Psychotherapists' perspectives on loss of sense of control.

INTRODUCTION: Sense of control is an integral part of well-being. Studies have reported on the connection between loss of control and psychological symptoms. However, loss of sense of control has not yet been studied from the perspective of psychotherapists. METHODS: This study had three research objectives: to find out how psychotherapists define loss of sense of control, whether they consider loss of sense of control to play a role in the start of psychological symptoms, and, if so, in what cases. Lebanese psychotherapists were interviewed and the data were then analyzed using frame analysis. RESULTS: The analysis revealed two definitions for loss of sense of control and conflicting views on whether it plays a role in the onset of disorders. Problems within relationships and stress were the most mentioned examples of loss of sense of control. CONCLUSION: The findings shed light on psychotherapists' diverse opinions and explanations regarding the role of loss of sense of control in the development of psychological symptoms.

Client-reported impact of the Attempted Suicide Short Intervention Program.

BACKGROUND: A history of attempted suicide is the most significant predictor of suicidal death. Several brief interventions aimed at tertiary suicide prevention have been investigated in clinical trials. However, suicide attempt survivors' experiences of such interventions have rarely been reported. OBJECTIVE: To explore how suicide attempt survivors perceive the impact of the Attempted Suicide Short Intervention Program (ASSIP). METHOD: We interviewed 14 Finnish adults who had received ASSIP as an adjunct to treatment as usual. Semi-structured interviews took place 4-10 weeks after the last ASSIP session. A conventional content analysis of the interview data is presented. RESULTS: Three core categories depicting ASSIP's perceived impact were identified. The core category life-affirming change comprised subcategories of feeling better, thinking differently, acting differently, and having new resources. The core category collateral effects comprised difficult feelings and cognitive overload. The core category incompleteness of change comprised lack of desired change, gains as incomplete, need for sustenance, and unrealized potential. CONCLUSION: Clients perceived ASSIP as effectively facilitating life-affirming change but agreed that further support was necessary to retain and build on these gains. Identified needs for improvement included more predictable post-ASSIP service paths and more support for involving affected loved ones.

'I became more aware of my actions'-A qualitative longitudinal study of a health psychological group intervention for patients with myalgic encephalomyelitis/chronic fatigue syndrome.

OBJECTIVES: To explore myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients' experiences of a health psychological group intervention and its usefulness, non-usefulness or harmfulness for illness management and adjustment. DESIGN: A qualitative longitudinal study using inductive content analysis. METHODS: Semistructured interviews were conducted with 10 adults. Interviews were conducted before the 16-week intervention, immediately after its completion, and at 3 months after completion. RESULTS: Participants reported that the intervention was useful and not harmful. The model improved their ability to cope with ME/CFS by providing them with useful information about the illness along with peer support and professional guidance. Participants reported improved illness management and adjustment, which they perceived as an outcome of achieving new ways of thinking, feeling and acting. CONCLUSIONS: Participants viewed the health psychological approach to group intervention as meeting their needs. To achieve better illness management and adjustment, more consideration should be given to supportive interactional processes with peers and healthcare professionals. PATIENT OR PUBLIC CONTRIBUTION: The intervention was developed to meet patients' needs of finding ways to manage their illness. The research team consulted eight patients with ME/CFS and three clinical centres working with ME/CFS treatment and rehabilitation at the intervention planning stage. Their comments influenced the planning and content of the intervention as well as ethical issues that should be considered, such as potential harm to participants. All participants were informed about the theoretical foundations of the study and the principles guiding the intervention. Participants were not involved in the data analysis. CLINICAL TRIAL REGISTRATION: NCT04151693.

How do health care services help and hinder recovery after a suicide attempt? A qualitative analysis of Finnish service user perspectives.

