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A guide for helpers THE SERENITY PROGRAMME Updated 7 th June 2013.

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Presentation on theme: "A guide for helpers THE SERENITY PROGRAMME Updated 7 th June 2013."— Presentation transcript:

1 A guide for helpers THE SERENITY PROGRAMME Updated 7 th June 2013

2 SERENE.ME.UK/HELPERS/ #SERENITYPROGRAM FACEBOOK.COM/SERENITY.PROGRAMME 2 Contacts This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License SERENE.ME.UK/HELPERS #SERENITYPROGRAM SERENITY.PROGRAMME

3 Today … The programme Contracts and goal setting Phone support Governance Therapeutic considerations 3

4 Whats in the programme? A series of assessment measures A series of information pages A resource page for helpers – training materials and documentation A brief self-help programme, open to anyone A series of interactive workbooks Audio files Possibly a bespoke microsite? 4


6 Assessment meeting Modules 1 and 2 Support call Module 3 Goal setting meeting Module 4 Support callModule 5Support call Module 6Module 7 Module 8 Module 9 Support call Final meeting The Programme … 6

7 USERNAME: Intentionally blank PASSWORD: Intentionally blank 7


9 Egans five questions about goals Why should I pursue this goal? Is it worth it? Is this where I want to invest my limited resources? What competes for my attention? How strong are the competing agendas? Egan, G. (1994) The Skilled Helper (5 th Edition). Pacific Grove, CA: Brooks / Cole 9

10 The Three Ps Goals are best when they are: Powerful – vivid, clear and striking! Present tense – even stated as though already achieved! Positive – what you want, not what you dont! 10

11 Business contracts & treatment contracts Berne (1966) defined a contract as An explicit bilateral commitment to a well-defined course of action Business contracts clarify frequency, time, duration, payment, place etc. Treatment contracts identify goals and how we will attain them 11

12 Why contracts? Keeps client actively involved Protects client from being steered towards what should change Keeps image of goals foremost Provides an end-point Keeps process on track 12

13 Steiners four requirements A valid contract requires Mutual consent Lawful object Valid consideration Competency Steiner, C. (1974) Scripts People Live: Transactional Analysis of Life Scripts. New York: Grove Press. 13

14 Stewarts five questions about contracts Is the contract goal feasible? Is it safe? Is it stated in positive words? Is it observable? Does attainment mean a move towards greater health? Adapted from Stewart, I. (1989) Transactional Analysis Counselling in Action p. 96. Sage Pubs. 14

15 Contract let outs I want to work on I would like to try I could (instead of I will) The hanging comparative I would like to be more... Incongruence between social and psychological communication The outcome of the communication is determined at the psychological level 15

16 An overview PHONE SUPPORT 16

17 A hierarchy of engagement... Specific software e.g. Fear Fighter, Beating the Blues, LLTTF etc. No visual or auditory information - asynchronous (e.g. email) No visual or auditory information – synchronous (e.g. chat) Auditory information only (e.g. phone) Visual and auditory at a distance (e.g. Skype) Blended methods e.g. Serenity Programme (and many others in practice!) Immediacy, contextual richness and sense of presence are key dimensions 17

18 A Continuum, not either – or The blend can be adjusted to suit the client... Practitioner contact time Computer use 18

19 Controversies... If people can fall in love in chatrooms, by letter or email, then the medium can sustain a relationship and allow therapeutic, affective work If you cant see the client, can you still work effectively (ask a visually impaired counsellor!) We emote as if in virtual worlds – telepresence and our suspension of disbelief Telepresence entering social consciousness – Tron (1982, 2010), Matrix (1999), The Cell (2000), Gamer, Surrogates, Avatar (2009), Inception (2010), more 3D... more immersive tech 19

20 Telephone baggage Telephones mean different things to different people May bring good news, bad news, a lifeline or curse, may bring only work! What meaning does the telephone hold for you? Take 5 – 10 minutes to discuss with a partner, using counselling skills to help your partner explore... Can we leave this baggage behind when making a call to a client? 20

21 Interpersonal support – its important to CCBT... Andersson G, Cuijpers P. (2009) Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy. 38(4) p196-205 Included 12 studies found effect size of 0.61 for supported and 0.2 for unsupported CCBT (0.8=large; 0.5=moderate; 0.2=small) Attrition is high without interpersonal support This is support in the broadest sense – interpersonal support and encouragement – a containing relationship Its not counselling, though counselling skills are key... 21

22 22 The Samaritans Have been providing visual cue-less synchronous support since 1994, numbers roughly double each year! Also provide asynchronous support via email (< 24 hour response time) More males email than phone... People are 3x more likely to mention suicide in email than by phone... A short film...

