There is Actually Alone One Way to Accurate Accurate Adulation - Brainy Bloom Research

What is the purpose of life? The alone purpose that makes rational faculty is to accurate adulation to all active entities. All added purposes are apprenticed to be selfish, with a "getting" motive attached. The acquaintance of accurate adulation seems to appear rarely on our planet, as adumbrated by the abrogating altitude of humans and situations worldwide. The superior of our abundance and brainy bloom depends on our alertness to accurate adulation to the activity about us.

Many may be abashed to ascertain that accurate adulation is not a claimed resource. I accept no adulation of my own, nor do you, or anyone else. There is alone one way we can accurate accurate adulation to the activity about us, that is by consistently acting on what is absolutely right.

Here is accession shocker; to act accurately a getting cannot be acting selfishly. That agency that he or she cannot be acting from a egocentric or blowhard intention. It agency that a getting cannot be in a egocentric authoritative or artful mode, and cannot be acting to get something for self.

The announcement of accurate adulation requires that our intentions be pure; that we be aboveboard will to accord with no strings attached. We have to aswell be accommodating to act in acquiescently amenable ways, which includes getting accommodating to accurate accuracy as we apperceive it in adapted ways. In a egocentric environment, the announcement of accuracy can sometimes be alarming so acumen is in order.

At the affection of the activity of cogent accurate adulation is a aboveboard alertness to accurate love. Without that willingness, whatever comes alternating shall be some anatomy of egocentric action.

Here is an analogy:

Think of a animal getting as a "garden hose," and his or her will as the "faucet" absorbed to the ancillary of a house. The "water" is love.

In adjustment for us to acquaintance or accurate love, we have to accessible our claimed "faucet" (will) and be accommodating to acquiesce baptize to breeze (express love). If we are accommodating to accurate love, "water" flows through us and we feel acceptable (we acquaintance love). In addition, those about us get "wet" (are loved).

On the added hand, if we selfishly and defiantly debris to accurate love, we accumulate our claimed "faucet" shut so that no "water" can breeze through us. Like an bare garden corrupt larboard out in the sun, it anon dries out and begins to decay.

Compromise - The Best That Keeps Hurting - Mental Health Research

Who at times has not compromised? Accommodation is an capital allotment of our egocentric way of life. We accommodation to get forth and to go along. We accommodation to be accustomed and to abstain accident that which we do not wish to lose. We accommodation because we see no added option. Nevertheless, if any being were to attending aback at above-mentioned times if he or she had compromised what was right, a abutting assay would consistently acknowledge that the best to accommodation consistently beneath a bearings or relationship.

Choices to accommodation never advance to abiding absolute change. Probably, every being knows that, yet, we assume afraid to compromising what we apperceive is right. Why? The acknowledgment is for absolutely egocentric reasons. Accommodation is "selfish action." In addition, as with any egocentric action, it consistently after-effects in some affectionate of negativity and pain.

Fear usually plays a cogent role in compromise. Abhorrence is a egocentric affect and a "selfish tool." We generally use abhorrence to advice us get what we wish or to abstain what we do not want. We sometimes accommodation because we abhorrence judgment, rejection, or advance for not accordant with others or for not conforming.

We sometimes accommodation because we abhorrence that we ability not get as acceptable a accord or bearings as we accept now. We sometimes accommodation because we abhorrence accident control; a admiration to ascendancy and dispense consistently underlies a best to compromise.

Were we not active in a egocentric ambiance there would never be a charge to compromise. However, back we reside in egocentric families and communities, we are consistently pressured to accomplish compromises. The best action is to plan to accommodation as little as possible. That best is consistently possible, provided we are will to pay whatever amount is absorbed to abnegation to be in abrogating acceding with the humans we consistently interact; even if it agency bounce or worse.

Client Suicide and Clinician Response: Ensuring Policy Guidelines and Clinician Safety

In looking at issue of suicide within mental health field, we know that a person who suffers from mental illness, is more likely to be at risk for suicide.  According to the Mental Health America website of suicide victims suffer from major depression or bipolar (manic-depressive) disorder”.  One aspect that doesn’t often get looked into, is how does suicide of a client affect the clinician that they work with?  In working in mental health field, depending on setting and caseload, clinician’s often have fluctuating caseloads, and might lose a client to suicide, and then be required to have short turnaround in picking up a new client to replace them.  In dealing with a population that might show higher risk of suicide, the question becomes, are we ensuring that clinician’s are protected by policies, have confidence in being able to assess suicidal behavior?  An article does a study on 172 therapists, 125 who are from private practice, and 47 from institutions, and tries to assess their responses to suicide from clients.  The study finds that of these therapists, 85% from institutional setting and 17% from private practice had experienced at least one suicide in their professional careers.  From this article, it appeared there was more of a propensity for clinicians from institutional settings to be more at risk for having experienced a client suicide.  This would make sense in that institutional setting, clients would have more severe symptoms of mental illness, and in general, having to be institutionalized is a result of not being able to take care of one’s self, or possibly self harming behavior in the past.

