Therapeutic Space Research Articles

"Were you wearing underwear?" Stigma and fears around sexual violence: A narrative of stranger rape and considerations for mental health nurses when working with survivors.

WHAT IS KNOWN ABOUT THE SUBJECT?: Although sexual violence is prevalent, incidents of stranger rape remain statistically uncommon. Societal stigma and myths surrounding sexual violence are widespread. An individual's experience in the immediate aftermath and beyond can be shaped by the perception/s of sexual violence which are held and expressed by those they come into contact with. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper adds to the limited literature base and the population and practical-knowledge gap around a specific form of sexual violence. This paper also demonstrates the need for reflection and discussion in minimizing blame that can unconsciously be shifted onto survivors in the form of myths and stereotypical views of sexual violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Perceptions may be held around sexual violence, and by extension about the survivor, which may impede engagement and the building of trust within a therapeutic relationship. Myths that are synonymous with rape and all forms of sexual violence can be held by professionals, and lead to blame, negative judgement and lack of empathy towards survivors. Given the prevalence of sexual violence, this paper is applicable across all health and social care settings, and in particular mental health nursing professionals who may be more likely to meet people who have experienced sexual trauma. ABSTRACT: Introduction This narrative illustrates the lived experience of a specific form of sexual violence (stranger rape) and its resulting implications as experienced by the second author, which is discussed under the following headings: your body as a crime scene, how lived experience compares to the myth of the 'real rape' and the wellbeing and health consequences arising from the experience. [Correction added on 5 September 2022, after first online publication: The preceding paragraph has been corrected in this version.] Aim In their capacity as mental health nurses, the authors invite readers to consider the spoken, or more likely unheard stories of sexual violence, which are unfortunately commonplace among those who access mental health services. Implications for Practice For professionals holding the privileged position of hearing these stories, there is a need to be reflective as to how fear, and personal or professionally held myths and stigmatizing views of sexual violence, and by extension views towards the survivor, are carried into therapeutic spaces, and the implications these can have. Practical suggestions as to how to discuss and manage disclosure of sexual violence in the context of trauma informed care are also provided.

“I was reaching out for help and they did not help me”: Mental healthcare in the carceral state

BackgroundDespite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the carceral state create ideological and functional barriers to effective mental healthcare.MethodsData for the parent study of this analysis was collected via in-depth, one-on-one interviews of about one hour’s length, conducted at six-month intervals over the course of 2 years. These interviews were analyzed using an iterative process of open-coding, thematic code development, and code application to participant interviews.ResultsThe results showed a common perception of mental healthcare received within the carceral state as serving goals of the prison system, including control and punishment, rather than therapeutic goals of healing and empowerment. This often had negative implications for the quality of the treatment received, including patterns of diagnostic ambiguity, treatment that was ill-fitting to participants’ needs, and treatment that was undermined by the new trauma created by the prison environment. The results also highlighted racial disparities prevalent within the carceral system. Despite the barriers created by the subjection of therapeutic practices to carceral goals, participants demonstrated resourcefulness and creativity in engaging with these treatment modalities to reap benefits where possible.ConclusionsOverall, these results highlight the inappropriateness of combining therapeutic and carceral spaces, the need for greater public attention to how carceral mechanisms disadvantage vulnerable populations, and the need for a cultural reconceptualization of mental illness such that it is met not with criminal punishment but appropriate care.

Changing to remote psychological therapy during COVID-19: Psychological therapists' experience of the working alliance, therapeutic boundaries and work involvement.