BACKGROUND: Suicide attempt survivors are at high risk of re-attempts and suicide death. Previous research has shown that service users' experiences of post-attempt care are related to future treatment engagement and re-attempts. In-depth understanding of how current services meet service users' needs in the period immediately following a suicide attempt is thus imperative for the development of more effective tertiary prevention practices in real-life health care systems. METHOD: In this qualitative study, Finnish suicide attempt survivors' experiences of and perspectives on mental health services were explored through a semi-structured interview. Participants were seven female and seven male service users interviewed 3-6 months after the index suicide attempt. A conventional content analysis of these service user interviews is presented. RESULTS: Participants' experiences of care ranged from helping to hindering recovery. Seven key aspects of services were described as helpful when present and hindering when absent. These included (1) meeting the service user as worthy of help, (2) supporting the exploration of personal meanings, (3) supporting the exploration of suicidality, (4) psychological continuity and predictability, (5) offering a responsive partnership in navigating recovery, (6) inviting service user involvement in medication decisions, and (7) accounting for service users' relational context. CONCLUSIONS: Current health care services are inconsistent in meeting suicide attempt survivors' subjective needs, leaving clear room for improvement in tertiary suicide prevention. To be perceived as meaningful by service users, services should strive to offer opportunities for both biomedical, psychological, and social interventions, with responsivity to individual needs and preferences. A focus on the social aspects of recovery (e.g., offering support to loved ones affected by the suicidal incident; facilitating peer support and social belonging) was most often found to be lacking in current services.

Ego Impairment Index (EII-2) as a predictor of outcome in short- and long-term psychotherapy during a 5-year follow-up.

OBJECTIVE: This study examined the predictive ability of the Rorschach-based Ego Impairment Index (EII-2) on outcome of psychotherapy in different types and durations of therapy. METHOD: A total of 326 outpatients suffering from depressive or anxiety disorders were randomized into receiving solution-focused (n = 97), short-term psychodynamic (n = 101), or long-term psychodynamic psychotherapy (n = 128). Psychotherapy outcome assessments during the 5-year follow-up period covered psychiatric symptoms, social functioning, and work ability. RESULTS: Lower EII-2 values, which indicate less problematic ego functioning, were found to predict faster improvement in both short-term therapies as compared to long-term psychotherapy. CONCLUSION: The results provide preliminary support for the utility of EII-2 as a complementary measure to interview-based methods for selecting between short- and long-term therapies.

Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study.

Open Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20-F29) were asked about their treatment of FEP, initiated under OD 10-23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enabled interactions with other people and the chance to go through difficult experiences. A minority of the participants had mixed experiences regarding family involvement and immediate home visits. OD may have the potential to promote therapeutic relationships, but replications from other catchment areas are needed.

Domestic Violence Interventions in Social and Health Care Settings: Challenges of Temporary Projects and Short-Term Solutions.

Social welfare service and health care providers are in a key position to implement successful domestic violence (DV) interventions. However, it is known that DV intervention and prevention work is often lacking in coordination and continuity. In addition, the limited resources, hectic work pace, and changing practices negatively affect the development of successful ways to prevent and intervene in DV. This qualitative study involving 11 focus groups, composed of social welfare and health care professionals (n = 51) in a midsized Finnish hospital, examined the challenges and possibilities within DV interventions and the adoption of good practices produced by a DV intervention development project funded by the European Union (EU). The results show that short-term development projects, amid the pressure of limited time and resources, encounter serious challenges when applied to wicked and ignored problems, such as DV. Developing successful violence intervention practices requires a broad understanding of the challenges that rapid development projects present to professionals and social welfare service and health care practices at the organizational level. Hence, the implementation of good practices requires continuity in managerial and organizational support, distribution of information, documentation of DV, awareness raising, education, training, and agreement on basic tasks and responsibilities. Otherwise, the failure to continue development work derails the results of such work, and short project durations lead to unnecessary work and the need to reinvent temporary work practices time and again. Short-term interventions provide inefficient solutions to the problem of DV, and a built-in organizational structure can prevent the misuse of organizational and human resources.

Victims of family violence identified in emergency care: Comparisons of mental health and somatic diagnoses with other victims of interpersonal violence by a retrospective chart review.

