Journal articles on the topic 'Psycho-therapeutic counseling'

Abstract Introduction Preeclampsia is a serious complication during pregnancy that not only influences maternal and fetal physical health, but also has maternal mental health outcomes such as anxiety. Prenatal anxiety has negative short- and long-term effects on pre- and postpartum maternal mental health, delivery, and mental health in subsequent pregnancies. Objective To investigate the effectiveness of individual psycho-educational counseling on anxiety in pregnant women with preeclampsia. Methods This was a randomized, intervention-controlled study involving two governmental hospitals in the municipality of Sirjan, Kerman, from January 30 2017 to March 31 2017. A total of 44 pregnant women with preeclampsia were assessed. The women were randomized into two groups: control (n=22) and intervention (n=22). The intervention consisted of two sessions of individual psycho-educational counseling. The level of anxiety was measured using the Spielberger State-Trait Anxiety Inventory (STAI) as pretest before the first session and as posttest after the second session during the hospitalization period. Results There was a significant reduction in the anxiety level after the counselling sessions in the intervention group (p<0.005). In addition, there was a slight increase in the anxiety level in the control group after the study. Conclusion According to the results, psycho-educational counseling can significantly reduce the anxiety level in pregnant women with preeclampsia. Therefore, it is recommended that healthcare providers provide this type of therapeutic intervention for pregnant women after hospitalization, in order to reduce their anxiety level and its subsequent negative outcomes. Clinical trial registration: IRCT2017082029817N3.

113 Background: Tumor disease has not only somatic but also psychological impact on patients with complete change of life dimension. This resonates not only to the patients, their relatives and friends, but also to the therapy. A precise screening helps to determine the stress factor, to capture the psychological comorbidity and to initiate an early psycho-social care. Methods: 420 patients with various tumors got since October 2011 in the Urological Clinic of Aachen University Hospital screening using a Distress Thermometer. 410 patients were stationary and 10 patients came to the outpatient (ambulant) chemotherapy. 23 of the 40 questions of the Distress Thermometer depend on somatic complaints of patients. The other 17 questions cover the psycho-social problems. Results: 141 of the 420 patients reported to have a low stress level by the tumor. 139 patients showed, according to the Distress Thermometer, an average and 140 patients significantly higher stress level. This means that 279 of the 420 patients need a psycho-oncological counseling and possibly even further care and treatment. The most common entered symptoms were fears, nervousness, sleep disturbances, fatigue, sadness and worry. Depending on the wishes of the patient the psycho-oncological consultation was initiated. Only completing the Distress Thermometer helps the patient to face their problems and worries and makes perhaps the first great step in the perception of the disease. Since January 2012 a new component was inserted into the discharge reports of the tumor patients. This component contains the recommendation, depending on the result of the Distress Thermometer, to start if necessary the professional psycho-oncological support. That gives the patients a sense of security and a feeling not to fight alone against the disease. Conclusions: A targeted screening and an interdisciplinary, together with psycho-oncologists, care to cancer patients support them and their families at all stages of the disease, helps to deal with the new life situation and can possibly also increase the patient's compliance and the therapeutic response.

This article reports the findings of an outcome study done at ALONGSIDE, a counseling-focused retreat center that offers three-week intensive outpatient programs for Christian leaders, the majority of whom are missionaries. Repeated measures research utilized the Outcome Questionnaire - 45.2 (OQ-45.2) to explore whether or not clients participating in the three-week intensive outpatient program realized significant clinical progress and whether or not therapeutic gains were retained after the conclusion of the program. Missionaries and other Christian leaders took the inventory online a month before coming to ALONGSIDE, upon arrival, at the end of the three-week program, and three months after the program concluded. The results indicated that a month of time before arrival did not bring about a significant reduction in symptomatology among the 191 subjects, but three weeks of ALONGSIDE's intensive outpatient program resulted in significant clinical improvement which remained when the inventory was taken again three months post-program. This suggests that in a fairly short period of time, an intensive outpatient program consisting of psycho-education, group psychotherapy, and individual and/or marital counseling within a milieu of intentional Christian community can be a highly effective model for promoting enduring psychological healing.

