Selected Literature

EASE Engaging Activity Supporting Mental Health Patients

Selected Literature

This document is being published alongside No Health Without Mental Health: A crossgovernment mental health outcomes strategy for people of all ages, which outlines the Coalition Government’s overall Approach to improving mental health outcomes. It describes the Government’s key pledges and how its public sector reforms and commitment to a Big society will transform public mental health and mental health services.

In October 2011 the Centre for Social Justice (CSJ) published Completing the Revolution: Transforming mental health and tackling poverty. This report emphasised the need for more accessible mental health services and early intervention to prevent problems from becoming entrenched. We also argued that the Government’s current commissioning reforms offer an opportunity for creative and flexible service design that breaks out of existing professional silos. Although we welcomed the advent of the Improving Access to Psychological Therapies (IAPT) programme for adults and children, we were clear that it needs developing and improving, particularly in terms of choice and accessibility, if people’s needs are to be met.

Psychological therapies are on Gordon Brown’s mind due to Richard Layard and David Clark has spent more time than anyone else on the panel on this issue. I think there are 3 extraordinary things which have happened, Cabinet bringing us together as therapies in a general; in a spirit of comradeship; not just for 3 years but so that this can continue; huge job to persuade PCT’s and GP’s.

‘Recovery’ is an idea whose time has come. At its heart is a set of values about a person’s right to build a meaningful life for themselves, with or without the continuing presence of mental health symptoms. Recovery is based on ideas of self-determination and self-management. It emphasises the importance of ‘hope’ in sustaining motivation and supporting expectations of an individually fulfilled life.

This implementation pack has been designed to support commissioners to deliver Any Qualified Provider in Primary Care Psychological Therapies (Adults) locally. It has been developed by NHS commissioners, clinical experts and Department of Health officials, working in partnership. The use of this pack is not mandatory. Commissioners can refine it to meet local needs and, over time, help to improve it.

These clinical practice guidelines were developed to aid decisions about which forms of psychological therapy are most appropriate for which patients. Those who refer patients to psychological therapists include General Practitioners, psychiatrists and, often, other therapists. This is a complex field and in making referrals, these professionals may find it useful to have the relevant research evidence appraised and summarised, together with current expert consensus. Many General Practitioners, having decided a psychological therapy is indicated, will refer to local mental health specialists for ‘brokerage assessment’. It is anticipated that these guidelines will also be of value to people in local mental health teams and departments of psychology or psychotherapy undertaking this role.

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services.

This intervention is known as Existential Experimentation. It is a focussed enquiry into the living concerns of the client in a timely, systematic, goal oriented and recovery directed manner.

Assessing the influence of three therapy modalities on client change: The exploration of changes processes in three therapy modalities to assess common therapeutic factors and distinguishing features between each approach. Poster presented at the 2010 BPS Division of Counselling Psychology, Glasgow, July 2010.

Asking clients to complete outcome measures is an everyday occurrence for most practitioners working in healthcare. As the requirement to provide evidence of therapy’s quality, effectiveness and efficiency grows, collecting outcome measures is increasingly a service requirement. When I began as a practitioner, I asked clients to complete measures at the beginning, middle and end of therapy; now it is every session, and, on top of the minimum requirements, I can also choose from a range of disorderspecific questionnaires. It is increasingly necessary to use outcome measures, so how can we make them work for us and, more importantly, for our clients?

Recent National Health Service (NHS) policy and guidelines support the incrEASEd provision of psychological therapies. As secondary care providers of psychological therapies, we carried out a questionnaire study of how our services were perceived by local general practitioners (GPs). All GPs in the borough of Southwark were included. RESULTS general practitioners value secondary care psychotherapeutic input across a spectrum of complex diagnostic groups and are interested in further training/education. They also consistently complain about long waiting times and confusion about accessing the various services. CLINICAL IMPLICATIONS With increasing interest in and willingness to fund the delivery of psychological therapies, there is the potential for working more effectively across the primary-secondary care divide. However, improved communication between primary and secondary care is essential if the incrEASEd commitment at government level is to be translated into a locally effective service.

