Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Brief Therapy in Adult Psychiatry

Brief Therapy in Adult Psychiatry

Ratings: (0)|Views: 74 |Likes:
Published by Benjamin Cortes
Forty-one of forty-four referrals to a multidisciplinary team providing
brief therapy in adult psychiatry were followed up after one year.
Questionnaires were sent to attenders and their general practitioners. A
good outcome was reported in 29 cases (70%) while four cases (10%)
were worse. Good outcome was linked with more therapy sessions and
having specific goals for treatment. Lower social class did not predict
poor outcome, unlike other forms of psychotherapy. Benefit was not
linked to age, sex, place of residence, duration of problem, source of
referral, those attending, inpatient statuso r lapse from treatment.L ongstanding
problems dids lightly less well. The ‘worse’ group were younger
and all four were female. Training of the team took place during therapy
at little extra cost without any detriment to outcome. These findings
have implications for the team’s approach and for the provision of
psychotherapy services in general.
Forty-one of forty-four referrals to a multidisciplinary team providing
brief therapy in adult psychiatry were followed up after one year.
Questionnaires were sent to attenders and their general practitioners. A
good outcome was reported in 29 cases (70%) while four cases (10%)
were worse. Good outcome was linked with more therapy sessions and
having specific goals for treatment. Lower social class did not predict
poor outcome, unlike other forms of psychotherapy. Benefit was not
linked to age, sex, place of residence, duration of problem, source of
referral, those attending, inpatient statuso r lapse from treatment.L ongstanding
problems dids lightly less well. The ‘worse’ group were younger
and all four were female. Training of the team took place during therapy
at little extra cost without any detriment to outcome. These findings
have implications for the team’s approach and for the provision of
psychotherapy services in general.

More info:

Published by: Benjamin Cortes on Sep 16, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

09/16/2010

pdf

text

original

 
@
The Association for Family Therapy 1994. Published by Blackwell Publishers,
108
CowleyRoad, Oxford, OX4
lJF,
UK and
238
Main Street, Cambridge, MA, USA.
Journal
of
Family
Thcrab
(1994)
16:
41-26
0
1
634445
Brief
therapy
in
adult
psychiatry
Alasdair
J.
Macdonald*
Forty-one of forty-four referrals to a multidisciplinary team providingbrief therapy in adultpsychiatry were followed upafteroneyear. Questionnaires were sent to attenders and their general practitioners.
A
good outcome was reported in
29
cases
(70%)
while four cases (10%)were worse. Good outcome was linked with more therapy sessions andhaving specific goals for treatment. Lower social class did not predict
poor
outcome, unlike other forms of psychotherapy. Benefit was notlinked to age, sex, place of residence, duration of problem, source ofreferral, those attending, inpatient status
r
lapse from treatment.Long-standing problems did lightly less well. The ‘worse’ group were youngerand all
four
were female. Training of the team took place during therapyat little extra cost without any detriment to outcome. These findingshave mplications for he eam’s approachand for heprovision ofpsychotherapy services in general.
Introduction
Family therapy of all types is recognized as an effective treatment inchild andadolescentpsychiatryand in social work. Onlyasmall number of reports exist of its use in adult psychiatric settingssee, forexample, Bloch
t
al.,
1991). In this era of community care, the eed toassess and modify family interactions is an ncreasingpart of allpsychiatric services. Wilkinson and van Boxel
(
1992) have drawnattention to the mportance of training in family work in generalpsychiatry for all professions involved with patients of all ages. Inaddition, financial and stafing limitations mean thatall therapies arerequired to be cost-effective andshort-termasfar as this canbe achieved. The study reported here describes our attempts to addresssome of these issues.
*
Consultant
Psychiatrist/Psychotherapist,
Crichton Royal Hospital, DumfriesDGl 4TG,
UK.
 