The main task of specialists in their interaction with the family of a child with disabilities is not only to issue recommendations for the treatment and upbringing of the child, but also to create conditions that would maximally stimulate family members to actively solve emerging problems. Family, counseling, psychotherapy and psychocorrection work are stages of a single psychoconsultative and therapeutic process aimed at restoring and strengthening the mental health of the individual through the normalization of relations in the family. For a family raising a "special" child, such functions as correctional and developmental, compensating and rehabilitative are important, the purpose of which is to restore the child's psychophysical and social status, achieve their material independence and social adaptation. Understanding the family as a system leads, in turn, to understand the need for an integrated approach to the organization of clinical psycho-pedagogical correction of deviations in development of children, physiological system of the mother-child, the family system as a whole. Purpose is to help specialists in the field of special (correctional) psychology, defectology and pedagogy to master the knowledge and skills necessary to work with the family. Specialists have a unique opportunity to rely in their work on the most interested people in its success-parents who become their partners. Parents, in turn, master the tools necessary to effectively help their own children. Methods: observation, interviews, questionnaires, testing, and projective methods. In the course of the study, the goals and objectives of working with families raising children with disabilities were determined, and the most effective forms of organizing the psychotherapeutic and correctional-pedagogical process of cooperation between specialists and parents were considered. Forms of individual work with parents of children with disabilities are proposed. Psychotherapy and psychocorrection, used in the consulting practice of working with children with disabilities, includes various methods. Keywords: children with disabilities, social and psychological counseling, methods of psychotherapy and psychocorrection, forms of interaction with the family.

Introduction. Today, cognitive therapy is one of the main methods of the cognitive-behavioral approach in psychotherapy, which is one of the leading areas of psychotherapy in the world. Cognitive psychotherapy effectively fights patients’ emotional and personal problems based on the assumption that the causes of a person’s psychological problems lie in thinking errors. Students and young people in general are one of those age groups that, due to a number of objective and subjective reasons experiences special internal conflicts and difficulties. The purpose of the article is to identify the negative experiences of students and the use of cognitive psychotherapy techniques when working with them. Materials and Methods. The solution of research problems was provided by a set of complementary theoretical (analysis of scientific, methodological literature on the studied problem, comparative analysis, comparison, generalization) and empirical (testing, forming an experiment, calculation of rank correlation coefficient) methods. Results. The following problems were identified that are sources of negative experiences among students: problems associated with professional identification; problems associated with disappointment in the chosen specialty; problems in interpersonal relationships associated with avoiding intimacy; problems in interpersonal relationships associated with a strong sense of jealousy; a number of specific problems associated with specific irrational ideas or cognitive distortions. The developed training of rational thinking and recommendations for improving the processes of psychotherapy, psycho correction and psychological counseling, which can be used by the psychological services of universities, are presented. Discussion and Conclusions. The expected effect of the implementation of psycho-therapeutic work based on cognitive therapy techniques is to reduce the level of anxiety, negative feelings of students, increase their self-esteem, which creates a favorable psychological basis for educational activities. The provisions and conclusions create the prerequisites for further studying the potential of cognitive psychotherapy in the practical aspects of normalizing the psychological health of various social and age groups.

The article discusses existing ways of recognising functional diagnosis in theoretical models in the field of psycho-pedagogy. It also examines strategies for the use of these models in diagnostic and therapeutic activities. By systematising the collected information, the authors describe goals, stages and features of functional diagnosis. In addition, they propose a synthetic definition that takes into account contemporary trends in psychological and pedagogical counselling. The article presents an example of application of the functional diagnosis model in the emotional and social spheres, the original psycho-pedagogical diagnostic tool TROS-KA, which was standardised in a group of 1,227 Polish students.

Aim. To study the effectiveness of personality-oriented educational program in the rehabilitation of young patients with chronic non-calculous cholecystitis. Methods. Examined were 64 people aged 18 to 35 years with a diagnosis of «chronic non-calculous cholecystitis in the remission phase». Conducted was a comprehensive examination and a clinico-psychological evaluation of the levels of personal and reactive anxiety, according to the method of Spielberger-Hanin, psychological diagnosis of types of attitudes to the disease, assessment of the quality of life according to the «ESADA» (Evaluation of the Situation of Adaptation, DysAdaptation). All patients participated in the educational personality-oriented program, which included individual counseling, coming up with a treatment and rehabilitation plan, visiting the «gastro-school». Results. As a result of educating of 64 patients the number of people with high levels of reactive anxiety decreased from 5 (7.8%) to 2 (3.1%), with a moderate level - from 27 (42.2%) to 21 (32.8%) and the number of individuals with low levels of anxiety increased from 32 (50.0%) to 41 (64.1%). The proportion of patients with high levels of personal anxiety decreased significantly: from 57.8 to 29.7% (p 0.001). Noted was an increase in the number of people with moderate and low levels of anxiety: from 32.8 to 43.8% and from 9.8 to 26.6%, respectively (p 0.001). The number of individuals with the type of attitude to the disease of the first block increased, with a clear trend towards an increase in patients with an ergopathic type attitude to the disease by the end of classes: from 6.3 to 25.0% (p 0.001). Among the type of attitide to the disease of the second block the largest positive trend was registered among individuals with anxious (from 23.4 to 12.5%) and hypochondriacal (from 43.8 to 29.7%) types. Before training only 9 (14.1%) patients were compliant with guidelines on therapeutic nutrition, 19 (29.7%) patients maintained the diet, but not on a regular basis; and after the training 41 (64.4%) individuals started maintaining the diet, 23 (35.9%) people - not on a regular basis. Prior to the training 7 (10.9%) patients had regular physical exercise, 18 (28.1%) - occasional physical exercise; upon completion of the training 18 (28.1%) patients engaged in regular physical exercise, 39 (60.9%) - in occasional physical exercise. 4 (6.3%) patients were able to «cope with the stress» prior to training, and 34 (53.1%) patients - upon completion of training. Conclusion. The developed personality-oriented educational program for patients with diseases of the biliary system has proven its effectiveness: the features of the psycho-emotional area have improved, favorable healthy lifestyles habits have developed.