A significant proportion of consultations with GPs are related to mental health problems. Approximately half of the 9000 practices in England employ a counsellor. Current evidence suggests that counselling can be useful in the treatment of mild to moderate mental health problems in the short-term (up to 6 months). In the longer-term (8-12 months), there are no differences in outcomes between counselling and usual GP care. There is limited evidence to suggest that the total costs incurred when patients are treated by counsellors are similar to patients receiving usual GP care.

Kevin Mullins (National IAPT Director) Presents an Update on the National IAPT Programme in November 2012.

Public mental health intelligence enables local assessment of: 1 Levels of mental disorder and wellbeing including in higher risk groups; 2 Local risk and protective factors; 3 Impact of mental disorder and low wellbeing; 4 Proportion receiving intervention for early treatment of mental disorder, prevention and promotion.

This framework has been developed jointly by the Department of Health, the NHS Confederation’s Mental Health Network, Mind, Rethink Mental Illness, Turning Point and Centre for Mental Health. They have been assisted by a range of organisations, including members of the Ministerial Advisory Group on the mental health strategy. The framework also takes into account a wide range of views, from interested individuals and organisations, including mental health professionals, people who use mental health services, their families and carers.

The New Public Health System : pportunities and Challenges for Counselling and Psychotherapy. Finding ways to make the case with evidence and innovation.

The continuing success of the Southwark Primary Care Counselling and Psychotherapy Service is due to the counsellors themselves, and the ability to demonstrate their worth to commissioners and GPs.

Selected and specialised literature resources

Cohn, H. W. (2002). Heidegger and the roots of existential therapy.

Anyone interested in modern philosophy is familiar with the name of Martin Heidegger but there is a serious gap in even the most complete accounts of his life and thought. This is Heidegger’s association with, and influence on, psychotherapy. Hans C Cohn explores the role of Heidegger’s thought in providing an alternative basis for psychotherapeutic practice to the dominant psychodynamic, humanistic and cognitive approaches, also focusing strongly on the practical therapeutic relevance of Heidegger’s ideas. This book will be essential reading for students and teachers of modern philosophy, as well as existential psychotherapists, and all practitioners interested in existential approaches to therapy.

Giorgi, A. (2007). Concerning the phenomenological methods of Husserl and Heidegger and their application in psychology. Collection du Cirp, 1, 63-78.

It is fairly well recognized that Edmund Husserl (1859-1938) and Martin Heidegger (1889-1976) were the two giants of phenomenological philosophy during the 20th century. The beginning of the movement took place, of course, with Husserl’s publication of his Logical Investigations, and Heidegger was his student who likewise first achieved worldwide fame in the twenties and thirties of the last century. Husserl was a mathematician, logician, epistemologist, and basically a philosopher interested in grounding theoretical and scientific knowledge. Heidegger, while touching upon scientific thought and the arts in his writings, was primarily motivated to think about the question of being and was interested in articulating issues related to fundamental ontology. Both thinkers claimed to use the phenomenological method: Husserl consistently, and Heidegger initially in terms of nomenclature, but what evolved for him as a method seemed radically different from what Husserl described. Because Husserl was a logician and an epistemologist, he was interested in grounding secure knowledge and because of his invention and use of the phenomenological reduction, he gave priority to careful description. Interpretation was, for Husserl, an articulation of the given object that was relevant to the experience, but not limited to the strictly given. For Heidegger, the question of being dominated his thinking, and since he traced the question of being back to Dasein, the being who raises the question of being, and discovered that Dasein has to interpret the meaning of being, Heidegger gives priority to interpretation. For him, “the meaning of phenomenological description as a method lies in interpretation.” 2 So, for Heidegger, at least with respect to research into Being, priority is given to interpretation, and description is a type of interpretation.

