Audit in the therapy professions: some constraints on progress.
AIMS: To ascertain views about constraints on the progress of audit experienced by members of four of the therapy professions: physiotherapy, occupational therapy, speech and language therapy, and clinical psychology. METHODS: Interviews in six health service sites with a history of audit in these professions. 62 interviews were held with members of the four professions and 60 with other personnel with relevant involvement. Five main themes emerged as the constraints on progress: resources; expertise; relations between groups; organisational structures; and overall planning of audit activities. RESULTS: Concerns about resources focused on lack of time, insufficient finance, and lack of access to appropriate systems of information technology. Insufficient expertise was identified as a major constraint on progress. Guidance on designing instruments for collection of data was the main concern, but help with writing proposals, specifying and keeping to objectives, analysing data, and writing reports was also required. Although sources of guidance were sometimes available, more commonly this was not the case. Several aspects of relations between groups were reported as constraining the progress of audit. These included support and commitment, choice of audit topics, conflicts between staff, willingness to participate and change practice, and concerns about confidentiality. Organisational structures which constrained audit included weak links between heads of professional services and managers of provider units, the inhibiting effect of change, the weakening of professional coherence when therapists were split across directorates, and the ethos of regarding audit findings as business secrets. Lack of an overall plan for audit meant that while some resources were available, others equally necessary for successful completion of projects were not. CONCLUSION: Members of four of the therapy professions identified a wide range of constraints on the progress of audit. If their commitment to audit is to be maintained these constraints require resolution. It is suggested that such expert advice, but also that these are directed towards the particular needs of the four professions. Moreover, a forum is required within which all those with a stake in therapy audit can acknowledge and resolve the different agendas which they may have in the enterprise. (+info)
The comparative importance of books: clinical psychology in the health sciences library.
Clinical psychology has received little attention as a subject in health sciences library collections. This study seeks to demonstrate the relative importance of the monographic literature to clinical psychology through the examination of citations in graduate student theses and dissertations at the Fordham Health Sciences Library, Wright State University. Dissertations and theses were sampled randomly; citations were classified by format, counted, and subjected to statistical analysis. Books and book chapters together account for 35% of the citations in clinical psychology dissertations, 25% in nursing theses, and 8% in biomedical sciences theses and dissertations. Analysis of variance indicates that the citations in dissertations and theses in the three areas differ significantly (F = 162.2 with 2 and 253 degrees of freedom, P = 0.0001). Dissertations and theses in biomedical sciences and nursing theses both cite significantly more journals per book than the dissertations in clinical psychology. These results support the hypothesis that users of clinical psychology literature rely more heavily on books than many other users of a health sciences library. Problems with using citation analyses in a single subject to determine a serials to monographs ratio for a health sciences library are pointed out. (+info)
Countertransference and limits of therapy in war situation.
Psychotherapy of war traumas and their specific emotional and psychological experiences is a challenge for the therapist. The two partners of the therapeutic dyad may undergo the same difficulties and suffer from the same anxieties, and be affected by the transference and countertransference processes. The conditions of neutrality that should be maintained in the treatment are thus prone to changes. The therapist may protect himself/herself from unconscious guilt, omnipotent fantasies and feelings of being overwhelmed by different modes of defenses. The historical and social context of the trauma have to be taken into account. A chronology to be introduced in the narrative is the first step in the process of reindividuation as the victim's identity has been attacked by the trauma as well as his/her physical integrity. The therapist may find in this intervention a reflection of his/her own needs. The aims of psychotherapy in war situations may be close to those of crisis intervention and at the same time deal with the reactivation of previous infantile traumas. The past plays a significant part in the readaptative process as much as it is relevant to the present. The therapeutic intervention is in essence a message of hope as it implies a potential future to be created. (+info)
Therapists' responses during psychotherapy of holocaust survivors and their second generation.
