(1) The document presents a treatment protocol for delivering Talking With Voices (TwV), a novel intervention for people with psychosis that involves dialogical engagement with auditory hallucinations.
(2) TwV follows four phases: (1) engagement and psychoeducation, (2) creating a formulation, (3) dialoguing with voices, and (4) consolidating outcomes. It draws from theories that voices can be understood as dissociated parts of the self that serve a protective function.
(3) The goal of TwV is to develop a more constructive relationship with voices by reducing hostility, promoting cooperation, and providing awareness of voices' protective role to ultimately decrease distress. It does
This the introductory presentation on the theory that underpins the consultation between doctor and patient. I would value any comments on these presentations: my hope is that your interest will lead to deeper insight into the process of consulting and to a sense of driving the quality of the interaction forward for the benefit of all parties.
This article tracks the history and development of the notion of using the client's ideas, preferences, and sensabilities about change to select model and technique. It argues for exploring and incorporating client ideas about change.
This the introductory presentation on the theory that underpins the consultation between doctor and patient. I would value any comments on these presentations: my hope is that your interest will lead to deeper insight into the process of consulting and to a sense of driving the quality of the interaction forward for the benefit of all parties.
This article tracks the history and development of the notion of using the client's ideas, preferences, and sensabilities about change to select model and technique. It argues for exploring and incorporating client ideas about change.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
Article just out in Psychotherapy in Australia. Incorporating the latest research about what works in therapy to address what makes a "master" therapist.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
- A brief and concise report on Narrative Therapy which includes a brief introduction, therapeutic goals, therapeutic relationships, therapeutic techniques and procedures
- For USTGS 1st semester 2013-2014
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
RUNNING HEAD THE ART OF LISTENING as a THERAPUTIC TECHNIQUE .docxagnesdcarey33086
RUNNING HEAD: THE ART OF LISTENING as a THERAPUTIC TECHNIQUE 1
The Art of Listening as a Therapeutic Technique. 5
The Art of Listening as a Therapeutic Technique
Cheri Cable
HHS307: Comm Skills for Health & Human Service Personnel
Instructor: Beth Delaney
August 24, 2015
In the very beginning of everyone’s lives we are taught to speak but not necessarily to listen. Throughout history listening has been studied and a conclusion has been made that in fact being a good listener can allow one to challenge the information that is heard. Studies have shown that effective listening is a critical tool that is so often not used. “In the health care setting the communication technique such as the quality of listening provides both therapeutic value in the patient and the provider,” Banar, M. (2011). There are many different ways to be an active and effective listener, one of which is the therapeutic technique. “Therapeutic listening is an interpersonal confirmation process, involving all the senses, in which the therapist attends with empathy to the client's verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client's situation,” according to the NCBI website. This paper will be taking an exploratory view of communication as a whole, effective health communication and focusing on the therapeutic technique of listening.
Let’s begin by examining what interpersonal communication can bring to the health care setting. Interpersonal communication consists of four principles which describes that interpersonal communication is irreversible, contextual, inescapable and complicated, thus meaning that communication cannot be avoided nor taken back once begun. Interpersonal communication is up close and personal and consists of verbal and nonverbal communication as well as listening. In order to have effective interpersonal communication one needs to consider these key areas, emotions, habits, needs, personalities and values of others. “Effective interpersonal communication skills are said to be the gateway to the development of other important life skills,” (Servellen 1).
Clear and effective communication is of great importance in order for patients to be enabled to properly and completely understand health information, without this ability adequate healthcare cannot be achieved. “Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors” according to the Institute for Healthcare Communication web site. A client that feels as though the provider is truly interested in their total care and well-being is more likely to follow the treatment .
COGNITIVE BEHAVIORAL THERAPY10
Cognitive Behavior Therapy
Donna O’Hara
Argosy University
Rough Draft
Fundamental Elements of CBT
According to Juarascio, Forman, and Herbert (2010), the broad nature of CBT (Cognitive Behavior Therapy) defies the use of any single/clear definition. The author’s idea concurs with the ABCT’ (Association for Behavioral and Cognitive Therapies, the international organization committed to the advancement of CBT), which escapes the use of any precise definition. Instead, the organization identifies its mission as advancing the scientific methods that target the clarification of many issues in the human condition (ABCT, n.d.). However, CBT therapies have special characteristics which make them unique in the presence of other psychotherapies. For instance, therapists form a collaborative working relationship with clients to identify the root causes of problems and challenge them. They believe that the problems/disorders originate from maladaptive cognitions which result from faulty perceptions about the world and its components (Cully & Teten, 2008). Comment by Donna O'Hara: Not sure it captures the clinical purpose of this assignment
Hofmann, Asmundson, and Beck (2013) contend that maladaptive cognitions comprise of general perceptions, attitudes or schemas concerning the humankind, self, the environment or the future which spark routine thoughts in a defined set of situations. Additionally, the therapy focuses on the present rather than the past and emphasizes on principles regarding how the clients interpret the world (Cully & Teten, 2008). Personality development is a result of internal thoughts and cognitions that define an individual’s worldview. Lastly, Hofmann (2011) argues that CBT is an umbrella term for many interventions that use an effective combination of cognitive, behavioral, and emotion-focused methods in psychotherapy. In this case, rational behavior represents facts and helps individuals feel as they would like and to achieve goals.
The concepts behind modern CBT were founded by Aaron Beck. Hayes and Hofmann (2017) argues that CBT’s history has three different generations that tend to overlap. The first generation comprises of the research by Skinner, Wolpe, and Eysenck who were concerned with the prevalent limitations of psychoanalytic therapy. The scholars used operant conditioning principle to study behavior modification primarily by using experiments with animals. In the second generation, Ellis’ (1962) and Beck, Rush Shaw, and Emery (1979) developed the rational emotive behavior therapy and the cognitive therapy respectively to illustrate the significance of language and cognition in psychopathology. They focused on the effects emotional interpretations in shaping the experiences of people. At this stage, clinical trials were used to test the efficacy of treatment programs.Comment by Donna O'Hara: yearComment by Donna O'Hara: yearComment by Donna O'Hara: such as????
On the othe ...
Mechanisms of Mindfulness inCommunication TrainingDaniel CAbramMartino96
Mechanisms of Mindfulness in
Communication Training
Daniel C. Huston, Eric L. Garland & Norman A.S. Farb
Mindfulness, an ancient spiritual practice, is becoming an increasingly popular
component of communication courses, training individuals to reserve judgment in their
dealings with others. However, the effects of mindfulness in communication courses are
not well researched. We compared students taking an introductory communication
course that included a mindfulness component (N �20) against a control group of
students taking an equivalent course without mindfulness content (N �24). Both groups
improved in their positive reappraisal tendencies following communication training;
however, the groups appeared to differ in how they positively reappraised situations.
Only the mindfulness group demonstrated improved mindfulness scores following
training, accounting for that group’s increases in positive reappraisal, and providing
evidence for mindfulness training as one mechanism for reducing negative reactivity in
communication.