But our purpose in this article is not philosophical investigation, but investigations at the level of human science. Since psychologists have already adapted both Husserl’s and Heidegger’s methods for psychological purposes, it is at the scientific level that we want to examine the legitimacy and the adequacy of both methods, i.e., according to how they were adapted.

Spinelli, E. (2015). Practising existential psychotherapy: The relational world. Second edition. Sage.

Drawn from the author’s experience as an internationally-recognised theorist, lecturer and practitioner, this practical book elucidates the notoriously difficult and distinctly different therapeutic approach, existential therapy. Balancing theory and practice, the book provides trainees with an accessible introduction to the author’s own three phase structural model for existential therapy, one which has become widely established and used in training and practice. Substantially revised and updated throughout, Part One examines the philosophical underpinnings, essential theory and distinctive features of existential therapy while Part Two goes on to present the author’s structural model for practice. Both parts are now prefaced by useful schematic overviews which introduce the content and pinpoint key themes in each chapter, helping readers to navigate the text with EASE. Practical exercises encourage further engagement with the text and the themes, issues and practices under consideration.

Seen by existential therapists across the world as one of the most influential books on the topic, this new edition is an essential read for all those training, practising or interested in existential therapy.

Spinelli, E. (2015a). Experiencing Change: A Phenomenological Exploration. Existential Analysis: Journal of the Society for Existential Analysis, 26(1).

This paper explores the experience of change from a phenomenologically-attuned perspective. It proposes three variants of change experience, of which the third, those change experiences that are reflectively troubling and deemed to be destructive, undesirable, and debilitating, is particularly pertinent to therapeutic practice. Further, the paper explores various paradoxes and polarities associated with the experience of change and considers what factors may be involved that shift our relationship to change from that of being unwanted and dangerous towards that of a reflective willingness ‘to meet’ change experiences and engage with their existential possibilities.

Stanghellini, G. (2011). Clinical Phenomenology: A Method for Care?. Philosophy, Psychiatry, & Psychology, 18(1), 25-29.

I develop here one of the many topics raised by Sass, Parnas, and Zahavi, namely the role of phenomenology in clarifying issues not amenable to standard empirical methods. The authors of this scholarly paper mainly tackle this issue from the angle of psychopathological research in schizophrenia. I would like to build on their argument, having in mind one dimension of clinical phenomenology that has not been approached in their paper: the issue of care, that is the use of the method implemented by clinical phenomenology in the therapeutic setting.

Kinsella, E. A. (2006, May). Hermeneutics and critical hermeneutics: Exploring possibilities within the art of interpretation. In Forum Qualitative Sozialforschung/Forum: Qualitative Social Research (Vol. 7, No. 3).

Hermeneutics has much to offer those interested in qualitative inquiry, and is especially suitable for work of a textual and interpretive nature, yet writings in hermeneutics are frequently viewed as dense and impenetrable, particularly to North American audiences and those unfamiliar with the Continental Philosophical tradition. Drawing on Hans Georg Gadamer, as well as other hermeneutic thinkers, an introductory overview of five characteristics of a hermeneutic approach is offered in this paper. Further, it is suggested that hermeneutics can fruitfully be partnered with a critical approach. In this regard, a critical attitude and a metaxological approach are explored and a conceptualization of critical hermeneutics is proposed. It is suggested that hermeneutics and critical hermeneutics implicitly underpin qualitative inquiry, both of which emphasize the interpretive act of understanding, and a dialogue on this subject is invited.

Rössler, W. (2013). What is normal? The impact of psychiatric classification on mental health practice and research. Frontiers in public health, 1, 68.

Psychiatry is a rather quite young medical discipline, psychiatry evolved into its present form at the beginning of the nineteenth century. From its beginning there has been a discussion about the classification of mental disorders. The modern classification systems originated during the middle of the last century. In 1949 a section on mental disorders was added to the International Classification of DisEASEs (ICD) of the World Health Organization (WHO). The first Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association was published in 1952 and listed 106 mental disorders.