Research aimsThis study aimed to investigate psychological therapists' perceived ability to form a working alliance and maintain therapeutic boundaries, and their work involvement patterns whilst working remotely via telephone or videoconferencing. Furthermore, the study aimed to explore therapists' experience of therapeutic boundaries when working remotely and how they managed these.MethodA mixed‐method sequential explanatory design was adopted. Descriptive and inferential statistics were used to analyse quantitative data, with thematic analysis used to analyse qualitative data.ResultsIn total, 161 psychological therapists completed an online survey, and 12 participants were selected using maximum variation sampling to engage in a semi‐structured interview. Although results between therapists varied, some perceived abilities regarding the working alliance and therapeutic boundaries differed when working remotely compared to face‐to‐face therapy. Therapists' work involvement patterns also differed compared to existing data for face‐to‐face therapy, indicated by increased rates of stressful involvement. Considering therapists' experience of therapeutic boundaries, four overarching themes were identified: ‘different boundaries in remote therapy’, ‘work home boundary’, ‘changes in the therapeutic safe space’ and ‘impact of boundaries when working remotely’.ConclusionsAspects of the working alliance and therapeutic boundaries are experienced differently by therapists working remotely, which relates to how they experience their work. The findings have clinical implications for increasing therapists' awareness of potential changes in their perceived abilities regarding the working alliance and therapeutic boundaries when working remotely, therefore, enabling them to address these changes where required. Future research possibilities are considered.

Could We Be Friends? When a Wish to Be Friends Becomes Part of a Therapeutic Relational Dynamic

Psychoanalytic theory and practice have moved toward privileging relational and attachment dynamics as both cause and cure of many of the issues that bring individuals into psychoanalysis and psychotherapy, highlighting the significance of each therapeutic relationship as a key part of the work. But, what is that relationship? We are not parent/child, nor are we friends, but a deep, mutual bond often develops and enhances the process. Fantasies of being friends, emanating from either and/or both participants, can represent important, often unformulated, aspects of this relationship. Psychoanalytic theory has not fully explored meanings of this wish to be friends, but it is my experience that finding ways to reflect on a wish or fantasy to be friends can lead to deeper and more complex understanding of adult attachment. In this article, theory and clinical examples will be utilized to examine resistances as well as contradictions, conflicts, and hopes and fears that come into play when thoughts, fantasies, and wishes to be friends to enter the therapeutic space.

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis

Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies - of Interventions and Risk of Bias in Randomized Trials. Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI -261.24 to -67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43-0.68; P < 0.001). Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.

A Review of Theoretical Approaches to Light Therapy in Therapeutic Spaces

Introduction: Hospital design is generally accepted as a complex task in functional dimensions. The present study examines the effect of daylight on the design of therapeutic spaces to create an effective treatment environment. This research aimed to acquaint the policy-makers of therapeutic spaces with the determining role of daylight and its related challenges. Method: To comprehend the intellectual, structural, and dynamic patterns of bibliographic backgrounds in this field of research, 121 related research were reviewed from valid research databases. Results: Studies are divided into four main categories: The first group of studies focuses on the role of natural light in improving the performance of the building (providing quality for the indoor environment and reducing energy consumption). The second group of studies focuses on the role of natural light in improving patients' health (mental and physical health). The third group considers the role of natural light in improving the efficiency of medical staff and the fourth group considers the role of natural light in alleviating environmental pollution. Conclusion: Review of the related literature shows that enhanced access to daylight in medical spaces is associated with reduced energy consumption, improved efficiency of health care delivery, and shortening the length of hospital stay. Optimizing medical spaces on this basis, in addition to satisfying users, will significantly reduce the cost of health care and positively impact the economic sustainability of these spaces.

Receiving teletherapy in Ireland: The experiences of service users in the public mental health system

AbstractObjectiveThe present study explored the experiences of service users of Adult Mental Health and Primary Care services in Ireland in receiving teletherapy during the COVID‐19 pandemic to provide an illustration of these experiences which may inform future applications of teletherapy.MethodSemi‐structured telephone interviews about participants' experiences with teletherapy were conducted, the transcripts of which were analysed using reflexive thematic analysis.ResultsSix themes were generated: Early Apprehensions, Adaptations Improving Experiences, The Therapeutic Space, Seeing and Being Seen, Technical Difficulties: The Loss of “The Moment,” and The Security of a Pre‐Existing Relationship.ConclusionGenerated themes highlight both the range of experiences that clients can have during teletherapy, and some of the most significant factors which influence these experiences. The quality and effectiveness of teletherapy are often susceptible to factors outside of therapists' and clients' control. In most cases, it may be best considered as a supplement to, rather than a replacement for, traditional in‐person services.

