Cognitive Behavior Therapy for Acute Inpatient Mental Health Units: Working with clients, staff and the milieu PDF
Preview Cognitive Behavior Therapy for Acute Inpatient Mental Health Units: Working with clients, staff and the milieu
Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units presentsinnovativewaysofdeliveringCBTwithintheinpatientsetting and applying CBT principles to inform and enhance inpatient care. Maintaining staff morale and creating a culture of therapy in the acute inpatient unit is essential for a well-functioning institution. This book shows how this challenge can be addressed, along with introducing and evaluating an important advance in the practice of individual CBT for working with crisis, suited to inpatient work and crisis teams. The book covers a brief cross-diagnosis adaptation of CBT, employing arousal management and mindfulness, developed and evaluated by the editors. It features ways of supporting and developing the therapeutic role of inpatient staff through consultation and reflective practice. Chapters focus on topics such as: • providing staff training • working within psychiatric intensive care • innovative psychological group work CognitiveBehaviourTherapyforAcuteInpatientMentalHealthUnitswillbe essential reading for those trained,or those undergoing training, in CBT as well as being of interest to a wider public of nurses, health care support workers, occupational therapists, medical staff and managers. Isabel Clarke and Hannah Wilson are working together to develop an innovative psychological therapies service at Woodhaven, an acute mental healthinpatientunit,servingWestSouthamptonandtheNewForest.They are both clinical psychologists working for the Hampshire Partnership NHS Trust. Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units Working with Clients, Staff and the Milieu Edited by Isabel Clarke & Hannah Wilson Firstpublished2009byRoutledge 27ChurchRoad,Hove,EastSussexBN32FA SimultaneouslypublishedintheUSAandCanada byRoutledge 270MadisonAvenue,NewYork,NY10016 RoutledgeisanimprintoftheTaylor&FrancisGroup,anInformabusiness This edition published in the Taylor & Francis e-Library, 2008. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Copyright(cid:216)2009selection&editorialmatter,IsabelClarke&Hannah Wilson;individualchapters,thecontributor Allrightsreserved.Nopartofthisbookmaybereprintedorreproducedor utilisedinanyformorbyanyelectronic,mechanical,orothermeans,now knownorhereafterinvented,includingphotocopyingandrecording,orin anyinformationstorageorretrievalsystem,withoutpermissioninwriting fromthepublishers. Thispublicationhasbeenproducedwithpapermanufacturedtostrict environmentalstandardsandwithpulpderivedfromsustainableforests. BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary Libraryof CongressCataloging-in-PublicationData Cognitivebehaviourtherapyforacuteinpatientmentalhealthunits:working withclients,staff,andthemilieu/editedbyIsabelClarke&HannahWilson. p.;cm. Includesbibliographicalreferences. ISBN978-0-415-42211-6(hardback) – ISBN978-0-415-42212-3(pbk.) 1. Cognitivetherapy.2. Psychiatrichospitalpatients. I.Clarke,Isabel.II. Wilson,Hannah,1971– [DNLM:1. CognitiveTherapy–methods.2. CrisisIntervention–methods. 3. Hospitals,Psychiatric.4. PsychiatricDepartment,Hospital.5. Psychotherapy,Group–methods. WM425.5.C6C676622008] RC489.C63C64282008 616.89'1425–dc22 2007052007 ISBN978-0-415-42211-6(hbk) ISBN978-0-415-42212-3(pbk) ISBN 0-203-59684-6(cid:13)(cid:10) Master e-book ISBN Contents List of figures viii List of tables ix List of contributors x Foreword xiv ANTHONYMORRISON Preface xvi List of abbreviations xvii 1 Introduction 1 ISABELCLARKE PART I Setting the scene 9 2 CBT on the wards: standards and aspirations 11 JOHNHANNA 3 New ways of working and the provision of CBT in the inpatient setting 22 PETERKINDERMAN 4 The service user perspective 30 MARIE 5 The use of formulation in inpatient settings 39 FIONAKENNEDY vi Contents PART II Individual CBT in the inpatient setting 63 6 Pioneering a cross-diagnostic approach founded in cognitive science 65 ISABELCLARKE 7 Working with overwhelming emotion: depression, anxiety and anger 77 ISABELCLARKEANDHANNAHWILSON 8 Making sense of psychosis in crisis 84 BERNADETTEFREEMANTLEANDISABELCLARKE 9 Working with personality disorders in an acute psychiatric ward 92 JOHNMcGOWAN PART III Working with the staff group to create a therapeutic culture 113 10 Running reflective practice groups on an inpatient unit 115 VIVIACOWDRILLANDLAURADANNAHY 11 Working with crisis: the role of the clinical psychologist in a psychiatric intensive care unit 129 SUZANNESAMBROOK 12 Training acute inpatient ward staff to use CBT techniques 143 CHE´ ROSEBERTANDCHRISHALL PART IV CBT group work 159 13 The ‘Making Friends with Yourself’ and the ‘What Is Real and What Is Not’ groups 161 GRAHAMHILL,ISABELCLARKEANDHANNAHWILSON 14 Running an emotional coping skills group based on dialectical behaviour therapy 173 AMANDARENDLEANDHANNAHWILSON Contents vii PART V The challenge of evaluating this service 183 15 Evaluating short-term CBT in an acute adult inpatient unit 185 CAROLINEDURRANTANDABIGAILTOLLAND 16 Conclusion 197 ISABELCLARKEANDHANNAHWILSON References 199 Index 214 Figures 5.1 Formulation: Sarah – developmental history 46 5.2 Formulation: Sarah – inpatient experience 47 5.3 Formulation: Archie – development 53 5.4 Formulation: Archie – precipitating factors for arson 53 5.5 Formulation: Archie – precipitating factors for self-harm 54 5.6 Formulation: Archie – ward environment 54 6.1 Typical formulation 70 9.1 Diagrammatic reformulation of C 108 11.1 Vicious cycle of self-harm (a) 136 11.2 Vicious cycle of self-harm (b) 136 13.1 Level of arousal and vulnerability to psychotic symptoms 170 Tables 7.1 Changes in Alan’s questionnaire ratings 83 12.1 Clarke’s four levels of evaluation 157 14.1 Before and after scores on the evaluation measures 180 15.1 Service users’ diagnoses 191 15.2 Number of sessions that service users received 191
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