Psychosocial Interventions or Support - Coursework Example

Psychosocial Interventions or Support Psychosocial interventions refer to the process of enabling and promoting tolerance with in persons, families and groups. The Psychosocial Framework of 2005 till 2007 has been established by the International Federation to serve as the guide for psychosocial support. Due to such interventions or support, families are able to recover from the impact of a tragedy or crises. Moreover, such a support also trains them how to cope up with the similar critical situations in the future. Psychosocial interventions facilitate the restoration of social adherence and bedrock through respecting the dignity, liberty and management of individuals and groups (IFRC 2005). Thus, psychosocial interventions are meant to facilitate people to bounce back to normal after their lives have been disrupted by some crises. Red Cross and Red Crescent National Societies exercise community based psychosocial interventions which emphasize over strengthening the social connections among people in affected communities. This is done through improving the psychosocial well being of a community and its people. The concept behind this approach is that empowering people for taking care of each other and themselves will improve their individual and collective self confidence and resources. This will ultimately cause positive recovery and improve their ability to face and overcome future challenges. Psychosocial interventions can be classified as both preventive and curative measures. They are preventive when they reduce the risk of the development of problems concerning mental health. They are curative when they help communities and people to solve their psychosocial problems that may have resulted through the shocks and aftermaths of crises. These two elements of psychosocial interventions facilitate the development of resilience with in people in the wake of new crises and other such challenging life scenarios. Psychosocial Well Being According to the World Health Organization, health is defined as a state of physical, mental and social fitness and not just the absence of any disease or disorder. Whereas the Psychosocial Working Group describes the psychosocial well being of people and communities with respect to the following three basic domains (World Health Organization, 1948). Human Capacity It is concerned with the physical and mental health of the people which particularly refers to their capacity, knowledge and skills. Recognizing a person’s own human capacity is actually knowing his or her individual values and strengths. Culture and Values Culture and values deal with the cultural norms and behaviors that are associated with the value system of every society, combined with the personal and social expectations. Both the culture and the value system impact the personal and social aspects of working and thus, are essential elements for determining the social well being of a person or community. Social Ecology It is concerned with the social relationships and support system of an individual and the community. Psychosocial well being and mental health are based over cohesive connections among people that encourage social equilibrium. Psychosocial well being is based upon the capacity to draw on resources from the above basic three domains in the wake of the issues that are related to the past events and scenarios. The challenging situations such as the disasters deplete these resources and thus, cause the need for external interventions and support in order to re-construct the psychosocial well being of people at both individual and communal levels. The external factors such as the shelter, livelihood and diseases also influence the psychosocial well being of a community and its people. The environmental conditions in which a person lives, basically determines his or her psychosocial well being. If any sort of direct or indirect disruption occurs in the immediate surroundings and community of an individual then the family and the neighbors will be anguished. Under such circumstances, it is not possible that the people will exhibit the positive psychosocial well being. The experiences of the psychosocial well being will change according to the ever changing contexts and influential factors. This dynamicity in the nature of the experience of the psychosocial well being makes it very hard to specifically define and recognize the psychosocial well being. Thus, the common understanding of the definition of the psychosocial well being not only differs from country to country but also differs from community to community with in the same country. Hence, it is very essential to know and understand the local perspective of psychosocial well being before planning out a psychosocial response for the particular affected person or community. This approach ascertains the relevancy of the planned and applied activities to the targeted population and not just a repetition of some generalized psychosocial procedures that had worked some where else. While defining the psychosocial well being of a person or community, it is important to know a local way of explaining the psychosocial well being and psychosocial support in accordance to the culture of the target population who are unaware of this concept. Mental Health Psychosocial interventions and mental health can be described as any sort of local or external assistance that is meant to safeguard and encourage psychosocial well being so that the mental disorders can be treated and prevented (Inter-Agency Standing Committee, 2007). Although mental health disorders and psychosocial interventions are closely linked together, however, they require different approaches. If severe or prolonged psychosocial problems are left with out any interventions then they can develop in to mild, moderate or sometimes severe mental health disorders. Similarly, people having mental health problems usually have psychosocial problems too. Case Study of Disaster Mental Health Care for a Patient from Sri Lanka Sri Lanka is a small island that has experienced natural disasters such as cyclones, flooding, landslides over a period time with the exception of tsunami. The country has no disaster planning. The Country has also suffered from war. Disaster mental health care is not