Читать книгу Mind-Body Medicine in Inpatient Psychiatry - David Låg Tomasi - Страница 18

The Psychotherapist/Group Therapist offers individual psychotherapy sessions to patients on both Inpatient Psychiatry Units Shepardson 3 and 6, as well as to patients throughout the hospital, especially in the Emergency and Medicine Departments, to meet the special needs of this type of population. Among the methods utilized in this context we find Cognitive Behavioral and Dialectic Behavioral Therapy to help patients identify cognitive distortions and improve their emotional and cognitive regulation, develop life and coping skills, better understand stressors and triggers and monitor vs/control their reactions. Problem-solving strategies are also at the center of group sessions such as the “Solve that Problem” and the “Wellness and Recovery Action Plan” developed by Mary Ellen Copeland (1997). Interpersonal Therapy techniques are also used to target communication skills and identify problems in relationships, while Psychodynamic therapy and counseling techniques are generally discussed in the form of basic theories and techniques in group sessions, and applied more in detail and with added focus during individual psychotherapy sessions, especially in the context of Posttraumatic stress disorder or other trauma-related psychological difficulties. These represents cornerstones of the psychotherapy-based interventions, an aspect discussed multiple times by therapist. In other words, since the Inpatient Psychiatry Units are “locked” units, the patient is brought to a deeper understanding of both challenges and opportunities for her/his healing process. If the patient might at times feel “closed in” “unable to relate to the external world,” “separated from family, friends, and opportunities,” she/he will also be “separated” from triggers, traumas, stressors, and even—another fundamental point in mind-body strategies—from addiction-related problems, such as specific temptations or external stimuli. Following the Therapist’s Perspective guidelines of the UVM Medical Center, these are the most important points followed in both clinical interventions and research study (Bancroft et al., 2014):

1 Evidence of increase in awareness or insights on the part of the patient(s), coupled with increased hope. Measurement: Patient’s self-report in session reflects understanding of the concepts or principles under discussion. Hope may not always be a component.

2 Patients fully participate in discussion and in whatever the directive of the group is. Measurement: Patients are attentive and engage in meaningful dialogue, complete associated worksheets or questionnaires.

3 Patients being respectful and supportive of each other, offering their own insights from their experiences as a help to their peers. Measurement: Patients operate within the confines of group norms as given by the therapist, they respect the personal space of their peers, remain silent while others are speaking, they offer on-topic, reality-based supportive comments.

4 There are few if any disruptions to group (i.e. staff needing to see a patient, or for a phone call/favors, patients with psychosis and disorganization). Measurement: Disruptions must not derail the continuity of the collective group process.

5 Sense of community on the milieu. Measurement: Patient alliances and unit camaraderie are intrinsic to satisfying group experiences.

Beside the organizational—teamwork perspectives discussed in the list above, there are many other essential task in the daily clinical work of Psychotherapists/Group Therapists. It is very important to note that, especially in the context of “Mind-Body Medicine strategies in Inpatient Psychiatry” the clinical intervention of a therapist covers the entire spectrum of activities and interactions on the unit. Thus, the clinical work starts with the solid preparation of evidence-based strategies for therapeutic sessions, continues with the meetings with the patients, and is monitored, controlled, and verified through electronic health records and clinical notes during the patient admission. Of course, to guarantee safety and privacy to each patient, the same level of attention and precision is required by every therapist also upon patient discharge. To explain all these aspects more in detail, we can refer to the list of Inpatient Psychiatry Group Therapists/Psychotherapists general/main tasks presented below:

1. Charts

Documentation

i. Prism EHR

ii. Therapy Group SOAP notes

iii. Clinical Assessments/database

iv. Signing of Multidisciplinary Treatment team (MT) notes daily

v. Signing of Safety Plan notes daily

vi. Reading Charts

2. Groups

Group rules

Observing groups

Co-leading groups

Taking the lead in group

MD/RN/SW Students observing

Yoga/meditation supplies

Relaxation CDs (order is needed for private patient use of boom box and CD from MD)

Journals

Karaoke machine

i. Location of

Games

i. Location of

Pet Therapy

Art Group

i. Safety issues

ii. Giving out of supplies (hoarding & safety)

Garden group

i. Pt eligibility to go (sometimes orders are needed)

ii. Calling Security

iii. Security’s role in general

iv. Calling Facilities re fans

Focus Group

i. Scheduling of

ii. Questionnaire

iii. Orientation → Favors

iv. Typing up of responses from questionnaire

3. Morning daily clinical rounds

Scheduling of Rounds & Signatures of ITP & MT notes

Observing Rounds

Presentation of summary of patient group participation/other input

Rounds book

Writing of update notes on each patient during Rounds.

4. Therapy Scheduling

Weekly schedule of groups

Monthly individual schedule

Scheduling of vacation/holidays

5. Basic Readings & Handouts

Cognitive Behavioral Therapy

Dialectic Behavioral Therapy

Grief Group handouts

Relaxation/Grounding techniques

6. Administrative

Computer/Prism passwords

Phone Codes

Copier Codes/Door code

GT communication log

Ordering of supplies

i. Budget

ii. Schedule of who orders

iii. Catalogues/Online (more accurate prices)

iv. Creating list for orders

v. Special Orders

7. Group Therapy Supplies Storage Spaces

Closet on 3

Overflow in Supply room on 3

Art Room

Closet/cabinets on 6

8. Keys

Patrick office/Shepardson 5 office

Art cabinets

Closets

Team station/group rooms/bedrooms/bathrooms

9. Daily Tasks

Check GT Log

Check White board and add group schedule

Check for new patients/sign up for DBs

Update GT Log if necessary/end of the day note in log

10. Saturday Tasks

Same as Daily

Check MT notes/sign new ITPs

Copy weekly schedule on colored paper—25 for each floor—leave for Sunday.

11. Sunday tasks

Same as Daily

Check MT notes/sign new ITPs

Distribute weekly schedule to floors/bedroom doors

12. Clinical Supervision

Meeting with PhDs/PsyDs in the Medical Psychology Department

13. Emergencies

Group Therapist/Psychotherapist’s role & safety

i. Code 8s (Violent Situation)

ii. Plan Red

14. Volunteers

Students

Pet Therapy

Recovery

15. Committees

QA council

Clinical Research

Practice

Operations

Psychiatry Green Team

Spiritual Care

Communication

Seclusion/Restraint

16. Library

Location of on each floor → Modification of 3rd floor space being turned into Quiet Room with Library in it

Signing out of

Returning of

Volunteers book cart/book drop