Keywords: Mindfulness; Positive Reappraisal; Blame; Mindful Coping Model; Spirituality
Mindfulness meditation is an ancient spiritual practice introduced over 2,500 years
ago as a means of calming the mind and gaining insight into the impermanent and
interdependent nature of the self. Over the last few decades, scholars and clinicians in
the West have begun to explore secular applications of mindfulness, and have noted
the practical benefits of observing thoughts, impulses, and emotions. This ability,
nurtured through the practice of mindfulness meditation, appears to help people lead
happier, more productive, and fulfilling lives through the process of coming to know
Daniel C. Huston is a Professor in the Department of English, Fine Arts, and Foreign Languages at NHTI,
Concord’s Community College, Eric L. Garland is an Assistant Professor in the College of Social Work at Florida
State University and a Research Affiliate for Trinity Institute for the Addictions, Norman A.S. Farb is a
postdoctoral fellow at the Rotman Research Institute. The authors would like to thank Beth Blankenstein,
Susanne O’Brien, Diana Levine, members of the NHTI Institute Leadership Team, and the students
who voluntarily participated in the study for their contributions. Correspondence to: Daniel C. Huston,
Grappone Hall, NHTI, Concord’s Community College, 31 College Drive, Concord, NH 03301, USA. E-mail:
[email protected]
ISSN 0090-9882 (print)/ISSN 1479-5752 (online) # 2011 National Communication Association
http://dx.doi.org/10.1080/00909882.2011.608696
Journal of Applied Communication Research
Vol. 39, No. 4, November 2011, pp. 406�421
http://dx.doi.org/10.1080/00909882.2011.608696
themselves and realizing they are more than the self-talk they experience, more than
the habitual patterns of behavior they have formed over the years. They come to
realize they can ‘‘let go’’ of that ‘‘chatter’’ and those ‘‘habits’’ ...
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
Article just out in Psychotherapy in Australia. Incorporating the latest research about what works in therapy to address what makes a "master" therapist.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
- A brief and concise report on Narrative Therapy which includes a brief introduction, therapeutic goals, therapeutic relationships, therapeutic techniques and procedures
- For USTGS 1st semester 2013-2014
This is the validation study of the Group Session Rating Scale (GSRS). In a nutshell, this study found more than acceptable reliability and validity with not only an alliance measure but also with group climate and cohesiveness scales. The GSRS was also predictive of last session outcomes. An RCT comparing PCOMS to TAU in group therapy has been submitted.
RUNNING HEAD THE ART OF LISTENING as a THERAPUTIC TECHNIQUE .docxagnesdcarey33086
RUNNING HEAD: THE ART OF LISTENING as a THERAPUTIC TECHNIQUE 1
The Art of Listening as a Therapeutic Technique. 5
The Art of Listening as a Therapeutic Technique
Cheri Cable
HHS307: Comm Skills for Health & Human Service Personnel
Instructor: Beth Delaney
August 24, 2015
In the very beginning of everyone’s lives we are taught to speak but not necessarily to listen. Throughout history listening has been studied and a conclusion has been made that in fact being a good listener can allow one to challenge the information that is heard. Studies have shown that effective listening is a critical tool that is so often not used. “In the health care setting the communication technique such as the quality of listening provides both therapeutic value in the patient and the provider,” Banar, M. (2011). There are many different ways to be an active and effective listener, one of which is the therapeutic technique. “Therapeutic listening is an interpersonal confirmation process, involving all the senses, in which the therapist attends with empathy to the client's verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client's situation,” according to the NCBI website. This paper will be taking an exploratory view of communication as a whole, effective health communication and focusing on the therapeutic technique of listening.
Let’s begin by examining what interpersonal communication can bring to the health care setting. Interpersonal communication consists of four principles which describes that interpersonal communication is irreversible, contextual, inescapable and complicated, thus meaning that communication cannot be avoided nor taken back once begun. Interpersonal communication is up close and personal and consists of verbal and nonverbal communication as well as listening. In order to have effective interpersonal communication one needs to consider these key areas, emotions, habits, needs, personalities and values of others. “Effective interpersonal communication skills are said to be the gateway to the development of other important life skills,” (Servellen 1).
Clear and effective communication is of great importance in order for patients to be enabled to properly and completely understand health information, without this ability adequate healthcare cannot be achieved. “Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors” according to the Institute for Healthcare Communication web site. A client that feels as though the provider is truly interested in their total care and well-being is more likely to follow the treatment .
COGNITIVE BEHAVIORAL THERAPY10
Cognitive Behavior Therapy
Donna O’Hara
Argosy University
Rough Draft
Fundamental Elements of CBT
According to Juarascio, Forman, and Herbert (2010), the broad nature of CBT (Cognitive Behavior Therapy) defies the use of any single/clear definition. The author’s idea concurs with the ABCT’ (Association for Behavioral and Cognitive Therapies, the international organization committed to the advancement of CBT), which escapes the use of any precise definition. Instead, the organization identifies its mission as advancing the scientific methods that target the clarification of many issues in the human condition (ABCT, n.d.). However, CBT therapies have special characteristics which make them unique in the presence of other psychotherapies. For instance, therapists form a collaborative working relationship with clients to identify the root causes of problems and challenge them. They believe that the problems/disorders originate from maladaptive cognitions which result from faulty perceptions about the world and its components (Cully & Teten, 2008). Comment by Donna O'Hara: Not sure it captures the clinical purpose of this assignment
Hofmann, Asmundson, and Beck (2013) contend that maladaptive cognitions comprise of general perceptions, attitudes or schemas concerning the humankind, self, the environment or the future which spark routine thoughts in a defined set of situations. Additionally, the therapy focuses on the present rather than the past and emphasizes on principles regarding how the clients interpret the world (Cully & Teten, 2008). Personality development is a result of internal thoughts and cognitions that define an individual’s worldview. Lastly, Hofmann (2011) argues that CBT is an umbrella term for many interventions that use an effective combination of cognitive, behavioral, and emotion-focused methods in psychotherapy. In this case, rational behavior represents facts and helps individuals feel as they would like and to achieve goals.
The concepts behind modern CBT were founded by Aaron Beck. Hayes and Hofmann (2017) argues that CBT’s history has three different generations that tend to overlap. The first generation comprises of the research by Skinner, Wolpe, and Eysenck who were concerned with the prevalent limitations of psychoanalytic therapy. The scholars used operant conditioning principle to study behavior modification primarily by using experiments with animals. In the second generation, Ellis’ (1962) and Beck, Rush Shaw, and Emery (1979) developed the rational emotive behavior therapy and the cognitive therapy respectively to illustrate the significance of language and cognition in psychopathology. They focused on the effects emotional interpretations in shaping the experiences of people. At this stage, clinical trials were used to test the efficacy of treatment programs.Comment by Donna O'Hara: yearComment by Donna O'Hara: yearComment by Donna O'Hara: such as????
