As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record
Forty-four patients were assessed for three different short-term dynamic therapies, with an evaluation form based on Sifneos' criteria for Short-Term Anxiety-Provoking Psychotherapy (STAPP). Ten patients were ascribed to STAPP, 22 patients to Malan's Brief Psychotherapy (BP), and 12 patients to a more eclectic/integrative form of brief psychotherapy in this project called the FIAT model. 78% of the patients completed their treatment in agreement with the original ascription to therapy, with good results for all three therapies. The evaluation form seems to be a reliable and valid instrument offering a good and systematic basis for designing a tailor-made treatment format for different types of patients.
Three hundred chronic mental patients participated in a survey to evaluate their attitudes towards the 2,000 beds hospital where they were staying. The mean duration of the actual hospitalization was 12.1 years and most patients (77.9%) suffered from schizophrenia or other psychoses. On the whole, results show a relatively high level of patients' satisfaction. Single, non psychotic and self-sufficient patients who have not been hospitalized many times and do not want to leave the institution are more inclined to be positive towards the psychiatric milieu. The authors report that participation of chronic mental patients in a survey can be reliable and give helpful suggestions in relation with the evaluation of psychiatric care and the improvement of the quality of life in state hospitals. They conclude that it will always be difficult to discharge satisfied patients without offering the same support and community services that they find in a state hospital.
Many countries allow for the use of restraint and seclusion in emergencies with psychiatric inpatients. Authors have suggested that the attitudes of staff are of importance to the use of restraint and seclusion.
To examine the attitudes to coercion at two Norwegian psychiatric units. In contrast to the idea that attitudes to coercion vary much within and between institutions, we hypothesized that staff's attitudes would be quite similar.
We distributed a questionnaire to staff at two psychiatric units in two Norwegian counties. Eight wards were included. The questionnaire contained fictitious case histories with one patient that was violent and one patient that was self-harming, and staff were asked to describe how they would intervene in each emergency. Emergency strategies were sorted according to degree of restrictiveness, from the highly restrictive (restraint, seclusion) to the unrestrictive (talking, offering medication). Data were analysed with regression analyses.
There was only a limited degree of variance in how staff at the different units and various groups of staff responded. Staff were more likely to favour a highly restrictive intervention when the patients were physically violent. Male staff and unskilled staff were significantly more prone to choosing a highly restrictive intervention.
Our hypothesis was confirmed, as there was a limited degree of variance in staff's responses with respect to degree of restrictiveness. The study supported the idea that a range of different interventions are used in emergency situations.
This study compared the caring situation, health, self-efficacy, and stress of young (16-25) informal carers (YICs) supporting a family member with mental illness with that of YICs supporting a friend. A sample of 225 carers, assigned to a family group (n = 97) or a friend group (n = 128) completed the questionnaire. It was found that the family group experiences a lower level of support and friends experienced a lower positive value of caring. No other differences in health, general self-efficacy and stress were found. YICs endure different social situations, which is why further study of the needs of YICs, especially those supporting friends, is urgently needed.
Case records of all non-forensic psychiatric admissions (n = 5,729), over a three year period, to all the inpatient psychiatric facilities, within one geographic area were studied on a number of demographic, clinical, and treatment characteristics. Patients who had received E.C.T. were compared with those who did not receive tis treatment. The results showed that a high proportion (21%) had received E.C.T. In comparison with patients not receiving E.C.T., E.C.T. recipients were significantly older, more often female, had greater number of previous admissions, greater incidence of violent behaviour, and longer stays in hospital. E.C.T. patients did not differ from others on social class, education, and marital status, nor was E.C.T. prescribed more often to patients who had demonstrated suicidal behaviour, even if they had a diagnosis of depression. E.C.T. and non E.C.T. patients received an equal number of psychotropic drugs.
Through questionnaries sent to all priests in a county in northern Norway (n = 78) we described and analysed the relations between the priests and a community mental health service. Results showed that the priests had contact with many persons with mental problems and also with many psychiatric patients. Priests described their work with psychiatric problems and psychiatric patients as based on a "holistic" concept of man, which they did not consider was the case in the professional work carried out by the psychiatric services. These ideological differnces did not result in the priests being unwilling to motivate persons to contact the mental health organisations, as four out of five priests had referred persons to psychiatric treatment in the 12 months before the study. There was also a strong wish among the priests for more contact with psychiatric professionals.
From a holistic perspective, psychiatric diseases are caused by the patient's unwillingness to assume responsibility for his life, existence, and personal relations. The loss of responsibility arises from the repression of the fundamental existential dimensions of the patients. Repression of love and purpose causes depersonalization (i.e., a lack of responsibility for being yourself and for the contact with others, loss of direction and purpose in life). Repression of strength in mind and emotions leads to derealization (the breakdown of the reality testing, often with mental delusions and hallucinations). The repression of joy and gender leads to devitalization (emotional emptiness, loss of joy, personal energy, sexuality, and pleasure in life). The losses of existential dimensions are invariably connected to traumas with life-denying decisions. Healing the wounds of the soul by holding and processing will lead to the recovery of the person's character, purpose of life, and existential responsibility. It can be very difficult to help a psychotic patient. The physician must first love his patient unconditionally and then fully understand the patient in order to meet and support the patient to initiate the holistic process of healing. It takes motivation and willingness to suffer on behalf of the patients in order to heal, as the existential and emotional pain of the traumas resulting in insanity is often overwhelming. We believe that most psychiatric diseases can be alleviated or cured by the loving and caring physician who masters the holistic toolbox. Further research is needed to document the effect of holistic medicine in psychiatry.