Psychotherapy and mental health teams

Abstract

Mental health teams in different configurations and settings are under increasing pressure to offer formal psychotherapies as well as psychologically informed management to large numbers of 'difficult' patients with severe and complex presentations. This pressure has arisen variously from consumers, governmental agencies and commissioning bodies. Although these teams are an important resource, they receive limited training, supervision or support in models of psychotherapy, especially those incorporating a relational dimension and offering a coherent 'common language'. This commonly results in impairment of collective team function, including the quality and consistency of assessments, and may result in stress, splitting and 'burn out' for team members. This situation is due in part to their burden of casework and responsibility but also to prevailing, largely symptom-based and biomedical, models of mental disorder which tend to minimize the importance of psychosocial dimensions in either aetiology or treatment. Formulating and delivering appropriate, evidence-based and robust models of psychotherapy in generic team settings represents a significantly different challenge from that posed by delivery of psychotherapy in specialist settings. Approaches to this important challenge are discussed and summarized drawing on general considerations and the limited direct research evidence, and are illustrated by a cognitive analytic therapy (CAT)-based training project.

Psychosocial care in mental health nursing: a think aloud study

“…Moyle 2003). In practice, the nursing role may be benevolent or coercive rather than collaborative (Lutzén & Nordin 1993, Kerr et al 2007. Nurses may see patients with enduring mental health problems as passive, with motivational deficits to be shaped through pragmatic compliance strategies (Latvala et al 2000).…”

“…However, significant and overriding factors intervene to impede routine implementation of this model, with a 'gulf…between these recommendations and the reality of what services can provide' (Brooker & Brabban 2004, p. 6). They can be explained by structural features, including restricted resources, biomedical dominance and a habitualized approach to practice (Kerr et al 2007, Couldwell & Stickley 2007. Attitudinal reactions by practitioners to formal regulation of assessment and interventions include scepticism and resistance (Godin 2004).…”

Cognitive analytic therapy at 30

“…This enables a 'common language' for formulation and treatment, helping team members reflect on the enactments occurring (a) between patients and the team, (b) within the team itself and (c) between the team and the wider system within which it is working (Kerr 2007).…”

The Model of Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP): Specific Features in the Treatment of Borderline Personality Disorder

“…Furthermore, MHS Teams (psychiatrists, psychologists, nurses and educators) need to be trained in borderline disorders treatment (Kerr, Dent-Brown, & Parry, 2007) in order to provide coherent care to patients. In our experience in Chivasso, Turin (Italy) this training involves: 1) a preliminary brief educational program concerning borderline disorders etiology, symptoms and care; 2) regular supervisions (every 15 days) in order to promote coherent treatment planning; 3) regular case discussions (monthly).…”