On the othe ...
Mechanisms of Mindfulness inCommunication TrainingDaniel CAbramMartino96
Mechanisms of Mindfulness in
Communication Training
Daniel C. Huston, Eric L. Garland & Norman A.S. Farb
Mindfulness, an ancient spiritual practice, is becoming an increasingly popular
component of communication courses, training individuals to reserve judgment in their
dealings with others. However, the effects of mindfulness in communication courses are
not well researched. We compared students taking an introductory communication
course that included a mindfulness component (N �20) against a control group of
students taking an equivalent course without mindfulness content (N �24). Both groups
improved in their positive reappraisal tendencies following communication training;
however, the groups appeared to differ in how they positively reappraised situations.
Only the mindfulness group demonstrated improved mindfulness scores following
training, accounting for that group’s increases in positive reappraisal, and providing
evidence for mindfulness training as one mechanism for reducing negative reactivity in
communication.
Keywords: Mindfulness; Positive Reappraisal; Blame; Mindful Coping Model; Spirituality
Mindfulness meditation is an ancient spiritual practice introduced over 2,500 years
ago as a means of calming the mind and gaining insight into the impermanent and
interdependent nature of the self. Over the last few decades, scholars and clinicians in
the West have begun to explore secular applications of mindfulness, and have noted
the practical benefits of observing thoughts, impulses, and emotions. This ability,
nurtured through the practice of mindfulness meditation, appears to help people lead
happier, more productive, and fulfilling lives through the process of coming to know
Daniel C. Huston is a Professor in the Department of English, Fine Arts, and Foreign Languages at NHTI,
Concord’s Community College, Eric L. Garland is an Assistant Professor in the College of Social Work at Florida
State University and a Research Affiliate for Trinity Institute for the Addictions, Norman A.S. Farb is a
postdoctoral fellow at the Rotman Research Institute. The authors would like to thank Beth Blankenstein,
Susanne O’Brien, Diana Levine, members of the NHTI Institute Leadership Team, and the students
who voluntarily participated in the study for their contributions. Correspondence to: Daniel C. Huston,
Grappone Hall, NHTI, Concord’s Community College, 31 College Drive, Concord, NH 03301, USA. E-mail:
[email protected]
ISSN 0090-9882 (print)/ISSN 1479-5752 (online) # 2011 National Communication Association
http://dx.doi.org/10.1080/00909882.2011.608696
Journal of Applied Communication Research
Vol. 39, No. 4, November 2011, pp. 406�421
http://dx.doi.org/10.1080/00909882.2011.608696
themselves and realizing they are more than the self-talk they experience, more than
the habitual patterns of behavior they have formed over the years. They come to
realize they can ‘‘let go’’ of that ‘‘chatter’’ and those ‘‘habits’’ ...
Running head RESEARCH PROPOSAL ON COUPLES COUNSELING RESEA.docxtoltonkendal
Running head: RESEARCH PROPOSAL ON COUPLES COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING 5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the best therapy method for couples between individual, group, and couples therapy. The proposal will detail the findings of past researchers and will occasionally focus on the therapy methods in the context of a couple that is experiencing conflict mainly based on the rejection of their same-sex marriage by their respective families. It will also detail the methodologies used by other researchers in investigating the therapy methods. The study will reveal the most recommended therapy method and the variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject their union or relationship or marriage. Most of the affected couples are those whose respective families are deeply divided on the basis of religion, race/ethnicity and socio-economic status. However, some families just oppose relationships because they threaten their traditions, which are mostly rooted on religion. Some families oppose gay or lesbian relationships or marriages. Even when a family member reveals that he or she may attracted to a member of the opposite sex, the other family members may rise up against that family member. It may make teenagers and young adults hide about their sexual orientation. The stigmatization may be too unbearable for the affected individuals, who may choose to go into seclusion and engage in suicidal actions. There are couples like Kathleen and Lisa who courageously seek the help of therapists. Upon setting a stage for positive development, couples can ease the tension in the mind. They can open up to people and feel ready to solve problems together. The question that comes in mind in light of these facts is: What it the true impact of sexual orientation-based rejection by family members on a relationship? How can a social worker help couples overcome sexual orientation-based rejection by family members on a relationship? The research question of the study is: which between individual, group, and couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated with individual psychotherapy, particularly in literature. Yet, the concept is increasingly used together within the marital and family therapy domains. According to Pinsof and Catherall (1986), “a systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework”. The authors examined family, couple and individual therapy and used some methodologies and deve ...
DQ 2-1 responses 55. The Change Theory was a three-stage model o.docxelinoraudley582231
DQ 2-1 responses 5
5. The Change Theory was a three-stage model of change developed by Kurt Lewin. This model was also known as the unfreezing-change-refreezing model that can be used by health care professionals when making discussing treatment for patients (Manchester, et al, 2014). The unfreezing process involves making it possible for people to change their mind. This can be done by helping them overcome a resistance or introducing new information. It is a way to increase the driving forces away from the current situation, such as encouraging a patient to have a diagnostic heart catheter after they have had several episodes of chest discomfort, but is afraid of going to the hospital for a procedure. Change is when there is a change of thought, behavior, or something that moves one from their current or frozen situation. This can be described as the patient agreeing to proceed with the heart catherization, getting on appropriate medication, and following a healthier lifestyle. The Refreezing is established after then change has happened and there is a new habit. For example, after the patient has the heart catheterization, he or she adopts a healthier lifestyle by being compliant with medication and the physician’s treatment recommendations, eating a heart-healthy diet, and exercising.
Communication is more than sending a message from one person to another. Communication involves nonverbal communication such as tone, body language, dialect, paralanguage, proximity, touch, eye contact, gestures, posture, and more. Nonverbal communication between a physician and patient influences patient perception, such as patient satisfaction (Montague, Chen, Xu, Chewning, & Barrett, 2013). Verbal and nonverbal communication barriers such as healthcare jargon, language barriers, emotional barriers, differences in perception and view point, and physical disabilities. Environmental barriers can also disrupt and distort messages. To minimize disruptions and distortions in communication, health care professionals should eliminate noise distractions by taking the patient to a quiet room or closing the door to the exam room or hospital room for privacy. One should speak clearly and slowly, checking for understanding before moving on to the next part of the message. Health care professionals should use a medical certified translator when there is a language barrier or hearing impairment. Reading the patient’s body language can also suggest if the patient is understanding and following along. Cell phones ringers should be turned off to not interrupt the communication. Eye contact demonstrates listening and understanding for both parties. Touch can be clinical and social (Montague, Chen, Xu, Chewning, & Barrett, 2013). A clinician must touch to the patient to assess, diagnose, and treat. However, touching through a handshake, hug, or pat on the back, can be social, therapeutic, and healing. The important part of communication is to make sure one’s message is recei.
