Dementia and Suffering in Nursing Homes

SUMMARY

This paper uses case studies of challenging behaviour associated with dementia to demonstrate, firstly, that disturbed behaviour is often a manifestation of suffering caused by multiple phenomena such as medical problems or the care environment. Addressing these causes instead of simplistically ‘treating the behaviour’ usually reduces the behaviour. Secondly, staff distress with a particular difficult resident is often caused by more general fundamental problems such as a lack of support or knowledge. Addressing these problems reduces staff distress. Finally, results from a Swedish intervention study are presented. They show that suffering for both staff and residents can be reduced, and quality of life improved, by providing increased autonomy for hands-on staff, systematic emotional support, and collaboratively developing care plans based on each resident's emotional and physical needs, rather than the problems they present.     

Matching therapeutic interventions to drug and alcohol abusers’ stage of motivation: The clients’ perspective

The present study aims to explore the issue of matching the appropriate therapeutic intervention according to the stage of readiness for change in addictive clients, following the model proposed by Prochaska and DiClemente in the 1980s. The study focuses solely on the perspectives of people with drug and alcohol problems, in contrast to previous ones which have been concerned with the researchers’ understandings and postulations of the issue under exploration. One of the most important findings of this study is that participants in the “early” stages of their readiness to change their addictive behaviour, irrespective of their gender or whether they had seen a therapist significantly prefer non-action-oriented therapeutic interventions than action-oriented interventions. Similarly, participants in the “later” stages, showed a significant preference to action-oriented than non-action interventions, irrespective of their gender or previous experience of counselling. It is suggested then that careful assessment of the stage of motivation and individual-tailored intervention should be an essential element of any treatment program for drug and alcohol addicted clients.     

Counselling in general practice: Clients' perceptions of significant events and outcome

An investigation of clients' perceptions of the change process and outcome of counselling in primary care is presented. Significant events were identified by 51 clients post-session for a mean of 4.7 counselling sessions. Outcome was assessed by clients, through their perceptions of goal attainment and change in quality of life from pre-to post-counselling. Four-hundred-and-nine events were categorized by use of the Therapeutic Impact Content Analysis System (TICAS) and a content analysis system was created to categorize clients' goals. Results showed that ‘reassurance’, ‘problem solution ’, ‘insight’ and ‘involvement’ impacts were reported most frequently by clients. No category of significant events was related to change in quality of life. For 11 clients who set goals in the ‘expression’ category, more ‘reassurance’ and fewer ‘problem solution’ impacts were related to attainment of ‘expression’. Some suggestions are made for the lack of significant relationships with overall measures of outcome and it was suggested that more qualitative analysis of the process of outcome is needed.     

A healing relationship: Clients’ experiences of the long-term relational significance of the horse in horse assisted psychotherapy

Horse assisted psychotherapy is a type of treatment for mental ill-health in which the client forms a relationship with a horse. Research suggests that the relationship to a horse is very helpful to clients, but how the horse is experienced many years after the end of treatment has not been investigated. The aim of the present study was thus to investigate how former clients from horse assisted psychotherapy experienced the horse several years after treatment was completed. Former clients (n = 5; all females) from one and the same treatment center were interviewed and the data was analyzed with an inductive thematic approach. The analysis showed that many years after completion of treatment, the horses were still remembered as the most important individuals in the informants’ lives during the time of treatment. This was captured by the core category ‘A healing relationship’. These findings are in line with previous research that found that patients in horse assisted psychotherapy and their family members attributed improvements from treatment to the patients’ relationship to the horses, but adds that the clients also keep these views at follow-up several years after termination of treatment.     

The relationship between therapeutic engagement,cognitive errors,and coping action patterns: An exploratory study

Aim: This exploratory study examined the relationship between clients’ involvement in therapy and their cognitive errors (CE) and coping action patterns (CAP). Method: Therapy sessions from N = 26 clients were rated for CE and CP using the CE and CAP methods. Client involvement was measured with the Positive and Negative Affect Schedule, as well as the . Results: The CEs’ ‘magnification of the negative or minimisation of the positive’ and ‘labelling’ were associated with measures of affective therapeutic engagement. The coping styles ‘negotiation’, ‘opposition’, ‘submission’, ‘isolation’, ‘support seeking’, ‘information seeking’, ‘delegation’, and ‘escape’ were found to be associated with affective and behavioural dimensions of therapeutic involvement. Conclusions: These findings provide preliminary supporting evidence that CE and CP are related to the extent to which clients engage in the work of therapy. Implications for researchers and therapists are discussed.     

