Making a difference for young people with learning disabilities: A model for inclusive counselling practice

The prevalence of mental health problems in young people with learning disabilities and the disability rights movement provide the background to this paper. The aims are to investigate the inclusivity of counselling; gain insight into inclusive practices; and put forward a model for inclusive counselling practice. Mixed methodology provides quantitative and qualitative data through a survey of counsellors (n = 396) and a series of semi‐structured interviews (n = 15). The results produce six indicators of inclusive counselling, which are used to build a model for inclusive counselling practice: proactive approach to inclusion; focus on building relationships; operationalising equal opportunities policies; inclusive initial assessments; adopting flexible and creative approaches to counselling; and training and awareness raising. The implications for research and practice are to acknowledge the exclusive nature of the profession and address the issue of inclusion through training, professional development and further research in the field. The model for inclusive counselling practice is put forward as a tool for auditing existing counselling provision and as guidance for counsellors and policy makers in increasing inclustion of young people with learning disabilities in mainstream counselling.     

虚拟现实技术在心理治疗中的应用

虚拟现实系统具有良好的沉浸性、互动性和构想性而被广泛应用于军事、工业、建筑、教育等诸多领域。近年来,国外一些研究者将虚拟现实技术用于恐惧症、社交焦虑症、创伤后应激性障碍和厌食症等心理疾病的治疗,并取得了良好效果。本文简要介绍了国外在方面开展的主要工作,并对未来的研究趋势进行了展望。     

Harriet Lerner: A Feminist Voice From the Wheat Fields

ABSTRACT

Harriet Lerner, a Menninger-trained psychologist, has published widely in scholarly journals and for a general audience. Her twelve books include The New York Times bestseller, The Dance of Anger, and she blogs for Psychology Today. In this chapter, she shares her personal and professional evolution as a feminist theorist, psychotherapist, and writer.     

Disclosure and nondisclosure about being in counseling

We interviewed 13 undergraduate students who had been or were currently in counseling about whether or not they disclosed about being in counseling. Participants generally disclosed when they felt close to a person, and did not disclose when they felt they would be misunderstood or judged. Participants reported both neutral and positive consequences of having disclosed. Differences were found based on the level of shame-proneness, such that participants who were higher in shame-proneness seemed more self-protective and vigilant about others’ reactions when considering disclosing. Implications regarding how to deal with the stigma related to counseling are discussed.     

Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment

The increasing use of pharmacotherapy raises specific ethical concerns for psychologists working with vulnerable populations. Due to a shortage of trained specialists, professionals without training in mental health, such as primary care providers, are increasingly prescribing and monitoring psychotropic medications. Vulnerable populations (e.g., older adults, people currently low in social status, immigrants, and racial/ethnic minorities) face additional barriers to mental health treatment and are at heightened risk when these factors intersect. Hence, these patients experience unique barriers to receiving optimal psychopharmacological care and are differentially vulnerable to deleterious outcomes associated with misdiagnosis and overmedication. Taken together, these factors fuel inequities in the access, quality, and utilization of mental health care. Psychologists working with these patients are ethically mandated to protect patients from harm and ensure equitable care across patient populations. Specifically, psychologists must respond to the dilemma of how to effectively treat patients within these vulnerable populations who have been misdiagnosed or poorly medicated while remaining within the bounds of their competence. This article recommends pathways to address these dilemmas through education, training, research, and advocacy.     

Acceptance and Commitment Therapy for Posttraumatic Stress Disorder in Early Psychosis: A Case Series

Persons with psychosis often report high levels of posttraumatic stress disorder (PTSD) symptoms, which render them more vulnerable to relapse, symptom exacerbation, and reduced well-being. However, less is known about how to adequately accommodate the needs of persons recovering from a first episode of psychosis, presenting with PTSD. Further, the existing evidence-based interventions for PTSD seem less equipped to deal with serious mental disorder and comorbid conditions. This study aimed to assess the efficacy, acceptability, and safety of Acceptance and Commitment Therapy (ACT) for persons suffering from PTSD with comorbid trauma and psychosis. Three consecutively referred participants meeting ICD-10 criteria for PTSD and a first-episode nonaffective psychotic disorder were treated in an outpatient service within a case-series analysis. A manual-guided ACT intervention of 12 sessions showed clinically relevant improvement on self-report measures of PTSD symptoms and emotional distress. These initial findings are promising and appear to justify a more controlled evaluation of this brief intervention.     

Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis

Movement psychotherapy (MP), and dance/movement therapy (DMT), are body-orientated psychotherapy approaches that use movement for the integration of emotional, cognitive, physical, social and spiritual aspects of self (European Association Dance Movement Therapy, 2010). It is distinctively a combination of moving and sensing the body with verbal self-reflection (Bloom, 2006). Several papers have presented DMT as a treatment in general medical care and cancer care, but there is still a paucity of evidence-based studies. The authors describe a clinical case illustrative of many of the situations in which facing death was particularly tormenting. The emotional pressure can produce a barrier of communication with the risk of rupturing the therapeutic relationship. The movement therapist’s function is to clarify the elements of body language and this has important implications for clinical practice because the end-of-life decisions are difficult, like palliative sedation therapy (PST). Even if procedural guidelines for PST help physicians and care teams through the decision-making process and make them more comfortable when responding to physical suffering, physicians more frequently report an emotional pressure when their patients experience psychological symptoms, with the risk that PST could become a potential “counterphobic defence to treat”.     

The emerging therapeutic landscape of psychotherapy in the twenty-first century and the contribution of anthroposophic psychotherapy

In recent years the counselling and psychotherapy profession has experienced significant changes. On the one hand there has been the advent of managed care and evidence based practice which in the UK takes the form of the Improved Access to Psychological Therapy scheme. On the other hand there has, during the same period since the 1980s, been a rich and varied process of innovation in the profession. This has included the so-called relational inter subjective turn in the United States. Second, an increased sensitivity to the interface between therapy and social and political phenomena. Third, the revolution in neuroscientific thinking. Finally, the development of therapy as an interdisciplinary intervention in complementary and alternative medicine teams as in the case of the spiritually-orientated anthroposophic psychotherapy in Europe. In this article I will argue that these innovatory developments, which I refer to as the ‘new integration’, are much needed in order to counterbalance the increasing dominance of managed care and evidence based practice.     

The existential dimension in psychiatry: an enactive framework

ABSTRACT

In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.     

More transparency of world view assumptions: Commentary on “Psychiatry and religion: Consensus reached!” (Verhagen, 2017)

ABSTRACT

The commentary compares the WPA position statement with a similar paper published recently by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN; Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde). These papers should be a starting point to foster R/S studies within the bio-psycho-social-spiritual framework, a thoughtful discernment of the psycho-spiritual mixture and more training opportunities for therapists to better integrate the spiritual dimension into treatment.