Monday, September 22, 2014

When Caretakers Become Victims

by Bonnie Eissner 

Assaults and threats of assault against psychiatric nurses occur regularly.

Four years ago, a nurse at Franklin Hospital on Long Island was brutally beaten and ultimately disabled by a psychiatric inpatient. Angry over not being discharged, the man broke the leg off of a chair in his room and used it to attack the nurse—Mary Sweeney—who was conducting a group therapy session in another room.

William Jacobowitz, Ed.D., an assistant professor at the College of Nursing and Public Health, knows from long experience that while Ms. Sweeney’s case was extreme, assaults and threats of assault against psychiatric nurses occur regularly and that they are traumatizing for the victims as well as their colleagues. “I used to manage a psychiatric emergency room where there was very frequent violence, and I had noticed that the staff exhibited certain symptoms, certain reactions, that reminded me of post-traumatic stress syndrome,” Dr. Jacobowitz says.

Personal experience prompted Dr. Jacobowitz to study the issue in greater depth. Last year, working with Cheryl Best, M.S. ’13, and Lucy Mensah, M.S. ’13—who, at the time, were College of Nursing and Public Health graduate students—Dr. Jacobowitz assessed the in-patient staff at a psychiatric hospital for symptoms of post-traumatic stress disorder (PTSD). Through surveys, he and his team found that nearly 14 percent of the staff reported symptoms of PTSD. Most surprisingly for Dr. Jacobowitz, the rate of PTSD did not correlate to exposure to violence or threats of violence. The only factors that the PTSD rate did correlate with were resilience and personal satisfaction with the work of caring for patients. Based on his research, Dr. Jacobowitz recommends that psychiatric hospitals facilitate the development of resilience in their staff by providing routine and early debriefing of staff after violent episodes.

This piece appeared in the Erudition 2014 edition.

Wednesday, September 10, 2014

Comorbid conditions revealed in substance abuse recovery

What the results of the Center for Health Innovation Poll on addiction and treatment trends demonstrate is what we have also seen in our mental health clinics and private practices since the 1990s: That is, an alarming increase in patients presenting with anxiety, depression or some other clinical condition comorbid with some substance abuse.  

Such comorbidity poses significant demands on clinicians and challenges with regard to their relationships with these patients and the roles they need to play in effecting change. For example, working with these patients often involves negotiating deception, emotional avoidance, confrontation, and other forms of interpersonal hostility.  It can also require that the clinicians take a more active-directive role in their relationships with these patients, which is a challenge to certain theoretical orientations, like some humanistic and psychoanalytic models.  

As the psychotherapy research suggests, so much depends on the nature and quality of the relationship between clinician and patient.  And of course, this marked trend in comorbidity with substance abuse has important implications for how we train and prepare future clinicians.  

For example, our approach to psychopathology should concentrate more on the nature of various comorbid conditions, and our approach to psychotherapy should emphasize how clinicians can more effectively negotiate their relationships with these patients.

written by J. Christopher Muran, Ph.D., Associate Dean & Professor, Derner Institute (former Chief Psychologist, Beth Israel Medical Center) 

Thursday, September 4, 2014

Professionals and patients divided on treatment options

A recent survey of mental health workers conducted by Wakefield Research for Adelphi University Center for Health Innovation found a significant divide between professionals and their patients when it comes to goals for treating the problem of substance abuse.  While the majority of the professionals viewed abstinence as the most appropriate goal for their substance-dependent clients, they believe that the majority of their patients favor a goal of harm reduction, which focuses on reducing the harm related to alcohol and other drug use rather than prioritizing abstinence.

How to explain this intriguing result?   Perhaps professionals are well aware that most people wouldn’t relish the idea of totally and immediately giving up a substance that – while causing significant harm to themselves or others – also provided them with a quick and easy fix to life’s ups and downs.  Moreover, someone who has regularly used chemical substances to solve their problems has in the process missed out on developing the emotional and cognitive tools needed to navigate and cope with life as a mature adult.   

How easy is it to give up something we like or are in the habit of doing?  In my master’s level course on Social Work Practice in the Prevention and Treatment of Substance Abuse, I ask my students to abstain for one week from some habit, for example, drinking coffee, eating sugar, or biting their nails.   Inevitably, hard as they try, less than half the class is able to abstain completely for one week.  And, since they get to choose what they abstain from, many are not even attempting to abstain from their “favorite” substance or behavior!   Interesting, some students who fail to abstain during the week report switching mid-week to a goal of cutting down and having more success with that.

Thus, while abstinence may be viewed by substance abuse clinicians as the “safest” option,  it may not be the most feasible or practical option for all.  Luckily, the mental health professionals surveyed were also open to utilizing newer chemical dependency intervention methods, such as cognitive-behavioral therapy and motivational interviewing, many of which are congruent with a more flexible approach to setting goals for treatment.   Ultimately, professionals need to collaborate with their clients to clarify their preferences and goals, and help motivate them to being working towards their goals. 

written by Judy Fenster, Ph.D., LCSW
Associate Professor
Faculty Chair for Curriculum and Instruction at Adelphi’s School of Social Work.