Psychotherapy and social support - Integrating research on psychological helping

Psychotherapy interactions and social support conversations have many similarities, as well as some important differences. Researchers studying these two manifestations of psychological helping - often known as formal and informal helping - usually apply a separate set of concepts and methods to each and tend to locate their work in separate bodies of literature. This paper argues that such a division of the field is unnecessary and unproductive. It outlines several ways in which the two bodies of literature might inform each other and argues for conceptual integration of the two fields. (C) 2001 Elsevier Science Ltd. All rights reserved

Culture and the therapeutic relationship: Perspectives from Chinese clients

Chinese people in the United Kingdom and United States underuse mental health services and, when they do seek help, may find that therapy does not meet their needs. In response to calls in the literature for naturalistic studies of therapy with people of Chinese background, this study used a qualitative, multiple-case approach to examine clients' individual experiences in depth and detail. Semistructured interviews were conducted with eight Chinese clients. The aim was to investigate how culture might play a role in the therapeutic relationship. Qualitative analysis yielded four key themes concerning clients' and therapists' awareness of culture and how this impacted their working relationship: "Cultural encapsulation", "cultural formulation", "cultural liberation", and "culture is not important." Although participants' perceptions of therapy showed similarities to those reported by clients of European American descent, culture entered into the therapeutic relationship in complex and diverse ways. The findings have implications for delivering culturally sensitive therapies

Mutual help groups for mental health problems: A review of effectiveness studies

This paper reviews empirical studies on whether participating in mutual help groups for people with mental health problems leads to improved psychological and social functioning. To be included, studies had to satisfy four sets of criteria, covering: (1) characteristics of the group, (2) target problems, (3) outcome measures, and (4) research design. The 12 studies meeting these criteria provide limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement. Seven studies reported positive changes for those attending support groups. The strongest findings come from two randomized trials showing that the outcomes of mutual help groups were equivalent to those of substantially more costly professional interventions. Five of the 12 studies found no differences in mental health outcomes between mutual help group members and non-members; no studies showed evidence of negative effects. There was no indication that mutual help groups were differentially effective for certain types of problems. The studies varied in terms of design quality and reporting of results. More high-quality outcome research is needed to evaluate the effectiveness of mutual help groups across the spectrum of mental health problems

Online peer support for students

While many UK higher education institutions have websites offering information and advice on common student problems, interactive online support is less common. This article describes a project developing internet-based mutual support for students experiencing psychological problems at University College London

The experience of adolescent inpatient care and the anticipated transition to the community: Young people’s perspectives

This study explored adolescents' perspectives of inpatient mental health care, focussing on aspects of the inpatient environment they anticipated would help or hinder their transition back home. Semi-structured interviews were conducted with 12 adolescent inpatients; transcripts were analysed thematically. Participants experienced inpatient treatment as offering a mix of benefits (e.g., supportive relationships) and drawbacks (e.g., living in a “fake world”). They anticipated the transition home as providing opportunities for personal growth and consolidation of new coping skills, but also posing challenges concerning re-entering the “real world” after the experience of being “wrapped in cotton wool”. Self-determination theory and attachment theory offer two potential frameworks for understanding these opportunities and challenges. Inpatient care has the potential to foster key mechanisms for adaptive development, creating a platform for developing positive future behaviours. Community teams should work closely with inpatient units to support the generalisation of the young person's newly acquired coping skills

Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis

AIMS: Clinical guidelines recommend psychological interventions be offered to caregivers of people with bipolar disorder. However, there is little clarity about the efficacy of such interventions. This review examined the efficacy of psychological interventions in improving caregiver-focused outcomes, including burden, psychological symptoms and knowledge. METHOD: A systematic search for controlled trials was conducted using a combination of electronic database searches (PsycINFO, MEDLINE, and CENTRAL), and hand searches. Risk of bias was assessed using the Cochrane Collaboration tool. Outcomes were meta-analysed using Review Manager (RevMan). RESULTS: Nine studies met inclusion criteria. All meta-analyses compared psychoeducation to a control. At post-treatment there was a large effect of psychoeducation on burden (g = -0.8, 95% CI: -1.32, -0.27). However, there was high heterogeneity, confidence intervals were wide, and the effect was not maintained at follow-up. The apparent effect of psychoeducation on psychological symptoms was driven by a single outlying study. There was a very large effect on knowledge at post-treatment (g = 2.60, 95% CI: 1.39, 3.82) and follow-up (g =2.41, 95% CI: 0.85, 3.98). LIMITATIONS: There was considerable diversity in study methodology and quality. The number of included studies and sample sizes were small. CONCLUSIONS: This review provides tentative meta-analytic evidence for the efficacy of psychoeducation in improving caregiver burden at post-treatment, and knowledge at post-treatment and follow-up. Services could consider offering psychoeducation as part of a multi-disciplinary package of care. However, more methodologically rigorous research is needed before clinical recommendations can be made with confidence

'Between a rock and a hard place': family members' experiences of supporting a relative with bipolar disorder

Purpose: Clinical guidelines emphasise the central role of family members in supporting people with bipolar disorder. However, there has been little focus on the challenges family members face in supporting their relative. This qualitative study explored the challenges of providing support to a relative with bipolar disorder, and how family members attempted to meet these challenges. Factors that helped or hindered their efforts were also explored, including experiences of professional support. Methods: Semi-structured interviews were conducted with 18 family members (partners, parents, adult children, and siblings). Transcripts were analysed using the Framework approach. Results: Participants faced numerous challenges pertaining to the nature of the disorder and specific illness phases, their relative’s responses to their attempts to help, and the limitations of support from healthcare professionals. Although participants were resourceful in managing these challenges, they strongly valued professional input. Six themes were identified: ‘Not knowing: like being in a minefield’, ‘It’s out of my control: sitting waiting for the next thing to happen’, ‘Treading on eggshells’, ‘Picking up on signs’, ‘Times of crisis: between a rock and a hard place’, and ‘I have to make my voice heard’. Conclusions: Family members supporting a relative with bipolar disorder face significant challenges but show considerable resourcefulness in managing them. The findings underline the importance of input from healthcare professionals to help family members effectively support their relative and manage the challenges they face. Professional support should be strengths-based, and tailored to family members’ needs

Clients’ experiences of treatment and recovery in Borderline Personality Disorder (BPD): a meta-synthesis of qualitative studies

OBJECTIVE: This review synthesized findings from qualitative studies exploring clients’ experiences of their treatment for borderline personality disorder (BPD) and their perceptions of recovery. METHOD: Fourteen studies were identified through searches in three electronic databases. The Critical Appraisal Skills Programme was used to appraise the methodological quality of the studies. Thematic analysis was used to synthesize the findings. RESULTS: The meta-synthesis identified 10 themes, grouped into 3 domains. The first domain, “Areas of change,” suggests that clients make changes in four main areas: developing self-acceptance and self-confidence; controlling difficult thoughts and emotions; practising new ways of relating to others; and implementing practical changes and developing hope. The second domain, “Helpful and unhelpful treatment characteristics,” highlights treatment elements that either supported or hindered recovery: safety and containment; being cared for and respected; not being an equal partner in treatment; and focusing on change. The third domain, “The nature of change,” refers to clients’ experience of change as an open-ended journey and a series of achievements and setbacks. CONCLUSIONS: The meta-synthesis highlights areas of change experienced by individuals receiving treatment for BPD, and treatment characteristics that they value. However, further research is needed to better understand how these changes are achieved

Effectiveness of one-to-one volunteer support for patients with psychosis: protocol of a randomised controlled trial

Programme Grant for Applied Research from the NIHR; grant no. RP-PG-00611-20002

Individual psychological therapy in an acute inpatient setting : service user and psychologist perspectives

Objectives The acute inpatient setting poses potential challenges to delivering one‐to‐one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users’ and psychologists’ experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. Design The study used a qualitative, interview‐based design. Methods Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi‐structured interviews eliciting their perspectives on the therapy. Service users’ and psychologists’ transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. Results The accounts highlighted the importance of forming a ‘human’ relationship – particularly within the context of the inpatient environment – as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning‐making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users’ difficulties. Conclusions Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice‐based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models