Travailler l’acceptation de la maladie en éducation thérapeutique : exemple d’une intervention « ateliers théâtre » pour des personnes porteuses d’un lupus

In this article, a reflection concerning the acceptance of chronic illness in patient education (PE) is proposed. The research focuses on a therapeutic theatre intervention, inspired by theatre of lived experience as proposed to people with lupus. The aim of the intervention is to enable a putting into words and a staging of events that are identified by the patient as disabling. The framework and the process of the intervention are being presented. The results of an exploratory analysis followed by a clinical case will shed light on the contribution of these workshops on the improvement of life satisfaction and illness perception as well as the understanding and the acceptance of illness by the patients and their families. The article will be concluded by the interest of this project in proposing optimized support in PE.     

“Heartbreaking” Referrals,Professional “Disgrace”: The Impact of Medicare Ineligibility on the Counseling Profession

To better understand the impact of the Medicare mental health coverage gap, the authors analyzed survey data provided by 1,859 members of the American Counseling Association using a conventional qualitative content analysis. One overarching theme, direct impact of Medicare policy on the counseling profession, is presented, along with 3 thematic categories: emotional impact on providers, economic toll on providers, and negative influence on profession's credibility. Implications for the counseling profession are discussed.     

Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care

In an earlier paper (Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326–335) an approach to treatment delivery was examined in which the duration and frequency of the appointments was scheduled by patients. Results of this approach were encouraging but the generalizability of the results was constrained because only one clinician trialed the approach and no standardized assessment measures were used. In the present study there are two clinicians involved and the Depression Anxiety Stress Scale (DASS) was used. The approach was introduced at one GP practice and monitored over a six-month period. Results suggest that this approach might be an effective way of promoting patient access to, and involvement in, service delivery as well as reducing waiting times.     

New Development in Legal Advocacy

Mental health service users are voicing the need for advocacy which is responsive to the social oppression they encounter in their lives, and within services. The Kent Law Clinic provides free, independent legal representation for people with a mental illness or a learning difficulty. This article describes the development of the Clinic and some of its work.     

An Ethical Imperative: Effectively Reducing SGM Disparities Utilizing a Multi-Level Intervention Approach

Health disparities for sexual and gender minority (SGM) populations are well documented and manifest systemically. Mental health professionals have begun working to address these disparities, demonstrating efforts to more effectively define and increase competency in SGM health and by adapting existing evidence-based interventions to more effectively target the unique needs of the SGM community. While such efforts are necessary, they inadequately address the systemic nature of the problem, placing an unnecessary burden on SGM individuals to tolerate systemic discrimination, injustice, and inequality. The current special series attempts to address this gap by featuring papers that describe multilevel (e.g., micro, mezzo, macro) intervention approaches to reduce SGM health disparities. We argue that advocacy is inherent to the work, and we hope that this special series will empower mental health professionals to engage in multilevel, systemic interventions as an ethical imperative.     

Développement des collectifs de travail et développement de la sécurité : une étude sur les décisions à risque en anesthésie

This article highlights the collective dimensions of risk management for patients before an anesthesia. After a phase of observation of real activity, interviews were conducted with 20 anesthetists from two French hospitals. The analysis reveals interindividual diversity in practices. This diversity is explained by the inclusion, in decisions, of knowledge about “distributed” skills in the team and about local “shared practice”. The results establish a link between the site where the anesthetists are working and the choice of an anesthetic technique. They also show that the positioning of anesthetist vis-à-vis the “shared practice” is significantly related to their seniority in the profession. These results open perspectives for research and intervention for the joint development of collective work and safety.     

Sleep and Aging: Challenges and Recommendations for Middle‐Aged and Older Adults

Understanding and alleviating sleep problems for middle‐aged and older adults is addressed through discussion of the following topics: age‐related sleep changes; gender considerations; interactions among sleep, mental health, and physical illness; lifestyle and sleep; and assessment and treatment recommendations.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants

Hope has a significant place in many literatures and most recently in health context. Nevertheless, there is still little research describing the distinct concepts and representations of hope in patients’ population. Hope is defined as perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways. The main objective of this study is to explore the representation of hope, in the context of chronic disease, for both patients and health providers. For that purpose, we conducted the present study considering the social representation approach. The sample consisted of 67 chronic disease patients (mean age = 51.13 years; SD = 19.05; 68.70% female), 83 health care professionals (mean age = 35.32 years; SD = 11.49; 74.70% female) and 103 individuals from the general population (mean age = 30.41 years; SD = 13.85; 64.10% female). They completed two free associations task: write “everything that comes into your mind when you think about hope”, one in general and one in disease context. Free associations allowed us to identify shared conceptions of hope as well as intergroup variations in these representations. Associations with the word of hope produced by our respondents were depending on (a) the context (hope in disease or hope in general), and (b) the type of participant (patient, healthcare professionals or individuals from the general population). The results first indicate that hope, for all participants and whatever the context, refers to the beliefs of positive issues and perspectives. Moreover, dealing with a chronic disease seems to create, for the patients, a very specific representation of hope. It appears that when disease becomes serious and persistent, and when patients need to deal with uncertainty, hope is mainly described as a coping strategy, determined by specific objectives and resources.     

Advocating for Atheist Clients in the Counseling Profession

Atheism is a controversial topic, with individuals who identify as atheist reporting high rates of discrimination. Despite increasing literature discussing religious/spiritual views and beliefs, few scholarly discussions of atheism in the counseling field can be found. Counselors need to be made aware of the issues facing atheist clients and educated on the best interventions to use in collaborative work with clients. Counselors should also be prepared to advocate for atheist clients in multiple domains. This article aims to explore the relevant literature around atheism, identify implications for counselors, and provide a path to advocacy for counselors in their work with atheist clients.