Men's health issues and depression have both been identified as key priorities in health policy in Australia. A community health service in Melbourne has developed and delivered an integrated and holistic series of interventions specifically targeting depression in men, in addition to individual counselling services. These include a psycho-educational group program, an ongoing therapeutic and support group, and walking and gym exercise activities. Levels of participation, and outcomes, indicate that this type of package of services can be a highly successful way for community health services to respond to issues relating to men's health and wellbeing.

Third party reproduction is an increasingly important part of family building but also challenges societal understanding of family and ‘kin’ relationships as being primarily hetero-normative and based on genetic connection. At the same time, understanding of the longer-term psycho-social implications of gamete donation is changing as knowledge grows. Research, professional and personal experiences demonstrate that a range of meanings can be triggered regarding relationships, identity and health matters that challenge normative views. This raises questions of how best to assist those contemplating this route to parenthood. With knowledge gained from research and practice over many years, we argue this requires a shift from focusing on assessment/evaluation of prospective parents and/or therapeutic work to a psycho-educational partnership approach offering help with managing relationships, thoughts and feelings and building strategies for healthy family functioning alongside sharing knowledge from research and experiences. Such approaches can also be appropriate for later professional interventions.

Background: Hospitalization and Disease can be the first crisis situation that a child encounters. Hospitalization may leads to increase the stress and level of anxiety among children and parents. An excessive or persistent state of anxiety can have a devastating effect on child’s physical and mental health. Psych education is an evidence-based therapeutic intervention for clients and their family members who help them to cope with illness and give the information as well as support to understand in better way. Psych education is helps to children and their family to minimize the emotional trauma during the hospital stay. Objective: To evaluate the impact of psycho educational intervention on level of anxiety among hospitalized children. Methods: A systematic literature review is conducted. Electronic database search to Collect Literature: The following electronic databases are searched: ProQuest, Research gate, Pubmed, EBSCO, science direct, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature (CINHAL) and journal available in library. Result: collected review of literature result shows that psycho educational intervention considers a positive effect on reduce the level of anxiety among hospitalized children. Conclusion: psych educational intervention is cluster of the strategies like play therapy, storytelling, guided imagery etc. It is a non- invasive and safe intervention which helps to reduce the anxiety level. Keywords: psych educational intervention, anxiety level, hospitalized children, search engine, counselling

From the patients’ point of view, valued-based mental healthcare is mental healthcare based on a holistic vision of care, according to which patients are actively involved in their treatment to achieve the best possible outcomes. They are invited to collaborate with both mental health care providers such as psychiatrists and primary caregivers to determine what types of treatment are the most effective.GAMIAN-Europe believes that the best package of care includes the following four elements:– medication – antipsychotic medication is consensually regarded as first-line treatment for people with mental health problems;– psychotherapy/counselling – although antipsychotic medications are the mainstay of treatment for mental health problems, pharmacotherapy alone produces only limited improvement in negative symptoms, cognitive function, social functioning and quality of life. Additionally, many patients continue to suffer from persistent positive symptoms and relapses, particularly when they fail to adhere to prescribed medications. These situations emphasize the need for multimodal care, which includes psychosocial therapies as adjuncts to antipsychotic medications in order to alleviate symptoms and to improve social functioning and quality of life;– psycho-education – the more a patient learns about his/her condition the better placed he/she will be to take control of it. Psycho-education embodies this principle by using a clearly-defined therapeutic programme, in which a trained therapist delivers targeted information designed to reduce both the frequency and the severity of symptoms. Psycho-education increases patients’ knowledge and understanding of their illness and treatment options and helps them cope more effectively. Many people find that they benefit not only from the information they receive during psycho-education, but also from the learning process itself. There are several different ways in which psycho-education can be delivered, including one-to-one sessions with a therapist, sessions aimed specifically at carers and family members, group sessions attended by several people coping with mental illness and mixed group sessions attended by people with mental illnesses and family members;– self-help – self-help groups offer patients a voice and an audience with the time and inclination to listen to patients’ concerns and reassure them and ease their anxiety. For example, a self-help group may be able to quell anxiety regarding side effects, to reassure the patient, from first-hand experience, that these side effects are transient, normal and non-threatening and will diminish over time. The real experts on living with a mental disorder are those who are already doing so. Therefore, most support groups are full of people who can share information about how they have managed to cope with their illnesses.Disclosure of interestThe author has not supplied his declaration of competing interest.