Human personality contains three layers of identity: the collective, the familial, and the individual, intra-psychic. All three have been directly traumatized and damaged in Holocaust (Shoah) survivors and indirectly through overt and covert transmission in their children. Survivors and the second generation usually contain a few of these identity components in a state of fragmentation, which become central in the therapeutic dialogue between therapists and the patients. When the therapist belongs to the same traumatized population there exists a unique complexity of an a priori countertransference. Sharing the same traumatogenic reality that the patient seeks to alleviate through therapy poses unique difficulties and challenges for the therapist. In working with survivors, pre-war intra-familial traumatizations are of little significance in the face of the massive traumas and death suffered in the Holocaust. In the case of the second generation, "ordinary" developmental impairments and difficulties cannot be fully understood without knowledge of the parents' war experiences and the resultant family atmosphere. Thus, every therapist has to examine both his knowledge and especially his responses not only about the Shoah as a massive trauma but the specific war history of both parents families. Self-knowledge and awareness are necessary to a far greater extent than usual if one is not to be shocked or surprised into acting out. The depth and degree of openness which therapists need when dealing with Holocaust survivors and their children are at least as important as clinical skills. (+info)
Countertransference problems in the treatment of a mixed group of war veterans and female partners of war veterans.
AIM: Analysis of countertransference problems in the treatment of a heterogeneous group of war veterans. METHOD: The method used in this work was psychodynamic clinical observation and analysis of countertransference phenomena in group therapy. RESULTS: In the beginning of our work, we faced with a regressive group, which was behaving as it was re-born. The leading subject in the group was aggression and the need for hospitalization to protect them and their environment from their violence. With the development of group processes, a feeling of helplessness and lack of perspective appeared, together with suicidal ideas, which, because of the development of group cohesion and trust, could be openly discussed. With time, the group became a transitional object for its members, an object that gave them a feeling of safety but also a feeling of dependence. CONCLUSION: The role of the therapist is to support group members in becoming independent. The therapist's function is in controlling, containing, and analyzing of the destructive, regressive part and in encouraging the healthy parts of the patient. With the integration of good therapeutic process, the healthy parts of the patient gain control over his or her regressive parts. (+info)
Managed mental health care: attitudes and ethical beliefs of child and pediatric psychologists.
OBJECTIVE: To examine child and pediatric psychologists' ethical beliefs and attitudes toward managed mental health care. METHODS: In a survey mailed in spring 1997, 252 child and pediatric psychologists responded to three vignettes depicting ethical dilemmas related to working with managed mental health care (confidentiality, restriction of services, misdiagnosis). Data were collected about psychologists' ethical choices and reasons given for choices, attitudes toward managed care, the extent to which managed care affected ethical decision making, and level of managed care involvement. RESULTS: Differences were found in choices made for the ethical dilemmas in regard to what participants thought they should do, would do, and actually did do. Overall, participants endorsed negative attitudes toward managed care. Participants reported that managed care somewhat affected their ethical decision making for the vignettes. Level of managed care involvement was not related to ethical decision making or attitudes toward managed care. CONCLUSIONS: The findings suggest areas for examination as new ethical standards are created for work in managed care environments. (+info)
A psycho-endocrinological overview of transsexualism.
The technical possibility of surgical sex change has opened up a debate concerning the legitimacy and utility of carrying out such an intervention at the request of the transsexual. Diagnostic, psychological, medical and ethical arguments have been brought forth, both for and against. Nonetheless, anatomical transformation by surgical means has currently become a practice as the frequency of serious gender identity disorders is constantly progressing. After a brief introduction, the present paper will consider typological, aetiological and epidemiological aspects of transsexualism. Treatment of the sex change applicant is then defined and discussed in terms of psychological, psychiatric, endocrinological and surgical aspects. Finally, the question of post-operation follow-up will be examined. (+info)
Psychiatric referral rates and the influence of on-site mental health workers in general practice.
Psychiatric referral rates vary widely between different general practices. To increase our understanding of this variation, we conducted a one-year prospective observational study of outpatient psychiatric referrals made by all general practices (622 referrals from 29 practices) within the catchment area of one inner-city psychiatric service. Contrary to our hypothesis, practices with higher allocations of on-site mental health workers did not have lower psychiatric referral rates. On the other hand, the highest referring practices had lower mental health worker allocations suggesting a possible influence upon referrals in this subgroup. A wide range of quantitative variables explained very little of the referral rate variation, implying that more subjective factors, such as general practitioner attitudes, may be influential in the decision to refer a patient to the psychiatrist. (+info)