Therapeutic Space Research Articles

The Bonny Method of Guided Imagery and Music for family caregivers of people with dementia: A within subject feasibility study

ABSTRACT Introduction The Bonny Method of Guided Imagery and Music (BMGIM) is a psycho-therapeutic intervention that has not been examined with family caregivers of people with dementia. Method This within subject pre-post feasibility study aimed to examine a protocol involving six sessions of BMGIM with family caregivers. Estimates of effect examined sensitivity of the Patient Health Questionnaire-9 (PHQ-9) and Quality of Life-6 Dimensions (AQoL-6D). Qualitative interviews explored participant experiences. Results Of 11 participants who enrolled (nine women/two men, M age = 71.2 years), seven completed the study and four withdrew. Music programs used in BMGIM sessions were diverse and often modified to accommodate individual participant needs. Favourable small to moderate effect sizes were observed for the PHQ-9 (r = 0.11), and for the AQoL-6D global score (r = 0.18) and domains examining independent living (r = 0.20), mental health (r = 0.30), pain (r = 0.29), and senses (r = 0.44). Thematic analysis of interviews recognised BMGIM as: something different that might help; an empathic therapeutic space with aptly selected music; insightful and transformative; and psycho-educative. Discussion The majority of participants completed the project and described important benefits from BMGIM, suggesting that the protocol was acceptable. However, a large sample would be required to detect change in a fully powered trial based on effects observed for the PHQ-9 and AQoL-6D following six BMGIM sessions. Conclusion While early evidence from this study recognised the therapeutic potential of BMGIM for family caregivers, further feasibility research with this population is warranted.

The woman who chose the terreiro. Lay care and medical landscapes in mental health care in Rio de Janeiro

Brazilian mental health care reform understands mental health as a complex social process. There is a large literature production within the country focused on deinstitutionalization policy, social determinants of mental health and human rights, however, with little recognition beyond Latin American borders. In addition, cultural dimensions of mental suffering have been neglected in Brazilian debates which limits an expanded understanding of health care and users’ inclusion. This paper aims to discuss the role of cultural determinants in mental health care in Brazil. We followed a patient in the city of Rio de Janeiro who opted for therapy based on her religious beliefs—using ayahuasca in the context of the Afro Brazilian religion of Umbanda—over the treatment-as-usual in mental health. We draw on the notions of autoatención (self, domestic, and group-care in lay contexts) and medical landscapes to examine how therapeutic negotiations reflect embodied cultural traits and both social and political determinants shaping therapeutic spaces. We argue that recognizing sociocultural differences and therapeutic negotiations are key elements in making a more inclusive health practice. Moreover, this recognition enables identifying and reasoning the broader social processes framing health practices. This debate is relevant to the Brazilian mental health context and to other scenarios, especially those where local and global knowledge and practices in mental health are entangled.

Biotinylation of an acetylenic tricyclic bis(cyanoenone) lowers its potency as an NRF2 activator while creating a novel activity against BACH1.

The transcription factor BACH1 regulates the expression of a variety of genes including genes involved in oxidative stress responses, inflammation, cell motility, cancer cell invasion and cancer metabolism. Based on this, BACH1 has become a promising therapeutic target in cancer (as anti-metastatic target) and also in chronic conditions linked to oxidative stress and inflammation, where BACH1 inhibitors share a therapeutic space with activators of transcription factor NRF2. However, while there is a growing number of NRF2 activators, there are only a few described BACH1 inhibitors/degraders. The synthetic acetylenic tricyclic bis(cyanoenone),(±)-(4bS,8aR,10aS)-10a-ethynyl-4b,8,8-trimethyl-3,7-dioxo-3.4b,7,8,8a,9,10, 10a-octahydrophenanthrene-2,6-dicarbonitrile, TBE31 is a potent activator of NRF2 without any BACH1 activity. Herein we found that biotinylation of TBE31 greatly reduces its potency as NRF2 activator (50-75-fold less active) while acquiring a novel activity as a BACH1 degrader (100-200-fold more active). We demonstrate that TBE56, the biotinylated TBE31, interacts and promotes the degradation of BACH1 via a mechanism involving the E3 ligase FBXO22. TBE56 is a potent and sustained BACH1 degrader (50-fold more potent than hemin) and accordingly a powerful HMOX1 inducer. TBE56 degrades BACH1 in lung and breast cancer cells, impairing breast cancer cell migration and invasion in a BACH1-dependent manner, while TBE31 has no significant effect. Altogether, our study identifies that the biotinylation of TBE31 provides novel activities with potential therapeutic value, providing a rationale for further characterisation of this and related compounds.