Palliative care is delivered to patients and their families when t.docxsmile790243
Palliative care is delivered to patients and their families when they are at their most helpless and vulnerable situations. Undoubtedly, palliative care is a perfect fit APRNs since they love the challenge of working with difficult and complex situations in addition to enjoy building close relationships with their patients and families. This type of care focuses on providing relief from physical symptoms and stress of serious or terminal illnesses (e.g., cancer), in addition to address the whole person. Likewise, palliative practice offers the opportunity to work thoroughly with an interdisciplinary team, including psychologists, nurses, physicians, social work, dietitians, pharmacists and volunteers, all functioning to treat challenging symptoms such as pain, depression, fatigue, constipation and a number of other symptoms associated with chronic medical conditions and mental health (Schroeder & Lorenz, 2017).
APRNs play a unique role in palliative care. As APRN typically implement a holistic approach to address the physical, emotional, spiritual and social aspects of the patient’s and family’s needs. At present, the Institute of Medicine (IOM) recommends that care decisions be evidence-based to effectively and efficiently care for patients and provide effective care in the end of life. This type of approach has been shown to improve patient outcomes and reduce health care costs throughout the lifespan, particularly at the end of life. Accordingly, a palliative care is regarded an evidence-based intervention and result in a higher quality of life and increased dignity, emotional and spiritual support, and patient and family well-being. Evidence suggests that patients receiving palliative and hospice care live longer when compared with similar patients who do not receive those services. At present, hospice services extend palliative care principles to the end of life (Dobbins, 2016).
In summary, multiple studies have emphasized the importance of meaningful conversations on an individual level in which key aspects related to patients’ values, goals, and preferences of care are discussed. Typically, most patients are not aware of the choices they have at the end of their lives. Therefore, APRNs should use the information and materials available to inform and advise their patients of possible options. Definitively, APRNs are recognized as skilled clinicians who interpret patient responses to diseases and treatments, advocate for holistic and effective care, facilitate relationships with other care providers, and provide bio-psychosocial care. Nowadays, APRNs serve as primary care hospitalists, administrators and health care providers. In addition, they function as researchers, educators, and advocates, and researchers. APRNs are perfectly positioned to improve the quality and availability of medical and social services for patients and their families, enhancing quality of life through the end of life (Dobbins, 2016).
References
Dobbins, E.
Communication can broadly be defined as exchange of ideas, messages and information between two or more persons, through a medium, in a manner that the sender and the receiver understand the message in the common sense, that is, they develop common understanding of the message
The Role of Horticultural Therapy in the Therapeutic Community Workshop Flyer
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For more information, Please see websites below:
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Organic Edible Schoolyards & Gardening with Children
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
2. improve the relationship between voice(s) and voice-hearer. Further research is now
required to evaluate feasibility, acceptability, and efficacy.
Practitioner points
It is feasible to integrate a dissociation model of voice-hearing within a psychological intervention for
people with psychosis.
Combining psychosocial education, formulation and direct dialogue can be used to facilitate a more
peaceful relationship between clients and their voices.
Practitioners trained in other therapeutic modalities can draw on existing transferrable skills to
dialogue with their clients’ voices.
The input of those with lived experience of mental health difficulties has an important role in guiding
treatment design and delivery.
Despite longstanding associations with psychiatric illness, there is growing recognition
that voice-hearing (‘auditory hallucinations’) is a psychosocially meaningful event with
manifest associations between adverse life events and the content of, and responses to,
the voices people hear (Corstens Longden, 2013; McCarthy-Jones, 2011; Peach et al.,
2020). In turn, a proportion of individuals may also experience dynamic relationships
with their voices, perceiving them as distinct and separate from their sense of self (Dorahy
Palmer, 2016; McCarthy-Jones et al., 2014; Romme, Escher, Dillon, Corstens, Morris,
2009). Correspondingly, an emergent wave of treatment strategies is placing greater
emphasis on the interpersonal aspects of voice-hearing. These include compassion-
focused techniques (Heriot-Maitland, McCarthy-Jones, Longden, Gilbert, 2019);
Progressive Approach psychotherapy, which facilitates an attitude of acceptance and
empathy from the reflective ‘Adult Self’ to the distressed ‘experiencing self’ (Gonzalez
Mosquera, 2012; Mosquera Ross, 2017); Avatar therapy, a dialogical approach that
incorporates digital representations of hostile voices (Leff, Williams, Huckvale, Arbuth-
not, Leff, 2014); Relating Therapy, which addresses ‘power’ and ‘proximity’ dynamics
between hearer and voice (Hayward, Jones, Bogen-Johnston, Thomas, Strauss, 2017)
and Cognitive Behavioral Therapy for psychosis (CBTp), which examines how
psychosocial dynamics can influence voice phenomenology (Tai Turkington, 2009).
Taken together, these approaches expand traditional views of voices as merely perceptual
anomalies by explicitly acknowledging the impact of the hearer–voice relationship both
in maintaining distress and promoting recovery.
Talking With Voices (TwV) is one such intervention which incorporates recent
advances for understanding voices in more relational terms. Specifically, it draws from a
growing clinical/conceptual position that voices, at least for some individuals, may be
understood as dissociated parts of the self which serve a protective function by indicating
social and emotional vulnerabilities (see Longden, Moskowitz, Dorahy, Perona-
Garcel
an, 2019; Moskowitz, Mosquera, Longden, 2017). Within this framework, voices
can be considered a dialogical experience: ‘self-positions imbued with intentionality and
shaped by one’s unique interpersonal circumstances [in a way which] highlights the
interaction between subjective mental experience and external social influence’
(Longden et al., 2019; p. 216). This premise is expanded upon elsewhere (Longden
et al., 2019; Perona-Garcel
an, P
erez-
Alvarez, Garc
ıa-Montes, Cangas, 2015) but
essentially presents a rationale for moving beyond models of hallucinations primarily
based in cognitive/perceptual dysfunction; instead considering voices as a dynamic
embodiment of social, emotional and interpersonal influences which are often
Talking with voices therapy protocol 559
3. experienced as subjectively real states of consciousness. Correspondingly, positioning
voices as dialogical provides a framework for verbally engaging with them as a possible
way to decrease conflict and promote a process of understanding and reconciliation.
Although dialogical engagement with voices is employed and promoted within the
survivor-led Hearing Voices Movement (HVM: Corstens, Longden, McCarthy-Jones,
Waddingham, Thomas, 2014), evidence from clinical services remains in development.
In addition to the TwV study, empirical investigations are limited to a case series (n = 15;
Steel et al., 2019), and a small randomized control trial ([RCT] n = 12; Schnackenberg,
Fleming, Martin, 2017); yet while not all participants report a positive experience of
communicating with voices (Steel et al., 2020), this emerging evidence-base suggests
provisional signals of efficacy and no indications for adverse events. It is hoped these
results can be further refined through definitive, clinical and cost-effectiveness trials. As
such, TwV is currently being evaluated in a single-blind feasibility and acceptability RCT in
which 50 participants with a diagnosis of psychosis are allocated to receive either
treatment as usual (TAU), or TAU plus up to 26 sessions of TwV over six months.
