The Therapist's Dilemma: Be Sincere or Fake It?Morstyn, Ron
doi: 10.1046/j.1440-1665.2002.00490.xpmid: N/A
Objective: To examine the pressure on therapists to fake sincerity and the significance of genuine sincerity in psychotherapy.Conclusions: There are many reasons why therapists might fake sincerity. We live in a post-modern culture of dissimulation and ‘playing the game’ that puts a premium on faking sincerity. Manualised and scripted psycho-therapies encourage fake sincerity, as do the measurement requirements of EBM, and the short-term approach of Managed Care. Kohut's ‘corrective emotional experience’ of empathy reinforces benevolent faked sincerity. Studies demonstrate the importance of the therapist appearing warm and genuine but do not differentiate appearance from reality. Therapists may fear that true sincerity will lead to crossing boundaries, harming patients, being poorly judged or medico-legal problems. Nevertheless, if therapists aren't willing to strive for genuine sincerity, despite all the attendant risks and possible complications, then they deny their patients the opportunity of working through the difficulties of achieving sincerity in any human relationship. Moments of true mutual sincerity in psychotherapy are healing not only because of the insight achieved but also because they restore the damaged hope that sincerity is possible. Therapists who fake sincerity ultimately leave their patients feeling alone and colluding in a mutually fake therapeutic relationship.
Is there a Place for Psychoanalysis in Public Mental Health?Curnow, Rick
doi: 10.1046/j.1440-1665.2002.00492.xpmid: N/A
Objective: To describe a programme of theoretical and clinical seminars, and to discuss the benefit of introducing a psychoanalyst's perspective to the supervisory process in psychiatric training.Conclusions: Vignettes of work from seminars provide examples that explain how the teaching that occurs is at the level of understanding of the countertransference experience, rather than at the level of psychoanalytic formulations. An application of the psychoanalytic concept of containment is found to be helpful to the trainees in understanding patients, particularly those with borderline personality disorder.
Best Evidence Medical Education in Psychiatry TrainingMcGuckin, Cathy; Burke, David; McGuckin, Cathy
doi: 10.1046/j.1440-1665.2002.00494.xpmid: N/A
Objectives: To examine the evidence-base in medical education and psychiatry training, in relation to: the most effective method of imparting the attitudes, skills and knowledge essential to prepare future psychiatrists for modern psychiatric practice; the most effective method of optimising trainees' motivation to learn and their enjoyment of learning; and the most effective method of fostering trainees' commitment to self-directed, life-long learning.Methods: The current available literature was reviewed by searching medical and education computer data-bases up to December 2001; a web search of evidence-based education was conducted; and the references cited in the articles obtained were scanned for papers not yielded by the database and web searches.Results: There is evidence to support the use of both the directed and the constructivist approaches to education, there is evidence to support the use of problem-based learning in medical education, and there is no evidence for adult learning theory or transformative learning theory, although elements of both appear to be incorporated into problem-based approaches.Conclusions: The emphasis in modern medical education is on a con-structivist approach, dominated by problem-based learning and built around small-group activities. Postgraduate psychiatry training could be improved significantly by adopting the evidence-based advances that have been made in education and undergraduate medical education over the past three decades.
Interagency Training in Dual DisabilityMohr, Caroline; Phillips, Alex; Curran, Jenny; Rymill, Ann
doi: 10.1046/j.1440-1665.2002.00495.xpmid: N/A
Objective: Mental health care professionals are poorly trained in intellectual disability, and workers in intellectual disability (ID) services are similarly unskilled in mental health care principles. Consequently, the mental health needs of adults with intellectual disabilities and psychiatric disorders are not being adequately met.Method: A three day training programme was designed to redress this situation and encourage these separate services to work collaboratively. The programme was evaluated with 30 participants drawn from MH and ID services.Results: Evaluations conducted pre- and post-training indicated increases in participants' confidence in working in and knowledge of DD, and ability to complete study assessments. Post training letters written by participants to their managers indicated their commitment to educate their co-workers in DD, learn more about DD, change their clinical practices, and collaborate with staff from the other service.Conclusions: This preliminary evaluation suggested the promise of positive outcomes for people with DD following joint training of staff from ID and MH services.
Description of a Rural Australian Free Call Telephone Mental Health Information and Support ServiceLedek, Veronica; Deane, Frank P; Lambert, Gordon; McKeehan, Catherine
doi: 10.1046/j.1440-1665.2002.00496.xpmid: N/A
Objective: To describe the activity of a rural-based free call 1800-Mental Health Information and Support Service (1800-MHISS) which provides a 24-hour single point of contact for people experiencing a mental health problem.Method: Routine data collected during a 15 month period concerning service utilisation, caller characteristics, service provision, triage assessment and the impact of the service on after-hours services are described. Qualitative data from a survey of emergency department and community mental health is discussed.Results: The service received an average of 1117 calls per month. While a majority of calls were for information and support, 13% required a triage assessment and, of these, 13% resulted in an emergency response. Analysis of pre and post study data demonstrated a 43% reduction in the activation of after-hours services.Conclusions: Overall, the study suggests the 1800-MHISS provides a safe and efficient response to psychiatric emergencies and is valued by Emergency Department and community mental health staff.
The Phenomenon of Collocation: a Local Solution to an Australian ProblemTaylor, Andrea; Bernardi, Elsa
doi: 10.1046/j.1440-1665.2002.00497.xpmid: N/A
Objective: To describe the phenomenon of collocation in a metropolitan mental health service.Conclusions: Collocation is the locating of private and public mental health sectors in a joint working relationship. In the context of increasing numbers of clients referred to a public Community Mental Health Service, a restricted ability to refer clients to other practitioners, a limited number of medical officer hours available and a new purpose built premises with spare rooms, the Service investigated and implemented a model of collocation. This in effect locates private and public psychiatrists together, working from the same premises. Collocation has been a modest local initiative increasing cooperation between the public and private sector and partially increasing consumer choice and private psychiatrist availability
Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care InitiativeHickie, Ian; Groom, Grace
doi: 10.1046/j.1440-1665.2002.00498.xpmid: N/A
Objective: To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content.Conclusions: The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non-pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non-medical mental health specialists and psychiatrists to meet population-based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system-related outcomes.