The 1960s saw persistent attacks on the field of psychiatry from so-called anti-psychiatrists. During that time these opponents assumed that the main purpose of psychiatric classification was to discipline maladjusted individuals. This “Zeitgeist” was best expressed in the movie “One Flew over the Cuckoo’s Nest”,which portrayed a repressive psychiatric system intent on enforcing “normal” behavior through electroshocks.

Lantz, J. E., & Walsh, J. F. (2007). Short-term existential intervention in clinical practice. Lyceum Books.

Short-Term Existential Intervention in Clinical Practice presents an existential approach to clinical intervention with clients experiencing a variety of emotional problems stemming from biological, psychological, social, and meaning and purpose issues. The book also focuses on the realities of short-term intervention and the effects limited contact between clients and treatment providers has on successful intervention. The authors first relate theoretical material to the nature and experience of crisis including short-term intervention, environmental modification strategies, the principles of existential intervention, and cross-cultural concerns in existential practice. They then apply the existential intervention approach to various client populations, focusing on the existential strategies of holding, telling, mastering, and honoring.

Cooper, M. (2003). Existential therapies. Sage.

What does it mean to practice in an existential way? What are the different existential approaches? What are their strengths and limitations? Existential Therapies addresses these key questions, and more, by providing students and practitioners with an invaluable introduction to the diverse and multifaceted world of existential therapeutic practices. Focusing on practical, face-to-face work with clients, the book:

  • introduces readers to six key existential therapies
  • discusses key figures and their contributions, including Irvin Yalom, Emmy van Deurzen, Ernesto Spinelli, Viktor Frankl and R D Laing
  • compares and contrasts the various approaches highlighting areas of commonality and difference
  • outlines key debates within the existential therapy field
  • provides detailed suggestions for further reading

Existential Therapies offers students and practitioners of all orientations much that they can incorporate into their own therapeutic work, and each approach is vividly brought to life through therapist-client dialogues and case studies. Written in an accessible, warm, and engaging manner, Existential Therapies is an essential introduction to this rich, vibrant and stimulating field.

Morley, J. (2010). It’s Always About the Epoché. book, Giorgi, A., Aanstoos, C., Cloonan, T. and Thiboutot, C, 223-232.

To honor Giorgi’s contributions to psychological research methodology, this essay strives to elucidate a key component of phenomenological methodology (the epoché), which is too often taken for granted, misunderstood, or neglected in qualitative research and the secondary literature. It calls for a renewed appreciation of the epoché and the phenomenological reduction in light of current scholarship that restores Husserl’s understanding of transcendental subjectivity as always an embodied subjectivity adhered to the lifeworld – not at all a transcendentalism. Furthermore the essay comments on how mundane versions of the epoché permeate everyday life and how the methodological epoché shares elements in common with contemplative meditation traditions across cultures. The essay concludes with an affirmation of the epoché as more than an intellectual operation, but as an action involving the entirety of the person in the manner of an ethos.

Giorgi, A. (2012). Difficulties encountered in the application of the phenomenological method in the social sciences. Análise Psicológica, 24(3), 353-361.

While it is heartening to see that more researchers in the field of the social sciences are using some version of the phenomenological method, it is also disappointing to see that very often some of the steps employed do not follow phenomenological logic. In this paper, several dissertations are reviewed in order to point out some of the difficulties that are encountered in attempting to use some version of the phenomenological method. Difficulties encountered centred on the phenomenological reduction, the use of imaginative variation and the feedback to subjects.

Conrad, P. (2008). The medicalization of society: On the transformation of human conditions into treatable disorders. JHU Press.

Over the past half-century, the social terrain of health and illness has been transformed. What were once considered normal human events and common human problems—birth, aging, menopause, alcoholism, and obesity—are now viewed as medical conditions. For better or worse, medicine increasingly permeates aspects of daily life.