Family violence is a global health problem incurring significant costs to both individuals and health care systems. However, family violence as a cause of trauma and other health issues is often unidentified in patients attending emergency care. Better understanding of the risk factors associated with family violence could improve the identification and treatment of victimized patients in health care settings. Little longitudinal research exists on the mental and somatic health of family violence victims currently identified in EDs and little is known about how victims of family violence differ from other help-seeking victims of interpersonal violence. A total of 345 patients were identified as victims of interpersonal violence in a mid-size Finnish ED during the period 2011-2014. A retrospective chart review was conducted to analyze their mental and somatic health two years before and two years after identification. Victims of family violence were most likely women and they were significantly older than other victim groups. Victims of family violence also presented the most varied health symptoms both before and after identification, although differences between victim groups were not as clear as in previous studies comparing victims of family violence with non-victims. Comparison with previous data demonstrated that family violence was severely under-identified at the study site, further increasing the likelihood of family violence victims revisiting health care services. More attention should thus be paid to the identification and treatment of family violence in emergency care and other health care settings.

Family violence and mental health in a sample of Finnish health care professionals: the mediating role of perceived sleep quality.

BACKGROUND: Family violence (FV) is a prevalent health issue around the world and health care services have an important role in both recognizing and treating the consequences of violence. However, FV experiences among health care professionals themselves have not been investigated much. We also lack specific knowledge on the associations between FV and mental health. AIM: The purpose of the study was to investigate the prevalence and effects of FV in a sample of Finnish health care professionals. In addition to analysing direct connections between different types of FV and mental health, the mediating effect of sleep quality was also taken into account. METHODS: The study followed a cross-sectional design. The sample comprised 1952 health care professionals from Central Finland, who participated in a survey measuring their health and well-being. The dependent variables were perceived sleep quality and mental health as measured by depressive symptoms and the mental health continuum short form (MHC-SF) questionnaire. Data were analysed using cross-tabulations, anova and structural equation modelling. RESULTS: Thirty-eight per cent of the participants reported experiencing FV. The most common forms of abuse were 'psychological FV only' and 'psychological & physical abuse'. Participants with FV experiences scored significantly worse on depressive symptoms (p < 0.001), MHC-SF classification (p = 0.008), sleep quality (p = 0.001) and emotional (p < 0.001), social (p < 0.001), and psychological (p = 0.008) well-being. The mediation analyses indicated that the harmfulness of FV was at least partially explained by impaired sleep quality. CONCLUSION: The results indicate that FV experiences are common among Finnish health care professionals and that they can significantly affect their mental health. FV should thus be taken to account in seeking to promote the occupational well-being of health care professionals. The results also suggest that the harmfulness of FV might be mediated by sleep quality. This finding prompts the need for further investigation and FV-related interventions.

Dialogues in partner abusive clients' group treatment: conversational tools used by counselors with differently motivated clients.

This qualitative study investigated talk and interaction as process factors potentially influencing outcomes in abuser group intervention. The findings showed that (a) abusers participate in group programs with considerably different degrees of motivation; (b) the interaction in abusers' various stages of change is characterized by different qualities; and (c) group counselors face a challenge in adapting their ways of working to abusers' various needs and backgrounds. The findings demonstrate the importance of attending to the interactional elements in abuser treatment programs and show the value of matching an abuser's needs and degree of motivation with the timing of interventions. It is argued that attention to all these matters could help in making abuser programs more effective.

Subjectively evaluated effects of domestic violence on well-being in clinical populations.

Effects of domestic violence are reflected in victims' physical, psychological, and sexual health as well as in victims' subjective evaluations of health or subjective well-being. The principal aim of this study was to study the extent to which the consequences of domestic violence are reflected in patients' subjectively evaluated well-being, life management, and sense of security in an emergency department, a maternity department, and a reception unit of a psychiatric hospital. A questionnaire on the effects of domestic violence was administered to 530 patients. 61 patients reported either current or previous domestic violence that affected their current well-being and life management. Domestic violence was reported to have an effect on subjective well-being and sense of security: the more recent or frequent the experience of violence was, the greater was considered its impact on well-being and sense of security. Routine inquiry can uncover hidden cases of abuse and hence would be of great benefit in the healthcare context. Early identification of abuse victims can prevent further harm caused by violence.

