Bartenders and Hairdressers As Natural Helpers After the Terrorist Attacks of September 11

Question: Why were professional mental health services apparently underutilized after 9/11, and did people receive emotional support from alternative sources? Approach: Bartenders and hairdressers in New York City were surveyed by telephone to evaluate their role as natural community helpers. Objective: Pathological emotional responses to trauma can paradoxically lead to reluctance to engage in treatment. Some people may feel more comfortable discussing emotional reactions with members of the community, such as bartenders or personal service providers, who are referred to as “natural helpers,” and can serve as de facto care givers. The purpose of this study was to learn more about the role of these helpers and their reactions following the attacks of 9/11. Method: A brief questionnaire was developed. Bartenders and hairdressers were contacted by telephone during June and July of 2002, and asked how the 9/11 attacks affected their business, their interactions with customers, and whether they suffered adverse reactions to filling the role of natural helper in a disaster environment. Librarians were used as a control. Results: 37 bartenders, 48 hairdressers, and 48 librarians agreed to participate in the study. Compared to librarians, significantly more hairdressers and bartenders reported that their customers wanted to talk about their emotional reactions to the attacks, that it was difficult for them to talk to so many people about this topic, and that they tried to avoid the topic with others because of so much exposure at work. Conclusions: Bartenders and hairdressers reported an increased desire among their customers to talk about emotional topics following the 9/11 attacks, and experienced some adverse emotional effects

Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?

Objective: Consultations about medically unexplained symptoms (MUSs) can resemble contests over the legitimacy of patients' demands. To understand doctors' motivations for speech appearing to be critical of patients with MUSs, we tested predictions that its frequency would be related to patients' demands for emotional support and doctors' patient-centered attitudes as well as adult attachment style.Methods: Twenty-four general practitioners identified 249 consecutive patients presenting with MUSs and indicated their own patient-centered attitudes a, well as adult attachment style (positive models of self and others). Before consultation, patients self-reported their desire for emotional support. Consultations were audio recorded and coded utterance by utterance. The number of utterances coded as criticism was the response variable in the multilevel regression analyses.Results: Frequency of criticism was positively related to patients' demands for emotional support, to doctors' belief in sharing responsibility with patients and to doctors' positive model of themselves. It was inversely associated with doctors' belief that patients' feelings were legitimate business for consultation and was unrelated to their model of others.Conclusions: From the perspective of doctors, speech that appears to be critical probably reflects therapeutic intent and might therefore be better described as &quot;confrontation.&quot; Understanding doctors' motivations for what they say to patients with MUSs will allow for more effective interventions to improve the quality of consultations. (C) 2007 Elsevier Inc. All rights reserved.</p

Development of the Verona coding definitions of emotional sequences to code health providers’ responses (VR-CoDES-P) to patient cues and concerns.

Objective To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) [2] and Zimmermann et al. (submitted for publication) [3]). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion. Methods The Verona-CoDES-P system has been developed based on consensus views within the “Verona Network of Sequence Analysis”. The different phases of the creation process are described in detail. A reliability study has been conducted on 20 interviews from a convenience sample of 104 psychiatric consultations. Results The VR-CoDES-P has two main classes of provider responses, corresponding to the degree of explicitness (yes/no) and space (yes/no) that is given by the health provider to each cue/concern expressed by the patient. The system can be further subdivided into 17 individual categories. Statistical analyses showed that the VR-CoDES-P is reliable (agreement 92.86%, Cohen's kappa 0.90 (±0.04) p < 0.0001). Conclusion Once validity and reliability are tested in different settings, the system should be applied to investigate the relationship between provider responses to patients’ expression of emotions and outcome variables. Practice implications Research employing the VR-CoDES-P should be applied to develop research-based approaches to maximize appropriate responses to patients’ indirect and overt expressions of emotional needs