Therapeutic Spaces in Public Places

Abstract. The effectiveness of both mental health education and clinical practices is often limited by an overemphasis on US perspectives and approaches. Based on a lens and practice of reflexivity within international community psychology, this article describes a theater-based practice that is both an educational tool for training mental health providers and a community mental health intervention. This practice is based on an integration of the work of three Latin American theorists: Augusto Boal’s Theater of the Oppressed, Ignacio Martín-Baró’s liberation psychology, and Paulo Freire’s Critical Pedagogy. The approach we will describe integrates these Latin American originating theories with the practical and pragmatic clinical and theoretical assumptions of walk-in/single-session therapy. This mental health perspective addresses many of the barriers to services faced by underserved and international populations. We will discuss how we have utilized these ideas and practices by developing a form of street theater that provides educational opportunities for future mental health providers and creates community dialogues about common clinical concerns in Mexico City.

Adolescent Ruthlessness and the Transitioning Of The Analyst’s Mind

Features of ruthlessness may come into play in the encounter between adolescents who come into the therapeutic space with clear and precise demands to be supported through their gender transition. Winnicott's concept of ruthlessness, extended from the infant-mother matrix to the emotional situation of the clinic, allows a consideration of the conditions under which the analyst can think about adolescent demands. These conditions involve the desire of both patient and analyst for certitude and the analyst's urgency to respond, as well as the adolescent's contradictory desires to both destroy and create gender. The work of Sally Swartz, who brought to Winnicott's conception a notion of ruthlessness in protest, helps us consider the qualities of ruthlessness in constituting gender. A snippet of work with a nonbinary patient shows how questions of gender cannot be understood apart from the intersubjective transferential field. Tying ruthlessness to the enigma of desire illuminates the emotional situation of the clinical encounter between the nonbinary or trans patient and the analyst, a situation that is also libidinal. An analytic move from the question of gender identity to the realm of an emotional situation allows the analyst to meet adolescent ruthlessness. This meeting is an ethical attempt to understand the other, but also reveals one's resistance to giving up something in order to understand.

Analysis of Spatial Composition in the Therapeutic Landscape

After the epidemic of Covid-19, people’s demand for healthcare is increasing, and the demand for landscape municipal facilities as healthy cities and green gardens have also sprung up. Therapeutic landscape space is needed for people who is looking for a place to be physically and mentally comfortable, not only limited for patients, but also for city workers who are under pressure. In this paper, we analyzed on how to create or design a healing health landscape, starting from the design space of therapeutic landscape to its design methods.

“It's normal to admit you're not okay”: New York City college students shaping mental health through journaling

Emerging data make clear that, while there are common pandemic experiences related to mental health across different populations, access to those shared experiences is often disproportionate. In the context of exploring expansive definitions of health as part of their Introduction to Urban Community Health course, students at a large, public university in New York City were given the opportunity to engage with the Pandemic Journaling Project (PJP) beginning in June 2020. This paper explores the impact of both creating their own journals, and reading and reflecting on the public entries of others, on student mental health, and on students' abilities to discuss and process their health status, holistically defined. It raises questions of how definitions of “normal” in relation to feelings of diminished mental health are shared and reified in the context of the pandemic, asking if the process of journaling might be a way not just to capture mental health histories of the pandemic, but also to create an inclusive, therapeutic space for a conversation around mental health.

Negotiating penal hybridity: Time–space boundary-work in parole decision making

Drawn on qualitative findings from discretionary chairpersons of parole boards in Israel, the study aims to theorize parole decision making as time–space boundary-work. Parole decision-makers were found to act within a hybrid professional environment that requires them to process distinct, and possibly conflicting, penal values, competencies and orientations. In order to address their professional tensions, parole decision-makers constantly negotiate their time and space, and thereby their professional identity. First, the parole decision-makers perform temporal boundary-work—conceptualizing their work and identity through qualitative-expansive time. Second, they perform spatial boundary-work—conceptualizing their work and identity through either (a) judicial space or (b) therapeutic space. This time–space work is used both to span and demarcate their boundaries in relation to other penal actors and to increase their visibility and legitimacy.

