Cognitive Behavior Therapy for Acute Inpatient Mental Health Units: Working with clients, staff and the milieu

246 Pages·2008·1.02 MB·English

by  Isabel Clarke

Cognitive Behaviour Therapy for Acute
Inpatient Mental Health Units
Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units
presentsinnovativewaysofdeliveringCBTwithintheinpatientsetting and
applying CBT principles to inform and enhance inpatient care.
Maintaining staff morale and creating a culture of therapy in the acute
inpatient unit is essential for a well-functioning institution. This book
shows how this challenge can be addressed, along with introducing and
evaluating an important advance in the practice of individual CBT for
working with crisis, suited to inpatient work and crisis teams.
The book covers a brief cross-diagnosis adaptation of CBT, employing
arousal management and mindfulness, developed and evaluated by the
editors. It features ways of supporting and developing the therapeutic role
of inpatient staff through consultation and reflective practice. Chapters
focus on topics such as:
• providing staff training
• working within psychiatric intensive care
• innovative psychological group work
CognitiveBehaviourTherapyforAcuteInpatientMentalHealthUnitswillbe
essential reading for those trained,or those undergoing training, in CBT as
well as being of interest to a wider public of nurses, health care support
workers, occupational therapists, medical staff and managers.
Isabel Clarke and Hannah Wilson are working together to develop an
innovative psychological therapies service at Woodhaven, an acute mental
healthinpatientunit,servingWestSouthamptonandtheNewForest.They
are both clinical psychologists working for the Hampshire Partnership
NHS Trust.

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