Experience from the therapy team, qualitative participant feedback and empirical
measures of recruitment and retention so far suggest that it is an acceptable treatment
option to offer patients, and below we offer our impressions of engaging in psychother-
apeutic dialogues with the voices people hear.
Overview of the protocol
Talking With Voices follows four phases for working with clients: engagement and
psychoeducation, formulation, dialogical work, and consolidating outcomes. While
dialogue is the focus, it is important to acknowledge that voice engagement is something
many individuals naturally undertake without any kind of formal therapeutic input.
However, the conceptual/theoretical background for TwV is inspired by Voice Dialogue,
a therapeutic approach developed by Stone and Stone (1989, 1993). Within this model, all
individuals are considered to contain different subpersonalities, or Selves, each of which
possess their own physical, emotional, and cognitive characteristics and ways of relating
to the environment. These Selves are believed to develop in response to formative social
and emotional circumstances and are arranged in opposites: ‘primary’ Selves, which
emerge as dominant; and ‘disowned’ Selves, which become suppressed. Their expansion
and compartmentalization are deemed a protective process to promote attachment and
avoid social rejection, and Voice Dialogue aims to facilitate healthy functioning by
experiencing and acknowledging the different Selves and understanding their develop-
mental perspective.
In contrast, voices are often experienced as autonomous entities who impose on the
hearer rather than as personality parts (although the overlap between voices and
dissociated structures observed in dissociative identity disorder is also noted: Moskowitz
et al., 2017). Nevertheless, TwV is derived from the same premise as Voice Dialogue, in
that contact is established with voice(s) in order to understand more about what they are
trying to achieve through their interactions with the voice-hearer. Consistent with the
growing emphasis on voices as a dissociative experience (Longdenet al., 2020; Moskowitz
Corstens, 2007; Pilton, Varese, Berry, Bucci, 2015), the model offers a comparative
view of ego-dystonic voices as disowned (or dissociated) selves which relate to adversity
in the voice-hearer’s life and offer an adaptive function by signposting unresolved
emotional vulnerabilities (sometimes in a metaphorical way). Gaining a different
560 Eleanor Longden et al.
4. perspective on what the voices are expressing can, therefore, help develop a more
peaceful, empathic way of relating to the Self that decreases internal conflict (Ross
Halpern, 2009). As such, the intervention aims to develop a more constructive
relationship by (1) reducing hostility, (2) promoting cooperation and communication,
and (3) providing an increased awareness of the voices’ protective role. In turn, and
consistent with existing cognitive models (Birchwood et al., 2004; Chadwick
Birchwood, 1994; Morrison, 2001), it is expected that reducing negative beliefs and
attributions for the voice(s) are central for a corresponding reduction in distress.
Therapeutic principles and values
Talking With Voices adheres to general best-practice principles for psychological therapy
with psychosis patients, including building collaborative relationships, developing shared
goals, using inclusive language, validating individual experiences, and providing hope
that recovery is possible (Brabban et al., 2017). In turn, these principles underpin many of
the specific values of TwV, which are outlined below.
As discussed previously, dialogical approaches are already established within the
HVM, an influential initiative derived from the work of Romme and Escher (1993, 2000)
that promotes a psychosocial, person-centred approach to the voice-hearing experience
(see Corstens et al., 2014). TwV is, therefore, guided by many of these same core values.
Firstly, it incorporates a normalising approach by acknowledging voices as a common
human experience that may cause distress but from which many people recover.
However, it is important to note that the concept of ‘recovery’ within the HVM is not
defined by cessation of clinical symptoms; instead, an emphasis is placed on reducing
distress and promoting positive goals, with full recognition that individuals can live
fulfilling lives as voice-hearers (Romme et al., 2009). It is also a user-led intervention,
where clients have a central role for determining the pace and goals of therapy and
identifying the most useful strategies to cope with their experiences. In this regard, a
subjective interpretative framework for understanding voices (e.g., trauma-based,
spiritual, cultural) is also respected, and the therapist works within that mindset without
insisting their clinical perspective is the correct one (Corstens, Escher, Romme,
Longden, 2019; Longden Corstens, 2020).
There are also additional values rooted in the theoretical framework within which
TwV is based. Primarily, it understands voices, including hostile or derogatory ones, as
representing parts of the self that ultimately serve a protective purpose. These parts
(which may or may not occur with the level of structural dissociation linked with
dissociative identity disorder: van der Hart, Nijenhuis, Steele, 2011) may often originate
in traumatic events and/or reflect overwhelming emotion along with negative beliefs
about oneself, other people, and the world. The core of the intervention is to use emerging
information about the voices’ ‘purpose’ in a way that facilitates a more peaceful
relationship. Voices’ comments are therefore seen as meaningful in the sense of drawing
attention to unresolved distress, and it is considered valuable to explore the protective
role they have played in the person’s life and understand how features such as persecution
or aggression are often masks for unresolved pain. In this respect voices often originate in
overwhelming situations (and are frequently rejected by the voice-hearer), so are forced to
communicate in ways that are hostile, critical, or otherwise extreme in order to be noticed
(Romme Escher, 2000). Because attempts to suppress the voice may also suppress the
emotions/beliefs which they embody, a complementary goal is therefore to help the voice
Talking with voices therapy protocol 561
5. communicate its purpose and needs in ways that are more constructive and respectful of
the voice-hearer. Indeed, as noted by Mosquera and Ross (2017), ‘any approach that
implies getting rid of the voices or ignoring them, only creates more internal conflict. The
greater the [. . .] conflict, the greater the dissociative barriers need to be and the less
integrative capacities the patients develop’ (p. 168).
Protocol phases
Adherence to a therapy manual may be associated with several positive outcomes,
including service-user satisfaction and improved treatment effects (Morrison, 2017). It is
additionally important in a research context for reliability/validity and assists the
dissemination and replication of therapies in clinical settings, as well as being
advantageous for therapist training/supervision, promoting consistency, examining
therapy acceptability, and determining whether milestones are achievable. However,
despite these benefits, adhering to a manual should not mean sessions are delivered in
didactic fashion or inhibit creativity on the part of the therapist. The therapeutic
relationship remains paramount and a competent, well-trained practitioner can be skilled
at adhering to a manual while remaining responsive to client needs and delivering
individualized therapy with empathy and respect.
The phases and associated milestones of TwV were offered in 26 hourly sessions over
6 months (see Table 1). As discussed, it is important to apply these in a flexible,
customised manner and variations should be expected in session attendance, as well as
their length/frequency and the pace (and potentially order) in which milestones are
attained. The five therapists delivering the intervention were clinical psychologists
specializing in CBTp, all of whom had previously worked on RCTs and whose practice
experience post-qualification ranged from 3 to 18 years (mean length = 7.4 years). They
received eight-day training and fortnightly supervision from the trial’s chief investigator
(EL), a lived experience researcher (AB), and a psychiatrist with experience of the
technique (DC). To maximize fidelity, adherence checklists and electronic session
records were utilized, with any protocol divergences monitored during supervision.