The same study found that for psychiatrists who had “less than 5 years of professional experience” reported significantly more feelings of “guilty, shocked and insufficient” at their job, after 6 months of the study, opposed to colleagues with more experience. This makes argument for importance of developing policies, as well as offering trainings to ensure new staff feel confident in assessing clients for suicidal risk.  One of the main sources of distress, interestingly enough, was that of “fear of reaction of parent’s relatives” and that was found to be even higher than fear of a lawsuit in this study. This study also found that in dealing with client suicides, of the therapist responses, 80% reported being “supported by the institution” they worked for, 72.3% found some type of “conference” around grieving to be helpful, and 44% had reported wishing they had some type of “conference”. This data shows support for clinicians wanting to feel supported or protected by policy guidelines of institution, as well as some type of debriefing process to allow discussion of the client’s case.  Of all the therapists involved in the study, “one third or 34.5% suffered from severe distress”, which the study did not find significant differences in gender, but were slightly more prevalent among women, and also the study pointed out distinction that with mild distress, usually over 6 months, symptoms lessened, but with severe distress, symptoms were persistent over this time.  The study shows a  prevalence of “severe distress” within clinician’s, which argues for being able to notice this within staff, as well as developing policies that ensure staff protection and confidence in being able to assess client’s for suicidal risk.

Another article  was a study done within the United States Air Force and collected information from 74 of medical treatment facilities, to determine if trainings around suicide assessment, could impact clinician confidence, as well as impact policy or clinician ability to assess suicidal behavior.  One argument that the article starts with is the fact that most clinician ability to do suicide assessment effectively, is dependent upon organizational policies, as well as clinician motivation to access literature on, or continuing education into this area.  For instance, Bongar and Harmatz (as cited by Oordt et al. 2009) found that “only 40% of graduate programs in clinical psychology provided any formal training in clinical work with suicide patients”.  In other words, even clinicians with advanced degrees in psychology or other mental health degrees, would have minimal exposure with how to work with suicide patients, which puts their ability to be effective on what they learn working in the field, putting further emphasis on training their employer offers, what program policies are around this, etc. Depending on what state this occurs, continuing education might not be required, and so this  would put more emphasis on the clinician seeking out these trainings.  The article offers a link to the Air Force website, which offers “18 recommendations for effective clinical work with suicidal patients”.  Without continuing education, the article by Oordt et al. (2009) describes that clinical supervision would be primary source of setting guidelines for how to assess suicide risk.  This requires that with good policies, supervisors could also feel confident in providing feedback to clinicians, as well as in clinicians being trained and having knowledge of what to do in these situations, wouldn’t need as much supervision.

Going back to the article, the study used a 12 hour training session, with 4 hours spent on “suicide assessment”, 4 hours on “management and treatment of suicidal behavior” and 4 hours on “military specific practices, policies” around suicidal assessment.  The goal of the study was to follow up on participants from the training and see if this impacted them, up to 6 months after the trainings.  The study was made up primarily of 82 participants, 48% who were doctorate psychology clinicians, 27% doctoral social work majors, and 13% that were psychiatrists.  Initially, of these participants, 43% reported “little or no formal trainings in graduate programs” around suicidal assessment, and 42% reported “little or no postgraduate or continuing education”.  This information supports the findings that even with advanced degrees, clinicians don’t have much exposure to policies or guidelines around how to do suicide assessment?  At the 6 month follow up, 44% of all participants reported “increased confidence in managing suicidal patients”, 83% “changing suicide practices”, and 66%, “changing clinical policy”, as a result of attending the trainings. The article also offers a 9 step guide to what trainings should look like, around suicidal assessment.  This study was done specifically with the Air Force, but offers an example of support for giving clinician’s trainings around practice of suicide assessment, as well as making sure they have knowledge of what policies are and what is expected of them by organization, in doing suicide assessments.

From these articles, we can see prevalence of “distress” amongst clinicians in having to deal with a client who has committed suicide.  Oftentimes, as clinician’s, we feel sense of needing to be detached or be professional in dealing with our clients, and yet it is important to understand it is normal to experience some grief in losing a client to suicide, or other factors.  What is important is knowing organizational policies, or ways in which we are expected to assess suicidal risk, as well as knowing resources available to aid us.  As these articles point out, through trainings and continuing education, we can feel more confident, as well as develop better policies to deal with clients that display suicidal behaviors.  Here are some lists of resources for info on defining policies around suicide assessment, as well as helpful tips for clinician being able to deal with loss of a client to suicide.
Mental Health America (Suicide Info)
SAMHSA (Statistics on Suicide Likelihood)
Suicide.Org Non-Profit Organization (Warning Signs)
Mayo Clinic Website (General Coping Skills for Losing Someone to Suicide)

Citations

Oordt, M.S., D.A. Jobes, V.P. Fonseca, S.M. Schmidt (2009). “Training Mental Health Professionals to Assess and Manage Suicidal Behavior: Can Provider Confidence and Practice Behaviors Be Altered?” Suicide and Life-Threatening Behavior 39(1).

