Intensive care diaries

Intensive care patients are particularly vulnerable to one of the key risk factors for post-traumatic stress disorder (PTSD); failing to fully process a traumatic experience, this is due to the sedation, sleep deprivation and delirium.

One in ten patients who are in intensive care for longer than 48 hours later develop PTSD according to a recent estimate. A new study has suggested that an effective way to reduce this risk could be through the use of a daily text and photo diary. This diary would be kept by the patients nurse and family. Christina Jones at the University of Liverpool and her colleagues recruited 352 intensive care patients. They were randomly allocated to receive the diary one month after discharge (a doctor or nurse explained its contents but not how to use it), or in the control group.

PTSD symptoms were recorded at the one month stage and two months, the controls also at this point received their diaries. The main findings were that 5% of patients in the diary group developed PTSD between one and three months after their discharge compared with 13% of patients in the control group. The comments of the patients were also very positive.

When compared with providing formal therapy to all patients struggling to cope with what they have experienced, diaries are likely to be cost-effective at the same time as being effective in helping intensive care patients. However two new studies by Dr Alex Mitchell, a consultant psycho oncologist at Leicestershire Partnership Trust, suggest that nurses involved with patient care struggle very often to detect depression in patients. Most receive very little training in mental health, therefore it may be unrealistic to expect nurses to remember complex criteria to enable them to detect depression and apply lengthy screening tools.

To read more this article can be found in The Psychologist, November 2010 issue. Vol 23 no 11.

Commitment to Psychological Therapies in the Spending Review 2010

The Spending Review 2010 Presented to Parliament by the Chancellor of the Exchequer (see this link for full review) states that despite vast cuts across other departments the Department of Health settlement includes a commitment by the government to “expanding access to psychological therapies”. George Osborne speaking in the House of Commons stated “We will expand access to psychological therapies for the young, elderly and those with mental illness."

This commitment has been welcomed by many including Professor Peter Kinderman, a Clinical Psychologist and Member of the British Psychological Society; the Royal College of Psychiatrists and the mental health charities, Mind, Rethink and Young Minds, particularly because previous expansion of psychological therapies via the Improving Access to Psychological Therapies Programme, has focussed on working age adults with difficulties that could be classified as mild to moderate depression or anxiety.

At this stage no further information has been provided on the form this expansion will take, or the timescale for the changes, but the Spending Review highlights the Government’s position “that while it should continue to fund important services, it does not have to be the default provider. This stifles competition and innovation and crowds out civil society”. Therefore the Spending Review announces that to address this and create new opportunities for non-state providers “the Government will pay and tender for more services by results”. Again, at this stage, there is no further information about how results will be measured and therefore how services will tender for mental health or psychological therapies contracts, but this is likely to be an important time for innovation and development within the private sector.

Psychoanalysis: The Unconscious in Everyday Life

A new exhibition entitled Psychoanalysis: The Unconscious in Everyday Life opened yesterday, 13th October 2010, at the Science Museum in London. The exhibition uses historical artefacts and contemporary artworks to explore the workings of the unconscious and its influence on everyday life. The exhibition is free and open until 2nd April 2011.

See www.sciencemuseum.org.uk for further information and the exhibition catalogue.

 

Psychology in the media - “Please don’t take our child”, Panorama, BBC

On Monday 23^rd August 2010 the BBC broadcast a Panorama programme entitled “Please don’t take our child”. This programme portrayed the story of the Ward family, who had been investigated by police and social services when they were unable to explain serious injuries to their three month old son. After two years the family were cleared of causing non accidental injuries to their son and the programme focussed on the family’s fight to be able to speak openly about their case, including identifying the names of the expert medical witnesses who they believe made significant errors in their provision of evidence. A bill was passed in the final week of the last Parliament which rubber stamped the Ward ruling that paid expert witnesses could be identified.

As one of Psychology Associates’ expert witnesses in child and family cases I was interested to read the comments on the BBC blog following the programme. I wondered how the programme would influence the public’s perception of expert witnesses. However, very few respondents appeared to pick up on the key theme in the programme about changing the rules regarding identifying expert witnesses. Instead the majority of the comments were criticisms of the Local Authority, or narratives about the bloggers’ own experiences of being investigated by the Local Authority. There were in addition some comments which supported Social Workers and the necessity of investigating cases of unexplained injuries in children.

The Panorama programme, in reporting one family’s story, was explicitly one sided. I reflected (as did some of the BBC blog respondents) on the response of the media and the general public to cases where a family has been cleared, in comparison to cases where a family has been found guilty, or where a child has been harmed or killed. I wondered if there is a psychological task in relation to providing psychoeducation around managing the media and emotional response to issues which are hugely publicly important and emotive?

