influence based on sense of identification) and expert power (i.e., influence based on knowledge and expertise) in Schizophrenics Anonymous (SA), a mutual-help group for persons experiencing a schizophrenia-related illness. The study describes SA participants' experience of referent and expert power with SA members, SA leaders, and with mental health professionals. It also examines whether or not referent and expert power ascribed to fellow SA participants predicts the perceived helpfulness of the group. One hundred fifty-six SA participants were surveyed. Participants reported experiencing higher levels of referent power with fellow SA members and leaders than with mental health professionals. They reported higher levels of expert power for mental health professionals and SA leaders than for SA members. The respondents' ratings of their SA group's helpfulness was significantly correlated with ratings of referent and expert power. Although expert power was the best independent predictor of helpfulness, a significant interaction between referent and expert power indicated that when members reported high referent power, expert power was not related to helpfulness. These results are interpreted to suggest that there are multiple forms of social influence at work in mutual help.     

Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.     

Introduction to the Special Issue on Mental Health Self-Help

Since the 1950s, people with mental illness and their families have been organizing a wide range of self-directed, mutual support oriented initiatives, including self-help groups, nonprofit organizations, and businesses. These initiatives have become increasingly widespread over the years and today mental health self-help initiatives outnumber traditional mental health organizations in the United States (Goldstrom et al., Admin Policy Mental Health Mental Health Serv Res 33:92-103, 2006). Mental health self-help embodies much of what community psychologists promote, including the self-directed organization of people to create social change and facilitate personal transformation. This special issue provides new insight into several prominent areas of inquiry surrounding these low-cost interventions including: (1) their evidence base; (2) the processes by which people benefit; (3) how they interface with the mental health system; and (4) the value dilemmas they face.     

Capturing system level activities and impacts of mental health consumer-run organizations

Since the 1970s mental health consumer-run organizations have come to offer not only mutual support, but they have also adopted agendas for broader social change. Despite an awareness of the need for system level efforts that create supportive environments for their members, there has been limited research demonstrating how their system level activities can be documented or their impacts evaluated. The purpose of this paper is to feature a method of evaluating systems change activities and impacts. The paper is based on a longitudinal study evaluating four mental health consumer-run organizations in Ontario, Canada. The study tracked system level activities and impacts using both qualitative and quantitative methodologies. The article begins by describing the development and implementation of these methods. Next it offers a critical analysis of the methods used. It concludes by reflecting on three lessons learned about capturing system level activities and impacts of mental health consumer-run organizations.     

Development of the Uni Virtual Clinic: an online programme for improving the mental health of university students

ABSTRACT

There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people.     

What members of Alcoholics Anonymous really believe

Many mental health professionals work with people who are members of Alcoholics Anonymous (AA) or may benefit from AA attendance. This article provides practical information about AA that professionals can use to understand and work with people in AA. It is a summary of a survey of 187 members of AA as well as synthesising the literature on AA. Specifically, it describes what AA is, the twelve steps and principles that underlie them, common AA expressions and how they can be used in therapy, common concerns about AA, and how to get more information about AA. Implications of how AA's steps and language can be incorporated into therapy, how therapy can facilitate working the steps of AA, and how to address consumers’ (or professionals’) concerns about AA are addressed.     

Factors affecting the birth and death of mutual-help groups: The role of national affiliation,professional involvement,and member focal problem

Examined the predictive relationship of three variables to the birth and death of mutual-help groups for a statewide New Jersey sample of 3,152 groups over a 2-year period. The three variables studied were group affiliation with a national mutual-help organization, local professional involvement in group activities, and group members' type of focal problem. Log-linear logit analysis revealed that the best-fitting model included Affiliation Status x Professional Involvement, and Affiliation Status x Focal Problem interactions. Among unaffiliated groups, professional involvement was related to lower group mortality, while among affiliated groups it was related to higher group mortality. Unaffiliated behavior control groups had higher odds for mortality and for birth than either unaffiliated life stress groups or unaffiliated medical groups. Among main effect findings, unaffiliated groups had consistently higher odds for birth than affiliated groups. The implications for research and action are discussed.     

Lernen im Team

The recent rapid changes of the economic conditions in the health care system have lead to a sense af crisis especially in mental health care organisations. The goal of high quality health care is in conflict with the economic necessity of cost cutting and profitability. The demand for rapid change processes collides with a special need for stability in mental health care organisations. In treating this dilemma, we can observe a marked inclination for splitting as a defence, which is acted out especially between leadership and work force, as well as between the management and the therapeutic part of the institutions. This danger of splitting can be counteracted with an attitude of integrating and balancing the different needs and by orientating the organisation at the principles of a ?learning organisation“ (Senge 1990). Such an organization can use the capacity of self-management in treating the above mentioned dilemma. In addition, the capacity of ?learning from experience“ (Bion 1962) proves as an essential asset in the survival of mental health care organizations. In such organizations, work and learning is primarily organized in the structure of teams — this article will therefore discuss how teams organize learning and how they treat the dynamics of stability and change.     

