Papers, case formulation and hyperbole

I am enjoying a three night break in Keswick where it is dry, windy and chilly. Invigorating for all that.

In between taking in the hills and the atmospherics of the skies I am working on completing the revision to the - scope of nursing - paper. There is still a paragraph to lose to reduce the length for the target journal.

The case formulation and h2cm paper is taking shape too - 5,000 words. I am sure the ongoing advice and thoughts of my co-author on the scope effort is making a difference. As a result the case formulation paper will be in final draft form soon. Then I'll seek some feedback from a CBT therapist before trying to locate a journalistic home. Here's a snippet from the draft:

... If the talking therapies are specialised forms of conversation then we should also be able see case formulation as being on a continuum, derived from narratives that can include extreme case formulation, and hyperbole (Norrick, 2004). The specific therapies discussed here [cognitive behavioural therapy and cognitive analytical therapy] are concerned with overstatement and exaggeration in thought not just speech. Things may be said in everyday speech that are rhetorical and not necessarily indicative of deeply held core, dysfunctional beliefs. ...

Norrick, N.R. (2004). Hyperbole, extreme case formulation. Journal of Pragmatics 36. 1727–1739.

I receive regular reminders about a part time PhD application that remains incomplete. So I will address this too (and check other opportunities) over the next few days.

Post on a new laptop and a socio-technical-existential addiction to follow ....

Update on new papers: 1. Case formulation & 2. Scope of Nursing

At present, with the support of a co-author, I am editing a paper on Hodges' model and the scope of nursing. The text some 6000 words was submitted to a journal last April and rejected, but as ever feedback is golden and the comments are being used to revise. The referees have set a challenge as amongst several points I tease out where the inherent theoretical perspectives lie in Hodges' model and how their identification within h2cm helps to define the scope of nursing.

Another paper in final draft - 4400 words - concerns the model and case formulation. At last I've arrived at this topic. Hodges' model is basically a simple drawing with care concepts superimposed. Cognitive behavioural therapy [CBT] and cognitive analytical therapy [CAT] make use of case formulation and CAT utilizes what are called sequential diagrammatic formulations.

The old website pages were written rather on the fly. They almost comprise a 'to-do-list' of thoughts and findings to revisit and check. Of two old pages one dealt with possible ideas and sources that might inform the structure of Hodges' model; the other page theory.

On the latter page I learned of SDRs - the sequential diagrammatic reformulations used in CAT and related this to the care domains of h2cm -

It feels good to be able to address this theme at long last.

In just over a week I'm looking f/w to a three day break in the Lakes. Weather permitting some  walking and a few runs, a bike ride, writing and Drupal - which I have put down of late...

Conceptual Reflections on Schizophrenia - Hodges' model

A decade ago I was studying the Psychosocial Interventions for Psychosis (COPE) pathway part-time at Manchester University. The student body was interprofessinal made up of nurses, psychologists, occupational therapists, nurses and if memory serves me right people from the voluntary (third) sector. What I learned then left me wondering where I had been all those years since qualifying (lost in IT....).

There are many universities now delivering this curriculum, presenting the very latest research. The lecturers are frequently the researchers themselves, working in ongoing multicenter trials studying  various aspects of the treatment and care management of psychosis.

This is why it is very alarming to hear of the lack of progress not just within in-patient care as per the findings of the Schizophrenia Commission, but the delivery of care for these individuals and their families across the health and social care system. Of course, as a former student and holder of a PG(Dip.) I am not at present practising these skills formally.

In the h2cm table that follows I have highlighted some of the main concepts across the care domains of Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

beliefs, perception, attention, anxiety, stress, vulnerability, pleasure, feedback, motivation, mood, therapies, therapeutic relationship, communication, assets, cognitive triad, perception, delusions, hallucinations, positive and negative symptoms, person-centered care, existing coping strategies, mental health assessment, literacies (3Rs, emotional, health), salience, attention, attribution, meaning, creativity

physical health, weight, fitness, side effects, medication, atypical antipsychotics, evidence, genetics, research, diagnosis, (cognitive) information processing, dual diagnosis, risk, models of care, recovery, hierarchy of clinical evidence, care processes - assessment, care planning, access to interventions, audio recording of sessions, protocols, DSM IV

clinical supervision, social attitudes - family, friends, community, stigma, myth, media, carers, familes, social relationships, network, self help groups, survivors, www.hearing-voices.org/ activities, daily routine, 'value' of a diagnosis - pros & cons (discuss), community centers, clinical supervision, positive risk management, employment, social history of mental health, social psychiatry, stories,education - schools & community, 'community care', housing

mental health history, institutional vs. community care, mental health law, autonomy, consent, capacity, best interests, equity mental health services, early intervention, access, POLICY, anti-psychiatry, equity, governance, data gathering, statistics, reporting, outcomes, services, secure provision, early intervention, crisis intervention, DSM V, commissioning, funding for mental health, education and training, sickness - welfare benefits - 'incapacity' review 'return to work'

The relative position of concepts above does not indicate priority.

Cognitive Therapy & Community MH Nurses - anyone for tennis?

Last week there was quite an announcement about psychological therapies - specifically cognitive behavioural therapy, with a £170 million boost to help treat the millions of people affected by anxiety and depression. Stuck with their condition many are also stuck on waiting lists.

On the media the inevitable debate followed about research, the evidence base and the possibility that perhaps nurses could undertake some of this work. You guessed it - the 'but' followed in the form of 'training'. True, training will be needed, as the conveyor belt that is the workforce takes on-board the new kids in town and seeks to squeeze the best out of its more senior clinicians. With mention of training though someone had better watch that £170 million, to ensure it really does deliver quality therapy with the required supervision. There's also an invitation here for the various schools of therapy to take up arms - and this could be a further distraction.

A stock-take of EXISTING skills would be in order. Many people have already been trained in CBT as part of a skills set to deliver psychosocial intervention. Personnel information systems that are breathing (alive!) are critical, since there are many nurses (one hand raised here) and other disciplines who have the skills to maximise the effectiveness of that investment. Polish those rusty skills and there's a regular Genie there. So where are they?

Well many are playing tennis and it sure is not pretty...

If you listen carefully you can hear the grunts; the thud-after-thud as the players seek the sweet-spot. Any applause was lost a long time ago. You see, primary and secondary care are locked in a tie-break. Primary care refer; secondary care continue to hone their return of service, trying to spot the attempted ace down the centre. Screening tools are perfected, referral thresholds revised - the net gets dizzy; meanwhile, who is doing the therapy, the carer support, the public mental health education? Of course, this word therapy also comes with economic and status baggage.

You have to feel sorry for both these players and their coaches, now they can't just run to return the ball, the rules say that between shots they have to include a gymnastic element too.

Wimbledon 2008 should be fascinating: there's bound to be a break soon - I bet your demographic dollar$

Image source http://www.tennisserver.com/set/set_03_09.html