The purpose of this paper was to present and analyze a therapeutic case report of short-term psychological assistance to a client with anxiety and pronounced psychosomatic complaints. The article describes the psychosomatic manifestations presented by the client, the assessment of her mental status, the analysis of findings obtained by psychodiagnostic examination, the course of the client's psychotherapeutic intervention and the outcomes achieved. The methodology included Hospital Alarm and Depression Scale (HADS), A. Beck Depression Scale, Alarm Scale (HAM-A), SF-36 Quality of Life Questionnaire, the Gisen Psychosomatic Complaint Questionnaire, Psychosomatic Disorders Questionnaire by Chaban O. and Haustova O., the self-esteem scale of depression and anxiety according to Chaban O. and Haustova O., diagnostic techniques of psychosomatic complaints according to Chaban O. and Haustova O. Results: According to the results of the psychodiagnostic examination, the client was found to have expressed anxiety and mild depression, low level of anxiety disorder, lowered indicators of viability, psychological and physical health and social functioning according to the scales mentioned above. The patient demonstrated an increased overall rate of subjective physical complaints with prevalence of psychosomatic complaints of pain in different parts of the body, exhaustion and cardiac symptoms, as well as moderate manifestation of somatic symptoms. A significant impairment of the patient’s psychological health component was diagnosed. The client's physical health component was slightly above average, vital energy was reduced. Integrated counselling and psychotherapy were conducted with the patient. Conclusions. Following the psychotherapeutic assistance, and in particular, psychosomatic therapy, the anxiety level significantly decreased that resulted in somewhat amelioration in the psycho-emotional state of the patient and dying out of frequent psychosomatic complaints.

Context: Cancer diagnosis and its therapeutic methods can lead to considerable psychological problems and decrease the levels of hope in patients. Due to the considerably important multidimensional effects of hope on the life of patients with cancer, this study aimed to assess the effect of psycho-socio-spiritual strategies on the hope level of patients with cancer. Evidence Acquisition: In this narrative review, electronic databases were searched including Google Scholar, Scientific Information Database, Magiran, PubMed, ScienceDirect, Web of Science (ISI), Ovid, and Scopus. Those articles published between 1978 and 2020 were retrieved and assessed through the abstract and full-text appraisal. Finally, 74 articles were included in this study. Results: Psycho-socio-spiritual strategies for affecting the hope level of patients with cancer were classified as follows: (1) psychological interventions (psychotherapy, counseling, coping skills training, stress management training, crisis management, individual or group supporting therapy, hope therapy, and psychoeducational interventions); (2) social interventions (social and family support intervention); and (3) spiritual interventions (logotherapy, religion therapy, and praying). Conclusions: Due to the chronic nature of cancer disease, in addition to the important role of pharmacological treatment such as chemotherapy and radiotherapy, considering non-pharmacological approaches such as hope-fostering interventions for these patients is essential and can lead to a better quality of life.

Prevalence of Hypertension increased in line with changes of life style as smoking, obesity, non physical activity, psycho-social stress in many countries. Comprehensive and intensive treatment could be more control of blood pressure. Understood, knowledge and adherence of patient expected will improve along with act of distributed useful and correct information by pharmacist. The aim this study to determine the effect of counseling pharmacist on therapeutic outcomes and adherence and to know the correlation between therapeutic outcomes and adherence of outpatients hypertensive in the internal disease clinic at RSUD Kraton Pekalongan District. This research was experimental intervention with pre-post intervention with randomized without matching. Data was collected by prospective method. The control group given a leaflet at the first month, and the intervention group given a leaflet at the first month and counseling every early month, during 3 months.There was 75 patients, the intervention group (N=39) experienced a significant decrease in blood pressure at the end of the study, on systolic amounted 11.28±8.33 mmHg [P=0.000(P<0.05)] and diastolic amounted 7.18±6.86 mmHg [P=0.000(P<0.05)], whereas in the control group (N=36) did not experience a significant decrease in blood pressure is systolic amounted 2.22±10.45 mmHg [P=0.203(P>0.05)] and diastolic amounted 0.28±6.09 mmHg [P=0.782(P>0.05)]. Adherence of patients as measured by MMAS scale in the intervention group better adherence than the control group (33.33% : 2.78%). There was have correlation a means between MMAS score with change of systolic (P=0.019; r=0.270) and diastolic (P=0.001; r=0.372) which positive direction. It was concluded that counseling has an effect on adherence positively in the intervention group better than the control group and decreasing systolic and diastolic blood pressure until reach targets. There was a close correlation between decrease in blood pressure with MMAS score in hypertensive patients.

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. 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