Development of a training programme in individual case formulation skills and a scale for assessing its effectiveness.

BACKGROUND: Little is known about the skills involved in clinical formulation. The individual case formulation (ICF) approach, based on functional analysis, employs clinical descriptions that are theory-free and depicts formulations constructed according to a set of basic conventions. AIMS: We report a test of whether this method could be taught and if the quality of the resulting diagrams could be reliably rated. METHOD: Participants (n=40) participated in a training course in formulation. A draft rating scale was refined in the course of rating formulation diagrams and basic inter-rater reliability established. RESULTS: Results of the study support further development of the ICF approach.

Conversation tactics in persons with normal hearing and hearing-impairment.

OBJECTIVES: To investigate the tactics people use when aural communication fails owing to environmental circumstances or impaired hearing. DESIGN: Persons with different degrees of self-reported hearing impairment completed an online questionnaire constructed from items taken from the literature on communication strategies but reworded to be understood by people with normal hearing. Tactics were examined for frequency of use in two severities of impairment and between genders. All the data were then factor analysed and factor scores related to variables of relevance to communication. STUDY SAMPLE: A large convenience sample (n = 188) with a range of self-assessed hearing impairment from normal to profound. RESULTS: Descriptive data revealed some differences in frequency of use in relation to severity and gender. Factor analysis yielded six clearly interpretable factors, the largest relating to disengagement (avoidance). Self-assessed impairment was chiefly associated with a speech reading tactic, negatively with environmental optimization strategies, and to a small extent with disengagement and conversation repair. CONCLUSIONS: Only the tactic of speech reading was closely associated with impaired hearing, with some evidence that females were more inclined to use it. Otherwise, all tactics were commonly employed, regardless of hearing status.

Persons with acquired profound hearing loss (APHL): how do they and their families adapt to the challenge?

The study examined the impact of acquired profound hearing loss (APHL) on the relationship between the hearing impaired person and their normally hearing close family member, usually a partner, and identified the kinds of adjustment leading to maintenance or deterioration of the relationship. The participants were 25 people with APHL and 25 family members, interviewed separately in their own home. Analysis of the interview transcripts adopted a grounded theory methodology. The different levels of analysis were linked in terms of a core category based on the social construction of a committed relationship. The conceptual codes were grouped as: (a) aural impairments giving rise to the need for adjustment; (b) pragmatic adjustments to spoken communication and family activities; (c) managing the adjustments without negative consequences; (d) adjustments leading to negative interaction. The results suggest that APHL places considerable strain on relationships and increases their vulnerability to failure, consistent with previous research. They highlight the need for professional support and suggest that a systemic conceptual framework is needed that includes the public response to profound hearing impairment.

Acquired profound hearing loss: mental health and other characteristics of a large sample.

The study investigated the mental health and other characteristics of people with acquired profound hearing loss (APHL) and contrasted this group with acquired hearing loss (AHL) in general. A survey was completed over the internet by 95 adults and by 27 people who had attended a one-week course of rehabilitation. The latter group completed questionnaires of anxiety and depression, post-traumatic stress, and hearing handicap. The survey covered a wide range of factors associated with the history of hearing loss and evaluated previous contacts with professional services. The data from the two samples were very similar and were combined. The results indicated the existence of sudden and progressive onset groups, reliance on lip-reading, a severe effect of tinnitus, and some support for the conclusion that the psychosocial impact was greater in APHL than in AHL. A subgroup of APHL was severely distressed and handicapped. Respondents valued medical and audiological services but there was little evidence that previous counselling and support had been helpful. Recommendations for rehabilitation are briefly discussed.

CBT for psychosis: a qualitative analysis of clients' experiences.

OBJECTIVES: The study explored clients' understanding and experience of cognitive behavioural therapy (CBT) for psychosis. DESIGN: Four inpatients and one outpatient who received CBT for psychosis were interviewed following a semi-structured format, designed for the purpose of the study. METHOD: The transcribed interviews were analysed using discourse analytic methods and focused in particular on the way clients positioned themselves in relation to their therapists. The consistencies and contradictions within clients' accounts were also examined. RESULTS: The following discourses are described: 'This is truly happening', 'I am ill', 'CBT as an educational process', 'CBT as a respectful relationship between equals', 'CBT as a healing process' and 'CBT participation as compliance with the powerful medical establishment'. Three of the participants switched throughout the interview between insisting that their experiences were true and accepting that they were ill and in need of treatment. With one exception, all highlighted the value of the educational component of therapy. Two participants showed an awareness that their therapist was trying to convince them that their experiences were not true but presented this as educational rather than coercive. Most participants emphasized the value of a trusting and respectful therapeutic relationship. One client presented therapy as unhelpful and described it only in terms of his passive compliance with the powerful medical establishment. CONCLUSIONS: The study throws light on the experience of receiving CBT for psychosis and points to some of the therapeutic process variables worthy of consideration in clinical practice and future research.