provided up to the satisfactory level in the country. The war and the tsunami severely affected the individuals, families and communities. In Tamil culture, the family members in both nuclear and extended families are very closely and strongly bonded with each other and thus, the families respond and work as a single entity in response to external threats instead of working as an individual. Therefore, it would be more appropriate to discuss with respect to family dynamic in spite of discussing individual personalities. Absence of a family member due to some tragedy causes severe damage to the family functional unit. Psychological disturbances such as separation anxiety, depressive symptoms, conducts disorders, cognitive impairments and sleep disturbances were experienced by our consumer belonging from Sri Lanka. Disputes and quarrels with family members resulted due to financial stress. The consumer developed deep suspicion and mistrust for others and learned to live up to the fulfillment of the immediate needs and survival to the other day. Therapeutic Interventions The following therapeutic interventions were required and provided to the consumer since he was suffering from the severe psychosocial problems mentioned above. Crisis Intervention Psycho-education Psychotherapy Relaxation Techniques Behavioral Cognitive Methods Pharmacotherapy Family Therapy Group Therapy Expressive Methods Rehabilitation Psycho-education Basic information related to trauma and normal responses with suggestions about Dos and Don’ts and coping techniques were provided to the consumer through discussion and lectures. Psychotherapy Different forms of psycho-therapeutic techniques such as listening and counseling to short dynamic psychotherapy were given to the traumatized consumer. The foundation was laid through listening to the stories, establishing trust and strong relationship, supporting to ventilate emotions and building terms with what had occurred. Useful supportive techniques such as symptomatic relief and problem solving were applied with in the counseling process. Grappling with issues which included lack or loss of control, guilt and powerlessness, which are very essential in the West, however, were found to be not quite conclusive and obligatory in the context of the local culture of the consumer. But shame, blame, loss of fate and loss of trust were relevantly important. This must be done by fully understanding the belief system of the local population to which the consumer belongs. Logo therapy (Frankl, 1959) which is more ambitious approach was applied to determine the meaning in what had occurred. As people have found to recover more quickly after the meaning had been understood. Also the cultural and religious beliefs such as the doctrines related to the karma and suffering that are the gist to both Buddhists and Hind faiths were very important. Due to this reason, the consumer was also referred to his traditional resources that included monks and healers wherever required and whenever possible. Relaxation Techniques Culturally acceptable techniques similar to Jacobson’s Progressive Muscular Relaxation were useful for various consequences of the traumatization such as the states of anxiety, arousal and somatization (Somasundaram, 2002). Conventional techniques adapted according to the consumer’s cultural and religious beliefs were formulated to be applied twice a day. Behavioral Cognitive Methods Importantly this accounted to trauma desensitization through exposing the trauma that is done by making the consumer confront the traumatic scene with the help of using imagery. Consumer also got Narrative Exposure Therapy which was very useful for treating PTSD. The following measures were taken to help the consumer change his behavior, attitude and thinking. Helped the consumer in comprehending that behaviors and feelings are determined by beliefs and thinking. Explained how to identify the relevant beliefs. This was done through direct explanation, reading and record keeping with the help of the therapist along with the home assignments in between the sessions. Educated the consumer how to confront and change the irrational beliefs. Helped the consumer how to get in to action. The most important element of Cognitive Behavior Theory (CBT) is to act against the irrational beliefs. As for instance, the consumer can dispute the belief that accusation is intolerable by purposely doing something to bring it on in order to find out that he can actually survive. CBT acts as a powerful tool for change since it addresses both rethinking and action. Mostly, the action part was executed as home work by the client. The main components of CBT intervention are summarized below: Engage the Consumer Build the relationship with the consumer in the first step. Use basic emotions of warmth, respect and empathy for this purpose. Determine any secondary disturbances for taking the help such as anxiety for being interviewed, needing assistance or self drowning in the issue. Probably the most effective way of involving the client is to show him initially that the change is possible and that the CBT enables us to attain this goal. Assess the consumer, his problem and his situation This assessment actually differs according to the person but some most common areas of assessment in CBT intervention are given below: Begin with the consumer’s perception of what is his problem. Identify the existence of any related clinical disorders. Acquire the history of the consumer’s personal and social lives. Observe appropriate personality factors. Identify any secondary disturbances. Analyze the consumer for having any psychological causative factors such as medications, physical condition, substance abuse and lifestyle factors. Prepare the consumer for therapy Explain the expected and targeted outcome of the treatment. Analyze that how motivated is the consumer for the desired change. Briefly make him aware of the basics of the CBT and the bio-psychological model of causation. Explain the approaches to be practiced along with the implications of the treatment. Formulate a contract. Implementation of the treatment Following activities will be employed in the implementation phase consisting of various sessions. Study different episodes of the occurrence of the target problem. Identify the beliefs