Posted by Psych@Bower on 27th March 2009
Impaired practitioners are those who are unable to fulfil professional or personal responsibilities because of psychiatric illness, alcoholism or drug dependency. In Australia most of the literature is from professional registration boards about procedures and complaints panels, not about prevalence, prevention, assistance or intervention. In exploring the literature it was a surprise to discover that there is almost no reference to impaired psychologists and counsellors while there is more available around impaired physicians and psychiatrists. I suspect the dearth of information is not because psychologists are immune to mental health problems. The small amount of literature, from America in the mid 1990’s, suggests that they are at risk of anxiety, depression, alcohol problems and relationship difficulties.
Mental illness is stigmatising. and those working in mental health are often the most inclined to stigmatise their colleagues. There is often the belief that if a mental health problem is admitted then you might as well retire as you are ‘no good to anyone anymore.’ This personal and professional stigmatisation adds to stigma already present in the community. Then there is the fact that practitioners have a tendency to either protect or ignore impaired practitioners – I have experienced opposition to getting appropriate assistance for co workers on a number of occasions – and the delay in treatment causes significant problems in relationships and professional reputation, not to mention personal distress. The impact on family is often not seen by co-workers, but is significant.
Working in the mental health arena is stressful, and primary and secondary prevention of mental health problems is important. Early warning signs include irritability, social withdrawal, reduced quality of work, reduced productivity, emotional exhaustion and fatigue, isolation, disillusionment, job relocations and sleep problems.We know these things for our clients but are reluctant to turn the mirror on ourselves and our colleagues. Information and education about burnout, about building resilience, about the need for a general practitioner, as well as confidential assistance programs and rehabilitation programs are all important in looking after ourselves and our colleagues.
References
Wilson A, Rosen A, Randal P, Petherbridge P, Codyre D, Barton D, Norrie P, McGeorge P, Rose L. Psychiatrically impaired medical practitioners: an overview with special reference to impaired psychiatrists . Australasian Psychiatry 2009 17:1 6-10
Wilson A, Rosen A, Randal P, Petherbridge P, Codyre D, Barton D, Norrie P, McGeorge P, Rose L. Psychiatrically impaired medical practitionersbetter care to reduce harm and life impact, with special reference to impaired psychiatrists. Australasian Psychiatry 2009 17:1 6-10
Posted in General, Mental Health, Communication, Relationships, Therapy, Change | 1 Comment »
Posted by Psych@Bower on 23rd March 2009
The calm of a therapists office seems miles from the tension of a hostage situation yet in both places the power of relationship, communication and strategy are primary. Sokas and Van Zandt (1986) paper “Hostage Negotiation: Law Enforcements Most Effective Non-Lethal Weapon” provides an instructive, easily read overview of an area largely unfamiliar to clinicians. The paper commences with a short history dating the beginning of modern hostage negotiations from the 1972 Olympic Games in Munich when a group of Palestinian terrorists took 11 Israeli athletes as hostages, culminating in the deaths of 22 people.
The authors categorize hostage taking along a continuum from trapped criminal incidents where a person is trapped by police in the course of committing an offence to acts of terrorism. By far the biggest group, 59% involve a person suffering a mental disorder, (depression, bi-polar disorder, schizophrenia or other psychoses) or emotional difficulties as a result of personal problems or family disputes. Drug and alcohol problems may also play a significant role. While clinicians may be consulted the authors suggest that direct intervention may in fact exacerbate the situation where the hostage taker has a history of unsuccessful experiences in the mental health field.
Despite the differences, many hostage situations share central dynamic features. A key aspect is that these are instrumental or triadic arrangements where “the hostage taker attempts to use the hostage to coerce or communicate with a third party, who inevitably becomes a part of the hostage incident, even at a distance” This essentially systemic understanding locates the negotiator within a web of relationships which must be understand in all their complexity if a positive outcome is to be achieved. This can be especially challenging when the hostage taker is delusional and the target or audience for the demand does not exist or has no real relationship to those involved. The paper describes a number of recognizable patterns which may apply in these situations and indicators when a negotiation is going poorly or well. It concludes with comments about selection and training of negotiators and future developments.
Reading this paper left me with a better informed respect for the work done by our police negotiators who, unlike the therapist ensconced in their office, has the added burden that, should their work go awry blood, not tears may be shed.
Sokas, D and Van Zandt, C (1986) “Hostage Negotiation: Law Enforcements Most Effective Non-Lethal Weapon” Behavioral Science and the Law Vol 4, No 2 pp 423-435
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Posted by Psych@Bower on 14th March 2009
In our sex saturated world it should come as little surprise that research confirms that a satisfying sexual relationship is intricately connected to relationship satisfaction. As Timm (2009) says in her paper “Do I Really Have to Talk About Sex? Encouraging Beginning Therapists to Integrate Sexuality into Couples Therapy” ‘conventional wisdom tells us that sex is only 5% of a relationship when its going well and 95% when it is not’ perhaps because it is the physical expression of the primary emotional bond. What may be more surprising is how absent the discourse about sex is in couple and relationship therapy. Timm proposes a number of explanations for this including a lack of formal training with many courses having no requirement for specific education on the topic and neglect in supervision. Another crucial element is the self of the therapist. It is clear that the more comfortable a practitioner is to discuss sexual issues the more likely they are to include the topic in the therapeutic conversation. Messages received in the family of origin, the current quality of the practitioners’ own sexual relationship and their knowledge about sexuality all contribute to their comfort. A belief that raising the topic would embarrass clients can also act as a constraint, yet it is clear that the therapists’ ability to speak freely is liberating and normalizing for clients.
Timm offers a reassuring guide to the nervous therapist “The good news is that couples therapists do not need extensive, formal sex therapy training to address issues of sexuality in their clients’ relationships. This paper educates about the PLISSIT Model, offers specific suggestions to increase the therapist’s comfort level, provides basic questions to ask every couple, and recommends more detailed sexual history questions to use when relevant.”
The paper then proceeds to fulfill all its promises explaining the PLISSIT model ( Permission Giving, Limited Information, Specific Suggestions and Intensive Therapy) a graded series of interventions which allow even the most junior and nervous therapist to offer something to their client. In addition the author provides a series of specific questions to ask when exploring a couple’s sexual relationship and an extensive bibliography of resources for both the practitioner and client. By the end all are liberated and well informed!
Timm (2009) “Do I Really Have to Talk About Sex? Encouraging Beginning Therapists to Integrate Sexuality into Couples Therapy Journal of Couple & Relationship Therapy, 8:15–33
Posted in General, Marriage, Relationships, Therapy | No Comments »