 

Psychology in the media - Be a better parent – and improve your child's mental health, The Guardian

An article in the the Guardian newspaper on 24th August 2010 reports on a pilot project called “Empowering Parents, Empowering Communities”, in Southwark, South London, which offers courses on ‘Being a parent’ and provides training to parents who have completed the course who then wish to go on to become facilitators of the group in order to share their learning within their local community.

The Southwark Council website indicates that  Empowering Parents, Empowering Communities is an 8 week course for parents and carers, of children aged two to 11 years old, to “learn practical communication skills for everyday life and develop their abilities to bring up confident, happy and co-operative children”.

The programme is funded as a two year outcome study and is being evaluated by Dr Crispin Day, Clinical Psychologist at the Centre for Parent and Child Support, Child and Adolescent Mental Health Service Research Unit, at the Institute of Psychiatry. He is quoted in the Guardian as saying that “about half the children whose parents are on the course have difficulties which would be equivalent to a diagnosed disorder, but the parents who go to the group are reporting that their children are showing a significant reduction in the severity of their behaviour problems”.

The Guardian article lists some “lessons to learn from the course” which include thinking positively about yourself as a parent; thinking about your own experiences of being a child and trying to act from this awareness; being specific when praising and stating what you want your child to do, rather than what you do not want them to do; explaining your own behaviour and trying to understand your child’s motivation for behaving as they are; and using star charts to reward good behaviour and discourage bad behaviour.

Further findings should be published as the study continues.

Psychology in the media – Between Ourselves, Radio 4

A recent Radio 4 programme “Between Ourselves” interviewed Clinical Psychologist Oliver James and Educational Psychologist Laverne Antrobus about parenting.

When asked what a child needs more than anything else Oliver James replied “all they really need is responsive, sensitive care from the same person” and Laverne Antrobus replied “a very reliable adult who is really prepared to think of them, and have their mind available to them”.

Oliver James said that he believes it is really important for one parent to stay with the child until three years of age. He said that parents can become focussed on parenting methods, whereas the needs of children under three are very simple. He said that the most difficult task as a parent is “actually getting your head into the right place”, and he recommends that for mothers especially, (because mothers still tend to be the primary caregivers), there are three things they need to consider in depth about themselves in order to be able to get into the right frame of mind to parent effectively. He said these are:

· their own childhood and how that impacts on how they behave as a parent

· the conflict between their identity as a mother and their identity as a worker

· their relationship with their partner and how that can be modified to the maximum advantage of each partner and the child/children

He suggested that it is important for mothers to make arrangements that really suit them and enable them to meet the needs of their under threes, or to employ another individual, such as a child minder, to fulfil this.

Laverne Antrobus agreed and said that in our consumer driven society some parents perceive children as “an accessory” to their lives, and this creates problems because parents may not be prepared for instances when the child inevitably does not fit in with their plans. She said that she is concerned that people do not seem to think seriously enough about having children before they become parents.

Oliver James described three trends in parenting in the Western world that have grown in the last ten years that he considers to be concerning. The first trend is day-care. He suggests that parents have been persuaded by the idea that children need stimulation and the company of other children, but there is no evidence for this, whereas there is a lot of evidence that what they need is the attention of one adult who is familiar to them. The second trend is ‘positive psychology’ which encourages the accentuation of the positive and the elimination of the negative. He said this again is not well supported by the evidence and in contrast attempting to boost children’s self esteem regardless of good or bad behaviour has been shown to encourage antisocial behaviour. The third trend is for strict behavioural routines, as taught by proponents of such things as the naughty step and time out. He gave a caveat that such strategies may be important where parental management of a child’s behaviour has completely broken down, as a first step to regaining some consistency.

Laverne Antrobus disagreed with this third point and said that she had used time out with her children because this would allow her some cooling off time if she felt an interaction with them had become difficult. Oliver James agreed that time out would be preferable to a parent losing their temper with their child.

When asked by the interviewer about “monster children” who assault or kill other children, Oliver James said that we know that extreme maltreatment in childhood produces such behaviour and it is nothing to do with their genes, so they should not be described as evil. Laverne Antrobus said that as a society it can be unbearable for us to accept our responsibility in allowing such extreme maltreatment to occur and that is why she thinks it is reported as it is in the media. Oliver James pointed to evidence that abuse in childhood affects brain development, and both interviewees raised their concern that there are some children for whom the abuse and maltreatment they have experienced has been so severe that no intervention is going to be able to repair this damage.

In conclusion Laverne Antrobus and Oliver James agreed that in ordinary circumstances ‘good enough’ parenting is sufficient, and what all parents should aim for, and the most important elements of this are love and empathy.

Therapy

Psychological therapy, psychotherapy, talking therapy, psychoanalysis, cognitive behaviour therapy, counselling, there are lots of different words used to describe interventions which aim to help people with difficulties with how they are feeling psychologically or emotionally. So what do all these different terms mean and how do you work out which kind of intervention might work for you?

