BackgroundCompassion is vital in healthcare. Current understandings of the nature of compassionat... more BackgroundCompassion is vital in healthcare. Current understandings of the nature of compassionate care, its aids and barriers, are more theoretically developed than grounded in staff experience. This study explores staff perceptions of compassionate care in child and adolescent mental health wards.MethodsThree focus groups were conducted with a total of 35 staff from adolescent mental health wards (10–12 people in each group), on the nature of compassionate care, aids and barriers. Transcripts were analysed using thematic analysis. A follow-up survey with 36 workers from other UK child and adolescent mental health wards was completed and means and standard deviations of responses were analysed to confirm wider resonance of themes.ResultsElements of compassionate care fell into six themes relating to individual, team and organisational factors: emotional connection, sense of being valued, attention to the whole person, understanding, good communication, and practical help/resources....
BackgroundIn cognitive models of adult psychosis, schematic beliefs about the self and others are... more BackgroundIn cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs.MethodSixty-seven children aged 8–14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS).ResultsThe BCSS was readily completed by participants, and scale psychometric properties...
European child & adolescent psychiatry, Jan 14, 2014
Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associ... more Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associated with distress or impairment (UEDs; UK National Institute for Health and Care Excellence, 2013 [1]). Accurate models of the psychological underpinnings of childhood UEDs are required to effectively target therapies. Cognitive biases, such as the jumping to conclusions data-gathering bias (JTC), are implicated in the development and maintenance of psychosis in adults. In this study, we aimed to establish the suitability for children of a task developed to assess JTC in adults. Eighty-six participants (aged 5-14 years) were recruited from Child and Adolescent Mental Health Service (CAMHS) and community (school) settings, and completed the probabilistic reasoning ('Beads') task, alongside measures of intellectual functioning, general psychopathology, and UEDs. Self-reported reasoning strategy was coded as 'probabilistic' or 'other'. Younger children (5-10 years) ...
Background: Over half of children in the general population report unusual or “psychotic-like” ex... more Background: Over half of children in the general population report unusual or “psychotic-like” experiences (PLEs). The development of a later at-risk mental state is associated with persistent, distressing, PLEs, which are appraised negatively and hard to cope with. We have designed a novel, manualized, cognitive behavioural intervention for children aged 9 to 14 years, which aims to reduce emotional problems, improve coping and resilience, and help children manage PLEs, before an identifiable psychosis risk develops. We report on the feasibility, acceptability and clinical impact of the intervention. Method: Four children who reported PLEs and emotional problems in a community survey completed the intervention, and gave detailed feedback. Clinical outcomes were assessed before, during, and after therapy. Results: Emotional problems, PLE frequency, and PLE impact all decreased during the intervention. Child and therapist satisfaction with the treatment was high. Conclusions: It is f...
What a great book! This text provides a positive and dynamic approach to working with self-harmin... more What a great book! This text provides a positive and dynamic approach to working with self-harming adolescents, a client group with which it can often be hard to maintain a solution-focused, hopeful stance. Written in a friendly and enthusiastic style, whilst retaining a professional and expert tone, this book could be read by therapists, parents or adolescents, although therapists are the group likely to benefit the most. Selekman divides his book into nine clear and well-structured chapters. He prefaces these with a chapter on practical guidelines for parents of self-harming adolescents, which is sensitively written and provides a wealth of helpful information from both research and clinical experience. It includes a chapter for parents, fits with Selekman’s systemic approach, and provides therapists with a helpful document that they can use when working with families or an individual while also wanting to communicate with the parents. The following chapters provide therapists with a wealth of different techniques to use when working with families, with individual adolescents, or with adolescent groups. Throughout the chapters Selekman gives case examples, transcripts, examples of question sequences and examples of exercises to use. He draws on cognitive-behavioural techniques, whilst retaining an overall tone of solution-focused and systemic practice. This book feels truly integrative. Selekman weaves together different approaches and constantly expands the realm of possible interventions for the therapist. Each chapter can be read as a stand-alone entity, and the book can be dipped into to generate ideas for sessions, as well as read as a cohesive whole. Most importantly, the book managed to retain an optimism in tone that felt realistic and encouraging. Working with self-harming adolescents can feel very distressing for the therapist, and can generate feelings of helplessness. Selekman is a valuable resource for all such professionals, as a source of ideas, a way of changing your perspective, and a way of freeing yourself up to see the progress that is often being made without being noticed. My only criticism would be that occasionally Selekman’s ideas stray into territory that seems far-removed from the average NHS adolescent setting. Not many clients could afford to implement Selekman’s advice of getting an art room set up in the adolescent’s home! However, this is very minor pick at a book that I found really valuable, and which I think would be an incredibly useful addition to the bookshelf of any therapist working with adolescents and families.