Making sense of domestic violence intervention in professional health care.

Intervening in domestic violence in the health care and social service settings is a complex and contested issue. In this qualitative, multidisciplinary study, the barriers to but also the possibilities for health care professionals in encountering victims of violence were scrutinised. The focus was on omissions in service structure and practices. The data consisted of six focus group interviews with nurses, physicians, social workers and psychologists in specialist health care (n = 30) conducted in Finland in 2009. The aim was to explore professionals' processes of making sense of violence interventions and the organisational practices of violence interventions. Four types of framing of the domestic violence issue were identified: (i) practical frame, (ii) medical frame, (iii) individualistic frame and (iv) psychological frame. Each frame consisted of particular features relating to explaining, structuring or dismissing the question of domestic violence in health care settings. The main themes included the division of responsibilities and feasibility of treatment. All four frames underlie the tendency for healthcare professionals to arrive at sense-making practices where it is possible to focus on fixing the injuries and consequences of domestic violence and bypassing the issue of violence as the cause of symptoms and injuries. The results indicate that developing successful practices both in identifying survivors of domestic violence and in preventing further victimisation requires a broad understanding of the effects of domestic violence and the challenges for health care professionals in dealing with it. New perspectives are needed in creating adequate practices both for victims of violence seeking help and for professionals working with this issue. Strong support at the organisational level and established practices throughout the fields of health and social care are the key elements in building a responsible approach to domestic violence.

[Identifying domestic violence within specialized care]. / Lähisuhdeväkivallan tunnistaminen erikoissairaanhoidossa.

In the present study involving 530 patients in three specialized hospital wards, the prevalence of domestic violence, forms and recurrence of experienced violence and need of further care were elucidated. The health care personnel utilized a questionnaire to identify experiences on domestic violence and putative need of further care. According to patient self-assessment, in 11%, 32%, or 7% of the patients in the maternity department, psychiatric department and emergency department, respectively, domestic violence had a negative impact on well-being and life management. The need for help of these patients would have remained unrecognized without a systematic survey.

Constructing and negotiating 'change' in follow-up meetings for intimately violent men.

This study reports on follow-up meetings of a group treatment program for intimately violent men. The focus is on the construction of change narratives; on how indicators of 'successful change' are negotiated and produced in the conversations. We describe in detail five discursive strategies used by client and therapist participants, e.g., the construction of temporal differences, personalizing the problem, reformulations of failure stories, taking presence at the follow-up as evidence of success, and the use of out-siders as an audience. We also demonstrate how the notion of success is ascertained and to whom credit is given for achieving it. We conclude that the followup meetings are established as an integrated part of the whole treatment program, and contribute to the promotion of the treatment ideology.

Loss of self-control as excuse in group-therapy conversations for intimately violent men.

This article examines the constructions of loss of self-control by male perpetrators of intimate violence in therapy-group conversations. It looks at discursive strategies used by therapists and clients in therapy-group negotiations concerning the issue of self-control. The data are part of a larger corpus of videotaped and transcribed recordings of treatment groups for male perpetrators and consists of four treatment group processes. The analysis concentrates on episodes of self-control talk where a participant referred to loss of self-control when accounting for his violent behavior. The loss of self-control was found to be a fundamental constituent of excuses and was used to account for the clients' behavior in past violent situations. It allowed the speaker to admit the reprehensible character of his behavior, while denying full responsibility for it. It also permitted the speaker to be portrayed as a responsible person in the present conversational group therapy context. These different representations of the past and present selves gave those presentations the appearance of inconsistency. The therapists used this inconsistency in the clients' talk to challenge the use of loss of self-control as excuse, and thus called for more responsible accounts.