Evolving Formulations:sharing complex information with clients

Psychological formulations are central to cognitive behavioural approaches. The use of such formulations presents a number of difficulties when working with clients with psychotic problems. Despite this, sophisticated psychological formulations can be collaboratively developed with psychotic clients. This paper presents one method of developing such formulations through an evolutionary process. Early in the therapeutic process, simple formulations involving straightforward theoretical models are presented, which are systematically elaborated as therapy proceeds. This involves developing, collaboratively with clients, successive layers of formulation. Each of these layers builds on and incorporates the previous one, yet involves an incremental increase in complexity, depth and informational content. The evolutionary process is illustrated with a case example

Psychological Processes Mediate the Impact of Familial Risk, Social Circumstances and Life Events on Mental Health

<p>Results of a structural equation model testing the mediating effects of the psychological processes of response style and self-blame on the contribution of familial mental health history, relationship status, income and education, social inclusion and life events on mental health problems and well-being, with S-B χ² (3,199, N = 27,397) = 126,654·8, p<·001; RCFI = ·97; RMSEA = ·04 (·038–·039). The path diagram shows completely standardised robust parameter estimates which represent the relative contribution of each latent factor to the model. All coefficients are statistically significant, p<·001. Latent factors are represented by ovals. The double headed arrow between mental health problems and well-being represents the correlations between these latent constructs.</p

Empirically grounded clinical interventions - Clinical implications of a psychological model of mental disorder

Kinderman (2005) presented a psychological model of mental disorder, based on a critique and reformulation of the biopsychosocial model. Kinderman suggested that disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. These processes include, but are not limited to, cognitive processes. This 'mediating psychological processes model' proposes that biological and environmental factors, together with a person's personal experiences, lead to mental disorder through their conjoint effects on these psychological processes. The clinical implications of this model are discussed further here. It is proposed that formulations rather than diagnoses should predominate clinical planning, that these formulations should detail the hypothesised disruption to psychological processes or mechanisms, that psychological therapies should receive higher priority, and that medical, social and even psychological interventions are most likely to be clinically effective if they are designed on the basis of their likely beneficial impact on underlying psychological mechanisms. © 2006 British Association for Behavioural and Cognitive Psychotherapies

Knots and black holes: why we’re all prone to madness and what we can do about it

AbstractPeople from all walks of life can suffer from mental health problems such as low mood, anxiety, obsessive-compulsive problems, even hearing voices. In extreme circumstances, people can begin to fear that other people are plotting to harm them, and some of us even take our own lives. While it is overwhelmingly true that traumatic experiences or on-going deprivation or abuse are possible factors that contribute to psychological problems, there remains an apparent capriciousness to mental health problems. Some people seem to rise above trauma; other people are plagued by great misery without obvious external causes. There is a tendency to explain these differences as reflecting personal, even biological, vulnerabilities. This article is published as part of a collection entitled “On balance: lifestyle, mental health and wellbeing”.</jats:p

Imagine there's no diagnosis, it's easy if you try

The recent discussions over the reliability, validity, utility, humanity and epistemology of psychiatric diagnosis have had wider implications than might at first sight be apparent. Diagnosis is, for many people, both the entry-point to services and the starting-point for public debate. Challenges to the scientific and professional basis for diagnosis, therefore, can have profound implications. Such is the dominance of traditional diagnostic thinking about mental health care that it is often wrongly assumed that there is little alternative – or that any possible alternatives would require lengthy and expensive periods of development. In fact, there is no present impediment to the development of new ways of thinking and delivering services, and especially no impediment to practical and scientifically valid alternatives to diagnosis. </jats:p

“But What About Real Mental Illnesses?” Alternatives to the Disease Model Approach to “Schizophrenia”

The old dichotomy between “neurosis” and “psychosis” appears to be alive and well in the debate about psychiatric diagnosis. It is often suggested that while diagnostic alternatives may be appropriate for the relatively common forms of distress with which we can all identify such as anxiety and depression, psychiatric diagnoses remain vital for experiences such as hearing voices, holding beliefs that others find strange, or appearing out of touch with reality—experiences that are traditionally thought of as symptoms of psychosis. Such experiences are often assumed to be symptoms of underlying brain pathology or “real mental illnesses” that need to be diagnosed or “excluded” (in the medical sense of ruling out particular explanations of problems) before deciding on the appropriate intervention. This article argues that this belief is misguided, and that far from being essential, psychiatric diagnosis has the potential to be particularly damaging when applied to such experiences. It describes an alternative perspective outlined in a recent consensus report by the British Psychological Society Division of Clinical Psychology ( Understanding Psychosis and Schizophrenia), which has attracted significant attention in the United Kingdom and internationally. The report argues that even the most severe distress and the most puzzling behavior can often be understood psychologically, and that psychological approaches to helping can be very effective. It exhorts professionals not to insist that people accept any one particular framework of understanding, for example, that their experiences are symptoms of an illness. This article outlines that report’s main findings, together with their implications for how professionals can best help. </jats:p

An Evaluation of Shared Reading Groups for Adults Living with Dementia: Preliminary Findings

Purpose – Although there is a growing evidence base for the value of psychosocial and arts based strategies for enhancing wellbeing amongst adults living with dementia, relatively little attention has been paid to literature-based interventions. This service evaluation assesses the impact of Shared Reading (SR) groups, a programme developed and implemented by The Reader Organisation, on quality of life for care home residents with mild/moderate dementia. Design/methodology/approach – Thirty one individuals were recruited from four care homes, which were randomly assigned to either reading-waiting groups (three months reading, followed by three months no reading) or waiting-reading groups (three months no reading, followed by three months reading). Quality of life was assessed by the DEMQOLProxy and psychopathological symptoms were assessed by the NPI-Q. Findings – Compared to the waiting condition, the positive effects of SR on quality of life were demonstrated at the commencement of the reading groups and were maintained once the activity ended. Low levels of baseline symptoms prevented analyses on whether the intervention impacted on the clinical signs of dementia. Limitations – Limitations included the small sample and lack of control for confounding variables. Originality/value – The therapeutic potential of reading groups is discussed as a positive and practical intervention for older adults living with dementia