416
Alasdair
J.
Macdonald
Method
Therapy style
In the cases reported here,we used brief therapy of the type describedby Fisch
et al.
(1982). The basic assumptions are that problems aremany, but hat unsuccessful solutions fall intoa few recognizabletypes. Clients persist withnsuccessful solutions leading o a feedbackloop which maintains the problem. We seek concrete descriptions ofhow theproblemappears o heattenders.Goalsand first steps towards them are then described. The team highlights the attenders’existing skills and recommends tasks which obstruct ineffectivesolutions. This allows patients to use their own problem-solving skills,usually to good effect.
As
a esult, herapy equires imited datacollection and is usually completed within a small numberf sessions.
Care
example.
A
young mother complained ofobsessional handwashing.She fought constantly but nsuccessfully against this impulse and asregularlycriticized by herhusband for her ailure
to
control t.Handwashing occurred about
30
times daily. Her goal was to reduce
it
to
10
timesdaily by gradual steps. The team reframed herbehaviour as
a
maternal attempt to protect her child from infectionand she was advised not to reduce below
25
times daily in the firstmonth. Her husband greed to supervise this task. When shewas seenagain four weeks later her anxiety and the handwashing were muchreduced, as was her husband’s criticism. Further similar advice wasgiven and the couple regarded the problem as resolved after threemonths four interviews in all).Handwashing at hat time hadreduced to about 10 times daily but they no longer bothered to countit or to talk about it.Our Brief Therapy Team s made up of mental health professionalsfromseveraldisciplines.We use
a
one-way screen and prefer tovideotape all sessions. One team member acts as the key worker andmakes all contacts with the attenders and outsidegencies. The teamsare anonymous, passing messages to the therapist via an earphoneand meetingwith he herapist for discussion during breaks. Thestructure of thelinic is described in moreetail elsewhere(Macdonald, 1990; Bowditch, 991). The team includes traineetherapists from several disciplines. Only one member (the author)had previous experience of this approach. The technique has provedeasy to teach and applicable to work in other areas of the MentalHealth Unit such as wards and day hospitals.
0
1994
Tfu
Association
for
Family
Therap?
 
Brief therapy in adult pychiatry
41 7The team receives referrals from general practitioners, consultantpsychiatrists and other health careprofessionals. The Mental HealthUnit of which our team is
a
part serves
a
scattered rural populationand has
a
long history of traditional high quality hospital-based care.We exclude patients with acutesychosis but do not elect referrals inanyother way.Referringagentsmay select cases where they see family issues as relevant, but therwise the rangeof problems referredis very wide.Clients themselves decide who will come to sessions although weinvite all family members.We assess motivation by looking for‘customers’ who seek change, ‘complainants’ who seek change inothers, and ‘visitors’ who do not wish change at this time. Tasks aremodified acording to our assessment of motivation on this basis. Wewill specifically invite other amily members orsignificant others if wethink this relevant. We rarely exclude anyone but may choose to seecertain combinations f family members. Discharge maye negotiatedor may be decided by the family.Our attenders are sent
a
leaflet in advanceoutlining he basicstructure for therapy. We include aetailed explanation of their rightsinrelation to videotapingalong he lines recommended by Birch(1990), using this as
a
first step towards involving them in therapyand in decision-making about their own goals and plans.
Follow-up design
This is derived from the descriptions in Watzlawick
et al.
(1974) andde Shazer (1985). One year after theirast session, all clients receive apostal questionnaire asking:
Is
the problem solved? Were your goalsfor therapy achieved? Have other problems been solved at the sametime? Have new problems appeared? Has further involvement withmental ealth professionals been necessary? Comments nhetherapy style and setting arelso sought. At the sameime we write toall the general practitioners asking f the problem is better, worse orthe same. Again, any additional comments are requested. We choseone year or follow-up, as a shorter eriod might reflect
a
‘honeymoon’effect of therapy and over
a
longer period further life events mightobscure the outcome.The study had the approval f the Dumfries and Galloway Ethical(Research)Committee.Statisticalcalculations followed Swinscow
(
1983) and Siege1
(
1956).
@
1994
Thc Association
or
Family Thcrafy

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->