Wurst, F.M., S. Mueller, S. Petitjean, S. Euler, S. Thon, G. Wiesbeck, M. Wolfersdorf (2010).  “Patient Suicide: A Survey of Therapists’ Reactions”. Suicide and Life-Threatening Behavior 40(4).

submitted by Jim Linderman.  Jim is currently a M.A. student with University of Colorado-Denver Sociology Program.

Evidence based practices

Currently, one of the most important areas in healthcare is accountability.  As part of this movement toward accountability, the mental healthcare industry and their stakeholders tend to talk about Evidence Based Practices (EBP) as a way to link programs to desirable outcomes.
Evidence based practices can be found in multiple areas: from Education to Mental Health. And within mental health you can find them from medication (Kentucky Medication Algorithm; and Texas Medication Algorithm  where the main goal is to use the medication that will create the best outcomes), to specific interventions or programs like Assertive Community Treatment (ACT) in adult individuals and Multi-systemic Therapy (MST)  for youngsters; to specific illnesses like Schizophrenia  and Bipolar disorder.  Furthermore, the Substance Agency (SAMHSA) which supports most substance abuse and mental health funding at the Federal level, maintains and supports through funding multiple studies to determine and encourage the use of EBP throughout the country (go here to see what SAMHSA endorses) Professional organizations like the American Psychological Association, the American Psychiatric Association, as well as organizations for Occupational Therapy, Psychiatric Rehabilitation, Nursing , etcetera, endorse the use of EBP with their members. Insurance providers, Federal funded entities like the National Institute of Health and Consumer advocacy groups like NAMI  fund or endorse Evidence Based Practices.  In fact, Tanenbaum 2008 states that “EBP is a matter of mental health policy in USA” (page 699).
So what is the big deal about EBP? Why would we want to use EBP rather than other practices that are not considered EBP’s? The main reason has to do with the definition of EBP, and the rationale for the creation of EBP. There are multiple definitions for Evidence Based Practices (this is one); but most of them speak about interventions that are backed by empirical or scientific research. What that means for the individual on the receiving end is the certainty that what is being used is scientifically sound, and not just some unproven therapy, or, even worse, some form of quackery that will not deliver the expected outcomes on a regular basis.
If EBPs are the best thing since sliced bread, then why is there resistance to implement them? There are several issues associated with the implementation of EBP. One is related to the level of information regarding EBPs (who knows about them and how much). Evidence about consumers knowing or participating in decisions regarding services (in this case, EBP services) is usually limited. Tanenbaum, for example, found out that though consumers may be willing to use EBP, they are rarely consulted about the services they received (the decision is not up to them).
Another area is the science to service gap associated with research. There are multiple numbers being tossed around, but Druss 2005 speaks about a twenty year gap between scientific research and implementation in an applied setting. In that regard entities like SAMHSA are doing the best to help move research to practice. For example, SAMHSA instituted an award for centers that do their best to bridge that gap (MHCD received this award in 2009  for its Growth and Recovery Opportunities for Women (GROW) program).
Finally, there is also resistance from providers to implement EBP for multiple reasons: From need for new training, to expense, to the importance of fidelity to the model. 
• Regarding training, most EBP require that clinical people learn new techniques, or ways to do things that seem to be counterintuitive to what is known or has been practiced for many years. As an example, of new implementations for trauma-oriented for women survivors of trauma, the Trauma Recovery and Empowerment Model TREM;  uses an approach where abuse is not seen as “the primary problem”.
• Regarding expense, many of these interventions require very extensive training, or require special certifications to be used. This not only means expense in terms of training and materials, but also certifications; not many centers can afford such implementations.
• Finally, most of these models have been created in research settings, under very controlled situations, and they have been proven to work –mostly-- under those circumstances. Therefore, the model creators will require that you “follow the model” with fidelity. For example, clinicians may have to be on call on a 24 hours/7 days a week schedule; or the ratio of clinician to individuals receiving services is 1-10. And if you do not follow the model within some specific bounds (determined by instruments created by the model designers), then the center or clinicians doing the implementation are formally not using the model, or will not be endorsed by the model developer.
Why then try to use Evidence based practices? The short answer is because they have been proven to work in most situations. That is, the expected outcomes are met as described by the model. For example, youth receiving Multi-Systemic Therapy (MST) will stay at home (rather than at out-of-home-placements), stay in school, reduce the number of arrests, and reduce psychiatric symptoms and substance/alcohol use. Therefore, most people figure that the cost, extra training, continuing certification is worth the hassle. But the field is new, and sometimes it is not clear whether all the program components work as intended, or whether the model really works as intended outside the –most times-- very restrictive conditions imposed by the program developers. This is a new field, and new evidence is mounting every day that speaks in favor or against what we know about EBP.  We’ll have more to say about this area in future blogs.