All these talking treatments share the understanding that the experiences you have in your life affect you and potentially those around you. Some focus on how your early or childhood experiences shape the way you see yourself, others and the world, and shape the ways you learn to cope with stress or upset, while others focus on how difficulties at any point in your life may cause you distress or disruption.

Counselling is a term often used in everyday language to describe any intervention where an individual talks to a professional about something that is troubling them. There are many different types of counselling. Counsellors are trained to listen to people with empathy and counselling is usually recommended to help an individual talk through their feelings about a specific, and usually recent, event, such as a bereavement, the end of a relationship, or being made redundant.

In comparison psychological therapy, also referred to as psychotherapy or therapy, has the aim of helping people not just to speak about events but to do so in a way that enables them to make changes in their behaviours, relationships, or feelings about themselves and the world.

Psychoanalysis is the oldest of the psychological therapies and was developed by Freud in the early part of the twentieth century, although a number of different schools of psychoanalysis have developed in the intervening years. One of the most important tenets of psychoanalysis is that we are affected not only by experiences in the external world, but also by experiences in our internal worlds - in the unconscious. Because of this, psychoanalysis, and the psychoanalytic and psychodynamic therapies that derive from it, aim to help individuals explore their internal worlds (or make elements of the unconscious conscious), in order that the effects can be understood and modified. Psychoanalysis and the psychoanalytic psychotherapies tend to be long term and intensive therapies, meaning people may have sessions twice or more a week, and over many months or years.

Most other therapies, draw on psychoanalysis to some extent and share the emphasis on exploring experience so that its effects can be understood and modified, but they may not share the emphasis on the unconscious. They may focus instead on the here-and-now of people’s experience in order to try to reduce the amount of therapy someone may need in order to make change. Perhaps the most well known of these therapies is cognitive behavioural therapy or CBT, which aims to help people to understand how their thoughts, feelings and behaviours connect to each other, in both helpful and unhelpful ways.

There are also a number of integrative therapies for example Cognitive Analytic Therapy which combines elements of cognitive behavioural and psychoanalytic models; and Dialectical Behaviour Therapy which combines elements of cognitive behavioural therapy and techniques of Buddhist meditation.

To make matters even more confusing some therapies are recommended for specific difficulties. This occurs particularly within the NHS, which is a huge organisation and has to attempt to make access to different treatments fair nationwide. There are some good reasons for this, but it can also be overly simplistic, and can lead to people being categorised in ways that they might find unhelpful. You may have heard of the Improving Access to Psychological Therapies or IAPT programme. This is a national government funded programme which aims to increase the amount of psychological therapy available on the NHS. This is a fantastic idea but unfortunately at the moment the funding is specifically directed towards people who fit into the categories of having mild to moderate depression and anxiety. In most parts of the country IAPT provides guided self help (which is when a worker meets a person, or speaks to them on the telephone and suggests either computer programmes or books that they can use to help them identify helpful or unhelpful patterns of thinking or behaviour), and one-to-one short term CBT.

Other therapies may be available via the NHS in your area – ask your GP or check your local NHS Trust website to find out more.

In order to see what therapies are available via Psychology Associates go to www.psychologyassociates.org.uk

 

 

What is Clinical/Counselling Psychology and what do Clinical/Counselling Psychologists do?

Most people will have heard of, or seen a Clinical or Counselling Psychologist, these days they appear quite frequently on television programmes or in the newspapers, commenting on a range of human behaviours and dilemmas. So where has this fascination with psychology come from and what do Clinical and Counselling Psychologists do? Clinical Psychology and Counselling Psychology are professions which apply psychological knowledge and understanding, gained from research and observation, to real life problems. UK Registered Clinical and Counselling Psychologists have an undergraduate degree in Psychology and (if they trained in recent years) a doctorate in Clinical or Counselling Psychology. This qualifies them to work with all sorts of different groups of people: adults; children; people with mental or physical health problems; people who have committed crimes; people who have learning disabilities or brain injuries; to name just a few, to help them find psychological solutions to their difficulties in their life, their work, their relationships, their parenting.

Contemporary TV is full of reality shows, documentaries and docu-dramas, while contemporary non fiction is full of self-help and pop psychology. It appears that people’s interest in themselves and  other people is at an all time high. Clinical and Counselling Psychology are disciplines that are called upon to share their understandings with the public via the media. This blog is an example of that. All blogs on the Psychology Spot will be added by Registered Clinical or Counselling Psychologists. So…check back regularly to see what’s new…

Psychology Associates new blog

Welcome to the blog of Saltash based company Psychology Associates. This first post is from the web designers and developers, Tim & Jake of The Drawing Board. We hope the Psychology Spot will develop into an informative and fun read that those in the profession visit regularly.