Capturing Dynamic Processes of Change in GROW Mutual Help Groups for Mental Health

The need for a model that can portray dynamic processes of change in mutual help groups for mental health (MHGMHs) is emphasized. A dynamic process model has the potential to capture a more comprehensive understanding of how MHGMHs may assist their members. An investigation into GROW, a mutual help organization for mental health, employed ethnographic, phenomenological and collaborative research methods. The study examined how GROW impacts on psychological well being. Study outcomes aligned with the social ecological paradigm (Maton in Understanding the self-help organization: frameworks and findings. Sage, Thousand Oaks 1994) indicating multifactorial processes of change at and across three levels of analysis: group level, GROW program/community level and individual level. Outcome themes related to life skills acquisition and a change in self-perception in terms of belonging within community and an increased sense of personal value. The GROW findings are used to assist development of a dynamic multi-dimensional process model to explain how MHGMHs may promote positive change.     

Prohibiting Versus Discouraging: Exploring Mental Health Organizations Varied Stances on Sexual Orientation Change Efforts (SOCE)

Research has shown that sexual orientation change efforts results in more mental health damages than positive outcomes; yet a recent study found that 19.4% of mental health practitioners believe it is ethical to practice sexual orientation change efforts. The purpose of this paper is to highlight existing literature on sexual orientation change efforts, showcase mental health professional organization's stances on ethically prohibiting versus discouraging sexual orientation change efforts, and propose suggestions and learning objectives to mental health organizations. By doing so, we hope all mental health professional organizations enforce a clear ethical code against the practice of sexual orientation change efforts.     

There’s More Than Catastrophizing in Chronic Pain: Low Frustration Tolerance and Self-Downing Also Predict Mental Health in Chronic Pain Patients

Among the potential range of irrational beliefs that could be used as predictors of physical and mental health, catastrophizing is the process that has received most attention in chronic pain research. Other irrational processes such as demandingness, low frustration tolerance, and self-downing have rarely been studied. The goal of this study was to explore whether this wider range of beliefs is associated with health in chronic pain patients beyond catastrophizing. A total of 492 chronic pain patients completed a measure of irrational beliefs, a measure of physical and mental health, and a numerical rating scale designed to assess pain intensity and interference. Irrational processes were more strongly associated with mental than with physical health. Low frustration tolerance and self-downing were found to be significantly related to mental health even after controlling for the effect of catastrophizing. Processes other than catastrophizing appear to have potentially important relationships with the mental health of people with chronic pain. These results may offer new intervention targets for practitioners.     

Stages of change and stuttering: a preliminary view

As a way to better understand the process of change that occurs in stuttering, Craig [Craig, A. (1998). Relapse following treatment for stuttering: a critical review and correlative data. Journal of Fluency Disorders, 23, 1-30] compared the behavioral changes that people who stutter often experience with and without treatment to those that have been observed for certain (non)addictive behavior disorders such as smoking, overeating, phobia and anxiety disorder. The process underlying these behavioral changes has been described by the transtheoretical or "stages of change" model, which is a model of behavior change that can illuminate "where" a person is in the process of change, and how this may relate to the outcome of either treatment or self-change attempts [Prochaska, J. O., & DiClemente, C. C. (1986). The transtheoretical approach. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy. New York: Brunner/Mazel]. The purpose of the present study was to analyze the extent to which the responses of adults who stutter on a modified Stages of Change Questionnaire yield interrelations among questionnaire items that are consistent with a stage-based interpretation. Results of both confirmatory and exploratory factor analyses indicated that while the modified questionnaire was a relatively good fit for participant responses, the structure derived from the exploratory analysis provided a significantly better fit to the observed data. Results suggest that a questionnaire incorporating items that better reflect the unique behavioral, cognitive and affective variables that characterize stuttering may better discriminate stages of change in people who stutter as they move through therapy, or are engaged in self-directed change. Educational objectives: After reading this paper, the learner will be able to: (1) describe the transtheoretical or "stages of change" model; (2) describe the various processes that are associated with different stages of change; (3) summarize research findings in stages of change as they apply to a variety of clinical populations; (4) discuss the applicability of the findings from the present study to stuttering treatment, and (5) relate conventional strategies and techniques used in stuttering therapy to different stages in the process of change.     