Unless requested otherwise, therapy was conducted in client homes in a manner
consistent with assertive outreach practice.
Phase 1: Engagement and psychosocial education
The start of therapy focuses on engagement and psychosocial education, with an
emphasis on normalizing voice-hearing and providing literature on coping and recovery.
It also covers an explanation/negotiation of the protocol, including confidentiality,
logistics, and the basic premise of the intervention, as well as a discussion of the client’s
presenting difficulties, treatment history, and beliefs about their voices. Further time is
spent establishing a sense of safety and refining self-soothing/coping techniques in
preparation for more in-depth emotional exploration. Following initial discussions, this
latter area should then be regularly revisited throughout subsequent sessions.
Because many people feel a degree of shame about their experiences, it is important
for therapists to model from the outset that it is normal to have conversations about voice-
hearing. In turn, a key component of this early stage is establishing an alliance with the
voices by emphasizing that the therapist does not intend to act in a hostile way or attempt
to banish them; rather, the aim is to facilitate a more constructive relationship through an
562 Eleanor Longden et al.
6. Table 1. Therapy phases and associated milestones for Talking With Voices
Phase
Approximate
session number Therapy milestones
Engagement and
psychosocial
education
1–2 Establishing client contact and explaining intervention
Discussing experiences of, and beliefs about, hearing voices
Normalizing and destigmatizing voice-hearing
Psychosocial education focusing on the relationship
between voice-hearing, life circumstances and negative
emotions
Establishing an alliance with the voices
Commencing development of self-care and
coping/grounding skills
Assessment and
formulation
3–5 Developing a construct that encompasses all the voices a
person hears
Where applicable, explore renaming voices with less
negative/derogatory names
Based on the construct, have a shared understanding of (1)
who or what the voices represent, and (2) what difficulties
the voices represent
6 Make a report of the construct and have a conversation
about the report
7 Reiterating therapy aims
Planning which voices to speak with and the issues to
explore
Gaining voices’ permission to dialogue
Developing acceptable shared goals for dialogue
Establishing the client’s capacity to regain control and pre-
agreeing a signal for ending the dialogue
Identifying an ally within the client’s social network and/or
health care team to attend the final sessions
Dialogical work 8–23 Collaboratively setting between-session tasks
Establishing boundaries for the voice via ‘time-sharing’
Encouraging voices to use therapy sessions as a space to
express their own frustrations, rather than harassing the
client during the week
Achieving a direct dialogue with the voices
Developing short replies/mantras that the client can use
between sessions in response to the voices’ concerns
Evaluation and
consolidation
24–26 If desired/available, assist the client to access a local HVN
peer-support group and provide signposting to relevant
local services
Handover session with identified family member and/or
health care worker for support to take the work forward
Create a collaborative summary of what was achieved
during therapy and identify strategies/goals for the future
(e.g., continue time-sharing, using respectful langue, not
obeying commands, self-soothing)
Talking with voices therapy protocol 563
7. increased understanding of their concerns and their role in the client’s life. This requires
sensitive negotiation, as many voice-hearers understandably wish to eradicate their
voices. However, we have found that this is not necessarily a realistic aim, at least in the
short-term, and can ultimately create further conflict between hearer and voice.
Phase 2: Assessment and formulation
The second phase applies a standardized method known as ‘the construct’ as a means of
psychological formulation (Romme Escher, 2000). This involves the therapist and client
co-constructing a shared understanding of the psychosocial conflicts represented by the
voices, as well as developmental events that may havepredisposed a vulnerability to voice-
hearing and/or created difficulties in tolerating and regulating strong emotions. An
emphasis is placed on experiences of abuse and adversity, and therapists should help
clients prepare for the emotional challenges of these conversations. Likewise, the client
should not be pressured into disclosing information before they are ready (for highly
dissociative clients, it may also be the case that such events are initially inaccessible and
are subsequently disclosed by the voices).
Detailed descriptions of the construct method are available elsewhere (Corstens et al.,
2019; Longden et al., 2012). In summary, it focuses on the voices’ (1) identity and
characteristics, including gender, age, emotional valence, frequency, and content; (2)
their emotional and social triggers; (3) their history, including the circumstances in which
they first arose and whether they have changed over time; and (4) the life history of the
voice-hearer. The final construct should encompass all the voices a person hears, but in
case of time constraints should prioritize the most problematic ones. The method’s final
goal is twofold: to have a shared understanding of who or what the voices represent and to
elucidate what problems or challenges they might embody.
Phase 3: Dialogical work
Dialogue is the intervention’s main focus and is guided by frameworks developed in the
previous phases: specifically, that voice-hearing often relates to adversity and that voices,
including threatening or critical ones, have a protective function in terms of indicating
underlying vulnerabilities. The overarching aim of this work is toimprove the hearer-voice
relationship through developing more positive communication styles, increasing the
client’s sense of empowerment, increasing understanding towards the voices, and
identifying the voice’s goals (i.e., their protective functions) while exploring how they can
be supported to achieve these in ways that are more constructive and less distressing for
the voice-hearer. Three main methods are employed for achieving this: (1) between-
session tasks; (2) role-play, which entails practicing communicating with the voices in the
session; and (3) the therapist communicating with the voices by requesting the voice-
hearer repeat their responses, either directly or by paraphrasing.
Although many people resist distressing voices, a common result of such avoidance is
that the voices intensify their attempts to gain the person’s notice, often through
increasingly disruptive behaviours. A main goal of between-session tasks is therefore to
establish a sense of control for the client while reinforcing feelings of safety, practicing
self-soothing techniques, and facilitating change strategies. One such task is ‘time-
sharing’, where clients set specific daily slots to listen to their voices on the condition that
the voices cannot expect their attention outside the allotted ‘meeting’. A further
technique focused on boundary-setting and assertiveness is developing short replies,
564 Eleanor Longden et al.
8. which the client can use to acknowledge the voices’ presence without being drawn into a
distressing exchange (e.g., ‘I know you’re trying to tell me something you feel is
important, but I can’t discuss that right now’). The voices’ concerns can then be explored
later with the support of the therapist. Other between-session techniques include diary-
keeping, the use of visual imagery, and practicing grounding and self-soothing techniques.
The client may also set tasks for the therapist, such as collecting specific information (e.g.,
self-help leaflets, contact details for local services), researching a relevant topic (e.g., a
certain cultural practice/belief), or arranging requested meetings (e.g., with a religious
leader or police officer). Any tasks should be collaboratively agreed upon and regularly
reviewed in-session.