Prosocial and antisocial children's perceptions of peers' motives for prosocial behaviours

This study investigated whether peer‐nominated prosocial and antisocial children have different perceptions of the motives underlying peers' prosocial actions. Eighty‐seven children, aged 10–12 years old, completed peer‐nomination measures of social behaviour. On the basis of numbers of social nominations received, a subsample of 51 children (32 who were peer‐nominated as ‘prosocial’, and 18 who were peer‐nominated as ‘antisocial’) then recorded their perceptions of peers' motives for prosocial behaviours. Expressed motives were categorized predominantly into three categories, coinciding with Turiel's (1978) ‘moral’, ‘conventional’, and ‘personal domains’. Results indicate that children's social reputation is associated with the extent to which they perceive peers' prosocial motives as ‘personal’ or ‘moral’, with more prosocial children attributing moral motives, and more antisocial children attributing personal motives. Although traditionally Turiel's domain theory has been used to understand ‘antisocial’ children's behaviour, the current findings suggest that ‘prosocial’ children's behaviour may also be related to domains of judgment.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Mapping grief: A study in practice using a quantitative and qualitative approach to exploring and addressing the range of responses to loss

The Adult Attitude to Grief (AAG) scale was devised for an earlier study (Machin, 2001) to test the validity of a concept of loss, which proposed that grief reactions fall broadly into three categories — ‘overwhelmed’, ‘balanced’ and ‘controlled’. There was statistical support for the proposed differences but the AAG scale, more importantly, provided insight into the diverse reactions taking place in individual bereaved respondents. This paper describes a second study undertaken to examine the clinical usefulness of the AAG scale with clients receiving help within the Psychological Services Operating Unit of the North Staffordshire Combined Healthcare (NHS) Trust. The scale has been used both in its original form with bereaved clients and in a modified form with clients having distress symptoms associated with other losses, such as relationship breakdown or the onset of chronic illness. The use of the AAG scale in this clinical setting suggests that, both as an assessment tool and as a cue for therapeutic dialogue, it provides a promising way of mapping the general and particular characteristics of response to loss in individual clients. Consideration is also given to varying therapeutic approaches needed to help clients regain the equilibrium disturbed by their grief.     

Making the shift from ‘addict self ’ to ‘spiritual self ’: Results from a Stage I study of Spiritual Self-Schema (3-S) therapy for the treatment of addiction and HIV risk behavior

A manual-guided intervention, Spiritual Self-Schema (3-S) therapy, for the treatment of addiction and HIV risk behavior is being developed in a Stage I behavioral therapies development project. 3-S therapy integrates a cognitive model of self with a non-sectarian Buddhist framework suitable for people of all faiths. Data are presented on a sample of 29 cocaine- and opioid-dependent clients. Seventy-nine percent completed the 8-week intervention. Drug use and other HIV risk behaviors decreased with treatment. Evidence of a shift in self-schema from ‘addict self?’ to ‘spiritual self?’ is presented. Reaction time to endorse spiritual qualities as ‘me’ and addict qualities as ‘not me’ decreased, and self-report of daily spiritual experiences and practices, and the perceived influence of spirituality on behavior increased. A shift in self-schema was correlated with change in drug use and other HIV risk behaviors.     

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource‐impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co‐constructing meanings for ambiguous but significant experiences in therapy are discussed. Possibilities for more research examining poetic practices and processes in therapy are also considered in terms of positioning theory.     

Is systemic thinking really extraneous to common sense?

Systemic therapists assume, but have not yet proved that ordinary people: (i) normally do not use triadic thinking and (ii) are able, thanks to therapists' interviewing techniques, to construct triadic explanations. To test these assumptions this study analyses the explanations provided by 400 undergraduates of an unexpected piece of behaviour framed in four stimulus situations where the breadth of the observation field was manipulated. The results show that triadic explanations are unusual and increase with the widening of the field of observation from the monad to the triad. It is the ‘enigmatic’ triadic situation – adding a puzzling discrepancy between the actors' forms of behaviour – that elicits more triadic explanations. This suggests that therapists should explore with clients the contradictions disclosed by the widening of the field of observation and support reframings actively co‐constructed with them instead of ‘pre‐packaged’ ones.     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Forced Migrants or Voluntary Exiles: Ethnic Turks of Bulgaria in Turkey

