Shared decision making (SDM) is an effective health communication model designed to facilitate patient engagement in treatment decision making. In mental health, SDM has been applied and evaluated for medications decision making but less for its contribution to personal recovery and rehabilitation in psychiatric settings. The purpose of this pilot study was to assess the effect of SDM in choosing community psychiatric rehabilitation services before discharge from psychiatric hospitalization. A pre-post non-randomized design with two consecutive inpatient cohorts, SDM intervention (N = 51) and standard care (N = 50), was applied in two psychiatric hospitals in Israel. Participants in the intervention cohort reported greater engagement and knowledge after choosing rehabilitation services and greater services use at 6-to-12-month follow-up than those receiving standard care. No difference was found for rehospitalization rate. Two significant interaction effects indicated greater improvement in personal recovery over time for the SDM cohort. SDM can be applied to psychiatric rehabilitation decision making and can help promote personal recovery as part of the discharge process.
Group analytic and relational writings point to the development of mutual recognition between individuals as a main treatment goal. To achieve this, it is necessary to face up to issues of control and oppression in the therapeutic relationship, particularly as enacted by the therapist. The relationship between the therapist and group members is a co-construction, shaped by their respective subjectivities. The therapist's willingness to enter into an open examination of his or her enactments can stimulate change in relationships with patients, resulting in freer and more spontaneous communication in the group. To illustrate, several sessions of an analytic therapy group are presented in which there were struggles between (1) the desire for equality and mutuality and (2) firm exercise of authority.
A psychiatric hospital is an environment designed to help people to recover from a mental crisis. While an atmosphere of acceptance and open communication is conductive to that aim, institutional milieu is usually full of misunderstanding, conflict, projection and paranoia. An ongoing large analytic group, available to all hospital members of staff, can help to contain these tensions while facilitating an open dialogue and a reflective stance within the organization. In this article, we present the development and principles of conducting such a group. It has been running for five years. It meets once a month and includes clinicians, administrators and management. Participation is voluntary. It is conducted by two co-conductors, one a member of the hospital staff, and the other not. Group dynamics including power relations, different professional languages and different worldviews are discussed. These include the dynamics of watching and being watched, displayed in the group and the two conductors.
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