involved and then change them through designing and assigning relevant home work for the consumer which is also referred as ‘rational analysis’ or ‘thought recording’. Formulate behavioral assignments in order to alter the behavior or reduce the fears. Supporting strategies and techniques as per the requirements such as the trainings for interpersonal skills, relaxation, etc. Determine the progress At the end of the CBT intervention, it is important to determine that the improvements are either because of the significant changes in the thinking process of the consumer or merely, due to some coincidental external circumstances. Prepare the consumer for termination This is a very important step to prepare the consumer for dealing with the setbacks. Mostly people after getting well consider that they are cured forever but to the contrary, when they figure out that some of the problems are still there to some extent then they get anguished and abandon both hope and self help. Make the consumer aware of the fact that relapse is likely to occur for most of the psychological problems. Further, make sure that the client is well aware of what to do in case of the symptoms return. Get the views of the consumer about asking for help in the future, if required. Overcome any irrational beliefs about consulting for help again. Breathing Exercises The objective of the therapy was to consciously control breathing and make it smooth, deep and regular. This commonly included training abdominal, diaphragmatic breathing rather than the usual thoracic breathing technique. Ana Pana Sati, a mind full breathing was taught since the consumer was Buddhist. Progressive Muscular Relaxation The consumer was asked to practice mind full body awareness along with teaching him Jacobson’s Progressive Muscular relaxation technique. Replication of Words A meaning full word or phrase was repeated again and again to oneself. Since the consumer was a Buddhist, thus, this selected phrase was Buddhang Saranang Gachchami. Meditation Vipassana meditation from Buddhist belief system was selected for the consumer to practice regularly. Moreover, the conventional techniques of massage were also employed to get profound relaxation. The consumer was culturally familiar with both of the Ayurvedic and Siddha oil massages which were found to be very effective too. Pharmacotherapy Anti-depressants were given to the consumer in case of severe PTSD or depression. Emotive Methods Artistic way of expressing emotions with in oneself was found to be very purgative for the consumer. Emotive methods such as story telling, art, drama, writing, dancing, singing, sculpturing, and many more are very effective methods. The traumatized consumer was enabled to externalize the traumatic experience through the medium of story telling and thus, to a certain degree was able to take care of work by external activities without the related internal distress. The consumer was even able to communicate well and polite with his children and family by means of expressing their emotions and thoughts both verbally and in drawing. Group Therapy Support groups such as the groups for torture survivors, ex-detainees, tsunami victims and many others were recommended for the consumer which benefited him to prevent burn out. Family Therapy Efforts were taken by the consumer to develop and strengthen family cohesion in order to keep his family together. The principles for family dynamics were employed to encourage supportive and healing relationships among family member along with overcoming the damaging and the maladaptive interactions. Impact of Interventions The interventions seem to yield effective results but it is difficult to quantify their impact at this point of time as the treatment is going on. Psychosocial activities were recommended to the consumer. Evaluation of the Interventions The evaluation of interventions has been limited. The outcome of relaxation exercises was evaluated along with the outcomes of NET therapy and the counselor training program. Discussion of Issues In the wake of widespread traumatization and various psychosocial problems as mentioned above, the most effective approach would be a holistic and integrated community based program. The program should develop psychological, physical, social, familial, and spiritual well being of its participants who have been deeply hurt through natural and man made disasters. This approach as a whole should also include psychosocial interventions. The consumer should have an integrated training covering all aspects so that he is able to attend any of these problems as part of his regular work routine. He should possess basic and simplified knowledge and skills which will enable him to cope with the most common challenges and psychosocial problems. But he should also be able to determine the more intricate problems that would require assistance from some expert and thus, should reach or contact the appropriate person for consultation. A multidisciplinary team would be required for psychosocial problem of extreme nature. The environment of terror, fear and silence will have to be relinquished. The consumer should be able to found some space for his activities. The psychosocial programs recommended for and attended by the consumer should meet the professional standard since the capacities of psychological counseling varies to great extend from place to place, person to person and program to program. Conclusion The consumer should be evaluated regularly through periodical counseling sessions to determine his psychosocial well being. Based on which further psychosocial interventions would take their course of action. Guidelines about various Dos and Don’ts should be provided to the consumer in order to enable him to deal with future complications. References IFRC (2005). Psychosocial Framework. World Health organization (1948). Constitution of the World Health organization. Inter-Agency Standing Committee (2007). guidelines on Mental Health and Psychosocial Support in emergency Settings Frankl, V. E. (1959) Man’s Search for Meaning: An introduction to logotherapy. Boston: Beacon Press Somasundaram, D.J. (2002) Using traditional relaxation techniques in minor mental health disorders, International Medical Journal, 9 (3), pp. 191-198. http://www.depression-treatment.mobi/ Read More