Prior to beginning dialogue, shared goals should be developed that are meaningful,
achievable, and mutually acceptable for both voices and voice-hearer (e.g., a goal ‘to get
rid of the voices’ is one that the voices themselves are unlikely to cooperate with). These
will typically be related to a greater understanding of why a voice behaves the way it does,
which in turn is often linked to developing longer-term goals for reducing distress and
enhancing quality of life. Role-play may be used in advance to increase the client’s
confidence and familiarity with the concept of engaging with voices, which might include
improvising a voice’s comments, practicing how to respond to the voice in a constructive
way, or engaging with one of the Selves in the manner of Voice Dialogue.
In advance of the allotted session, therapist and client will decide which voices to
speak with and the specific issues to explore. However, it is generally better to not begin
with the most vulnerable voices, as the dominant voice (whose role is to protect the
person’s vulnerabilities) may grow threatened and aggressive. The client’s ability to regain
control is likewise ascertained in advance, and a pre-agreed signal to end the dialogue
(including the use of a ‘panic button’ metaphor) can also be explored. Before dialogue
commences, it is also important to re-emphasize that the aim is simply to explore the
voices’ perspective, not to try to change or eradicate them. The therapy session is a space
focused not just on the reactions and needs of the client, but also of the voices; therapists
should therefore acknowledge the role the voices have played in the client’s life, ask the
voices questions about how they feel about what is going on, and use a respectful language
and tone. Permission to dialogue should likewise be sought from the voices in addition to
the voice-hearer, and consent should be re-established during every session.
Dialogue itself can be applied either directly or indirectly. In the indirect method, the
therapist begins a conversation by asking the client to paraphrase the voice’s responses
whereas direct dialogue involves the client repeating its words verbatim. It may be easier
to start with indirect dialogue; however, with the client and voice’s permission, it is
recommended to use the direct method so the voice can express itself more fully. When
the dialogue is ready to begin, the therapist invites the client to move their chair to a
desired place in the room and then welcomes the voice (if the client does not wish to
move, then the therapist can change positions instead). The conversation is conducted in
an open, committed way and after the questions have been answered the therapist thanks
the voice for its explanations. Initial queries can focus on the identity and purpose of the
voice, the relationship it has with the client and, where appropriate, the relationship
between the voices and the therapist. Some potential questions are outlined in Table 2.
Once dialogue is underway, specific questions will vary based on the identity and purpose
of the voice, as well as the mutual goals established by the voice and voice-hearer.
Examples of such dialogues are provided in more detail by Corstens, Longden, and May
(2012), Corstens, May, and Longden (2012) and Longden and Corstens (2020).
Talking with voices therapy protocol 565
9. At the close of the conversation, the client and therapist reflect on what occurred and
discuss any new insights or questions. The therapist may summarize what s/he
experienced and check this interpretation with the client. Based on what content arose,
future conversations can be planned and more specific between-session tasks can be set.
For highly dissociative clients, we have found that audio-recording can be a useful way to
assist processing the events of the session.
Phase 4: Evaluation and consolidation
The final sessions provide time for the client, therapist, and voices to collaboratively
review their progress, discuss ways of consolidating new knowledge, and develop
monitoring and action plans for future difficulties, including planning tasks with the voice
(s). A written summary of this discussion is then provided by the therapist. The
penultimate session is delivered in collaboration with a supporter(s) of the client’s
choosing (e.g., a friend, family member and/or health care worker) to help facilitate
continuity of the approach and establish shared goals and strategies. However, the final
session is reserved for the client, voices, and therapist to privately review and reflect on
their experiences and to say goodbye to one another. At this stage, clients will also be
supported to access local HVM peer-support groups, if available and/or desired.
Implementation issues
Current indications from the feasibility trial suggest that TwV can be delivered within
clinical services as a complement to routine care. The main challenges include those
Table 2. Potential questions to ask a voice when beginning a dialogue
Area of enquiry Example questions
Voice identity and function [Client] told me your name was X; do you agree?
How do you feel at the moment?
When did you first come into [client’s] life? Why?
What is your task/role?
What would happen in [client’s] life if you weren’t present?
Relationship between voice and voice-
hearer
What’s it like being a part of [client’s] life?
How does [client] relate to you and how do you relate to
them?
How would [client] behave/feel if you weren’t there?
Do you have any advice for [client]?
Do you need anything from [client]?
Is there anything you would like to change in your
relationship
with [client]?
Do you want to change anything more generally?
Relationship between voices Do you know the other voices?
How do you relate to them? How do they relate to you?
Relationship between voice and therapist Do you have any questions for me?
Is there anything you think I could help you with?
Would you like me to give a message to [client]?
Would you like to speak with me again?
566 Eleanor Longden et al.
10. applicable to psychological therapies for psychosis more generally, such as training and
supervision of therapists, client motivation, establishing a therapeutic relationship, and
difficulties with attention and memory. There are also issues more specific to the protocol,
which are discussed further below.
Trauma and dissociation
Dissociation is known to affect therapy outcomes across different modalities and
presenting difficulties (Jepsen, Langeland, Heir, 2013; Kleindienst et al., 2011; Resick,
Suvak, Johnides, Mitchell, Iverson, 2012). In turn, it is our experience that core beliefs
resulting from trauma exposure (e.g., ‘The world is dangerous’, ‘I’m a bad person’,
‘Other people cannot be trusted’) are often embodied in voice content. Precautions
should therefore be taken to help clients facilitate an ongoing sense of safety before and
during the dialogue. This includes awareness from the therapist of interactions between
different parts of the person’s internal system (e.g., perpetrator-identified voices in
relation to child voices), an understanding of the impact of dissociated memories and
beliefs, knowledge of appropriate soothing/grounding strategies, and the ability to
monitor emotional responses during the session (see Boon, Steele, van der Hart, 2011).
In many cases, psychoeducation and normalization of the impact of trauma may also be
required. In this regard, it is important to remember that a sense of safety is a fundamental
principle from which all subsequent work is conducted.
Voices refuse to dialogue
Voices are often wary of engaging with a therapist, so time must be spent acknowledging
their presence and building an alliance with them in tandem to that developed with the
voice-hearer. Where necessary, this should also include proactively addressing voices’
beliefs that therapists want to get rid of them. However, if the voice continuously refuses
to dialogue no pressure should be exerted. Instead, both voice and voice-hearer should be
reassured that it is not their fault if this method is not right for them and that other therapy
approaches are available which may suit them better. Flexibility should be employed
wherever possible, and we have used several strategies for maintaining communication
which include role-play, indirect dialogue, therapists acknowledging the voices’ presence
during each session, drawing/writing messages to give to the therapist, and asking the
voice-hearer to provide translation for a voice that did not speak English. If clients
themselves choose not to dialogue, then role-play techniques can likewise be employed.
However, if this proves unacceptable, the decision must be respected and the therapist
can place a greater focus on the protocol’s formulation and psychosocial education
aspects as a substitute, or instead refer to alternative therapeutic approaches.