23 23

24 Telephone support – is it second best? (1 of 5) There are benefits to the client To the provider Possibly to the wider environment too... Take 5 – 10 minutes to discuss with a partner, using counselling skills to help your partner explore... What are these benefits? Who might benefit most? Why, and who, might choose telephone-support over other approaches? 24

25 Telephone support – is it second best? (2 of 5) Benefits to the client Convenience Access for disadvantaged groups Cheaper – less travel required Anonymity 25

26 Telephone support – is it second best? (3 of 5) Benefits to the provider Less physical space required Reception and appointment administration Personal safety Practitioner anonymity Cost effectiveness 26

27 Telephone support – is it second best? (4 of 5) Who might benefit most (1 of 2) Young men – less likely to disclose in relationship Single parents, people with childcare problems Older or more physically vulnerable people People in remote or rural areas (access of confidentiality issues) People with caring responsibilities 27

28 Telephone support – is it second best? (5 of 5) Who might benefit most (2 of 2) People who find movement or transport difficult People with restricted freedom – children or people in abusive relationships People on very low incomes Certain diagnoses – social anxiety, agoraphobia, shame-based pathology, issues with authority or dependence, impulse control issues 28

29 Telephone support – is it second best? There are of course, disadvantages... Reduced visual cues Caller can terminate the call easily – esp. If dealing with sensitive subjects Assessment issues Potential distractions and interruptions Cant ensure clients privacy – potential recording, others listening in Cant absolutely identify the client! Try some of this while youre waiting – self-fulfilling prophecy mentality 29

30 Telephone support – remember... Leaving messages with people? Consent to leave messages Block caller ID with 141 Who may answer the phone? Non-committal introductions Call recording Others listening in on extensions Procedure in the event of repeated no answer Last number redial breaching clients confidentiality Procedure for contingencies – drunk / abusive / deteriorating / suicidal clients 30

31 Telephone support – privacy Telling a client their call is confidential, then they hear background voices Client becomes hesitant, distracted or monosyllabic – It sounds as though someone has walked in – if they have, just say yes Calls ideally take place behind closed doors – like face-to-face therapy Trivialising phone calls – interruptions are thought to be permissible would you like a coffee? 31

32 Telephone support – reasons for referral Because of you... Your personal limits Your professional limits The limits of your competence / training Because of the client... The client needs broader / deeper / more enduring intervention Because of your agency... Time limits Restrictions on type of service offered Organisational policies 32

33 Safeguarding and Governance... What do you think a provider needs to have in place to provide a high-quality telephone support service? Take 5 – 10 minutes to discuss with a partner, using counselling skills to help your partner explore... Consider: Safety Effectiveness Acceptability Equity Efficiency 33

34 Telepresence and non- proximal attunement Frustration tolerance Object constancy Transference to hardware Disinhibition Who / what is the relationship with? Dissociation Reflexive self-function? Primitive processes Time distortion Learning issues Avoidance Suspicion and personality disorder Some therapeutic considerations 34

35 What we did … The programme Contracts and goal setting Phone support Governance Therapeutic considerations 35

36 Thanks for taking part! 36

37 References Meltzer, H., Gill, B. & Petticrew, M. (1994) OPCS Surveys of Psychiatric Morbidity in Great Britain. Bulletin No. 1: The Prevalence of Psychiatric Morbidity among Adults Aged 16-64, Living in Private Households, in Great Britain. London: OPCS. Cuijper,s P., Donker. T., van Straten, A., Li, J., Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943-1957. Sanders, P. (2007). Using Counselling Skills on the Telephone and in Computer Mediated Communication. 3 rd Ed. PCCS Books. 37

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