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引入对话式模型治疗方法作为团队护理模式:性侵犯服务中的临床医生体验。

Introducing a Conversational Model Therapy Approach as a Team Model of Care: The Clinician Experience in a Sexual Assault Service.

作者信息

McLean Loyola, Kornhaber Rachel, Holt Rachael, West Sancia, Kwiet Julia, Visentin Denis, Cleary Michelle

机构信息

a Brain and Mind Centre , The University of Sydney , Sydney , Australia.

b Westmead Psychotherapy Program, Cumberland Hospital, Western Sydney Local Health District and Discipline of Psychiatry, Sydney Medical School , The University of Sydney , Sydney , NSW , Australia.

出版信息

Issues Ment Health Nurs. 2018 Oct;39(10):821-828. doi: 10.1080/01612840.2018.1491655. Epub 2018 Sep 25.

Abstract

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants' understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.

摘要

本文通过探索澳大利亚一家医院性侵犯服务机构(SAS)工作人员的经历和观点,审视了临床医生采用当代心理动力护理模式的情况,进而思考如何在护理模式变革及培训中更好地让临床医生参与其中。治疗对话模型(CMT)是一种当代心理动力方法,整合了发展心理学、神经科学和创伤方面的证据。针对短期强化心理动力心理治疗的CMT方法提供了培训,旨在使该服务机构能够更好地满足成年性侵犯受害者的需求,这些受害者的性侵犯经历发生时间较久,和/或能够接受短期心理治疗。进行了五次半结构化个人访谈和一次焦点小组访谈(有四名参与者),以确定SAS工作人员在接受多达13节CMT初始培训后的经历感受。进行了主题分析,以识别、分析和报告回应中的模式,出现了以下主题:工作人员在为客户提供服务时面临的挑战;工作人员在工作中采用的应对机制;当前的服务结构以及与他们的CMT体验的比较,以及;SAS工作人员对被评估的感受和想法。研究结果表明,大多数工作人员理解变革的必要性,并且由于工作中的有效应对机制和团队内部的良好支持,能够为此接受培训。该研究还强调需要确保进行有效的培训,以评估参与者对所教授模式的理解。在其他地方的培训经验背景下,学习和整合与心理动力护理模式相关的所有知识可能需要通过对录音治疗过程的督导进行体验式学习,尽管这在SAS环境中有挑战。

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