Perpetrator voices
Therapists may feel apprehensive about engaging with voices that are strongly identified
with a real-life perpetrator. However, it is our experience that these voices still perform a
protective function (e.g., by taking on the role of aggressor in preference to feeling
victimized, pre-emptively criticizing to avoid external disapproval, drawing attention to
unprocessed emotions, and/or being primed to detect potential sources of threat: see
Moskowitz et al., 2017; Mosquera Ross, 2017; Ross Halpern, 2009). In turn, it may
often be the case that very hostile, dominant voices represent the most wounded parts of
Talking with voices therapy protocol 567
11. the person’s internal system and are ultimately in need of the most compassion and
reassurance (Heriot-Maitland et al. 2019). It is our experience that voices do not inevitably
claim to be a real-life perpetrator when asked directly about their identity. However, they
can often replicate messages that were learnt from real-life aggressors, and it can be
helpful to explore ways of framing them as ‘copies’ or ‘screenshots’ to introduce a sense of
distance: that is, that despite surface similarities, the voices’ role is to embody feelings and
beliefs about what happened as opposed to being the ‘actual’ perpetrator. As noted by
Romme and Escher (1993, 2000), voices are both ‘the problem and the solution’ in that
while their function is to protect the person, this paradoxically occurs in a way that causes
significant distress. As such, a voice that is identified with a real-life aggressor is likely to
have internalized these external messages and thus have a limited repertoire of emotional
responses/strategies with which to achieve its goals. However, as described by Mosquera
and Ross (2017), even very aggressive voices will often prove responsive to attempts to
increase safety and learn more positive ways to protect the voice-hearer.
An important exception to this are voices which cannot dialogue and communicate
solely with repetitive statements. A conversant voice implies a degree of co-conscious-
ness; thus, it can be understood as being internally generated as part of the Self to fulfil a
protective function. In contrast, more explicitly memory-based voices have been
externally imposed on the person and, with the exception of drawing attention to
unresolved conflict, have a narrower psychological role. These voices are less complex
and therefore more suitably addressed with broader trauma-informed techniques than
direct attempts at engagement. They are also not conceptualized as protective in the way
described above. However, if the client is amenable, then time can still be spent with
reassurancethat such voices are a commonresponse toadversity and represent the mind’s
tenacity in attempting to process an overwhelming event.
Distressed voices
Distressed voices are those which ostensibly express high levels of fear, shame and/or
guilt. They may also be experienced in a child-like way, and therapists are advised to match
the ‘energy’ of different voices with a suitable tone and demeanour: assertive yet
respectful with a hostile voice, and soothing and age-appropriate with a more vulnerable
one. For the latter, we also advise caution with language that may be triggering for child
grooming (e.g., ‘You should trust me’ or ‘You’re a good girl’). In this respect, if a voice
wishes to reveal abuse, consideration should be given to the effect on the whole system.
For example, a voice identified with a perpetrator may feel threatened by such a
disclosure, as might voices which have internalized real-life threats of retaliation for
speaking out. It is important to cultivate a sense of safety for distressed voices and various
methods can be employed to assist this, including the use of imagery, flash cards, reading
aloud, colouring books, transitional objects like blankets or soft toys, or grounding items
such as a reassuring photograph. In time, we have found it may often be possible to
facilitate an alliance between different voices, wherein the dominant ones learn to adopt a
comforting or supportive role on behalf of the voice-hearer and/or more distressed voices.
Systemic issues
In may sometimes be the case that clients are exposed to external situations which can
hinder therapeutic progress. For example, they may receive contradictory explanatory
messages about their experiences from health care staff (e.g., as a symptom of disease) or
568 Eleanor Longden et al.
12. their community (e.g., as a sign of demonic possession). They may also live in unsafe
housing or in proximity to abusive individuals. In such instances potential for progress can
be limited, although time should still be spent developing coping strategies, providing
psychoeducation, and signposting towards alternative sources of support. Offering a
choice for therapy venue is often advantageous, as is confirming prior access to health and
social services (including safeguarding) to ensure client well-being and avoid the session
being overtaken with care coordination duties.
Beliefs about voices
People with strong convictions about their voices (e.g., that they are electronic
communications) may be especially wary or sceptical of the rationale for dialoguing. It is
important to work within a client’s belief system at all times and to not impose a
psychological framework that is inconsistent with their preference. However, it is our
experience that changing causal beliefs is unnecessary for successful dialogue. Instead, it
can be beneficial to frame the voices (whatever their perceived origin) as being in a
relationship with the voice-hearer, in which the goal is simply to improve the relationship.
Conclusions
Talking With Voices is a user-informed intervention guided by the ethos of the HVM and
the work of Romme and Escher (1993, 2000) which draws upon dissociation theory and
the Voice Dialogue model (Stone Stone, 1989) to propose that the concept of disowned
and primary Selves can be applied to understanding auditory hallucinations, specifically as
a form of mental compartmentalization that arises in response to adversity. The protocol
has specific phases and milestones and aims to improve the hearer–voice relationship via
normalization; increasing a person’s understanding of their voices, including the life
events and conflicts they might represent; and dialoguing with voices to achieve shared
goals. A strong emphasis is also placed on developing adequate coping strategies, along
with creating a collaborative formulation, before embarking upon dialogue work. Taken
together, it is intended that these components can increase patient benefit while
minimizing the likelihood of adverse effects.
Talking With Voices is part of a growing range of therapeutic models which emphasize
the value of interpersonal, relational, and dialogical principles for supporting voice-
hearers (including those with a diagnosis of psychosis/schizophrenia). However, it is
important to note that the current trial is only the first step in establishing an evidence-
base for this novel approach. Further research is required to demonstrate cost-
effectiveness and treatment efficacy, as well as refining ways that the method could be
used in routine practice to complement established interventions, such as CBTp.
However, our protocol suggests that it is possible to manualize a dissociation-based model
to support psychosis patients with distressing auditory hallucinations and that this is a
feasible and acceptable treatment option to implement within formal health care settings.
Overall, it is hoped that future work can contribute to continued understanding of the role
of relational dynamics in facilitating recovery from distressing voices.
Talking with voices therapy protocol 569
13. Acknowledgements
Eleanor Longden is funded by a National Institute for Health Research (NIHR) Postdoctoral
Fellowship Scheme for this research project (PDF-2017-10-050). This paper presents
independent research funded by the NIHR: the views expressed are those of the authors
and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
The study was facilitated by the Greater Manchester Local Clinical Research Network. The
authors would like to thank Dr. Jacqui Dillon of the English Hearing Voices Network and the
members of the Psychosis Research Unit’s Service User Reference Group for their valuable
feedback on the trial’s therapy manual.
Conflicts of interest
Three authors (EL, DC, and AB) have received financial payments for delivering teaching
and/or supervision on the Talking With Voices approach. There are no other reported
conflicts of interest.
Data availability statement
Data sharing is not applicable to this article as no new data were created or analysed in this
study.
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