Open Mind Presentation for Offender Managers
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Transcript Open Mind Presentation for Offender Managers
IAPT
Improving Access to
Psychological
Therapies
Who are we?…..What do we do?
Barbara Fulton, Lorraine Parker & Yvonne Drew
Psychological Therapists: Open Mind Service
Part of the wider NHS IAPT programme which
implements guidelines for people suffering with
depression and anxiety disorders
We offer realistic and routine first-line
psychological treatment
Based at Cobden Street: our aim is to reduce
barriers to accessing psychological treatment
(that offenders may come across)
Stepped care model
Step 1: Recognition
Step 2: Mild/Moderate common mental health problems
Step 3: Moderate/Severe common mental health problems
Step 4: Treatment resistant, Atypical and psychotic depression,
psychotic illnesses, those at significant risk, Personality disorder
Step 5: Risk to life, severe self-neglect
Barriers
• Blocking of Treatment (many offender service
users have repeated experiences of refusal
and exclusion from services)
• Problems dismissed
• Not registered with a GP
Psychological Therapies
A variety of therapies have been reviewed for their
effectiveness (Nice Guidelines)
CBT – depression & all anxiety disorders
IPT, BCT, Counselling, BDT- depression
(varying indications)
CBT, EMDR- post traumatic stress disorder
Cognitive Behavioural Therapy
EMDR
Barbara Fulton & Yvonne Drew
Depression: Moderate to Severe
Depression: Mild to Moderate
Panic Disorder
Generalised Anxiety Disorder
Social Phobia
OCD (Obsessive Compulsive Disorder)
PTSD (Post Traumatic Stress Disorder)
Hypochondriasis (Somatoform disorder)
Specific Phobias
Integrative Therapy
Lorraine Parker
Blends elements of a range of therapies
- Gestalt
- Object relations
- Cognitive behavioural approaches
- Attachment
- Psychodynamic
Personality disorder or characterlogical issues
underlie depression and/or anxiety.
Consider a referral if…..
Depressed mood lasting for more than two weeks
Anxious mood lasting for more than 2 weeks
Has already been diagnosed with depression or an
anxiety disorder
Problem behaviour: which appears to be associated
with anxiety or depression
Sufficient time remaining: sentence/licence
Not Offender Rehabilitation
We specifically target depression & anxiety and
not offending history
We work within psychological models formulating
the offender’s problems from their point of view
Not about prosocial modelling, reinforcement and
reward of prosocial behaviour
Offending history is only focused on if identified
as significant to their psychological problem and
formulation
Risk assessment and risk management throughout
treatment
Not offender Rehabilitation:
case study
Male, aged 45
Offence history: sexual relationship with a minor
(15yrs), downloading & distributing images of children
Unrepentant (makes this clear at initial meeting)
Diagnosis: agoraphobia (since release from prison)
Fear: “I could be chased, have to fight for my
survival, do damage to my attackers and then end up
back in prison”
Problems identified: Isolated and depressed
Therapy: Cognitive and behavioural interventions
targeting avoidance of situations perceived as
difficult to escape from
Referral Process
Provide the service user with information about
IAPT
Advise that therapy is not compulsory
Complete referral documentation
Questionnaire: this needs to be the service users
interpretation of their mood and situation
Service user needs to sign 2 consent forms (inc)
Return the completed referral pack & book an
available appointment slot
IAPT staff are happy to guide you
Referral Process
1st appointment: Initial assessment
Assess for service suitability
Assess for therapy suitability
(CBT, EMDR or Integrative)
Agree an initial treatment plan
If not suitable: signposting/referral
If not suitable: OM guidance
Assessing for CBT Suitability
why is this important?
Service users with unfocused, multiple or very
chronic problems are least likely to benefit from
short term CBT
Demoralisation
CBT is not a one size fits all
How OM’s can help with assessing
suitability for CBT
Is there potential for acceptance of the CBT
model?
“what are your beliefs about what’s causing your
difficulties”
Those with an insistence that their problem is due
to a chemical imbalance or caused by other people
are unlikely to be suitable
How OM’s can help with assessing
suitability for CBT
Are the able to identify thoughts, feelings,
behaviours and body sensations?
Thought
Body
sensation
Emotion
behaviour
How OM’s can help with assessing
suitability for CBT
Are they able to access their own emotions in relation
to situations ?
“how did you feel when that happened……”
(look for a one word answer)
Are they able to comment on their thoughts in
relation to situations ?
“what ran through your mind when that happened….”
How OM’s can help with assessing
suitability for CBT
Are they goal orientated?
…do they have the ability to work on one specific
problem at a time?
….be aware of vagueness, rambling, frequent topic
changes, desire to work on all problems at once
How OM’s can help with assessing
suitability for CBT
Do they have alliance potential?
- Note: eye contact, posture and general ‘feel’
- Poor rapport, idealising or blaming
How OM’s can help with assessing
suitability for CBT
Are they able to accept personal responsibility in the
therapeutic process?
“what would you like to get out of therapy?....what
might your role be in that”
“you’d be expected to work on your problems in between
cbt sessions….what’s your thoughts about that?”
Active v Passive?
Are they Anxious/Depressed……but
struggling to meet the CBT checklist???
Seek IAPT guidance….. “It’s good to talk!”
May be more suited for Integrative Therapy
CBT checklist: the assumptions can be difficult to
meet (those who
Transference
have PD or other characterlogical issues)
Countertransference
A redirection of feelings towards the service user
Emotional entanglement with a service user
Heart sink feeling….or hot potato
Look out for:
Service user reminds you of someone you have strong
negative feelings towards
Feeling parental towards them
Overly identify with them
Difficult to supervise/relationship breaking down
Countertransference
Is the service user wanting help with their anxiety
or negative mood?....if not:
Could the difficulties encountered be better
dealt with in supervision with your manager
Reflective and reflexive practice is key
Be aware that countertransference is normal
Be consistent with boundaries
Co- existing Drug and Alcohol Use
70-80% of clients in drug and alcohol services
have anxiety disorders, depression, trauma
(Weaver, 2003)
IAPT services should be working inclusively
alongside substance misuse services to improve
outcomes (IAPT Positive Practice Guidelines)
CBT: Co-existing anxiety/depression
(NICE guidelines (2007) Dug misuse: psychosocial Interventions)
Co-existing Drug and Alcohol Use
High Intensity
Formal therapies delivered by IAPT therapist
CBT for depression or specific anxiety disorder
Low Intensity
Delivered by IAPT therapist
Guided self-help & Behavioural Activation for anxiety
disorders and depression
Low Intensity
Delivered by Probation Key Worker
Motivational Interviewing & Contingency Management
Co-existing Drug and Alcohol Use
No evidence that using substances makes usual
psychological interventions ineffective
Problem
solving
Time
management
Decision
making
Goal
directed
behaviour
if an executive function deficit
exists: CBT can be adapted
Analytical
thinking
Executive
Organisational
ability
Co-existing Drug and Alcohol Use
Accepted: experimental, recreational as well as
stable drug and alcohol use
IAPT staff will determine stability
Not accepted: unstable drug and alcohol use
Instability across drug and alcohol use can lead to
therapy disruption
Multiple Competing Needs
inc personality disorder, learning disability, drug
dependence, alcohol dependence, homelessness,
domestic violence etc.............
• May lead to non attendance/disrupted therapy
sessions /poor homework compliance
• May compete with motivation for therapy and
treatment engagement
• Offender service users with multiple and competing
needs may be misunderstood as being a ‘time wasters’
Thank You
Any questions
………its good to talk!