Technology utilization in dyadic coaching sessions

In‐vivo coaching is a hallmark of most forms of dyadic (often parent‐child) therapy for young children. Providers utilize this process in the Pediatric Partial Hospital Program (PPHP) in the context of “floortime” which creates the opportunity to give pointed modeling and/or feedback to the dyad using real‐time instances of behavior in the milieu. Similarly, supervisors use in‐vivo coaching in the training context to build greater awareness of skill execution and attunement to the therapeutic relationship(s). While there are multiple ways to use in‐vivo coaching, the following discussion will explore practical and innovative applications for using technology (e.g., bug‐in‐the ear, telehealth, and video) in a manner that does not rely on the therapist (or supervisor) being physically present as another visible relationship in the treatment space. The application of technology to create this type of therapeutic and supervisory frame existed (e.g., Parent‐Child Interaction Therapy) long before the COVID‐19 pandemic; however, the circumstances of social distancing created a renewed necessity and appetite for conducting dyadic coaching in a modified and accessible manner. Further, as we migrate from a clinical space that has relied on telehealth in unprecedented ways, to a more hybrid (telehealth/face‐to‐face) treatment model, we will continue to be faced with questions of how to utilize technology in the therapeutic space in a creative and balanced manner.

Recovery capital in action: How is gender understood and employed by men and women recovering from gambling disorder?

Gender is a multidimensional construct that differentiates males and females according to its meanings in different socio-cultural contexts. Recovery capital (RC) describes the internal and external resources individuals employ and/or have access to when overcoming addictions. Negative RC refers to elements that hinder recovery. The literature on gender and RC is baffling since unlike quantitative studies that have found no differences between men and women in the levels of RC, qualitative comparisons indeed underscore differences. This study employed qualitative and quantitative research methods to explore how men and women with gambling disorder (GD) understand and employ gender as a factor in their recovery. Participants with GD (N = 133, 39 women) answered an open-ended question on gender as a component in their recovery. Content analysis revealed that 41.35% of the interviewees did not consider gender as a significant factor in recovery. By contrast, 58.65% viewed gender as important to recovery, indicating four gender-related elements that either enhance and/or hinder recovery: gender stereotypes, gender roles, mixed-gender therapeutic space, and sex in exchange for money for gambling. Chi-square analyses showed no differences between men and women in the distribution of the relevance of gender to recovery. Both groups reported similar perceptions of gender in relation to recovery, and identified similar gender-related specific elements that enhanced or hindered recovery from GD except for exchanging sex for money for gambling. These findings are explained by a combination of macro and micro-level theories that result in a new conceptualization of RC. We coined the term “Recovery Capital in Action” to show how the “RC toolkit” that individuals employ can hinder or enhance their recovery depending on cultural context, and that gender can be both a negative and a positive RC. Mental health professionals should consider the interplay between gender and the socio-cultural contexts during recovery.

FROM LONELINESS TO COOPERATION: COPING STRATEGIES OF INTENSIVE CARE NURSING WORKERS

Objective: to know the coping strategies developed by intensive care unit nurse practioners to maintain mental health. Method: qualitative descriptive study, with nursing workers from three Intensive Care Centers in a southern state of Brazil. Data collected between June 2019 and July 2021 through semi-structured interviews and submitted to thematic content analysis. Results: individual coping strategies based on situations that generate suffering were unveiled. The loneliness of work was evidenced because of the mismatches between the therapeutic spaces offered by the institution and the demands of the workers. Finally, the possibility of re-signifying loneliness in cooperation through collective strategies was identified as a path to face suffering at work and as a protective factor of greater effectiveness. Conclusion: collective coping actions and activities that strengthen the union and cooperation of intensive care nursing teams can be promoted.

Pilot Study on the Physio-psychological Effects of Botanical Gardens on the Prefrontal Cortex Activity in an Adult Male Group

Background and objective: With modern lifestyles and the increasing severity of stress-related diseases, the availability and accessibility of the natural environment are critical. Botanical gardens in an urban area can provide opportunities for city dwellers to experience nature and enjoy stress-reducing activities. This study focused on the health-related effects of botanical gardens by investigating prefrontal cortical activity and changes in psychological states.Methods: The experiment was conducted in a national botanical garden located in the city of Sejong, and in an urban area of a contrasting city. Nine healthy adult males participated in the field experiment. Subjects were instructed to 'see and feel' the landscape in a sitting position for 10 minutes, both in the botanical garden and in the city center. The health effects of botanical gardens were verified using Near-Infrared Spectroscopy (NIRS), including changes in cerebral blood flow, and Profile of Mood State (POMS) and Perceived Restoration Scale (PRS).Results: Our findings showed that the oxyhemoglobin concentrations in the left prefrontal cortex were considerably lower in the botanical garden (-0.057 ± 0.003 µM) than in the city center (0.162 ± 0.002 µM, <i>p</i> < .001). Significantly positive psychological responses to the garden environment were found in the analysis of POMS and PRS, compared to the urban setting. These findings may indicate that a botanical garden can reduce negative psychological symptoms and physiological stress levels in adult males.Conclusion: Our study proves that botanical gardens have the environmental characteristics of restorative and therapeutic spaces. The findings indicated that urban gardens could be considered as health-improving environments by reducing the physio-psychological stress levels of urban dwellers.

"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.