Integrating the criminal justice system into mental health service delivery: the worcester diversion experience

The substantial number of persons with mental illness encountered in many sectors of the criminal justice system has spurred actors from various agencies within that system to take actions aimed at reducing the growth of this population. These actions have included the development of specialty police units, jail diversion programs, and other mechanisms for channeling persons with mental illness out of the criminal justice system and into mental health treatment. The courts, too, have become involved in this effort with the recent development of the "mental health court," the latest of the "specialty" or "problem solving courts." These courts have not been without their critics, however, nor are they the only feasible approach to court-based diversion. This paper identifies and explores a range of options for structuring the relationship between criminal courts and local mental health systems. Beginning with a discussion of the rationale motivating the development of mental health courts, two alternatives to this specialty court model are discussed. One involves judges dealing with defendants having mental illness and substance abuse on a case-by-case basis. The other takes advantages of linkages that may already exist between most courts and the mental health providers who conduct their forensic assessments, expanding the role of these providers to serve as boundary spanners between courts and the components of local mental health systems. Regardless of the model adopted, however, appropriate linkages must exist between the courts and relevant providers. A case study is provided that demonstrates how the status of a locale's linkages can be evaluated and how the information derived from such evaluation can be used to improve the linkages between police, courts, and health and human services agencies.     

Promoting exercise behavior among Chinese youth with hearing loss: a randomized controlled trial based on the transtheoretical model

The transtheoretical model proposes that behavior change is experienced as a series of stages. Interventions tailored to these stages are most likely to be effective in progressing people through the model's hypothesized behavior change continuum. In this study, a stage-tailored, 12-week, exercise behavior intervention based on the transtheoretical model was conducted among a sample of 150 Chinese youth with hearing loss. Participants were randomized into an intervention or control group with all the core transtheoretical model constructs assessed pre- and post-intervention. Participants in the intervention group showed greater advances in their stage of exercise behavior change, decisional balance, and processes of change use compared to those in the control group. The intervention, however, was insufficient for increasing participants' self-efficacy for exercise behavior. The findings partially support the utility of the theory-based intervention for improving the exercise behavior of Chinese youth with hearing loss, while simultaneously helping to identify areas in need of improvement for future applications.     

The contributions of Rosenbaum's model of self-control and the transtheoretical model to the understanding of exercise behavior

ObjectivesRosenbaum's [1990. The role of learned resourcefulness in the self-control of health behavior. In M. Rosenbaum (Ed.), Learned resourcefulness: On coping skills, self-control, and adaptive behavior (pp. 3–30). New York: Springer Publishing Company; 2000. The self-regulation of experience: openness and construction. In P. Dewe, A. M. Leiter, &; T. Cox (Eds.), Coping and health in organizations (pp. 51–67). London: Taylor and Francis] model of self-control depicts learned resourcefulness as a key component of the goal attainment process. Despite this model's popularity, few studies have examined its importance in the maintenance of exercise. The transtheoretical model of change has been used instead. The two models, nonetheless, share strikingly similar components with the exception of learned resourcefulness.Design/MethodsOur 265 participants, ranging from wanting to be active to being regular exercisers, completed instruments assessing learned resourcefulness, stage of change for exercise, self-efficacy, reasons for exercising and the processes of change for exercise.ResultsAs predicted, participants in the maintenance stage for exercise were on average more highly resourceful than participants in the contemplation, preparation and action stages of change. Low resourceful participants in the contemplation stage of change were the least likely to be employing strategies to help facilitate activity.ConclusionImplications for exercise promoters are discussed.     

The Roles of Metaphor and Imagination in Child Trauma Treatment

ABSTRACT

This article presents developmental theory regarding the emergence and importance of metaphor and imagination to child development. The author then reviews psychotherapy research and clinical literature to identify ways that these two mental processes, as transtheoretical elements of child therapy, can be applied within trauma-specific treatment for expressing and processing difficult experiences, integrating traumatic memories, containing fears, bolstering self-efficacy, and expanding understanding of self and others. Case examples are provided to illustrate clinical applications.     

Birth cohort changes in Chinese adolescents' mental health

In China, rapid economic growth and increasing social problems constitute two basic characteristics of contemporary social change. During the process of dramatic social change, an emerging question is how adolescents' mental health has changed across birth cohorts. The present paper reviews four studies of crosstemporal meta-analysis conducted by us. By meta-analysis of previous literature, we examined changes in mean scores on mental health measures over time (from the early 1990s to the mid-2000s). It was found that since the early 1990s, Chinese adolescents' mental health deteriorated across birth cohorts, shown in increased scores on the negative indicators of mental health (e.g. mental problems, anxiety, and depression), whereas self-esteem as a positive trait decreased. The dropping trend in Chinese adolescents' mental health could be attributed to social change, especially increasing social problems. Therefore, adequate attention must be paid to potential influences of social change on individuals' psychological development.