BackgroundCompassion is vital in healthcare. Current understandings of the nature of compassionat... more BackgroundCompassion is vital in healthcare. Current understandings of the nature of compassionate care, its aids and barriers, are more theoretically developed than grounded in staff experience. This study explores staff perceptions of compassionate care in child and adolescent mental health wards.MethodsThree focus groups were conducted with a total of 35 staff from adolescent mental health wards (10–12 people in each group), on the nature of compassionate care, aids and barriers. Transcripts were analysed using thematic analysis. A follow-up survey with 36 workers from other UK child and adolescent mental health wards was completed and means and standard deviations of responses were analysed to confirm wider resonance of themes.ResultsElements of compassionate care fell into six themes relating to individual, team and organisational factors: emotional connection, sense of being valued, attention to the whole person, understanding, good communication, and practical help/resources....
BackgroundIn cognitive models of adult psychosis, schematic beliefs about the self and others are... more BackgroundIn cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs.MethodSixty-seven children aged 8–14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS).ResultsThe BCSS was readily completed by participants, and scale psychometric properties...
European child & adolescent psychiatry, Jan 14, 2014
Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associ... more Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associated with distress or impairment (UEDs; UK National Institute for Health and Care Excellence, 2013 [1]). Accurate models of the psychological underpinnings of childhood UEDs are required to effectively target therapies. Cognitive biases, such as the jumping to conclusions data-gathering bias (JTC), are implicated in the development and maintenance of psychosis in adults. In this study, we aimed to establish the suitability for children of a task developed to assess JTC in adults. Eighty-six participants (aged 5-14 years) were recruited from Child and Adolescent Mental Health Service (CAMHS) and community (school) settings, and completed the probabilistic reasoning ('Beads') task, alongside measures of intellectual functioning, general psychopathology, and UEDs. Self-reported reasoning strategy was coded as 'probabilistic' or 'other'. Younger children (5-10 years) ...
Background: Over half of children in the general population report unusual or “psychotic-like” ex... more Background: Over half of children in the general population report unusual or “psychotic-like” experiences (PLEs). The development of a later at-risk mental state is associated with persistent, distressing, PLEs, which are appraised negatively and hard to cope with. We have designed a novel, manualized, cognitive behavioural intervention for children aged 9 to 14 years, which aims to reduce emotional problems, improve coping and resilience, and help children manage PLEs, before an identifiable psychosis risk develops. We report on the feasibility, acceptability and clinical impact of the intervention. Method: Four children who reported PLEs and emotional problems in a community survey completed the intervention, and gave detailed feedback. Clinical outcomes were assessed before, during, and after therapy. Results: Emotional problems, PLE frequency, and PLE impact all decreased during the intervention. Child and therapist satisfaction with the treatment was high. Conclusions: It is f...
What a great book! This text provides a positive and dynamic approach to working with self-harmin... more What a great book! This text provides a positive and dynamic approach to working with self-harming adolescents, a client group with which it can often be hard to maintain a solution-focused, hopeful stance. Written in a friendly and enthusiastic style, whilst retaining a professional and expert tone, this book could be read by therapists, parents or adolescents, although therapists are the group likely to benefit the most. Selekman divides his book into nine clear and well-structured chapters. He prefaces these with a chapter on practical guidelines for parents of self-harming adolescents, which is sensitively written and provides a wealth of helpful information from both research and clinical experience. It includes a chapter for parents, fits with Selekman’s systemic approach, and provides therapists with a helpful document that they can use when working with families or an individual while also wanting to communicate with the parents. The following chapters provide therapists with a wealth of different techniques to use when working with families, with individual adolescents, or with adolescent groups. Throughout the chapters Selekman gives case examples, transcripts, examples of question sequences and examples of exercises to use. He draws on cognitive-behavioural techniques, whilst retaining an overall tone of solution-focused and systemic practice. This book feels truly integrative. Selekman weaves together different approaches and constantly expands the realm of possible interventions for the therapist. Each chapter can be read as a stand-alone entity, and the book can be dipped into to generate ideas for sessions, as well as read as a cohesive whole. Most importantly, the book managed to retain an optimism in tone that felt realistic and encouraging. Working with self-harming adolescents can feel very distressing for the therapist, and can generate feelings of helplessness. Selekman is a valuable resource for all such professionals, as a source of ideas, a way of changing your perspective, and a way of freeing yourself up to see the progress that is often being made without being noticed. My only criticism would be that occasionally Selekman’s ideas stray into territory that seems far-removed from the average NHS adolescent setting. Not many clients could afford to implement Selekman’s advice of getting an art room set up in the adolescent’s home! However, this is very minor pick at a book that I found really valuable, and which I think would be an incredibly useful addition to the bookshelf of any therapist working with adolescents and families.
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