Mental Health Support of Frontline Medical Personnel in the Javits New York Medical Station Federal COVID-19 Treatment Center.

The federal government responded to the early epicenter of the COVID-19 pandemic in the United States by mobilizing uniformed services and other federal medical personnel to treat patients at the Javits New York Medical Station. Deployment of large numbers of personnel required flexible psychiatric and psychological support. This report details the establishment of mental health support services for frontline personnel in a large convention center and explores lessons learned to encourage future mental health professionals to apply creative and assertive mental health interventions in disaster settings. Timely and effective interventions included securing safe therapeutic space in high-traffic areas, developing relationships with leadership and frontline workers in their own work environments, and disseminating services throughout the civilian medical system. We suggest mental health supplementation during the medical response mission strengthened morale in frontline workers in a disaster scenario.

Therapeutic Environments in Drug Treatment: From Stigmatising Spaces to Enabling Places. A Theory-Based Qualitative Analysis.

Investigating therapeutic environments for young drug users is needed to avoid a high dropout rate due to a potential stigmatising effect of the structure of the space. In this article, we draw from three semi-structured interviews with young drug users. The interviews focused broadly on their experiences being on drug treatment and on how they experienced counselling and treatment in different spaces. The findings show that therapeutic spaces that were viewed as clinical and sterile were experienced as stigmatising, which discouraged young drug users from engaging in treatment and therapeutic processes. In contrast, therapeutic places with a homely atmosphere reduced the experience of stigmatisation, facilitated participation in treatment and helped users to relax and feel part of a community. In the analysis, we show how enabling therapeutic places with a homely atmosphere can be produced through materials, activities, and sensory processes.

Spatial organisation of “therapeutic” spaces for autistic children in special schools: lessons learnt from the united kingdom experience

ABSTRACT Providing calming environments for children with autism spectrum disorders in schools is a common issue in the world as the unique cultures and characteristics of autistic individuals are increasingly revealed. However, in Japan, no architectural guidelines provide specific information to develop autistic friendly spaces in special schools. Consequently, the provision of “therapeutic” spaces such as calm rooms, soft play rooms, sensory rooms or terraces is lagging behind. We conducted field surveys at six special schools in the UK as model cases. We analysed: 1) the types and functions of therapeutic spaces, and 2) the configuration of therapeutic spaces around a classroom. As a result, we identified the spatial organisation of therapeutic spaces based on a classroom suitable for different age groups. In nursery areas, dedicated playgrounds with direct access from classrooms are in high demand. In primary areas, small terraces next to classrooms and calm rooms nearby play a role in maintaining the children’s well-being. In secondary or high school areas, the settings are becoming more similar to mainstream than to special schools as the students become more independent. These findings suggest the importance of supporting individuals and different age groups through the spatial organisation of therapeutic spaces.

Post-prostatectomy incontinence in patients with adjuvant radiotherapy: is there a therapeutic space for transobturator sling?

Post-prostatectomy incontinence in patients with adjuvant radiotherapy: is there a therapeutic space for transobturator sling?

Interrogating and recuperating masculinities in therapeutic practice

ABSTRACT In this invited commentary I reflect on issues concerning masculinities in therapeutic spaces. I draw on contemporary masculinity concepts as well as the psychonalytic, postmodern and post-qualitative aspects of the various articles. I consider how traditional and modern expectations concerning masculinities create problems and possibilities for men in different situations, for example men from different generations (e.g. me, my father, my son). Similarly, I discuss how therapists might unwittingly [re]construct traditional masculinities in their practice – but are also ideally positioned to deconstruct masculinities which are implicated in their client’s suffering. At the same time, I note that the promotion of healthy, caring and inclusive masculinities need not be confined to the therapy room since there are now various mental health intervention which are community-based, entail peer support and which are tailored to specific constituencies of men.

