Coaching for Mental Health: Ethical Dilemma or Ethical Development?

Appendix 9: Notes on Existing Provision

State mental health provision: Psychiatry, Mental Health Service, Social Services
It appears then that a symptom led, mind centred, scientifically based psychology is not able to fully appreciate or care for the multiple factors that initiate and exacerbate mental health problems.

Talk Therapies
A professional therapeutic intervention is Counselling. Raj Persaud caustically suggests that “counselling is in danger of psychotherapizing unhappiness” Staying Sane (p 102).

The counselling tradition holds that it is necessary to regurgitate and re-digest the past in order to move into the present and future. In contrast, present knowledge indicates that successful reconciliation of the past is achieved from a position of emotional strength in the present and that current problems need addressing first by taking into account the full context of their life.

Phobias are dealt with by using the observing self, until a person can observe for their self then it is possible for another person to substitute.

The counselling also offers offer a non-judgemental, non-intervening and supportive listener. This seems to be a healing strategy but a “1997 study found the most effective counsellors appeared to be altering the patients’ perspectives on their circumstances, in particular assisting the development of more optimistic viewpoints” Staying Sane (p 175).

A 2000 report on counselling concludes that the use of counselling is less effective than antidepressants over a 12 month period, but other research states that “Good, appropriate psychotherapy is twice as effective as drugs” Joe Griffin tape.

A report on Effective Psychotherapy. Hilgarth Press. 1993. concludes that the effectiveness of psychotherapy does not depend on – academic qualifications, length of training, school of therapist, or the practitioner having had analysis or counselling themselves (in fact this was found detrimental as the therapists became depressed or anxious with the introspection on the negative in their lives). Robertson (p.25). Richard Carlson considers the only benefits of therapy may depend “…more on the mental health and happiness of the therapist than it does on reliving past trauma and pain.” Stop Thinking and Start Living 1997 (p.4).

Psychotherapy is increasingly under criticism with books like “We have had 100 years of Psychotherapy and are getting worse” by James Hillman and “How to survive Psychotherapy”.

Another danger of such an intense, intimate relationship as in psychotherapy is the increasing dependency of the client and the potential for abuse by the therapist. Alarming statistics of the latter are cited p.129 of Staying Sane

Cognitive and behavioural therapies:
Cognitive Psychotherapy, Rational Emotive Therapy, MindFields, Brief Therapies.

Proactive training in detachment and meditation techniques, teaches not “to be dragged down into their highly habitual, almost hard- wired processing system” “ ..almost the antithesis of the ruminative replaying of traumatic events. It’s teaching people to maintain a broad focus of attention in the presence of these thoughts and thereby helping break some of the synaptic connections between these memories and the usual cognitive processes that follow on from them” Robertson (p.27).

Brief Therapy Strategies are developing in response to pressure from business and insurance companies. These offer solution based therapy helping people to develop skills to live their lives more effectively. Time Limited Psychotherapy in practise. Gaby Shefler But they do not provide continuity in supporting progress and do not address the environmental factors that are either causing or exacerbating the emotional reactions.

Personal Development programmes
NLP. Books. Magazines.
“Neuro Linguistic Programming, commonly referred to as NLP, is a set of tools and techniques devised to help us take charge of our lives. With NLP we can take control of our minds in positive ways that enable us to effectively change behaviours that disturb us, or enhance out ability to do the things we want to do to make our lives better”. www.nlpworks.com/products.htm

Prescribed Medication
There are thousands of tablets to pep you up and calm you down and pills to compensate for the side effects. Big money is invested and supported by an existing cultural dependency on medication and specialists. We are left with a tranche of highly dependent emotionally sedated humans, with multiple side effects, adding an enormous financial burden on the NHS and the public purse. Antidepressants have a valid but temporary role, assisting changing sleeping patterns, but exercise has been proved to be equally beneficial without the side effects and with whole life enhanced.

Self medication
Addiction. Drugs, Alcohol, chocolate
Addictive substances and behaviours
Self help:, self help groups

Nutrition
“Potatoes not Prozac” – A book on nutrition for depression and addiction.
The stimulation of serotonin by a balanced diet. “Natural Mental Health” pg 25. Reduction of stimulants: p.26

Relaxation and stress therapy. Hypnotherapy.
“Traditional stress management programs, which are based on relaxation training, while helping individuals feel better momentarily, may not sustain physiological and psychological benefits. The HeartMath programs, which focus on reducing emotional reactivity and promoting balance in the moment, have been shown to produce long-term, profound shifts in hormonal, immunological and cardiovascular systems”. www.heartmath.com …heart disease no 1 disorder, anxiety linked with heart disease. Important to address the anxiety soon heartmath
Stress workshops are effective interventions to reduce anxiety and offer clearer picture of physical and mental health and how they interact. p 172 of ‘making it happen’

Imagework and Visualisation
One of our inherent abilities is that of creative imagination. It underpins our personal understanding of our life experiences and literal language. Contemporary imagework has evolved from the ancient shamanic tradition and is used both in personal development and therapy. Mainstream psychology is now seriously researching this previously taboo territory. Ross Heaven 2001.

Inspiration and mentors
For the depressed and confused it can seem an impossible struggle to find any point in getting up in the morning, let alone living.
Peer support
Self help groups
Positive role models
Peer mentoring pg 180 ‘making it happen’

Physical Therapy
BTCV Green Gym
Physical rehabilitation strategies are proving as affective for emotional recovery as for brain and body. Ian Robertson a specialist in brain rehabilitation is adamant that emotional rehabilitation needs active, disciplined, repetitive behaviour. “What we know from rehabilitation in brain damage and from learning in general is that it takes thousands of repetitive trials before you can change a habitual pattern of behaviour and create a new default activity.” “therapies that get people to do things are more likely to cause a change in behaviour and feelings than those where people just talk and respond” Ian Robertson .2000 (p.25). “passive attention isn’t as effective as active attention in sculpting and shaping our models of reality in the brain.” Robertson 2000 (p.24).

Context/Environment/Social/Employment
Family Therapy
Community Initiatives.
Environmental Issues
Community: Charities, cultural initiation rites.
Volunteering
LETS
Social Firms
“The Unbalanced Mind by Julian Leff “examines a wide range of psychiatric disorders and argues that many mental illnesses are due to cultural rather than biological factors ”. Research by the USA Army during the Vietnam conflict convinced the medical teams that there would be a major heroin addiction problem among the returning troops. A massive addiction programme response was initiated but found to be partially unnecessary as those soldiers returning to stable family/ social backgrounds soon adjusted to a drug free environment, whereas those returning to less stability and poverty continued with their addictive behaviour.
Having control in the immediate environment is also vital.
“There are social factors such as poverty and isolation that contribute to the mental distress that people may experience.” Henderson 2001(p.17)

Values
Religion. New Age. Cults. Gurus. Philosophy
The mental health system does not successfully address personal or collective values. Therapists attempt to support and make sense for the patient, but may not be able to understand the ‘nitty gritty’ of each individuals motivations and how they express their values in their whole life.

Education: schools, colleges

Humour
An essential exercise is to activate the laughter muscles. A massage of the internal organs as well as lifting the spirits. “The Art of Medicine, consists of amusing the patient while nature cures the disease” Voltaire. The Listening Hand (p.198). Alas, the mental health system is not known for its humour.

www
Access to research and real life experience. Surfing the net may be laborious and potentially isolating but it can meet some basic human needs, stimulating the mind and forming social even intimate relationships. (Another addiction?).


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