Turkey has been experiencing various types of migration flows since the foundation of the Republic in 1923. Migration of ethnic Turks of Bulgaria in 1989 is one of the important immigration waves in size and in nature as well. More than 350,000 Bulgarian Turks refusing to assimilation policies of the Bulgarian Communist Party (BCP) fled to Turkey in 1989. Behind this triggering political reason, there were deeper sources of this migration, such as economic, social, institutional and cultural exclusion/inclusion problems in Bulgaria. Furthermore, most of the Turks of Bulgaria kept the idea of migrating to their “imagined motherland’ someday. The same migrants have been experiencing integration/exclusion problems where they settled in Turkey, too. This paper attempts to open a conceptual debate by using concepts of ‘mixed migration”, ‘accidental diaspora’ and ‘voluntary exiles’ to overcome the ‘forced and voluntary’ dichotomy in this literature, rather than analysing all the dimensions in detail. Hence, the multiple dimensions of this migration will be tried to be understood via the perceptions of migrants.     

The experiences of therapists using a new client‐centred psychometric instrument,PSYCHLOPS (Psychological Outcome Profiles)

PSYCHLOPS (‘Psychological Outcome Profiles’) is a newly developed client‐generated psychometric instrument which can be used as an outcome measure. Uniquely, it asks clients to state their own problems, in their own words. As part of its validation, we used it alongside an existing measure, CORE‐OM (‘Clinical Outcomes Routine Evaluation – Outcome Measure’). Based on a qualitative methodology, we report here on the first‐hand experiences of four therapists using both instruments. The key themes that emerged from therapists’ responses were feasibility, validity and usefulness. Both questionnaires were perceived as complementing each other, the qualitative information from PSYCHLOPS balancing the quantitative information from CORE‐OM and that both could contribute to the therapist‐client interaction. The key features of PSYCHLOPS are likely to prove attractive to therapists and should increase acceptance and uptake of outcome measures.     

Interventions in everyday lives: How clients use psychotherapy outside their sessions

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.     

Surveying the drug service users' perspective through self-help groups

Survey data is presented from a questionnaire designed and distributed through Victorian drug self-help groups. This survey yielded 203 returns representative of Melbourne metropolitan admissions to drug treatment services on the variables of sex and region. The survey is examined both from the perspective of its methodological potential for providing entry to this hard-to-access population and also on the basis of its findings. Questioning of this sample concerning the difficulties they had encountered when seeking help revealed that the most frequently listed difficulties were waiting periods for access to services. Respondents that had previously used particular services were asked how beneficial they had found these services: Respondents most frequently listed self-help groups, residential and methadone services as beneficial and least frequently listed medical (hospital casualty) and doctor services as beneficial. Stepwise logistical regression revealed six variables significantly predicting selfhelp treatment. Those reporting having sought self-help groups were predicted by more frequently listed problems with alcohol and ‘over the counter’ drugs, reports of having sought counselling services and more frequently reported difficulties due to a lack of information and admission restrictions when seeking services. Despite a number of methodological weaknesses identifiable in the survey, experience with this project suggested collaboration between researchers and those active in self-help networks as a useful model for future research into the drug service users perspective. Such collaboration should, however, begin at an earlier phase than occurred in the present study.     

Cognitive-Behavioural Group Therapy for Pure Victims with Internalizing Problems: An Evidence-based One-year Longitudinal Study

The present study evaluates a specific cognitive-behavioural group intervention for pure victims of school bullying, employing a longitudinal design with mixed methods. 68 high-risk pure victims were identified from 5071 schoolchildren through screening measures and structured interviews, and assigned to 10 treatment groups. They completed a self-report questionnaire comprising measures of anxious/depressed problems and peer victimization prior and after the treatment, and at 1-year follow-up. The students, their teachers, and parents/guardians also received structural interview assessing students’ cognition, affection, and behaviour pertaining to peer victimization before and after the intervention. The results showed that the students’ physical, verbal, and total victimization, social exclusion, and depressed-anxious scores decreased from the pre-test to the one-year follow-up. They also reported a more realistic self-image, less self-blame, more positive outcome evaluation, less fearful, and employ more rational strategy when encountering problems in post-test interviews. Teachers and parents also noted the student experienced less peer victimization, had learnt to speak up against victimization and was less isolated in class. The results suggested the CBT program was effective for treating pure victims with internalizing problem.