Elements of Healing Spaces in Hospital

Abstract: The research paper emphasises the study of design components for producing healing spaces in healthcare center. Because patients in healthcare centers undergo various treatments that make the surrounding environment strange compared to at home, architectural solutions that include a healing environment in the structure can be added. Health care organisations are beginning to incorporate aspects into hospital building that reduce stress and promote healing, as evidence of the benefits of healing places is being gathered. This paper reveals the relevance of human comfort in creating a therapeutic space, as well as the role of unique design in creating a healing environment. This covers topics such as air quality, colour, texture, light, and sound, among others. Keywords: Healing space, Healthcare, Environment, Design Elements, Unique Design, Human comfort

Alterations in the Experience of Time, Space, and Intersubjectivity and the Interaction with Pre-Existent Psychopathology during the COVID-19 Pandemic

Background: The COVID-19 pandemic and the measures to protect the physically vulnerable may disproportionately affect people with mental health vulnerabilities, who receive psychotherapeutic inpatient treatment, as many of these measures impact the (inter)subjective space crucial to psychotherapy. Objective: We investigate how people with pre-existing mental health conditions and healthcare professionals experienced changes linked to the COVID-19 pandemic. Methods: During the first COVID-19 outbreak and lockdown in spring 2020, we conducted semi-structured interviews with patients and healthcare professionals at a clinic for psychosomatic medicine in Germany and analyzed them following the principles of descriptive phenomenology focusing on social interactions, intersubjectivity, and the therapeutic space. Results: We conducted a total of >30 h of interviews with 19 patients and 17 healthcare professionals. Analyses revealed that the COVID-19 pandemic and the related measures have led to a sudden loss of a sense of normality. Participants experienced changes in the perception of time, space, self, and embodied interaction with others, resulting in a profound feeling of alienation and “unhomeliness” which seemed to magnify pre-existing psychopathology. The inpatient psychotherapeutic environment provided safety by offering spatial and temporal structures and opportunities for social interaction, supporting people to find new ways to be in a changed world. Conclusions: Our study shows that despite the threat of infection, it is vital to continue to provide people with psychological vulnerabilities with a safe therapeutic space in which to regain a sense of safety in a changed world. This is particularly important, as those people seem to suffer intensely from the collateral measures of a pandemic.

Nurse-led mental and physical healthcare for the homeless community: A qualitative evaluation.

Increased morbidity and mortality rates are prominent issues among homeless individuals. To help reduce these health inequalities, dedicated senior mental and physical health nurses have been deployed to work within and alongside local statutory and voluntary organisations. This qualitative evaluation examined the impact of nurse-led homeless healthcare in Warwickshire, United Kingdom. During January and February 2021, online semi-structured interviews were conducted with 17 professionals including the mental and physical homeless health nurses (n=4), statutory health and local authority professionals (n=4), and voluntary and community sector professionals (n=9). Interviews were qualitatively analysed using inductive, reflexive thematic analysis. Data analysis identified three overarching themes related to the meaning, impact and future development of nurse-led homeless healthcare: (1) Nurse-led homeless healthcare and health inequalities, (2) The multi-agency approach of nurse-led homeless healthcare, and (3) Future development of nurse-led homeless healthcare. The findings confirm the benefits of homeless healthcare in reducing health inequalities and promoting a more accessible, flexible and person-centred approach to holistic care. Yet, prevailing organisational and system-level barriers were also identified as currently limiting the capacity, provision and practicalities of delivering nurse-led homeless healthcare. Recommendations were identified with international relevance and included: (i) continued implementation of person-centred healthcare for homeless individuals, (ii) strengthening of organisational collaboration and communication pathways to improve coordinated care, (iii) development of the managerial and structural aspects of provision, (iv) addressing limitations associated with scope and capacity to ensure that delivered healthcare is adequately intensive, (v) increased availability of clinical or therapeutic spaces, and (vi) implementation of long-term plans supported by evaluation and commissioning.